There is little debate that Maine has a dental care deficit. There are two ways to address this problem. One is to increase the number of dental providers. The other is to ensure that dental care is affordable. Both must happen to ensure Maine residents, especially the poor, have access to dental care.
The Legislature is considering bills that address both aspects.
All Maine counties, except for Sagadahoc, have been designated as Health Professional Shortage Areas for dental care by the federal government, and Maine has fewer dentists per 10,000 residents than the national average. Because of limited access to dental care, dental problems are the top reason for emergency room visits among adults without health insurance or who have MaineCare coverage, according to a 2010 Muskie School of Public Service report on emergency room use in Maine.
Over the years, Maine has created many new categories of dental providers, such as expanded function dental assistants and independent practice dental hygienists, in hopes of easing the shortage of care. Some of these providers are allowed to do procedures that previously had been limited to licensed dentists.
In 2014, the Legislature approved a category called dental hygiene therapist. A bill currently under consideration, LD 1514, would ease some of the training and accreditation requirements. It would also remove the requirement that dental hygiene therapists work under the direct supervision of a dentist.
The goal of this change is to enable these dental practitioners to work in mobile clinics and other outreach venues that bring care to those who need it, especially in rural areas. The bill is backed by a diverse coalition, including Consumers for Affordable Health Care, the Christian Civic League of Maine and the Disability Rights Center of Maine, highlighting the importance of expanding dental care.
Dentists have expressed concerns that the bill would allow dental therapists to work under the general, not direct, supervision of a dentist. If complications arise, dental therapists wouldn’t have the level of medical training that may be needed to handle them, they argue.
This is a valid concern but this issue was settled in 2014, when lawmakers approved the original dental therapist legislation, which called for general supervision. The language was changed late in the process at the behest of Gov. Paul LePage. LD 1514 would return to the language previously approved by lawmakers.
For the poor and uninsured, it doesn’t matter who provides dental care if it is not affordable. LD 860 takes modest steps to extend dental coverage under MaineCare. An amended version of the bill would provide MaineCare dental coverage to pregnant and postpartum women and to other MaineCare recipients when it would avoid more costly medical or dental care.
The Maine State Chamber of Commerce took the unusual step of testifying in favor of similar legislation last year.
“This is one of those instances in which a modest investment today can lead to greater savings, better health outcomes and a more productive workforce in the years ahead,” Peter Gore, vice president of advocacy and government relations, wrote to members of the Committee on Health and Human Services in April. When the uninsured and adults with MaineCare seek emergency room treatment for dental problems, the costs are passed on to businesses and individuals that purchase private insurance, Gore wrote. On a more personal level, some struggling to become employed are too embarrassed by the condition of their teeth to interview with potential employers. Businesses also lose money when workers take sick days because of dental pain, he added.
There’s a strong case for extending dental coverage to all adult MaineCare recipients and for raising reimbursement rates. Without this, increasing the number of dental providers in Maine won’t ensure more people get the dental care they need.