October 13, 2019
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Dental care is health care. It should be funded that way.

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 during the statewide day of free care organized by the Maine Dental Association.

The Legislature had the opportunity to improve health care for thousands of low-income Mainers. It instead launched a study of an expansion of dental benefits to adult Medicaid recipients in Maine.

Another study is not needed to know that such an expansion is needed. In fact, lawmakers voted to extend dental coverage to an estimated 70,000 low-income Mainers. However, the bill was not funded in the final days of the Legislature.

Lawmakers should make funding dental care a priority when they reconvene. The bill’s projected $6 million annual pricetag was a reasonable price to pay to improve the lives of thousands of Mainers, especially when it would have come with nearly $17 million in additional federal funds each year.

The medical consequences of a lack of dental care are clear. A 2010 study of emergency room use by the Muskie School of Public Service at the University of Southern Maine revealed that dental disease was the top reason for someone age 15 to 44 with MaineCare or without insurance to seek emergency room care.

Dental problems can have medical roots, and medical problems can have dental origins. Diabetes can contribute to gum disease, for example. Gum disease, in turn, can exacerbate diabetes. Gum disease also is associated with increased risk of stroke and, according to recent research, Alzheimer’s disease. Pregnant women with poor dental health — such as untreated tooth decay and gum disease — are more likely than other mothers to have low birth-weight or premature babies. And at a most basic level, poor dental health can make it difficult for someone to eat a nutritious diet, Dr. Charles Norman, then president of the American Dental Association, told the website MarketWatch in 2014.

Researchers have found that adequate, preventive dental care is linked with fewer hospital admissions, and substantially lower medical costs during pregnancy and to treat type 2 diabetes, coronary artery disease and cerebrovascular disease. Preventive dental care, once integrated into the health insurance system, is a benefit that can go a long way toward paying for itself.

That’s why including dental care in comprehensive health insurance is long overdue.

Dental care is also about economic viability. In a 2015 survey by the American Dental Association and Health Policy Institute, nearly half of the low-income respondents in Maine said their teeth and mouth were in only fair or poor conditions. Thirty-seven percent of low-income Maine survey participants said the condition of their teeth affects their ability to interview for a job. A third of Maine adults said they avoid smiling because of the poor condition of their teeth.

Federal law requires that state Medicaid plans cover pediatric, preventive dental care — but no such requirement extends to coverage for adults.

That leaves adult dental coverage options inconsistent and dependent on a mix of state policy decisions and state-by-state insurer offerings. In Maine, adults with Medicaid can receive coverage only for dental emergencies, such as tooth extractions, which are generally needed only after manageable dental problems have developed into major — and expensive — health issues.

Lawmakers were right to approve a remedy for this situation. Now, they must find a way to fund it.



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