AUGUSTA, Maine — Maine is one of 10 states where low-income children are least likely to receive dental care, according to a national report released Tuesday that stands to reignite a months-long legislative debate that has pitted dentists against those who support allowing a new type of dental provider in the state.
The report by the Washington, D.C.-based Pew Charitable Trusts also ranks Maine second for the percentage of its dentists nearing retirement age (48.4 percent are older than 55) and in the top 12 for the share of its population living in certified dentist shortage areas (15.8 percent).
The report’s recommended solution is introducing a new type of dental provider, a dental hygiene therapist, who would perform some procedures, such as extractions and fillings, that are currently performed only by dentists.
The report comes days after the Maine Senate rejected heavily lobbied and hotly debated legislation that would have allowed dental hygiene therapists to open up shop in Maine.
The Pew Charitable Trusts was the main force behind the legislation in the Maine State House, registering 13 lobbyists who focused on the dental therapist bill, according to Maine Ethics Commission records. And Pew Charitable Trusts plans to continue pressing future Legislatures to allow dental hygiene therapists in Maine even after the Senate’s rejection of the measure last week, said Mike Saxl, managing principal for the firm Maine Street Solutions, which lobbied lawmakers on Pew’s behalf.
“There’s a huge opportunity here to have a positive impact on kids’ health,” he said. “When Maine is leading the country in the number of kids who don’t have access to care and the number of dentists reaching retirement age, it seems like a no-brainer to pursue strategies to help people get access to care.”
The Maine Dental Association, which has eight registered lobbyists, pushed hard against the dental therapist measure. Jonathan Shenkin, a pediatric dentist in Augusta and a Maine Dental Association member, called Tuesday’s report “substandard” and said it continued a campaign of misinformation Pew Charitable Trusts has used to push the dental therapist bill.
“It’s ineffective at helping policymakers navigate the complicated oral health policy arena,” Shenkin said. “If it does anything, it confuses people more about what’s best to do.”
The Pew report, citing federal government data, ranks Maine sixth in the nation for the percentage of children enrolled in Medicaid — 62.4 percent — who didn’t receive dental care in 2011.
But the Maine Dental Association points to a report from the Medicaid-CHIP State Dental Association that found Maine was one of four states that didn’t include patient visits to about 30 federally qualified dental clinics located across the state in the statistics it reported to the federal government. According to the dental association, those clinics had about 90,000 patient visits in 2011, including visits from thousands of children enrolled in Medicaid.
If those visits were included in Maine’s statistics, Shenkin said, “We wouldn’t even be on this ‘Top 10’ list anymore.”
Plus, Shenkin noted, Pew Charitable Trusts has given Maine high marks in the past on different children’s oral health care measures. In 2011, Maine received an “A” from Pew for overall children’s dental health, but Pew noted the state still faced dental care access issues. Earlier this year, Pew gave Maine an “A” for making dental sealants available to low-income children.
And while nearly a quarter of Maine dentists plan to retire in the next five years and 16 percent expect to reduce their hours, according to a report commissioned by the Legislature in 2011, the Maine Dental Association has argued a new dental school at the University of New England that will enroll its first class in the fall will help to address some of Maine’s dental access problems.
The focus on a new type of mid-level provider who can perform extractions and fill cavities, Shenkin said, is the wrong approach.
“The bottom line is, we need to improve the availability of preventive care for kids,” he said. “We don’t need kids getting more of the drill.”
But Saxl said dental hygiene therapists can provide care at lower costs to low-income populations with limited access to dentists. The legislation considered in Maine this year would require that 50 percent of patients served by dental therapists be recipients of MaineCare, the state’s version of Medicaid. And Saxl said many therapists would provide care at school-based clinics where many children already receive dental sealants.
“It’s unfortunate, but it seems like the [dentists’] MO is to deny there’s a problem, but every single Mainer who you talk to, except dentists, knows there’s a problem,” Saxl said. “To me, this is the most obvious thing you can do to positively impact public health, and it’s infuriating that we can’t get there.”