Our mouths, clearly, are very much part of our bodies. But for centuries dental care has been separate from medical care. Back in the 1800s, teeth were pulled by barbers.
Dental care, thankfully, has improved since then, but the separation between medical care and dental care has persisted. As a result, most Americans’ medical insurance — both private and public — does not include dental care.
Thirty-three states have bridged this divide for their low-income residents. Maine should join them.
LD 1955, a bill from Westbrook Democrat Rep. Drew Gattine, would expand the state’s Medicaid program, called MaineCare, to cover routine dental care. Such an expansion would have many benefits for a minimal investment of state funds. The Legislature’s Health and Human Services committee is scheduled to hold a public hearing on the bill at 1 p.m. on Monday.
The state (and federal government, which pays the majority of MaineCare costs) already covers emergency dental care — such as tooth extractions — if it is provided in an emergency room. This, and providing dentures to MaineCare recipients who have lost their teeth, costs Maine about $6 million a year.
Many Mainers put off dental care until it becomes an emergency. Dental problems were the top reason for emergency room visits among Mainers aged 15 to 44 who were uninsured or covered through MaineCare, according to a 2010 study by the Muskie School for Public Service at the University of Southern Maine.
This is an inefficient, and often ineffective, way to provide dental care, especially when caring for someone’s mouth can lessen the risk of other health concerns. Gum disease, for example, can exacerbate diabetes and 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.
Researchers have found that adequate, preventive dental care is linked with fewer hospital admissions, and substantially lower medical costs.
Dental care is also about economic viability and quality of life. 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.
Maine lawmakers had an opportunity to remedy this situation last year. Instead, they amended a bill that would have expanded MaineCare to include dental care to call for a study of the proposal. Although this legislation had bipartisan support, Gov. Janet Mills held on to the bill for months before sending it back to the Legislature.
Rather than revisiting this outdated legislation, LD 1955 gives lawmakers a fresh start at bringing Maine in line with the majority of states by including dental care in its Medicaid program.