Public dollars to increase dental access makes sense

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There has been much-deserved attention to the creation of a second medical school in Maine. We need a dental school even more. A look at any measure of Maine’s dental work force and patient access to dental care speaks to the need for a Maine-based dental school. State bond funding is essential to the success of the proposed school, which will have a profoundly positive impact on the entirety of our state.

Maine’s dental shortage is acute. Whereas the average U.S. dentist-to-population ratio is one dentist per 1,700 people, Maine’s ratio is significantly higher, with the worst shortages in underserved areas of the state — many with ratios as high as 5,000 to 1. The further north and east you look, the fewer dentists are willing to locate and practice in our rural communities.

So it’s no wonder that the leading cause of avoidable hospital emergency department visits among 15- to 44-year-old MaineCare and uninsured patients in Maine is dental pain, leading to almost 12,000 emergency department visits for this population alone, leading to millions in preventable costs. Hospital emergency departments can do little more than alleviate the pain and prescribe an antibiotic to stem off a more systemic infection caused by an abscess.

In addition, numerous dentists will be retiring in the next 10 years, and there are insufficient graduating dentists to fill those vacancies, let alone today’s gap of dental professionals. With 41 percent of Maine dentists being 55 years or older, we are going to be in even worse shape than we currently are unless we take action now to create a new cadre of dentists willing and able to work in our rural underserved communities.

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As the governor’s task force documented in 2008, we need more dentists, and we need dentists who will provide care in our underserved areas, treating all who live within the community. No one knows this more than Maine’s community health centers that integrate dental care within their primary care practices. Within Maine’s community health centers, the head is viewed as an integral part of the body: dental care and oral health are part of primary care (along with behavioral health). As a result, community health centers have worked in recent years to vastly increase access to dental care within the patient centered health home. From 2002 to 2006, the efforts of Maine’s community health centers to address the severe shortage of dental care access led to a five-fold increase in the number of dentists, dental hygienists and patient access.

However Maine’s dental shortage has already harmed health centers’ ability to ensure dental access in our state’s underserved areas: from 2006 to 2008 health center dental visits declined by 10 percent due to the dental vacancies that gripped parts of our primary care safety net. Certainly the need for dental care wasn’t reduced during those years, but access to it was constrained by the vacancies of dentists in many community health centers.

Herein lies the beauty of the proposed dental school model put forth recently by the University of New England: The dental school in development will be directly integrated into Maine communities. By design, the school integrates intensive training with meaningful engagement and delivery of care in the community. This promises improved recruitment opportunities, accelerated assimilation into Maine communities, and faster acquisition of skill sets required given the high incidence of dental disease across the state.

To be successful in this effort to improve the health of our public, we will need public financing to build training capacity. The bond package under construction in the Maine Legislature offers this opportunity to raise funding to help launch the new dental school in 2012.

Bond funding will support not just the bricks and mortar of the dental school’s flagship dental clinic, but also the growth and development of community-based training sites across the state to serve as the home for dental students’ fourth year of education and training. This will create jobs in each of these communities that are connected with the new dental school.

In sum, the benefits of this proposal are manifold. In addition to direct economic development in rural communities, increasing access to oral health care will restore a higher quality of life for hundreds of thousands of Mainers who are in daily pain from tooth decay and dental disease, leading to increased self-confidence and improvements in children’s school performance and adult’s work productivity. And just as important, in these times of constrained budgets, improved oral health will save millions of dollars in downstream health care costs and emergency department use.

A dental school in Maine will take its place with our proud medical schools to be a powerful engine to a healthier and more productive Maine.

Kevin Lewis is CEO of the Maine Primary Care Association in Winthrop, which represents community health centers across the state.

Jim Lysen is executive director of Community Clinical Services, a health center based in Lewiston-Auburn.

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