May 24, 2018
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New Maine dental provider can treat tooth decay, improve lives at lower cost

By Leon Assael, Special to the BDN

Mainers suffer from untreated tooth decay (dental caries). It destroys essential function and appearance in our most vulnerable family members, children, the elderly and practically all of us who have limited income to budget for health care. The numbers are staggering:

— Sixty-two percent of low-income kids who have insurance through MaineCare do not see a dentist.

— Fifty percent of all Maine kids go without regular visits to the dentist.

— Thirty-three percent of third-graders have untreated dental disease.

Others suffer as well: veterans, seniors, low-income adults. Dental disease can be devastating and has long-term health impacts. Kids who have tooth decay are more likely to start smoking and be afraid to go to the dentist later in life. As the disease continues, they are more likely to be obese, have premature babies and have cardiovascular disease. Oral health is really important, but oral diseases are the most likely to go untreated.

As the dean of the University of Minnesota School of Dentistry, I bring a message of hope to Mainers: LD 1230, which is pending in the Maine Senate, can make a big difference in the oral health of Maine kids and seniors.

In Minnesota, we have a dental system that reaches the unserved and underserved communities by using a dental team that includes dental therapists. LD 1230 would allow a licensed dental hygienist to go back to school for an additional two years (a total of four to six years) to earn a degree in dental hygiene therapy. The dental therapist would work under the direct supervision of a dentist for 1,000 hours, and then the supervising dentist would enter into a collaborative practice agreement with the dental hygiene therapist.

Right now in Maine there are 73,000 kids with dental insurance through MaineCare who do not see a dentist. To be clear, I don’t blame dentists, parents or the state for this. Though millions of dollars are allocated, MaineCare reimbursement cannot cover dentists’ costs to care for these children under the current dental practice model.

Similar to tooth cleaning and X-rays, the dentist cannot afford to personally provide tooth decay care for a sufficient number of these children, so access is limited. This problem worsens as parents who suffered as children with untreated tooth decay become resigned to its effects on their own children.

As a result, some don’t seek care, or they don’t show up for appointments. Transportation, time away from work and lack of understanding about the importance of oral health all contribute to the failure of the current system to serve these kids.

Here’s the good news: Dental hygiene therapists can alleviate these barriers to care and support the success of dental practices. In Minnesota, DHTs go to schools and set up portable equipment to reach out to kids. The DHTs perform routine cleanings, apply sealants and fluoride, and treat cavities. They do this with the ability to continuously communicate with the dentists with whom they practice. They get these untreated kids into the dental office for more complex needs.

The quality of care is excellent. We teach our dental therapists side-by-side with our dentists. Research has confirmed the quality of their care is equal to or better than a dentist.

Here’s why it works: A DHT becomes an expert in a very narrow scope of service — the initial treatment of tooth decay. With that kind of training, the therapist actually develops extraordinary competence in performing these few procedures.

More good news: For every $30 a DHT costs a dental practice in salary, the dental therapist brings in an additional $70. In other words, even with low reimbursement rates — and Minnesota’s is lower than Maine’s — DHTs actually make their dental practices money.

Here’s the result:

— No-shows are nearly eliminated.

— Unserved populations have access to quality care.

— Dentists practice at the top of their practice and make more money for their practice by performing more complicated procedures.

— DHTs more than pay for their costs and contribute to dental practices’ profitability.

Together with a supervising dentist, they make a dental team that will help bring smiles to Maine kids.

Leon Assael, DMD, is dean of the School of Dentistry at the University of Minnesota.


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