Dentists, who seem like perfectly nice people when you meet them at after-school events or at the grocery store, are carving out a bizarre public persona that is a mixture of Simon Legree, Snidely Whiplash, and Dr. Evil.
The women and men who fix your teeth now make more money per capita than doctors. To preserve their high incomes, dentists have historically refused to participate in Medicare because of low reimbursements, and ditto for Medicaid. Now dentists are resolutely — some would say fanatically — opposing efforts to let dental hygienists and dental therapists deliver prophylactic care to children, the elderly, and to poor and underserved regions in America.
The shocking outcome of dentists’ apparent indifference to the less fortunate came in 2007, when 12-year old Deamonte Driver died of an oral infection in Maryland’s affluent Prince George’s County. How unpleasant for the nation’s lawmakers to read the next day’s Washington Post headline: “For Want of a Dentist: Prince George’s Boy Dies After Bacteria from Tooth Spread to Brain.”
Staff writer Mary Otto wrote that story, and later left the paper to research her just-published book “Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America.” It’s an ungainly title, and it’s a subject that probably feels as foreign to you as it does to me. I bet that most Globe readers brush regularly and make sure their children show up for dental appointments, terrifying though they may be.
Otto’s book is about the other one-third of the country: the uninsured elderly (Medicare doesn’t cover dental check-ups), the tens of millions of children underserved by Medicaid (two-thirds of dentists don’t accept Medicaid patients), and the residents of the 400-plus rural counties that have no dentist at all.
Some dentists and public health types have a solution for these problems: They want to license lower-paid hygienists and dental therapists, so-called “mid-level” practitioners, to deliver baseline care to the needy. Dental associations have been fighting against them tooth and claw, forever.
Earlier this summer, The Washington Post compared the American Dental Association to the National Rifle Association in its relentless, single-issue attack on state legislators who support mid-level care. The ADA worked hard (and unsuccessfully) to scuttle a plan to let dental therapists treat Alaska Native tribes. “They went after these Alaskan therapists like they were ISIS,” dentist Jack Dillenberg told the Post. “It was embarrassing.”
A similar scenario is playing out in Massachusetts. The Massachusetts Dental Society is opposing Senator Harriette Chandler’s Senate bill 1169, which seeks to allow dental therapists to treat patients under the “general supervision” of a dentist, after 500 hours of training. The MDS is promoting a more restrictive bill that imposes limits on where therapists can practice, and on how they can be reimbursed.
“The battle going on in Massachusetts mirrors the battle going on in other states across the country,” says Otto, who will be speaking at the Harvard Dental School on Sept. 12, the same day that Chandler’s bill is scheduled for a joint hearing on Beacon Hill.
Last month the Boston City Council urged the Legislature to pass the Chandler bill. “More than 530,000 people in Massachusetts live in areas with a shortage of dentists,” Jamaica Plain councilor Matt O’Malley said in an accompanying statement. “Boston residents deserve better, and these mid-level providers can help bring cost-effective dental care to children, seniors, and people with disabilities currently going without it.”
Alex Beam’s column appears regularly in the Globe. Follow him on Twitter @imalexbeamyrnot.