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Editorial: Dental therapists could expand access to care

In 2003 only half of New Hampshire’s dentists accepted Medicaid patients. A decade later, the situation is the same. And while the opening of community dental clinics – there are now 17 in the state – has helped meet the needs of low-income residents and the uninsured, a big void remains. To help fill it, lawmakers should pass Senate Bill 193, which would create the position of dental therapist, a dental hygienist with sufficient additional training to perform a limited range of dental services that would include providing local anesthesia, drilling and placing temporary fillings and performing simple extractions.

The New Hampshire Dental Society opposes the legislation. Most private dental practices and some clinics that charge on a sliding scale are operating below capacity, the society says, though that’s not the case with the dental clinic at Concord Hospital. The society worries about the quality of care dental therapists would provide, and it wants lawmakers to allow more time to see how well other measures to increase access work. Those include last year’s creation of the position of public health dental hygienist and new dental society education, outreach and coordination efforts to divert patients from hospital emergency rooms to dental clinics and practices that accept Medicaid.

The geographic, psychological, educational and financial barriers to adequate dental care for all are so great that all of the efforts, including the licensing of dental therapists, are needed. Nine of the state’s 10 counties have areas that are deemed dental professional shortage areas. The wait to see a dentist who accepts Medicaid may last weeks and could require long-distance travel and lost time from work.

As in most states, New Hampshire’s Medicaid program does not pay for dental care for adults except in emergency situations, and then it only pays for prescriptions and extractions. Meeting the dental health needs of the state’s poorest residents requires increasing access and reducing cost, particularly for those without dental insurance. According to the federal Bureau of Labor Statistics, New Hampshire’s dentists, on average, are the highest paid in the nation. While the median wage for all dentists nationally was just over $161,000 in 2011, the highest-paid dentists earn more than $240,000 per year. Given the many years of training and education required and the demands of managing a practice, that isn’t an exorbitant sum, but the introduction of dental therapists – paid considerably less – would allow patients to obtain some services at a significantly lower cost.

Additionally, dental therapists might find it economical to set up shop in rural areas that couldn’t support a dentist. As in Minnesota, one of two states where such a position now exists, dental therapists could practice only under the supervision of a dentist who could view photographs and X-rays and consult by phone or online.

Primary care medicine adopted a tiered model of practitioners to reduce health care costs years ago. It’s time for dental medicine to do the same. To work, a dental therapist model will require the support of dentists willing to supervise therapists. Those who do so will increase their practices’ income. We think a fair number of dentists, despite their society’s position, will sign up. There’s only one way to find out. Lawmakers should pass SB 193.

Legacy Comments2

"What about forcing dentists to take Medicare first?" Statutory dental exclusion: MEDICARE Title 18 of the Social Security Act, is the federal health insurance for persons 65 years and older. It covers over 95% of America's elderly but pays for practically NO dental care. It does not pay for dental examinations, x-rays, dentures, fillings, or cleanings. Medicare will only pay for the setting of fractures of the jaw when performed in a hospital setting. It may also pay for the removal of teeth when completed in a hospital setting--but not their replacement. MEDICAID Title 19 of the Social Security Act, is a federal/state program providing reimbursement for health care services for persons with very low incomes and little or no assets. In order for a state to receive federal matching dollars, it must provide dental services for children. Unfortunately, this requirement does not extend to low-income adults, including the elderly. States can choose to provide dental care to their low-income adults as one of the "optional" services. Although some states choose to do so, most do NOT reimburse for basic oral health services needed by their adult population. I just love the word force. How about forcing people to read a bit more.

What about forcing dentists to take Medicare first? Retirees are on a fixed income, they qualify for Medicare medical benefits, yet they can't receive dental care from a qualified dentist because they don't have dental benefits. Retirees, contrary to popular opinion, don't expect he proverbial "free ride" that some others might - they just want dental care like the rest of us who do have insurance or at the very least an income that will support minimal dental care. Medicare reimbursements are accepted at many vision care facilities and hearing centers - yet not at a dental office? That, to me, is just not right, and dentists need to think about that. And no, I am not a retiree, and not even close to being eretired. I am thinking primarily of my late mother, who wanted to have dental care, yet had to forego it because her dentist would not accept Medicare.

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