Still, the Maine Dental Hygienists Association does support the midlevel practitioner program, or at least one that would allow existing hygienists to undergo a just little more training to become dental therapists. Pat Jones, lobbyist for the MDHA and a former registered hygienist, likens the dental therapy role to that of a nurse practitioner. That position, born out of a mid-20th-century shortage of doctors, requires graduate-level education and provides 60 to 80 percent of primary and preventative care in the United States, according to the American Nurses Association.
GETTING THEM IN THE DOOR
"Getting midlevel providers will do nothing about seeking care," says Robert Berube, an oral surgeon with his own practice in Augusta. Berube, who has 20 years' experience, identifies what he believes are the two biggest challenges to statewide dental health: a lack of awareness of the importance of oral care and low MaineCare reimbursement rates.
To address the first problem, Berube does advocate for a new type of position, just not the dental therapist proposed by others. Berube is a proponent of community dental health coordinators who would bridge the gap between patients and providers, helping people navigate the system by hooking them up with dentists, explaining sliding-fee scales at dental clinics, stressing the importance of general mouth and tooth care — in other words, eliminating all the things that might keep people from coming in the door for appointments before dental crises develop.
As for the second issue, Berube's solution is simple. "The access problem goes away when you increase reimbursement rates," he says, pointing to Connecticut, where hundreds more dentists agreed to take Medicaid cases when reimbursement rates were boosted to 50 percent of what their services cost. Only when it is financially viable can dentists accept more low-income patients, he says.
However, this still wouldn't address the problem of MaineCare not covering adults. And of course, with Republican Governor Paul LePage attempting to cut MaineCare benefits and the Fund for a Healthy Maine (which covers some of the state's free or reduced-fee dental services), the prospect of funneling more money toward oral care is unlikely. Dental care, by the way, totaled $32.4 million in 2009 — about 1.3 percent of all MaineCare spending.
What money there is should be put toward preventative care, says Wendy Alpaugh, a dentist in Stonington who also chairs the Maine Dental Access Coalition. She says Maine families should take advantage of existing dental benefits for kids, and federal programs like the Head Start Dental Home Initiative, which links young children with dental providers.
"We're trying to get away from the model of drill and fill," she says. "We need to be switching to a medical model of prevention, with fluoride, good home care, good nutrition. By doing so, we eliminate the need for midlevel providers. It's such a preventable disease," she says, of oral problems in general. "We need young kids coming up cavity free."
Deirdre Fulton can be reached at dfulton[a]phx.com.
