Inside Maine's mouth

By DEIRDRE FULTON  |  May 3, 2012

The midlevel concept aims to expand the pool of providers, not just by training more dentists and hygienists, as Maine schools are already doing (or will be doing soon), but by creating a whole new type of health-care worker.

Such positions already exist in Alaska and Minnesota as well as in other countries; similar legislation is on the books in five other states including Vermont, New Hampshire, and Connecticut. Sometimes called "dental therapists," these providers undergo specific training programs (in Alaska, it's a two-year program post-high school; in Minnesota, a four-year bachelor's degree) that take less time than a minimum of four years at dental school.

Now that their initial overview is complete, the Center for Health Workforce Studies intends to look more closely at the scopes of oral health care professionals in Maine, to evaluate whether such a midlevel position would make sense here.

"We expect the evidence to show that this is a strategy that's needed in Maine," says Mike Saxl, the former Speaker of the Maine House who heads up Maine Street Solutions, the public affairs and consulting service of the Verrill Dana law firm. Saxl believes that while Maine is "in an awful position right now" with regard to its oral health realities, "we're about to go over a cliff." He notes that mass retirement may soon drop provider levels steeply: 40 percent of Maine's dentists are over the age of 55.

"Dental therapists provide great quality of care, consistently and at a lower cost," he says.

But not everyone believes that midlevel providers are the answer. The Maine Dental Association, for example, is skeptical.

"Workforce isn't as big an issue as others think it is," says John Bastey, director of government relations for the MDA. "Dental practices all around the state have openings [for patients]." He suggests that oral literacy — getting people to understand the importance of regular dental care — is a bigger obstacle than a lack of hands on deck. And, he adds, in some areas where "there are not enough people to support a practice, there wouldn't be enough people to support a midlevel either."

Bastey and others point out that Maine has already done a good job of expanding how dental health professionals can do their jobs. For instance, certain dental hygienists can leave the confines of a standard dentist's office and provide their cleaning, X-ray, and other basic services in independent practices under the remote supervision of a dentist.

"I have lived and worked in several states, and I've found that Maine has a wider variety of oral health care providers than almost anywhere else," says UNE's Koelbl. "Some of these are new types of providers; others are the expansion of scope of practice of existing providers . . . Most of these changes were made in hopes that they would help to improve access to care for underserved populations. However, at this time, the impact of these changes is unclear at best. To introduce yet another new type of provider before we know whether the other changes have worked is probably not the best use of our limited resources."

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