Inside Maine's mouth

By DEIRDRE FULTON  |  May 3, 2012

• MaineCare REIMBURSEMENT RATES FOR DENTAL SERVICES ARE LOW compared with the rest of New England and the rest of the country; as of 2008, with a reimbursement rate of about 25 percent of so-called "usual and customary fees," we rank 38th in the nation. (However, it is also worth nothing that according to the US Bureau of Labor Statistics, Maine dentists are among the highest paid in the country — partially due to the fact that about half of the state's dentists don't take MaineCare patients to begin with and only accept patients with private insurance, which provides much higher reimbursements.)

MAINECARE DOES NOT COVER ROUTINE, PREVENTATIVE DENTAL CAREFOR ADULTS. And, while oral services for children are covered, they were used by only 45 percent of eligible children in 2010. This may be due to the fact that both specialty and general dentists are limiting the number of new MaineCare patients they take on because, as the Center for Health Workforce Studies points out, "practices with large MaineCare caseloads are challenged to meet the costs of providing care" (due to the low reimbursement rates described above).

But it's not all bad!

• The University of New England will OPEN A DENTISTRY SCHOOL NEXT FALL, which organizers and policymakers alike hope will help fill the pipeline with young men and women who want to practice dentistry in Maine. James Koelbl, dean of the college, points out that students will undergo an intensive program on-campus in Portland for three years, and then will spend their fourth year practicing dentistry in rural Maine. "During their time in these externships, the students . . . will deliver much needed care to underserved populations," he says.

• In 2011, Maine got AN "A" RATING FROM THE PEW CENTER ON THE STATES ON CHILDREN'S DENTAL HEALTH, meeting six of eight benchmarks. For example, the state has been very effective at administering sealants to high-risk children. Sealants are plastic teeth coatings that block food and bacteria from collecting on molars and thereby help prevent cavities.

• Maine is also "seeing MEDICAL PROVIDERS TAKE MORE OF A ROLE IN ORAL HEALTH, especially for young children," says Sarah Shed of the Maine Dental Access Coalition, a group of healthcare providers and low-income advocates that works to increase access to dental care. She points out that while the mouth has traditionally been "looked at outside the rest of the body for some reason," several initiatives are aimed at integrating the dental and medical communities. "We're working with dentists to encourage them to see children younger," she says, and "to accept more low-income children" (especially those who are enrolled in the federal Head Start program).



Among the proposals put forth to address Maine's dental-care gap, one stands out as having the most potential (in that it has the most PR momentum behind it): Introduce a midlevel provider position, someone between a full-fledged dentist and a dental hygienist, who could provide routine services such as sealants, fillings, and simple extractions, outside a traditional dental-office setting.

Generally speaking, a dental hygienist provides preventative services (such as cleaning the teeth, applying sealants, and taking X-rays) while a dentist provides restorative care (such as fillings, tooth extractions, and worse). In Maine, which already has an expansive interpretation of the hygienist's role, some hygienists can place temporary fillings and operate their own limited practices.

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