EAST PALO ALTO -- It has four basic parts, fits in the trunk of a car and represents what experts predict will be a major breakthrough in access to dental care for California kids.

The "virtual dental home" -- a collapsible dental chair, laptop computer, digital camera on the end of a dental probe and a handheld X-ray machine -- was put through its paces last week in a portable classroom of Magnolia Head Start Preschool in the parking lot behind St. Francis of Assisi Church in this less-than-affluent community in the middle of affluent Silicon Valley.

The event was a sort of coming out party for the dental telehealth project created by the University of the Pacific Arthur A. Dugoni School of Dentistry. Local and state politicians, officials from First 5 San Mateo County -- which is funding the project -- and members of the media watched dental hygienist Ushma Patel and dental assistant Leslie Estrada examine a nervous but willing four-year-old preschool student, Janelle Jimenez.

Digital photos and X-rays of Janelle's teeth were sent through the laptop via the Internet to a dentist in a dental office several blocks away who makes a diagnosis and prescribes treatment.

For Janelle and about 800 other kids in San Mateo County, the virtual dental home represents access to dental care that might not happen without telehealth.

"Here we are in Silicon Valley," said state Sen. Jerry Hill (D-San Mateo). "If we can't take advantage of what technology has to offer in health care, who can?"

Moving From Experimental to Everyday Process

Although words like "new," "pilot" and "innovative" were used to describe the virtual dental home project, Paul Glassman -- introduced at the press conference as the "visionary" behind it -- said the process is maturing beyond the experimental stage.

"We've been at this long enough now to show that it does work," Glassman said.

Glassman, director of the Pacific Center for Special Care at UOP's dental school, said demonstration sites across the state as well as studies comparing dentists who look at pictures and X-rays taken remotely and those who do in-person examinations show very little difference in diagnosis and treatment.

"It's actually highly reliable," said Glassman about the virtual dental home. "Dentists almost always make the same decisions in both scenarios."

The San Mateo County project started in September last year and has provided more than 180 remote exams, X-rays, cleanings and dental referrals in six Head Start sites. The program will expand to 12 sites this year.

Yogita Thakur, dental director at Ravenswood Family Health Center, which operates the dental clinic at the receiving end of virtual dental home data in the San Mateo pilot, said dental care is a particularly appropriate area to use technology for vulnerable populations.

"We know from epidemiological studies that children from low-income minorities across the U.S. have some of the highest rates of dental disease and some of the lowest numbers in terms of utilization," Thakur said. "The landscape in San Mateo County is no different. Children from low-income ethnic minorities often seek care in response to pain, problems eating or sleeping as a result of dental caries [decay], a condition that is preventable.

"Dental caries is the number one chronic disease of childhood, often cited as the silent epidemic that affects children because of lack of access to routine preventive and restorative dental services in a timely fashion," Thakur said.

"The virtual dental home project extends the opportunity to offer dental diagnostic and preventive services in the comfort of their familiar and non-threatening pre-school environment and introduces the child and the family to preventive dental services and education at a very young age."

California's 'Shameful' Oral Health Disparities

"Dental care experts say the oral health disparities are more severe here than other parts of the country," Hill said. "That's shameful for California. With programs like this we have an opportunity to break through that," Hill said.

Glassman said studies have shown that "25% of all children in California have never seen a dentist by the third grade."

"If 25% of all children haven't seen a dentist, you can imagine how that differs by the affluence of a community. In a community like the one being served here, the percentage is much higher," Glassman said.

East Palo Alto, a city of almost 30,000 celebrating its 30th year as a city, is markedly different than the upscale community to the west it shares a name with. Palo Alto, home of Stanford University, is in Santa Clara County and has a significantly different demographic makeup. Although East Palo Alto in San Mateo County is changing with the arrival of new Google and Facebook employees, the town is still largely low income minorities.

The East Palo Alto virtual dental home project is a partnership of the Institute for Human and Social Development, which administers San Mateo County's Head Start programs, Ravenswood Family Health Center and UOP's Pacific Center for Special Care.

Potential Beyond Children's Dentistry

Although most telehealth dental programs in California have been aimed at children, there is potential for using the technology for other populations, according to Glassman and other experts.

"The same technologies can be used for portable dentistry in all kinds of settings -- nursing homes, community centers, senior centers," Glassman said.

"This new delivery model can provide community-based virtual dental home for our state's most vulnerable people -- of all ages," Glassman said.

EAST PALO ALTO, Calif. – Sosepa Tonga Tulua lost more than 100 pounds over the last year since she started taking cooking, gardening and Zumba classes at the Ravenswood Family Health Center here.

The 47-year-old credits a Tongan-speaking nurse at Ravenswood who helped her “navigate” the health care system and encouraged her to make some lifestyle changes soon after she was diagnosed as borderline diabetic a year ago.

“Coming from an island culture, I used to eat a diet heavy in meat. Now I eat a lot of salads, and am willing to make even more changes,” said Tulua, who has been able to prevent herself from becoming a full-blown diabetic.

Ravenswood has been engaged in this kind of work for months now, but a new transfusion of $7.3 million in federal money it received earlier this month will allow it to hire more culturally sensitive “navigators” to expand the program. This will help to save San Mateo County an estimated $6.2 million in health care costs over the next three years, said the center’s chief executive officer, Luisa Buada.

Ravenswood was “handpicked” for the federal grant from a nationwide pool of 3,000 applications by the U.S. Centers for Medicare & Medicaid Services (CMS), observed Congresswoman Anna Eshoo (D-Palo Alto) at an event last week to celebrate the federal grant. Of the 26 recipients of the grant, it was the only community health center.

Some 19,000 patients are expected to benefit from the grant to Ravenswood, the majority of whose patients are poor, and from Latino, Pacific Islander and African-American communities.

Buada said the additional staff who will be hired will help clients coming out of hospital stays to stay on top of their medication needs and follow-up medical appointments. That will prevent expensive visits to emergency rooms.

“Twenty percent of our Medicare beneficiaries go back to the hospital with the same problem they first went there with,” observed David Sayen, CMS’s regional administrator in San Francisco.

The grant is part of a $1 billion effort by federal officials through the Affordable Health Care Act program to reduce the cost of health care nationwide by emphasizing community clinics and preventive health care practices among the public.

The health care navigators on Ravenswood’s payroll will offer more classes in nutrition, cooking, exercise and other topics of health education for patients with chronic conditions.

Partnering with Ravenswood in the program are the Health Plan of San Mateo, San Mateo County Health System and Nuestra Casa. Together they will bolster a health plan to treat patients with such chronic health conditions as diabetes and high blood pressure