Darla Dale, a hygienist in Eureka and a vice president of the hygienists association, said the department's denial numbers don't reflect what her organization is seeing.
"There's no way that's true," Dale said. "We're in contact with these hygienists. ... Many have stopped working because we can't spend our lives trying to get authorization."
Darci Trill, a hygienist working in Alameda and Contra Costa counties, is among those who stopped seeing patients in nursing homes after denial letters piled up. "I lost about 70 percent of my Denti-Cal clients," she said.
State health officials pointed to the American Academy of Periodontology, which considers the new authorization guidelines standard, including X-rays to diagnose gum disease.
An April 2016 report by the Little Hoover Commission, an independent state watchdog agency, said the state health services department found it "unusual" that nearly 88,000 out of 100,000 Denti-Cal-eligible patients in nursing homes had received deep cleanings during the 2013-14 fiscal year. This figure and other factors raised "questions about their necessity -- and hence the new policy requiring X-ray documentation," the report said.
In frail patients, advanced gum disease can cause not only tooth loss, but pneumonia and other respiratory issues, Trill said.
Maureen Titus, a hygienist in the San Luis Obispo area, said her clients rely entirely on caregivers for their dental hygiene, and that brushing and flossing is neither easy nor effective. "Most have bleeding gums, inflamed gums and tartar buildup," she said.
Among patients who are attached to feeding tubes, tartar builds up quickly because they don't chew their food, Aminloo said. "After two or three months, you can't even see their teeth."
The independent practice of dental hygienists in California dates to 1997, when the state legislature allowed them, with additional training and certification, to work without the direct supervision of dentists. Some started their own mobile businesses. This is the first time in the intervening 20 years that they've had to obtain preauthorization to perform dental cleanings, Trill said.
The California Dental Association, which represents dentists, said dentists have long been required to get prior approval for cleanings for patients in special care facilities.