IT’S WELL PAST most private practices’ office hours, but Disney radio is blasting on a bluetooth speaker at a pop-up dental clinic on the University of California San Francisco campus. A makeshift sign, taped to a folding reception desk, announces insurance consultations. In an adapted office cubicle, a child clutches an inflated blue nitrile glove while a pair of dental students inspect each tooth for signs of decay.

The Children’s Night Clinic, first opened on the UCSF’s Parnassus campus in 2018, reopened in January after nearly three years of closure due to COVID. On the first Wednesday of every month, the CNC offers free routine dental services provided by dentistry students. For patients without insurance, the out-of-pocket cost of an identical visit to SF Pediatric Dentistry for children aged 3-12 would be $414.

According to the San Francisco Health Improvement Partnership, one in three children enrolled in San Francisco public schools experiences tooth decay before reaching kindergarten, compared to the national average of 23 percent. The prevalence of dental decay — particularly in San Francisco ZIP codes with few or no dentists accepting Medi-Cal’s dental program — is among the leading causes of school absences. In addition to persistent pain, untreated decay and caries can also contribute to inflammation, cardiovascular illnesses, diabetes, and oral cancers in the long run. Through the Night Clinic, dental students work to provide transitional dental care, encourage proper brushing and flossing techniques, and help enroll uninsured families in Denti-Cal, connecting them with in-network dentists.

Jessie Allcock, left, and Jonathan Plascencia inspect the teeth of a 15-year-old at the Children’s Night Clinic on the UCSF campus in San Francisco on March 1, 2023. The clinic typically sees six patients on the first Wednesday of every month. (Kyran Berlin/Pagransen)

On the evening of March 1, the CNC welcomed six patients ages 3-15 for dental screenings and preventative care. For the majority of student providers, it was their first time treating children in the clinic. For some of the patients, it was their first trip to the dentist.

“We have a three-year-old coming in, probably for his first dental exam,” Catherine Cheng, a fourth-year student and first-time provider at the clinic, said as she prepared the exam cubicle for her patient. Her experience working with children as an orthodontic assistant had primed her nerves. “Should be fun. Hopefully he’s not too scared.”

From the classroom to the exam room

After the first two years of their four-year UCSF dental program, dental students transition from classroom learning and begin treating real patients in specialized clinical rotations, which are supervised by faculty practitioners. Prior to volunteering at the CNC, third- and fourth-year UCSF School of Dentistry students are required to have completed their pediatrics clinical rotation, where they first develop necessary skills for diagnosis and treatment for child patients. Two faculty supervisors observe and assist students during their work in the clinic, ready to step in if more intricate care is needed.

With their patients in the chair, the student providers set to work, accompanied by first- and second-year assistants. They scrub “sugar bugs” (cavities) off budding teeth and nest “tooth pillows” (cotton balls) in sore spots. In another cubicle, a stuffed crocodile puppet with a beaming smile — and an adult-sized set of teeth — is used to soothe a patient and demonstrate proper brushing and flossing techniques.

The 2021 census showed that roughly 3.5 percent of children in California do not have health insurance, compared to the national average of 5.4 percent. While 96 percent of California children eligible for Medi-Cal are enrolled, fewer than 60 percent utilize the included Denti-Cal program. Through the program, Medi-Cal enrolled children are automatically eligible for benefits such as preventative exams, x-rays, cleanings, fillings, and emergency extractions.

A grinning plush gator is used to demonstrate proper brushing and flossing techniques at the Children’s Night Clinic on the UCSF campus. (Kyran Berlin/Pagransen)

Limitations on dental care access do not end with insurance coverage. According to the California Department of Health Care Services, only 36 percent of private dentist offices statewide accept Medicaid for reimbursement as of 2021, and those that do may choose to cap the number of Medicaid patients they will accept. In California, Denti-Cal reimburses approximately half of what private insurance pays practitioners, dissuading many dentists from taking on new Denti-Cal patients.

In 2018, the San Francisco Department of Public Health reported that there were 42 full-time dentists accepting Denti-Cal reimbursement compared to the 18,342 Denti-Cal eligible pre-K children in need of care. With Medi-Cal enrollment rates climbing, families face shrinking access to an already limited number of providers in their network.

Children with disabilities face even greater hurdles and wait times before accessing dental care, according to a report by CalMatters. In the aforementioned 2018 SFDPH survey, only one of the 21 surveyed pediatric dentists citywide accepted Denti-Cal reimbursement for children with “all special health care needs.”

Happy patients and parents

Jackie Chang found the CNC through flyers distributed at his daughter’s elementary school in Visitacion Valley in December. Through correspondence with co-director Esther Gao, he was able to register both of his children, ages 6 and 10, to be seen at the clinic in March.

In addition to the saved cost, Chang said that his children preferred the experience at the clinic. “It’s the environment. They’re friendly, so that’s why when [kids] see it, they will think like ‘OK, this is just like a kids’ area, not just a hospital.’”

“It’s the environment. They’re friendly, so that’s why when [kids] see it, they will think like ‘OK, this is just like a kids’ area, not just a hospital.’”

Jackie Chang, parent of Children's Night Clinic patient

Dr. Jean Calvo, assistant professor at UCSF School of Dentistry and faculty supervisor at the Children’s Night Clinic, described the CNC as a “transitional dental home” for families navigating to assess and fulfill their dental needs. The clinic, which operates out of a refurbished office space, provides basic dental screenings, fluoride varnishes, and more involved procedures such as x-rays, if necessary.

Catherine Cheng, a fourth-year dental student at UCSF, demonstrates proper brushing techniques to a young patient using a plush alligator at the Children’s Night Clinic on the UCSF campus in San Francisco on March 1, 2023. (Kyran Berlin/Pagransen)

Funding comes from alumni donations, school support, and dental grants, said co-director Ursula Eisinger, allowing the clinic to operate at no cost to patient families.

Health care services beyond the clinic, like the cost of antibiotic prescriptions for an abscessed tooth, are not covered, Calvo said. For continued care, CNC patients are referred to a list of dentists and resources within the Denti-Cal network.

Gao directly processes and schedules patient applications ahead of each session, prioritizing families without insurance or a provider. Since the clinic reopened in January, she estimates it has received over 100 initial application emails, though many applicants drop away through the continued registration process via email. While the clinics treats a maximum of eight patients per session, additional respondents who complete the registration process are waitlisted for the next month.

In the future, Gao hopes to expand CNC’s translation services to reach more of San Francisco’s vulnerable populations.

Email the UCSF Children’s Night Clinic to apply for an appointment.