Maine lawmakers and medical professionals have debated for years how to improve the state’s oral health, especially among those with low incomes. A new dental school in southern Maine offers the potential for improved access to dental care, but many barriers remain.
Dental disease is possibly “the most prevalent yet preventable disease known,” according to the Maine Oral Health Program at the Maine Center for Disease Control & Prevention. An estimated 20 percent of third-grade students in Maine have untreated tooth decay, and nearly 12 percent of those ages 35-44 have lost six or more teeth due to tooth decay or gum disease.
In addition to causing pain and school or work absences, studies show oral infections are linked to diabetes, heart disease, stroke and premature, low-weight births.
Maine has studied, over and over, how to expand access to dental care.
In 2005, a group of state and local officials examined the issue. In 2007, the group presented the Maine Oral Health Improvement Plan. Also that year, Democratic Gov. John Baldacci signed an order to create a task force to again study the problem and devise solutions. That task force released its report in 2008.
Then, in 2011, the Republican-led Legislature passed a resolve to study and address oral health care. It resulted in two reports in 2012. There have been other studies as well, including a MaineCare Redesign Task Force, for example, that presented recommendations on dental health in a 2012 report.
All of the reports have similar themes: Maine needs to do more to recruit and retain dental professionals; it needs to focus more on preventive care; there is a need for more oral health care providers in rural areas; and the primary barrier to care is the ability to pay.
One popular solution has been a dental school. Last week, after years of planning, legislative support and a statewide referendum, the first school of dentistry in northern New England opened its doors in Portland. The University of New England’s College of Dental Medicine has 64 students in its first class, including 24 from Maine.
The school is a significant step for the state. During their fourth year, students will practice under supervision at community oral health care centers. By the college’s fourth year of operation, it hopes to serve 12,000-15,000 patients in Portland each year and another 20,000-25,000 in the college’s community network. The school aims to not only increase the state’s supply of dentists but to do so in underserved areas.
The school was never billed, however, as a way to solve all of Maine’s dental care problems. A big one still exists — the cost of care. One poll found that three out of 10 Mainers put off dental appointments because of the cost.
Yet Maine spends more money fixing oral health problems than preventing them. More is spent on oral health services in hospital outpatient settings — which are used for serious oral health problems requiring complex, expensive procedures — than in dental offices, dental clinics and hospital emergency rooms combined.
The wide use of emergency rooms is worth noting, however. For those ages 15-44 who are either uninsured or have MaineCare, the No. 1 reason they go to the emergency room is not for something like physical injury but, rather, untreated dental disease.
There’s no doubt Maine is spending public dollars for poor outcomes. One fix seems obvious: cover preventive care. About 20 percent of the state’s population has MaineCare — the state’s version for Medicaid that serves low-income individuals — but MaineCare does not cover routine, preventive dental treatment for adults.
MaineCare pays for expensive extractions and operations, but it does not pay for the basic care necessary to prevent them. We think it’s clear that patients should be seeing their dentists before the big problems occur, both for the patients’ sake and the state’s budget. They also need to show personal responsibility by paying for part of the cost of care and following through on appointments and basic dental hygiene.
Both the studies and lawmakers have suggested expanding the dental program. This year, one bill proposed to fund MaineCare coverage for one annual preventive oral health visit for each enrollee. Doing so would cost the state about $3 million over two years — without taking into consideration any savings from reduced emergency care. No one spoke in opposition to the bill, but the House and Senate delayed action.
There are other important ways to improve oral health, too, such as by increasing MaineCare reimbursement rates for dental services, establishing a reward system for dental service providers who see a high volume of MaineCare members, and continuing to coordinate public education campaigns about the connection between oral and overall health.
The state has studied extensively how to improve oral health, and it has many options at its fingertips. The dental school in Portland is one example of many things that need to happen to turn words on paper into healthier, happier patients and taxpayers.