The Maine House on Tuesday gave initial approval to LD 1230, a bill that would allow dental hygienists with additional training to become “dental hygiene therapists” and perform simple procedures such as extractions and filling cavities.
The bill is an attempt to solve the problem of limited dental care access in rural Maine, and for those who rely on MaineCare to pay their dental bills. At first glance, it seems that allowing hygienists with additional training to provide basic dental care without having to invest in dental school would be a good idea, but this bill does not actually get to the root of Maine’s dental ailment.
According to the Maine Dental Association, there are 15 federally qualified health center dental clinics, 11 nonprofit clinics, and several volunteer clinics established across the state ”“ and nearly 50 percent of the private practices accept MaineCare patients. The association also notes that 14 of the state’s 15 pediatric dentists accept MaineCare and have openings for new patients.
Yes, it can be argued that those practices and clinics are concentrated in the more populated areas of the state, making it difficult for those in rural areas to access dental care, but no part of this bill requires the newly minted dental hygiene therapists to locate only in sparsely populated spots. A traveling dental practice or more nonprofit clinics set up in the most rural areas would be a more dependable fix.
Additionally, this bill would require the hygiene therapists to be under the supervision of a dentist, who would be ultimately responsible for the outcome of their work, be required to sign off on any procedures and regularly review the patient’s file. Without autonomy, these hygienists won’t be able to make much of an impact in widening the scope of care. It seems this provision was put in place, at least in part, to appease dentists who may be concerned that these new hygiene therapists will take over the business of taking care of all but the most major dental issues. It also seems unlikely that any dentist would be willing to sign the required agreement with a hygiene therapist due to liability concerns.
There is a reason why people go to school for eight years to become a dentist, and it seems unwise to hand over the reins to someone with what will amount to a four-year degree. This new designation would give hygienist therapists the authority to prescribe medications, replace crowns and administer anesthesia. Are those really tasks we want performed by someone without a dentistry degree?
This bill seems the wrong fix to the problem of dental access. MaineCare doesn’t cover regular, preventive care for adults ”“ that’s why those without insurance aren’t going to the dentist. It wouldn’t matter if their town was flooded with dental professionals at whatever level of training; if they can’t pay, they’ll still have to wait until their dental needs rise to emergency room levels ”“ and that costs us all more in the long run.
Improving insurance coverage for Maine’s poor, along with spreading education of available services and increasing transportation options for families is a better answer. Most important is making sure the state not only offers a fair price for dentists’ work, but actually pays the bill. If we want more dentists to accept MaineCare patients, we have to accept that they are not going to do it for free. What would really improve dental access is setting up more nonprofit clinics in rural areas and fixing the insurance end of things, not a complicated new structure to allow hygienists with extra training to do the work that dentists should be doing.
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Today’s editorial was written by Managing Editor Kristen Schulze Muszynski on behalf of the Journal Tribune Editorial Board. Questions? Comments? Contact Kristen by calling 282-1535, Ext. 322, or via email at kristenm@journaltribune.com.
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