Dr. Michelle Mazur-Kary, president of the Maine Dental Association, wrote in her guest column (Feb. 3) about Maine’s “A” grade from the Pew Center on the States for dental sealants.
We wholeheartedly agree that the dental sealant grade is an important indication that Maine is doing well on prevention. However, in a separate evaluation, Pew found that Maine is performing much worse in providing care for those already suffering from dental disease.
A key part of the past success around prevention and dental sealants has been due to the collaborative approach that Maine has taken. Primary care providers, dental assistants, dental hygienists and dentists are able to apply dental sealants.
According to a December 2012 study (which the MDA helped fund), recent innovations in expanding the dental team for prevention has also increased access to care.
Another significant factor contributing to Maine’s success are Community Health Centers, leaders in team-based care, providing vital access points for oral health and primary care in many communities.
Despite improvements in prevention, the shortage of dentists (especially in rural Maine) remains a very real problem. Fifteen out of the 16 Maine counties have federally designated dentist shortages. That means many people in rural Maine can’t find a dentist in their own hometown. According to the previously mentioned 2012 statewide study, two-thirds of Maine residents live in rural areas, but only 13.5 percent of dentists practice in those areas.
Maine’s shortage disproportionately affects our children. In 2010, only 45 percent of eligible MaineCare children received a dental service. That dropped significantly in 2011, to 35 percent. Equally troubling, contrary to the original column, only 24 percent of general dentists are accepting new MaineCare patients.
The problem is getting worse, too. That same study concluded that, within the next five years, 23.7 percent of dentists in Maine plan to retire and 16.1 percent more expect to reduce their hours. That’s a total of 39.8 percent of dentists retiring or reducing hours in the next five years. At the same time, thousands more children will gain access to private dental insurance through the federal health care law next year.
Fewer dentists and more patients don’t add up.
The fact that 86.5 percent of dentists aren’t practicing in rural areas leaves too many people without a dentist when they are suffering from dental pain and disease. As a result, Mainers seek care in expensive emergency rooms for preventable dental problems.
On top of the costs to the health care system and taxpayers, oral health has been shown to have a significant impact on other health conditions, such as diabetes and cardiovascular disease. So when people have poorly managed oral health, their physical health is negatively impacted as well.
There are a number of potential solutions in addressing Maine’s oral health access issues. One is to improve reimbursement rates for preventive and restorative oral health care in the MaineCare program for both children and adults.
Another option to address the shortage is to expand the dental team in Maine, much like medical practices have by using care teams that include physician assistants and nurse practitioners. Dental providers and patients could benefit by expanding the use of a team-based approach to care.
Maine has the opportunity to join Alaska and Minnesota and establish a dental hygiene therapist. Fifty-three other countries have had these professionals for decades. Studies show that dental hygiene therapists provide quality care and effectively increase access to dental care.
There is much to be proud of, in terms of what Maine has been able to accomplish, including the success of CHCs in increasing access to oral health. But sealants are just one aspect of comprehensive dental care.
Far too many Mainers continue to forego dental care or wait until they are in serious pain to go to expensive emergency rooms for care. It will take a comprehensive, team-based approach to care to improve the treatment and prevention of dental disease for people of all ages.
Caroline Zimmerman is director of Health Initiatives, Maine Primary Care Association, a stakeholder in the development of the LD 1105 study.