A Jan. 10 article tried to shed light on what can be done to increase access and control costs of health care for our state's neediest residents ("Study shows emergency room costs," Monitor front page). It's no secret that costs to patients, insurers and the government are almost always more expensive when people seek treatment in an emergency room for aliments that could otherwise be handled in a doctor's office. In New Hampshire, the most common reason for emergency room visits by adult Medicaid patients is tooth or jaw pain.

The article gave two reasons for the high number of poor residents seeking oral health care at local emergency departments.

First, Dr. Doris Lutz, medical director of the state Medicaid program, cited a shortage of dentists in the state. I would strongly disagree with this characterization. New Hampshire is not experiencing a shortage of dentists. There are more licensed dentists in New Hampshire than at any time in our history.

The New Hampshire Dental Society does recognize there is a geographic misdistribution of dentists, with the need for more to relocate in rural areas - and there are several initiatives to recruit dentists to do just that. However, in the urban areas of our state, where our emergency rooms are overburdened by patients seeking oral health care, there are numerous public and private clinics.

The other reason cited in the article is that the state does not pay for dental care for adult Medicaid patients. While children on Medicaid can receive a full spectrum of oral treatments, needy adults must pay for exams, cleanings and fillings out of their own pocket. For this reason, many choose to skip routine care until they develop a toothache. New Hampshire emergency rooms do not have staff dentists so the only dental treatment available is pain medication. The only thing Medicaid will pay for is an extraction.

A budget proposal supported by the state Department of Health and Human Services would add $8.7 million to provide a basic dental benefit to adult Medicaid patients. The dental society strongly supports this priority.

New Hampshire spends more than $10 million treating Medicaid patients who seek last-resort dental care in an expensive emergency room. This benefit will go a long way toward saving the state that money. It also will increase the oral health and quality of life of many of our neediest citizens.

An independent study is under way to examine all the barriers to accessing dental care in New Hampshire. For the first time, this should give our leaders an accurate picture of the true issue. Some employers do not offer dental insurance. Some people do not have the transportation to get to a dentist's office. Some patients' fear of the dentist keeps them away. Others simply do not give much thought to their oral health until they develop serious pain. A 2001 study found that one-third of New Hampshire respondents who didn't see a dentist that year claimed they had no reason to go; 28 percent said they could not afford the visit.

The latest survey found that 77 percent of Granite Staters visited a dentist or dental clinic, well above the national average. There's still work to be done, and the New Hampshire Dental Society will continue to work to identify access barriers and educate the population about the importance of oral health.

(Earle Simpson is president of the New Hampshire Dental Society.)