June 18, 2018
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Cleaning up the facts about Maine dental care

By Dr. Jonathan Shenkin, Special to the BDN

Let’s begin our discussion on oral health care with good news: As of 2011, third graders in Maine have the second lowest rate of untreated tooth decay in the nation, according to state data submitted to the Centers for Disease Control and Prevention.

The benchmark of oral health access is the rate of untreated tooth decay. It is how the oral health care community measures the success of dental programs and the efficiency of the dental delivery system.

Maine’s rate of 14.6 percent is lower than New Zealand, a country chosen by outside groups as the one to emulate. A decade ago, 20 percent of Maine’s third graders had untreated tooth decay. The decrease indicates that access to proper care continues to improve.

Even more good news: The Pew Center on the States, which analyzes children’s dental health programs and services in all 50 states, awarded Maine “A” grades in its 2011 and 2012 reports. Maine is one of only two states to receive the highest mark from Pew for the past two years.

While we are pleased with this progress, Maine dentists believe even more should and could be done so that greater numbers of Maine children and adults have access to quality dental care.

That’s why so many of us showed up to oppose a bill being considered by the Maine Legislature that would add one more provider type to a list that is already longer than any other state.

What we need to do, instead, is get Maine people to dentists and reduce overall disease levels through prevention.

Swirling around the bill, backed by Pew, is a lot of misinformation that demands clarification.

A recent report by Medical Care Development, being touted by proponents of the bill, included incomplete data that has led to inaccurate conclusions.

A major flaw of the MCD report was in defining dental safety net providers, those who tend to the oral health of MaineCare patients. It is standard practice to include dentists who are Medicaid providers as part of the state’s safety net.

Yet, hundreds of dentists who treat MaineCare patients were excluded. This is particularly troubling, since dentists provide the majority of care to Medicaid-enrolled patients.

Another point not included in any discussion on access is approximately $4.5 million in free and reduced care dentists across the state provide annually.

The MCD report also confuses definitions of “rural” drawn from two different federal agencies. If the data had been compared properly, the results would indicate that Maine is considered 25 percent rural by the U.S. Department of Agriculture’s Economic Research Service.

Under the USDA definition, we find that 25 percent of Maine dentists practice in small towns with at least 2,500 people (11.7 percent) and in communities with fewer than 2,500 people (13.5 percent).

Independent practice dental hygienists (IPDH), a category included in the safety net, were established in 2009 to address the issue of access to dental care in rural Maine. The Maine Board of Dental Examiners reports that only 17 IPDHs have registered their practices in Maine and work out of 21 practice sites. Only two practice sites are located in a town defined as being “rural.”

The MCD report does not include a comprehensive discussion of pediatric dentistry in Maine. Since 2003, Maine has seen a 300 percent increase in the number of pediatric dentists. Each can care for thousands of children in a year. All 15 pediatric dentists in Maine are accepting new patients, and all but one accept MaineCare.

Further, a federally funded residency program in pediatric dentistry, located in Bangor, will graduate its first students this June. One will be practicing in Presque Isle, offering children in Aroostook County advanced pediatric dental services.

Another topic worthy of discussion, but omitted from the MCD report, is the impact of the University of New England’s College of Dental Medicine. The students entering this fall already include a number from Maine.

In their fourth year, student externs will provide services in communities across the state under the direct supervision of adjunct faculty. Because these externs will not be compensated for their work, clinics and practices will be able to open their doors wider than ever to patients in need.

Maine dentists will continue to focus on programs that increase access to quality dental care for all Maine people. We will continue our efforts to provide more education and prevention. And, we will continue to undertake initiatives to get more Maine children and adults into dental offices and clinics. We’re doing it now.

Dr. Jonathan Shenkin is a pediatric dentist in Augusta and on faculty in Health Policy, Health Services Research and Pediatric Dentistry at the Boston University School of Dental Medicine.

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