May 24, 2018
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Good facts, not good intentions, lead to good oral health

By Mark Eves, Special to the BDN

Health care does not end at the shoulders. It is time that we all acknowledge that dental care is health care.

Lack of access to a dentist, or indeed to any oral health care, has adversely affected Mainers’ health, happiness and economic performance for far too long. We know poor oral health contributes to the incidence of diabetes, cardiovascular disease and numerous other health issues. We know that poor oral health leads to lower self-esteem and hurts cognitive development.

We know that dental disease leads to missed school and work that hurts our economy. We know that lack of access drives people to emergency rooms. We know that ER care drives up costs for hospitals, MaineCare and the public, resulting in the loss of literally millions of dollars. We know that this ER care can address only pain management and infection, not the underlying disease. We know that untreated dental disease affects the health, wealth and happiness of hundreds of thousands of Mainers.

We also know that the Maine Legislature has tried to address some of these challenges. What we don’t know is whether those efforts are working. How have expanded function dental assistants been integrated into traditional dental practices? How will the new dental school planned at the University of New England affect access to care in rural Maine?

Will independent practice dental hygienists be able to positively affect access to preventive care? How has the application of dental varnish in primary care settings affected children?

Passage of LD 1105 and LD 1290 will forge a common understanding of how policy changes have affected access to dental care and what the projected dental shortages will be in the future. Perhaps even more important, LD 1105 also requires a substantive look at the treatment models used in the rest of the country and the world to see whether they could be effective in Maine. This is essentially a call for a timeout amid what amounts to a dental crisis.

Failure to agree on the underlying facts has sometimes driven dental professionals into spending all their time fighting about their interpretation of the numbers instead of debating the best public policy. Or to paraphrase Mark Twain, ”Lies, damned lies, and statistics” have been used to promote doubt and consternation instead of establishing good will and results in the debate on oral health.

Of course, like many of my colleagues, I would far rather concentrate my time on passing substantive legislation that directly addresses barriers to dental care than to spend time revisiting the collection of data and policy models. But at the same time, in order to make sure the legislation is effective, we also must take a moment to make sure that there is broader agreement on the underlying facts.

It simply is not enough for us to just pass another piece of legislation; we need to do our best to make sure we start from the same basic understanding of the problem in order to find a solution that will work. If we pass legislation by fiat, and dentists, hygienists and public health professionals don’t adopt the changes, we will not have addressed the core oral health crisis facing Maine.

Practically speaking, the legislation would bring together information currently collected by disparate state, national and nongovernmental entities such as the Office of Rural Health, the Maine Board of Dental Examiners, Maine Center for Disease Control and Prevention, the Maine Department of Labor and numerous studies to help us consolidate and standardize data and better understand the oral health challenge.

As I put my faith in this call for a timeout to build factual consensus on oral health, the public and the Legislature must also hold all parties accountable for making progress. Identifying and bringing to fruition new models of care to address the extraordinary shortfall must occur during the second session of this Legislature, or passage of the pending legislation will be a failure and result only in a further delay in helping Mainers get the dental care they so desperately need.

Good facts, good policy models and good results will help Maine address our oral health crisis.

Mark Eves, D- North Berwick, represents District 146 in the Maine House of Representatives. He serves on the Health and Human Services Committee.

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