California and the nation now face an oral disease situation that is of a crisis nature. The situation has developed over several decades and involves a complex set of problems, institutions, attitudes and financing arrangements. For millions across California, access to oral health care services is severely compromised. This report seeks to make sense of the complex issues that must be considered and addressed to improve access to oral health services in California. Recommendations are made for tangible action steps that can be taken to manage the changes that are needed, including fostering partnerships and collaborative efforts, using resources more efficiently and instituting evidence-based models.