Op-ed: Our Oral Health Crisis

This commentary originally ran in the Times Argus on May 1.

We have an oral health crisis in Vermont. Thousands of Vermonters go without needed dental care every single year — in 2011 and 2012, nearly 100,000 people didn’t get care. And, if you live in Vermont and you get your dental insurance through Medicaid or Dr. Dynasaur, you are even more likely to go without the dental care you need.

In 2013, more than 40 percent of kids and teenagers with Dr. Dynasaur didn’t have any dental visit. And, when the Green Mountain Care Board looked into dental care in Vermont it found that in the majority of Vermont’s towns fewer than half of people eligible for Medicaid had received any oral health care.

There are a lot of reasons why people with Medicaid and Dr. Dynasaur so often can’t get the dental care they need. They may live in a rural community without a dentist, or they may live in a town with a dentist but still have no luck because many Vermont dentists don’t take Medicaid or Dr. Dynasaur insurance because it doesn’t pay them as much. Or, if the dentist does take Medicaid, he or she sees only a few patients that have it and may not be taking new patients.

This is a crisis, and a growing one because more Vermonters are enrolling in Medicaid now that the Affordable Care Act has assured that many more people with low incomes qualify for the program. And Vermont’s dentists — the oldest in the nation — are nearing retirement age. Even the Vermont State Dental Society has declared that the future is a challenge because dentists are able to care for only a limited number of patients with Medicaid insurance and it is difficult to recruit young dentists to our state.

Something must be done, because when people don’t get the dental care they need they suffer in pain, miss work and school, and are at risk for serious, and sometimes life-threatening, infections.

The good news is that this is a problem we can address by adding dental therapists to the dental team in Vermont. Dental therapists are members of the dental team who expand its capacity to provide routine and preventive care to people who often would go with it. They are currently working to great success in 54 countries as well as in Alaska and Minnesota, and Maine just added them last year.

The evidence supporting dental therapists is overwhelming. In Minnesota, a state Department of Health report found that dental practices employing dental therapists are reporting extremely positive experiences. They see more Medicaid patients; they see more patients overall; the dental team communicates better; and dentists have more time to perform complicated procedures while delegating routine care. The report also found that the practices experience a cost-benefit that helps them deal with low Medicaid reimbursement rates.

We also know that dental therapists provide great care. A review of more than 1,100 articles found that dental therapists provide high-quality care. In more than 10 years of practice in Alaska and nearly five in Minnesota there have been no adverse patient events. And, according to an American Dental Association study published in the ADA’s journal, “a variety of studies indicate that appropriately trained midlevel providers are capable of providing high-quality service.”

Dental therapists are an evidence-based and proven way to address Vermont’s dental care crisis and assure that all Vermonters, especially those who get their health insurance from Medicaid and Dr. Dynasaur, get the dental care they need.

It is time dental therapists become part of the dental team in Vermont.