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Editorial: Dental care should be extended to underserved

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Sunday, April 09, 2017

Too many Massachusetts residents lack proper dental care, and a disproportionate number of those missing out on that care are poor, disabled or living in rural areas.

The Legislature this year is poised to address the problem by establishing a new category of dental jobs targeted at providing care to underserved people. However, competing bills, backed by different special-interest groups, are complicating the process of getting this needed legislation approved.

A survey in 2015 of Massachusetts residents found that one in five had unmet dental needs that were directly related to the cost of treatment, and that low-income people were least likely to receive any dental care. One of the reasons is that many dentists don’t accept payments from MassHealth, which typically offers lower reimbursements than private insurers. Only 35 percent of dentists in 2014 treated a patient insured by MassHealth, which is the state’s Medicaid program covering low-income and disabled people.

Financial barriers to adequate dental care are not limited to Massachusetts. A national study by the American Dental Association’s Health Policy Institute in Chicago concluded that cost was the most frequently cited reason for unmet dental needs, rather than other factors such as the availability of dentists.

“Low-income, non-elderly adults consistently experience the highest levels of financial barriers to dental care,” the institute reported in 2014.

Inadequate dental care is directly linked to oral diseases, including rotting teeth, and it can affect general health. According to the Mayo Clinic, oral bacteria can cause inflammation and infections leading to heart disease, clogged arteries and strokes.

Advocates for improved access to dental care favor a new mid-level job with skills falling between a dentist and dental hygienist, known as a “dental therapist” or “public health dental practitioner.” Such professionals could provide preventive care and some basic procedures at a lower cost than dentists.

Other states which have created similar jobs report improved access to dental care. Dental therapists were introduced in Alaska in 2004, and Maine and Vermont authorized them more recently.

The Massachusetts Legislature this year is considering two bills that would establish those jobs. Rep. Peter Kocot, D-Northampton, is co-sponsoring legislation backed by the Massachusetts Dental Society that would allow those mid-level practitioners to treat only patients who are insured through MassHealth or at federally qualified community health centers. That bill would bar the practitioners from performing irreversible procedures such as tooth extractions, require that they be supervised on-site by a dentist and have the state set educational standards for the jobs.

A second bill, whose sponsors include Rep. William “Smitty” Pignatelli, D-Lenox, would put fewer restrictions on dental therapists. That legislation — which was approved last year by the Senate, but not the House — would not require on-site supervision by a dentist, allow therapists to perform some nonsurgical extractions and leave their required education up to the national Commission on Dental Accreditation.

Backing that bill are more than 40 organizations, including the Massachusetts Dental Hygienists’ Association, Massachusetts Hospital Association, Massachusetts Public Health Association, the state’s branch of AARP, and The Pew Charitable Trusts, a national organization backing dental therapy programs in many states.

The less restrictive legislation allowing for “general” supervision by a dentist at another location, rather than direct physical supervision, is attractive to medical facilities serving rural areas, such as the Community Health Center of Franklin County in Greenfield, according to its CEO, Edward Sayer. “We do a lot of dental work, there’s tremendous demand and the main limitation is that we don’t have enough qualified staff,” he says.

Sayer adds that if dental therapists are allowed to treat only MassHealth patients or those at a federally qualified community health center, people who are uninsured or pay their own dental costs would not be eligible.

Despite the differences between the bills, legislators are optimistic that a compromise will be reached this year, in part because this is the first time the Massachusetts Dental Society has backed any measure creating the new class of jobs. “This is the first step of the process to come up with a compromise bill,” says Kocot. “I’m cautiously optimistic.”

We urge Kocot to help lead those negotiations and ensure that politics do not get in the way of delivering affordable dental care to the people who need it most — those living on the margins.