When Maine legislators voted in 2014 to create a new type of dental care provider – the midlevel dental therapist – it was supposed to be a step toward solving the state’s dental health crisis. But because the measure wound up being watered down, too many Mainers are still having to get their dental care in the emergency room rather than the dentist’s office.

Nearly one in four Mainers lives in an area designated as having a dentist shortage, and the crisis is worst in the poorest and most rural parts of the state. To address this longstanding problem, the original 2014 proposal would have set up the kind of program that has worked in other states with dispersed rural populations, like Alaska, where dental therapists get two years of training to provide both preventive and basic care (like cleanings, fillings and tooth extractions) in areas where few or no dentists have set up practice.

But unlike Alaska – where dental therapists can work remotely, on islands and in far-flung tribal villages, as long as a dentist signs off on their work – dental therapists in Maine can work only in the presence of a dentist. Even though multiple evaluations have shown that the Alaska model provides high-quality, effective care to people who’d had little to no access to it before, Maine dental therapists can’t even travel to schools or nursing homes alone.

Three years after the dental therapy bill became law, not one dental therapist has yet been trained in Maine – because the restrictions added to mollify the bill’s critics have made it less desirable to become a therapist, the bill’s supporters told The Washington Post in a June 1 article.

The eye-opening article – headlined “The unexpected political power of dentists” – outlines the full-court press put on to scuttle midlevel practitioner programs. The Maine Dental Association opposed even the compromise dental therapy measure; the American Dental Association, its parent organization, has spent millions of dollars trying to block such bills and filed multiple lawsuits in a fruitless effort to halt the Alaska program, the Post reported.

State Rep. Richard Malaby, R-Hancock, told the paper: “Dentists do everything they can to protect their interests – and they have money.” He found that out the hard way. After Malaby backed the dental therapist bill, local dentists, who’d held four Christmas parties in his country inn over the years, looked for another venue – costing him a $6,000-a-year customer.

Since 2014, efforts to make it easier for dental therapists to get accredited and to practice have faltered in the Legislature, though they had the backing of groups as diverse as the Christian Civic League and Maine Equal Justice Partners. Thousands of Mainers go without dental care every year until toothaches, abscesses and sepsis force them to resort to the ER – because too many of the officials who represent them in Augusta can’t live with the discomfort of pushing back against the interests who oppose even modest steps to expand access to these critically needed services.