Thursday, April 24, 2014
The Maine Legislature can take an important step to expand access to dental care by passing L.D. 1230, legislation very similar to a bill we passed in Minnesota five years ago. Last month, the University of Minnesota graduated its third class of dental therapists, an amazing group of committed oral health professionals that join the dentist as part of the health care team. Today, in Minnesota, more people get care, even though our reimbursement rate is lower than Maine’s.
While dentists initially opposed dental therapy at the Legislature, just like in Maine, now Minnesota dentists embrace this policy and have found that it is a great addition to the dental delivery team. I know this to be true since I am dean of the college tasked with training these new providers. I can tell you from personal experience, these new providers make a real difference in people’s lives.
Many Maine dentists provide charitable care, serve MaineCare and offer free services to thousands in need. This is great work and it is a part of the solution, but as the American Dental Association has said, alone it will not meet our oral health care needs. We must broaden the delivery team by adopting strategies that include expanding the provider team to include dental hygiene therapists and using fourth-year students at the new dental school.
As the dean of a school of dentistry, I believe we have plenty of dentists. Indeed dentists have openings in their offices as I am sure they do in Maine. Then why is there so much untreated dental disease? Why do middle-class families defer necessary treatment? Why can’t families, even those with public assistance, find anyone to care for them? The main barrier is the cost of care.
Imagine how much a dental cleaning would cost if it had to be done by the dentist? Furthermore, if dentists had to clean teeth, they would lose the opportunity to see more complex patients with needs more suitable to their high level of training. Today, dental hygienists are key members of the oral health professions. Dental hygiene therapy will do for untreated tooth decay what dental hygiene already has done for gum disease: Get patients in to get treated at a reasonable cost.
Barriers such as transportation are major issues for families living on the margins in Maine, Minnesota and around the world. Dental therapists eliminate these barriers by delivering care in community-based settings such as schools and nursing homes. They provide this care remotely under the supervision of a dentist — much like the model that has been working flawlessly in Minnesota.
A wonderful example of this is the work of Christy Jo Fogarty, an advanced dental therapist, who works in schools throughout Minnesota. Fogarty operates with mobile equipment and sets up shop in rooms in schools. She works with her collaborating dentist, who is not required to be on site, to develop a treatment plan and executes that plan in a safe and effective manner for children, some of whom have never seen a dentist. In 2013, Fogarty saw more than 1,200 patients — 95 percent of whom were on Medicaid. And she did this at a far lower cost than a dentist.
Maine has the opportunity to introduce similar providers through L.D. 1230, a bill being considered by the Maine Legislature. L.D. 1230 allows dental hygienists, providers with a solid background in prevention, to become licensed as dental hygiene therapists after an additional two years of education, 1,000 clinical hours and completion of a board-certified exam. They practice under the supervision of a dentist in community-based settings.
Many of the arguments opposing the bill in Maine are the same arguments that we heard when dental therapist’s were introduced in Minnesota. While some may argue that dental hygiene therapists are unsafe or uneducated to perform their scope of practice, I know this is not the experience in Minnesota and will not be the experience in Maine.
This policy helps dentists who want to serve low-income people more effectively, and those dentists will make a greater profit. Not every dentist will want to hire a dental hygiene therapist, and they don’t have to. Those who do, however, will have more patients, healthier patients, and the community and the dental practice will be enriched by gaining the benefits of improved oral health.
Passing L.D. 1230 will put Maine on the path to meet its unmet oral health need. It is safe, it is effective, it is a critical strategy that will serve Maine people.Leon Assael is the dean of the Minnesota School of Dentistry.