February 16

Access to dental care in rural Maine center of dental therapists debate

A mostly nonpartisan issue in the Legislature has divided hygienists and dentists who argue about the root of the problem: poor access or poor funding.

By Joe Lawlor jlawlor@pressherald.com
Staff Writer

Tanya Van Rose-Bell used to drive 60 to 90 minutes to reach a dentist, after she moved to the Lakes Region 14 years ago.

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Cathy Kasprak, a dental hygienist who owns a practice in Bridgton, wants to become a dental therapist. Maine is considering a controversial bill to create the mid-level provider position, which combines the services of a hygienist with some of those offered by dentists.

John Ewing/Staff Photographer

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Maine’s dental report card is a mixed bag. Maine often measures in about the middle of many categories nationally. It doesn’t have the dental care problems found in the Deep South, but it also often does not compare favorably with other New England states.

GOING TO THE DENTIST: The percentage of people who have seen a dentist within the past year is 65.3 percent in Maine, the lowest of the New England states, compared to 76.2 percent in Massachusetts, the highest in the nation, according to America’s Health Rankings. However, Maine was near the national average of 67 percent.

KIDS’ HEALTH: But Maine received an “A” grade from the Pew Center on the States for children’s oral health, including its children’s sealant program and because nearly 80 percent of residents drink fluoridated water.

THE PER CAPITA PROBLEM: The number of dentists per capita is low, at 50 per 100,000 people, compared to 61 nationally, according to America’s Health Rankings. However, the dentists are not spread out evenly, and in rural areas the number of dentists per capita is far below the national average.

GETTING REIMBURSED: Medicaid reimbursement rates are lower than the national average, at 44.7 percent of commercial costs compared to 50.3 percent nationally. Compared to New England, reimbursement rates for typical services are often 30 percent of the region’s rates, such as $30 in Maine for a cleaning instead of $90 in New England.

TOOTH LOSS: Maine adults ages 35-44 who had not lost a tooth were 63 percent of the population, compared to the national average of 38 percent, according to a 2013 Department of Health and Human Services report.

With dentists scarce in rural and small-town Maine, she said she would drive to Westbrook or Brunswick for care. And although she didn’t miss an appointment, she knows many people who rarely visit the dentist because of the travel time. They can’t easily take time off from work, or they don’t have a car, she said.

“A lot of people here do not have good teeth,” said Van Rose-Bell, of Bridgton.

How to improve access to dental care in rural Maine is at the root of a dispute between dentists and dental hygienists that’s being played out before the Legislature. The hygienists want to create a new, mid-level dental provider – a dental therapist. The dental therapists would be licensed to perform more dental procedures than a hygienist – such as filling cavities – but not as many as a dentist. Dentists argue that a new type of provider will not help improve dental care in Maine, saying it’s a side issue that does nothing to address the fundamental financial reasons some people are not receiving the care they need.

The House and Senate have both voted in favor of the dental therapists bill, but while the House voted overwhelmingly in favor, the Senate vote was 19-16, and a Senate vote in favor of final passage, which could happen this week, is not certain. Gov. Paul LePage has not indicated whether he would sign or veto the bill, should it reach his desk. The only states that have dental therapists are Minnesota and Alaska, but many other countries, including New Zealand and Canada, have the position.

The issue does not appear to be partisan, as both Democrats and Republicans are split on the issue. For instance, Democratic House Speaker Mark Eves of North Berwick is a sponsor of the bill, but Senate President Justin Alfond, D-Portland, voted against it.

A number of Republicans, including Rep. Carol McElwee of Caribou, support the effort to create licensed dental therapists to help fill in the gaps where there are shortages.

“We are desperate for dentists here in Aroostook County,” said McElwee.

Van Rose-Bell, 45, said although she has subsequently found a Bridgton dentist, she had previously started seeing an independent dental hygienist in Bridgton, Cathy Kasprak, for cleanings so she wouldn’t have to travel as much. She still sees a dentist, but not as frequently now that she’s getting her six-month cleanings from Kasprak.

“It takes the pressure off to have (Kasprak) here,” Van Rose-Bell said. “It’s so convenient.”


At her three-year-old independent dental hygiene practice in Bridgton, Kasprak said she hears a lot of sentences that begin with, “I haven’t been to a dentist in ...”

“They’ll say it’s been five years, 10 years,” said Kasprak, who estimates that more than half of her 1,000 patients fall into that category. “I can’t do everything, but at least they’re walking in the door.”

While Kasprak is not a dentist, a 2009 state law allows her to open a practice to perform cleanings and other basic dental services. Kasprak and others are trying to add the dental therapist position in Maine, a proposal that is drawing fierce opposition from dentists. Kasprak said she would go through the two-year dental therapist program and 1,000 hours of training to become a therapist and be able to perform more procedures at her Bridgton office. No dental therapist could operate without the written approval of and supervision by a Maine dentist, although the therapist could work in a separate building.

(Continued on page 2)

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Dentists are scarce in rural and small-town Maine, forcing people seeking dental care to drive long distances for care. Many choose to simply forgo routine procedures, says Tanya Van Rose-Bell, who lives in Bridgton, above. “A lot of people here do not have good teeth,” she said.

John Ewing/Staff Photographer


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Today's poll: Dental bill

Should the Legislature pass a bill allowing hygienists with advanced training to do some minor procedures now performed by dentists?



View Results