A recent Press Herald article (“Free dental care day seen as ‘a warning sign’ that Maine isn’t meeting need for coverage“) and a follow-up by the paper’s Editorial Board (“Our View: Dentists sound alarm on our broken system“) say that last month’s free dental care day – an annual event where Maine residents can receive care without charge – is a sign of a much larger problem.
The article is correct: Maine is facing a statewide dental care crisis. This problem should have been partially solved by the approval of a 2014 law authorizing dental hygiene therapists: providers who function similarly to nurse practitioners or physician assistants on a medical team.
Dental hygiene therapists can provide preventive and routine restorative care, like filling cavities. And while they receive the same rigorous training as dentists on the limited number of procedures they perform, dental therapists learn only a fraction of the number of treatments that dentists learn. Therefore, their education takes a much shorter amount of time and they are significantly less expensive to employ.
However, getting providers in the field has been stalled. Four years later, there are still no therapists practicing in the state. And that is a problem because both kids and adults in this state are not getting the care they need. The American Dental Association found that more than half (57 percent) of children over age 1 with MaineCare did not receive any dental service in 2016. And 53 percent of low-income Maine adults report difficulty biting and chewing because of the condition of their mouth, according to an ADA survey, while 37 percent report that the appearance of their teeth and their mouth affects their ability to interview for a job.
While Medicaid health plans in Maine currently cover dental care for children, that benefit does not extend to adults, except in instances that require emergency work. In Maine, pediatric dental care is reimbursed at rate that is 44.6 percent of what a private insurance plan would cover. Therefore, there are significant gaps in coverage for both adults and children.
And while a Medicaid expansion proposal that includes an increase in reimbursements for pediatric dental care and a solid dental benefit for adults is imperative, it will not address a major part of the issue. Maine still needs a substantial increase in the number of dental practitioners to be able to provide services to patients across the state.
Getting dental therapists practicing in Maine would help address this issue as well as another one: the aging population of dentists here. According to the Maine Department of Labor’s Center for Workforce Research and Information, nearly one third of the state’s dentists are over 60 years old, compared to the national proportion of 20 percent. Fifteen of Maine’s 16 counties suffer from a severe lack of access. Employing dental hygiene therapists will provide dentists with the flexibility to offer high-quality care in a cost-effective way to more patients.
The bipartisan effort that brought this bill to fruition was seen as a triumph at the time. But inaction has prevented it from effecting any meaningful change for the people of Maine. It was encouraging late last month when the Maine Board of Dental Practice announced it would be posting the application for those who want to become dental hygiene therapists on its website. And, simultaneously, the Department of Health and Human Services proposed rules outlining reimbursement and other matters.
We have one tool to help us address our oral health problems in Maine. It is time to start using it. We should train and dispatch dental hygiene therapists with no further delay.
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