June 20, 2018
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Dental therapists wouldn’t solve Maine’s dental care problems

Andre Cushing Hampden
By Andre Cushing, Special to the BDN

I am perplexed by the opening paragraph of the Dec. 11 opinion piece submitted by House Speaker Mark Eves, D-North Berwick, and Sen. David Burns, R-Whiting, regarding a bill that would authorize the creation of dental hygiene therapists in Maine.

I serve on the Labor, Commerce, Research, and Economic Development Committee where the bill was reviewed extensively, with more than 10 hours of public testimony and several work sessions.

There is no doubt that each and every committee member was moved by Brenda Akers’ testimony at the public hearing on LD 1230.

Let’s clarify something. Maine does not provide comprehensive dental benefits to adult MaineCare recipients. LD 1230 does not address that issue but instead seeks to create another dental provider type that would be reimbursed at the same level as dentists. How does that help Akers?

We’re fortunate in Maine to have a robust dental safety net. Across the state, there are a multitude of federally qualified health center dental clinics, private nonprofit clinics, state clinics, tribal clinics and volunteer clinics offering reduced fees and payment plans to low-income adults such as Akers.

And yes, Maine dentists, by their own commitment to oral health, do indeed provide millions of dollars annually in free and reduced services to needy Mainers.

To imply that dentists visited the State House to “cloud the waters” or did so for purely financial reasons is insulting and undermines our hallowed duty as legislators to listen first and foremost to the men and women we represent. Who, I ask, is better suited to advise us on oral health matters than dentists who practice in Maine?

It is unfortunate that proponents of LD 1230 choose to present an ongoing parade of horrors with regard to children’s oral health, failing to mention that in 2011 our third graders had the second lowest rate of untreated tooth decay in the nation. They also fail to mention that Maine is one of only two states to receive the top rank in the Pew Children’s Dental Campaign 50 state report in both 2011 and 2012.

To be clear, I do not disagree that 50 percent of Maine children don’t receive dental care, but that is vastly different than peddling the notion that over half of Maine kids don’t have access to routine dental care.

Maine ranks in the top 20 states for dentist participation in Medicaid. A review of MaineCare claims over the last three years confirms that nearly 50 percent of Maine dentists treat MaineCare patients.

Maine already allows independent practice for dental hygienists; we have hygienists with public health supervision working in our schools to provide oral health education and preventative dental care to thousands of children. Maine is a leader in providing oral health assessments and fluoride varnish to children between six months and three years of age at well-child visits with their health care providers. Last year more than 30,000 children benefitted from this program.

Of course we can do better. But do we really need dental therapists to drill and fill our kids’ teeth, or are we better served focusing our attention on oral health education, prevention and getting them to a dentist?

Proponents urge us to join Alaska and Minnesota, the only two states that allow this type of provider. In Alaska, the Dental Health Aide Therapists program is run by the Alaska Native Tribal Health Consortium, a nongovernment agency, and serves only Alaska native people who reside in remote villages, many of which are only accessible by boat or plane.

The Minnesota model is vastly different than what is proposed in Maine. And unlike MaineCare, Minnesota Medicaid has comprehensive adult dental benefits. In Minnesota, the dental therapist is part of the dental team, supervised by a dentist, much like the expanded function dental assistant in Maine. Only a master’s level or advanced dental therapist with 2,000 hours of clinical supervision may practice independently. There are currently only three advanced dental therapists in Minnesota.

In a recent email communication, Dean Leon Assael of the University of Minnesota School of Dentistry, frequently quoted by proponents, said about the Maine legislation, “The main problem with independent practice that should be emphasized is that it in no way will reduce the cost of care, since the overhead of an independent advanced DH will be the same as the dentist and indeed with a smaller menu of services than the dentist, such an individual would be LESS likely to care for underserved than a dentist in the same community.”

So who’s really clouding the waters?

Sen. Andre Cushing, R-Hampden, serves on the Maine Legislature’s Labor, Commerce, Research, and Economic Development Committee.

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