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Bring dental care to where it’s most needed

Massachusetts set an example for the nation by expanding health insurance coverage to nearly all of its residents. Now the state has an opportunity to be at the forefront of a movement to bring affordable dental care to more people.

At a hearing scheduled for Tuesday, the state Legislature’s Joint Committee on Public Health will consider a common-sense bill that would establish the position of advanced dental hygiene practitioner, or dental therapist. Under the law, dental hygienists who complete an additional 12 to 18 months of education could provide basic dental services such as tooth extractions, fillings, and temporary crowns in settings such as community centers, nursing homes, and schools. Senator Harriette Chandler, a Worcester Democrat who cosponsored the legislation, said dental therapists would not compete with dentists, but collaborate with them to reach people who won’t — or can’t — visit an office.


“This really expands the reach of oral health care for lots of people in nursing homes and children from low-income families,” Chandler said.

The Massachusetts Dental Society already has made efforts to make dental care more available, as has the state. For instance, certain Medicaid dental benefits for adults that were cut from the budget five years ago, such as coverage for dentures, have been restored. But even though there are two dentists within five miles of 95 percent of its members’ homes, Chandler said more than half don’t accept MassHealth, the state’s Medicaid plan for low-income residents. Besides, proximity isn’t the same as access, and office hours often don’t align with hectic schedules.

According to the Pew Charitable Trusts, which supports the dental therapist bill, 47 percent of children covered by MassHealth — more than 290,000 kids — didn’t see a dentist last year.

“That nearly half of all young people on MassHealth are not getting this care makes it clear that we must do more to improve access to and utilization of oral health services,” said Amy Whitcomb Slemmer, executive director of the Boston-based advocacy group Health Care for All.

Pew also reported that 59 percent of seniors living in Massachusetts nursing homes or other long-term care facilities in 2009 suffered from tooth decay.

It’s not just the old and poor who lack proper dental care. Leon Assael, dean of the University of Minnesota School of Dentistry, said only 35 percent of all adults in the United States visited a dentist last year. “Tooth decay is the greatest untreated disease we have,” said Assael, who noted that dental problems can lead to serious medical conditions throughout the body.


In addition to bettering health, dental therapists could save money. Assael — who said he speaks on behalf of Pew but is not paid to do so — estimates “two to three” dental therapists could be hired for the price of one dentist.

The Massachusetts Dental Society says therapists are not necessary and that it’s working to sign up dentists to MassHealth. The group wants to get more people to have checkups and then adopt long-term schedules that emphasize preventive care. In a letter to Chandler, it called for “education about the availability of benefits, language, and transportation options, and an increase in understanding of the value of oral health.”

No one would argue against better-informed patients, but why not make it easier for them to act on that information? Massachusetts should join Alaska, Maine, and Minnesota in allowing an expanded role for dental hygienists.