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opinion | Lisa Simon

Meeting Massachusetts’ urgent dental needs


Faces swollen, eyes red from lack of sleep, people in pain greet dentists like me every morning at clinics across the state. Some have been in pain for weeks or months. They have visited hospital emergency rooms and physicians’ offices, desperate for care. They have called dentists all over the state, and sometimes outside it, looking for someone who will accept their Medicaid coverage and can fit them in.

Everywhere I have worked, the demand has been overwhelming. I completed my residency at Cambridge Health Alliance, the safety-net health care system for Cambridge and Somerville, and currently work 12 hours a week at the Nashua Street Jail, providing the only dental care available there. As a faculty member at Harvard School of Dental Medicine, I also supervise and guide dental students working at safety-net clinics throughout the state. Clinics like these care for patients who otherwise would often be unable to obtain treatment. Our patients are either reliant on Medicaid for dental coverage or have no insurance at all. Many face numerous barriers to care, including speaking a language other than English, coping with physical disabilities or chronic illness, or lacking access to transportation.


Dental clinics in Massachusetts are tremendously overburdened. When I was a resident, patients had to wait more than eight weeks for dental care. For several months, the clinic was so overwhelmed that we were forced to turn away all new patients; this is, unfortunately, typical of dental clinics in the state.

The suffering is heaped disproportionately on the poorest and most vulnerable in our community, including children and low-income seniors. I have met patients in such agony that they pulled their own teeth with pliers. Some have lost alarming amounts of weight because they have been unable to eat solid food for months. I have treated children with mouths full of decayed, infected teeth, children who tell me that they do not remember what it feels like to live without pain.

The data paints a bleak picture: Low-income seniors are seven times more likely to have lost all their teeth, while 47 percent of children on Medicaid did not see a dentist in 2014, according to the US Department of Health and Human Services.

The lack of access to dental care also results in high costs for the Commonwealth. MassHealth, the state’s Medicaid program, paid $11.6 million from 2008 to 2011 for emergency room dental care for adults. By the time some patients reach a dental chair, they often require drainage of abscesses, antibiotics to stop the spread of infection, and the extraction of teeth.


So how can this problem be solved? State Senator Harriette Chandler and state Representative William “Smitty” Pignatelli have introduced legislation that would allow dental hygienists, already valued members of the dental team, to receive additional training so they can deliver basic dental services such as putting in fillings and extracting loose teeth. These dental hygiene practitioners could then help address problems before they worsen, allowing dentists to focus on treating the more urgent and complex needs of their patients. Dentists like me, who work with the state’s most vulnerable residents, would then have a valuable new ally in our mission to reduce the suffering we so often see.

Everyone deserves a life free from unnecessary pain. Massachusetts should adopt this law and take an important step toward ensuring a healthier life for everyone in our communities.

Lisa Simon is a dentist and faculty member at the Harvard School of Dental Medicine who is working to improve oral health care for poor and vulnerable populations in New England.