Access to oral health care is being debated at the State House by two legislative study committees: one looking at the oral health needs of young children and another examining barriers to dental care for all citizens. In addition, two reports on dental access - one funded by the New Hampshire Dental Society and another by the Endowment for Health - are due to be released this month.

While we are eager to see the findings of these studies, many of us in rural areas don't need to be told that there are great disparities in access to oral health care services, particularly for children and the elderly without financial means. We constantly hear about people unable to get to a dentist because of the cost and the travel required; the result is a growing number of patients in New Hampshire who rely on hospital emergency rooms for dental care.

Fifty-six percent of all hospital emergency room admissions in New Hampshire in 2005 were for dental problems or disease, according to statistics from the state Division of Public Health. Between 2001 and 2005, this percentage increased.

Simply put, not enough dentists practice in rural areas. Add to that the fact that comprehensive dental care without insurance, or Medicaid coverage, is expensive. (In New Hampshire, Medicaid-eligible adults do not receive regular dental care.) Although the American Dental Association asserts that there is no shortage of dentists, rural health care providers, emergency room doctors, school nurses and others disagree.

At the same time, there are plenty of dental hygienists in the workforce - almost twice as many as dentists in New Hampshire - and many new graduates have a difficult time finding employment. Expanding hygienists' scope of practice is one answer to the gaps in care, but it continues to be a contentious issue among dentists and some policymakers.

However, allowing hygienists to practice independently in some settings is finally becoming more accepted. One encouraging sign is the recent vote by the state Board of Dental Examiners to allow hygienists to apply sealants in public health settings, without an exam by a dentist. (Sealants are thin plastic coatings that seal crevices in teeth and act as a barrier to prevent bacteria from collecting and creating the acid environment that leads to tooth decay). Until now, requiring an exam by a dentist before sealant placement kept hygienists from using a proven and cost-effective method of decay prevention.

This step forward highlights the fact that access can be significantly increased by maximizing the services that licensed dental hygienists are educated to provide. Hygienists are the preventive care specialists; it only makes sense that the more services they are allowed to provide, the fewer people will wind up in hospital emergency rooms for dental crises.

As a health care advocate for children and the elderly, I know that bringing health care to people in need often makes more sense than bringing patients to where the providers are. To get there, we need to look at removing other restrictive supervision requirements and expanding settings where dental hygienists can practice.

(Democratic Rep. Carla Skinder of Cornish serves on the House Children and Family Law Committee.)