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Does Maine Need Dental Therapists? Bill Prompts Debate
04/11/2013   Reported By: Patty B. Wight

Some policy makers and health care providers have long lamented the need to expand access to dental care in Maine. A new bill aims to do that by allowing a new type of provider: dental hygiene therapists. But many Maine dentists are opposed, saying the bill fails to target the real problem with access to oral health care in the state. Patty Wight reports.

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On one side of this bill is an army of proponents: groups like the Maine Primary Care Association, the Children's Alliance, the Pew Charitable Trusts, plus more than 40 lawmakers - both Democrats and Republicans.

Leading the charge is Democratic Speaker of the House Mark Eves, who says a recent study found that 55 percent of children on MaineCare don't see a dentist.

"Too many Maine kids are not getting dental care," he said at a hearing today on the bill. "These kids have a higher rate of dental disease, which leads to poor overall health. Dental disease is the most prevalent unmet health need in Maine, and in our country. It's five times higher than childhood asthma."

One answer to getting them the oral care they need, says Eves, is through dental hygiene therapists. They're mid-level providers - like the physician's assistant of the dental world - who can perform routine procedures, like fillings and extractions. Fifty-three countries have dental therapists, and two states, Alaska and Minnesota.

Children's dental services is an organization based in Minnesota. Director Sara Wovcha says Minnesota struggles just as Maine does with health care in rural areas. But since the state authorized dental hygiene therapists a few years ago, that's begun to change.

"Our advanced dental therapists have consistently performed in the middle to top half of productivity when compared side by side with staff dentists," Wovcha said. "And the cost of an advanced dental therapist, at approximately $45 per hour is roughly half of the $75 per hour it costs to employ a brand new dentist."

But on the other side of this bill is an army of Maine dentists, who say the bill won't change access. Dr. Demi Kouzounas of Scarborough says she provides hours of free dental care every month - and that's really what people need.

"There is more to this than putting a new provider into the system," Wovcha said. "We have, already, more provider types than any other providers in the state. And so, this is an economic barrier, an educational problem. We can't drill and fill out of this problem."

The vice president of the Maine Dental Association, Robert Berube, says having two levels of providers diminishes the quality of care. "Let's not have two tiers. We have the capacity, we have the workforce, we have the ability. We've got the infrastructure. Let's use it."

Berube says a new Maine dental school opening this fall will ensure a steady flow of future dentists to the state. To get more people in the dentist's chair now, many dentists say, Maine should expand MaineCare, because adults are only covered when they seek emergency dental care.


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