May 21, 2019
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Maine must recognize that dental care is health care

Anthony Brino | BDN
Anthony Brino | BDN
Registered dental hygienist Nancy Watson, who works at area dental clinics in central Aroostook County, tends to a patient at the St. Apollonia Dental Clinic in Presque Isle on Nov. 2, 2018, during the statewide day of free care organized by the Maine Dental Association.

As a dentist practicing in coastal Maine, I’m deeply concerned by the number of low-income families who have no access to regular dental care.

In Maine, most low-income adults with MaineCare have no dental benefits, except for in limited emergencies. Often they cannot afford preventive cleanings, fillings or other needed services that would stop small problems from snowballing into major health issues.

Everyone wants to have healthy teeth, but not everyone can pay for them. I’ve seen low-income patients go to extraordinary lengths to get themselves and their kids taken care of despite how hard it is to miss work, how much they have to scrape and save to afford services, or to find child care. When their oral health deteriorates to the point that they have blackened, loose or missing teeth, severe infection, or need dentures to eat, they cannot afford the treatment. Their overall health may decline and their ability to find or keep a job may be impaired.

I have worked with low-income parents who, despite their own pain and suffering from oral disease, faithfully brought their children in for dental care. Over the years, more of these parents avoided spreading their dental disease to their children even through easily passed oral bacteria. They learned from their own troubles that a healthy mouth gives a child a good start toward good overall health and that preventing disease costs less than treating disease. If children see their parents caring for and about their own oral health, they are more likely to continue caring for their own oral health as they become adults.

Because there is a growing awareness that dental care is health care, 33 states plus Washington, D.C., offer comprehensive dental benefits, or at least free cleanings, through their Medicaid programs. Maine has a chance to do the same this year with LD 1453, a bill in the Legislature that would draw on federal and state funds to allow low-income Mainers to get access to this vital type of care through MaineCare (Medicaid).

Dentists in Maine do a lot to help people get the care they need by holding free clinics and by giving care away when we can afford to — but the need is much, much greater than private charity can meet. One in five low-income adults in Maine say their teeth are in poor condition, and one in three report anxiety about their dental health. In other words, there are tens of thousands of people whose oral health is headed for a crisis, and they simply cannot afford to change that on their own.

As with any other health emergency, the underinsured and the uninsured who have dental emergencies go to the emergency room. In 2010, the University of Southern Maine found that dental disease was the top reason for ER visits among MaineCare and uninsured young adults ages 15 through 24, and adults ages 25-44. This is costly to society at large, and an ER is not set up to actually treat the dental problem. They still need to see a dentist, which they still cannot afford to do.

The benefits for Maine are clear, and the solution is within our reach. States with preventive dental care in their Medicaid programs saw medical costs for patients with seven chronic conditions such as heart disease, diabetes and cancer lowered by as much as 31 percent to 67 percent. Access to better dental care is a virtuous cycle that could help improve lives for people for generations while lowering medical costs for our hospitals and the state.

Passing LD 1453 would be a boon for Mainers who cannot afford care and set a deep wrong in our health care system right. For the sake of the next generation, change is needed now.

Wendy Alpaugh, a dentist, practices in Stonington.

 



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