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Maine gets an A for children’s dental care, but lacks basic dental literacy

By Meg Haskell, BDN Staff

Posted May 23, 2011, at 11:43 p.m.
Last modified May 24, 2011, at 8 a.m.

Maine is one of just seven states to earn an A on a new national survey of children’s access to dental health services.

Although that’s good news in important regards, one public health expert says it should not be confused with the real goal: that all Maine children should have healthy teeth.

“The score of an A shows our success at achieving better access to dental care for kids,” said pediatric dentist and public health advocate Jonathan Shenkin, who practices in Augusta. “However, receiving an A [should not] be construed to mean that the oral health of Maine children is headed in the right direction.”

The new report released on Tuesday by the non-profit Pew Charitable Trusts raises Maine’s grade from a B last year, based on an increase in the percentage of youngsters covered by MaineCare who received basic dental services. In 2009, 40 percent of MaineCare-enrolled children saw a dentist, compared to the 38 percent national average.

MaineCare is the state’s Medicaid program for low-income and disabled residents.

Maine scores well on six of eight public policy measures in the report, including the percentage of public schools with a dental sealant program, the percentage of the population with fluoridated drinking water, and the authorizing of MaineCare to pay for early preventive care.

But despite Maine’s good grade, “the state still faces significant obstacles to providing dental care to all its residents,” the report reads.

Because many Mainers live in areas where dentists are scarce, it can be hard to schedule an appointment, the report notes. And that problem is compounded by the growing reality that many dentists won’t accept MaineCare’s low reimbursement rates. The report says Maine falls short in how much it pays dentists. Nationally, 60 percent of dentists’ median fees are reimbursed by Medicaid. In Maine, that figure is just 46 percent.

Maine also loses points for not supporting the licensing of mid-level dental providers who can fill small cavities and perform basic restorative treatments.

On the plus side, access to less expensive dental care is available at some of the state’s public health centers, the study notes, and a new dental school at the University of New England promises to increase the number of dentists interested in practicing in Maine.

But Francis Miliano, executive director of the Maine Dental Association, says it is unclear how much of the access problem is the availability of dental care. A bill working its way through the Legislature would authorize a study to pinpoint why Mainers don’t have better access to care. The barrier may have more to do with consumers’ household budgets than the number of dentists, she said.

“You can have a dentist on every street corner, but if Maine people can’t afford it, it won’t do much good,” she said.

Shenkin said the Pew report is good news in some regards but fails to address the underlying causes of dental and oral disease in children.

“Pew’s measures ignore the etiology, or cause of disease,” Shenkin wrote in an email. “By not having any measures relating to etiology, and by not challenging legislators, policymakers and the dental community to break the cycle of disease, Pew is guaranteeing very limited improvements in oral health outcomes for children.”

Shenkin said policymakers and public health advocates must focus on improving Mainers’ oral health literacy — the ability to understand and adopt behavioral changes — such as brushing regularly and avoiding sugary beverages and treats — that protect children’s teeth from disease and decay.

“The simplest steps [to promote] good oral health are not known by those at the highest risk for disease,” he said.

In addition, Shenkin said Maine policymakers should examine ways to decrease consumption of foods and beverages that promote tooth decay through such measures as eliminating the purchase of soda with food stamps and developing stricter guidelines regulating the marketing of junk food and beverages to children.

The Pew report is available online here.