June 25, 2018
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The promise of a new type of dentist

Troy R. Bennett | BDN
Troy R. Bennett | BDN
A man, who is missing most of his upper and lower front teeth, gets fitted for a partial plate by dentist Jennifer Fultz at the Heath Care for the Homeless Clinic on Portland Street in Portland in December 2011.


You might not be worried about your access to a dentist’s office if you have private health insurance or can afford to pay for care. But if you’re poor, or if you live in a remote area, the barriers you face make it more likely you and your children will delay getting preventive oral health care until it’s too late.

The Bright Smiles dental clinic in Portland is seeking more volunteer dentists to help serve uninsured and low-income children. The number of children seeking care is growing, and some of them arrive already with dental infections. The problem is apparent in other parts of the state, too: Many people can’t afford or lack access. Tooth decay is the No. 1 chronic illness for children, ahead of asthma.

Addressing oral health care in Maine is complicated. MaineCare reimbursements to dentists are low, making it difficult for them to take on low-income patients. The University of New England will open the College of Dental Medicine in the fall of 2013, but there is a lack of dental workers in sparsely populated areas — understandably, as offices need patients in order to sustain operations. Patients often do not fully understand the benefit of services.

But one proposed solution may have promise: allowing the licensing of dental therapists, who are mid-level practitioners with an aim to reach children and adults going without basic and preventive dental care. They handle routine procedures, such as cleanings and fillings, and may be required to work in underserved areas.

In 2011, the Maine Legislature commissioned a review of access issues. The first of a series of studies determined that all or part of 15 of Maine’s 16 counties have dental health professional shortages. In 2011, 16 percent of the state’s population lived in a shortage area, which is the 10th highest percentage of all states.

Several other studies have determined that accessibility of dental services can be improved. A 2008 report, “A Plan for Improving Rural Health in Maine,” concluded that rural Mainers should have better access to preventive services, oral health education, basic restorative treatment services and referral mechanisms for specialized care. Not only are clean mouths at risk, but untreated dental disease can become a serious medical condition, even leading to death.

One problem is that dentists often cannot afford to practice in rural areas. Dental therapist teams, though, can charge lower fees and focus more on dental disease prevention. Simply telling patients to brush their teeth and floss will not change behavior, so dental therapists are trained to be proactive, build plans with patients to enable healthy routines and follow up after appointments. In many countries they operate in conjunction with local school systems.

The Maine Dental Association and the American Dental Association have opposed the idea of dental therapists, saying that the problem won’t be fixed by adding one more type of dental provider. But it may be a big step in the right direction.

An April study released by the W.K. Kellogg Foundation reviewed more than 1,100 reports about dental therapists and their work around the world and found that they offer effective care and improve access. “Numerous federal reports, the Institute of Medicine, states, tribes and foundations, such as the Kellogg Foundation and the Pew Charitable Trusts, have recommended exploring midlevel providers, such as dental therapists, as a way to solve the current dental access crisis,” the foundation wrote.

There are dental therapists across the world, including in Canada, Great Britain, New Zealand, the Netherlands and Malaysia. They are also present in Alaska, where they have offered tribal villages access to dental care when they previously had none. Minnesota was the first state to establish a licensing system for dental therapists. More states are considering having the providers. Reviews of the care dental therapists provide show the providers are competent and safe, and there is strong public support for their work.

No one should believe dental therapists will solve all of Maine’s problems surrounding dental access. But they are certainly worth full consideration.

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