I am a general dentist and I have practiced in Maine for the last 24 years since graduating from dental school. My practice is located in Westbrook, where I employ three dental hygienists, two dental assistants, an office manager, one part-time bookkeeper, and one part-time cleaning person. My office has always accepted new patients. I have participated in Donated Dental Services since 1999 and have donated my expertise, time and services to low-income patients in Maine. In April of this year, we offered free oral cancer screenings to any member of the community. We offered that free service to anyone who needed it – without any conditions.
I’m not alone in my donation of services to the people of Maine. There are many dentists across our fine state who do everything they can to increase the oral health of our citizenry. I am proud of my profession.
I was compelled to write this piece to express my opposition to LD 1230. This proposal, if passed, would create a new level of dental provider – a dental therapist – that could perform some irreversible dental surgical procedures. The proposed scope of practice for this dental therapist includes fillings and extractions.
Unlike many tissues in the body, teeth do not grow back. For example, muscle, skin, bone and many organs have more healing and regenerative capabilities. When a dentist removes enamel, as it is usually necessary during the preparation for a filling, that enamel will never grow back. Likewise, the dentin that supports the enamel is usually altered during the preparation for a simple filling and it also has very limited regenerative capacity. If the pulp of the tooth is even slightly exposed during preparation, there is approximately a 50 percent chance that the tooth will need future root canal therapy or extraction.
Dental school is at least four years beyond a bachelor’s degree for a good reason. There is an enormous amount of knowledge, training and skill required before an accredited dental school can safely graduate a dental student who is then competent enough to not be dangerous. Even after dental school, many students planning on general practice choose to do an elective general practice residency to become more competent and skilled. Further proof of the complexity of dentistry is that most general dentists do not perform all aspects of general dentistry, though dental education involves training in all areas of dentistry.
With ever-increasing knowledge, new techniques, and new technology, dentistry is only becoming more complex all the time. It is absurd to think that with 121?2 weeks of training, a person could become competent to perform irreversible dental surgical procedures. We should not strive to greatly lower the bar in the name of access. Lowering standards is the wrong approach and will lead to bigger problems for the people of Maine.
There is no proof that licensing another dental provider in the state of Maine will increase access to care. Minnesota instituted a mid-level provider in 2009, and has graduated 25 students from their program. Only one of the 25 students is now working in a rural area.
Access to dental care is not merely a matter of having enough providers in different locations. Most dentists in Maine (95 percent) accept new patients and about half of Maine dentists accept MaineCare patients.
In just five months, the University of New England will welcome their first class of dental students. With an anticipated class of 62 students, and a model of training that utilizes externships in clinics in underserved areas, this program will make a big difference in access as for the number of dental providers and a lower cost of care. Moreover, with 24 Maine residents representing 11 Maine counties in the first year class, the prospects for an ever-increasing number of dentists in the state of Maine is very likely.
Now is not the time to create another new category of dental provider with far less training and expertise.
Dr. John Skvorak Jr. practices dentistry in Westbrook.
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