January 23, 2020
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Creating new providers may not improve Maine’s dental health

Maine lawmakers have been told over and over again that the solution to improving access to oral health care is to add new dental providers. They have created independent dental hygienists, public health hygienists and expanded function dental assistants. But no matter how many new categories are created, some people continue to advocate for yet one more.

Unfortunately those pushing for yet one more provider are using old data to bolster their position. That information was presented as facts in the Jan. 11 BDN article about a new dental provider being pushed at the Maine State House.

I am writing to provide current data to set the record straight. Making policy decisions about an issue as important as oral health must be based on facts, not old data or misleading assertions.

The article implied that people can’t receive dental care outside of dental offices. This is not true. Both public health hygienists and independent practice dental hygienists can provide services in alternative settings such as schools, Head Start centers and nursing homes.

Unfortunately, they often do not work in nursing homes because MaineCare doesn’t cover adults and many elderly cannot afford to pay. This points to an obvious and important fact — the Legislature can create as many dental providers as it can imagine but until there is adequate MaineCare funding to cover the cost of providing dental services, many people will go untreated.

Another error in the article is the out-of-date figure citing the number of people living in underserved areas. According to Maine’s Office of Rural Health and Primary Care, the actual number of people living in underserved areas is about half of what was quoted in the article, or 281,725.

It is also misleading to assume people in underserved areas don’t have dental care. What it really means is that people may have to drive longer distances to get care — whether it is medical or dental.

Very rural areas traditionally have problems attracting physicians and dentists. Any proposed alternative dental providers likely wouldn’t be in those areas either. The reason is simple and fundamental; it is difficult to sustain a practice and earn a living where there are few people to treat. This cannot be corrected by creating one more dental provider.

Other old data provided to the reporter are that only 40 percent of children who are eligible for MaineCare-funded dental care are treated. In 2011, the Department of Health and Human Services reported to the Legislature that 52 percent of eligible children are treated — a very positive trend.

The increase in MaineCare-eligible children being served is good news. It shows that more dentists are treating MaineCare patients and the steps we are taking to improve access are working.

One argument being used to push for another new dental provider, which is getting very tiresome to hear, is that 40 percent of Maine’s dentists will retire in the next 10 years, creating a crisis. I know this is a good sound bite when arguing for a new provider but it totally ignores the fact that many new dentists are moving to the state.

The number of new dentists setting up or joining practices in Maine is increasing, so while some dentists retire, other new dentists are adding to the total. There is no looming crisis.

Additionally, Maine’s first dental school will open next year at the University of New England. It is the plan to have dental students working in clinics in our outlying communities and we expect many of those students will stay in Maine after graduation, adding to our dentist numbers.

In its wisdom, the Legislature set up a study last year to look at what it means for Maine to have these new providers. That study has yet to be written and presented to the Legislature. Why would we ignore this study step and jump one more time into the argument that another dental provider is the answer? We’ve tried that — let’s not be fooled into trying it again.

Hopefully policymakers will realize that access to care is not simple. Until we face the complexity of this issue we will continue to throw darts at the target, hoping we get it right.

Dr. Dean Tourigny is president of the Maine Dental Association. He is a practicing general dentist in Biddeford. He can be reached at president@medental.org.

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