Will a new class of dental professionals improve oral care in Maine? Dentists, lawmakers disagree

By Jen Lynds, BDN Staff
Posted May 19, 2013, at 4:45 p.m.

AUGUSTA, Maine — Dental professionals across the state are watching a bill making its way through the Legislature that they say could decrease the quality of dental care in the state and make it more difficult for patients to get procedures completed.

Others, however, argue that LD 1230, An Act to Improve Access to Oral Health Care, will approve the creation of a new mid-level dental provider and ease the shortage of dentists in the state. This will then provide preventive oral health care in places where there is a shortage.

The bill was sponsored by Rep. Mark Eves, D-North Berwick. He said that while he understands that dentists and others in the profession are concerned about the bill, he believes that it will go a long way in easing the dental shortage in Maine, helping to reduce the 55 percent of children on MaineCare who currently don’t see a dentist.

He said late last week that the dental hygiene therapists established by the bill would be authorized to perform a very limited number of procedures like drilling and filling surface cavities and removing loose teeth, and they would have to practice under the supervision of a dentist. They would also have a hygiene degree, plus an additional 500 hours of clinical training under the supervision of a dentist.

“This is a bipartisan bill,” he said. “Programs such as this have been going on in other states and other countries for years. Minnesota has a program like this, as does Alaska.”

While it has gotten bipartisan support, it has rankled the Maine Dental Association. Last month, more than 100 dentists representing all 16 counties in Maine opposed the bill.

“While Maine dentists are working to get more children and adults into dental offices and clinics that have vacant chairs and available appointments, this group proposes letting people with minimal training perform invasive surgical procedures,” said Dr. Michelle Mazur-Kary, an endodontist and president of the Maine Dental Association.

The MDA is a voluntary membership organization with a mission to provide representation, information and other services for its dentist members and promote the health and welfare of the people of the state.

Mazur-Kary said that the MDA opposes the bill because its members believe that the therapists will not have enough training to perform the procedures that they will be allowed to undertake if the bill passes. They also believe that they simply aren’t needed, as Maine has made significant progress in improving children’s oral health over the past 10 years.

In 2011, the MDA said, Maine third-graders had the second-lowest rate of untreated tooth decay in the country.

Dr. Donald Cassidy, an orthodontics and dentofacial orthopedics specialist with a practice in Presque Isle, has been watching the bill closely. He said that he was one of approximately 100 dental professionals who closed their practices on a recent Thursday to travel to Augusta to testify against the bill.

He agrees with the MDA that the new therapists are not needed.

“I can honestly say that I think things are the best for patients right now that I have ever seen,” he said. “Aroostook County has gotten many new dentists over the last few years, and we now have several dental clinics that are wide open for MaineCare patients. We also currently have at least eight students in dental school from Aroostook County, and we are getting the first pedodontist ever this summer to treat children who have bad decay or are difficult to work on, instead of sending them to southern Maine.”

One of Cassidy’s biggest concerns is the fact that he believes that the bill, if passed, will fracture care for patients.

“Say a patient goes to a therapist created under this bill and they have pain in their mouth,” he said. “And the therapist sees that the patient has a few loose teeth and they are in pain because they need another procedure that the therapist can’t do. So the therapist can pull the teeth, but the patient is going to have to wait to get into a dentist to have the other procedure. Now, it would have been easier for the patient to go to the dentist and get it all done at once, instead of lingering in pain while waiting for the appointment.”

Supporters have written letters to local newspapers asking that LD 1230 pass, arguing that therapists are needed because there is a shortage of dentists and there are even fewer providing care to children covered by MaineCare. When he introduced the bill last month, Eves noted that Maine has the sixth-highest percentage of Medicaid children without access to care in the United States

Eves acknowledged that he and others on the Labor, Commerce, Research and Economic Development Committee heard from a large number of people in the dental profession during the public hearing on the bill. He said that he challenged them to provide statistics or evidence to show that the therapist program would not work in the state.

“No one came forward,” he said. “This model has worked in other states for years. They have not shown me that this cannot work in Maine.”

Cassidy disagreed.

“There were 100 dentists there who spoke into the evening,” he said. “We gave countless examples of why it would not work.”

Eves said that there is also a misconception that the therapists will have only 500 hours of training.

“It takes three to four years to get a degree,” he said. “Then they need to satisfy even more training requirements on top of that. It’s not just 500 hours.”

The last action taken by the committee on the bill was on May 17, when the vote resulted in a divided report. Since committee members disagreed on a recommended action, multiple reports are submitted for the Legislature to consider.

https://bangordailynews.com/2013/05/19/news/state/dental-professionals-fear-proposed-bill-could-make-it-more-difficult-for-patients-to-get-procedures-completed/ printed on April 21, 2014