Friday, April 25, 2014
AUGUSTA — The Maine Senate voted Thursday in support of a bill that would allow dental hygienists with additional training to take on some of the duties that are now done by licensed dentists.
L.D. 1230, sponsored by House Speaker Mark Eves, D-North Berwick, would create a “mid-level dental therapist” position in Maine. Proponents of the bill say it’s an attempt to increase access to dental care, especially in rural areas.
Groups representing dentists have fiercely opposed the measure, saying the state’s current shortage of dentists will be alleviated as dentists begin graduating from the University of New England’s new dental school in three or four years.
The Senate voted 19-16 to approve the measure. More votes are required before the bill goes to Gov. Paul LePage.
Mid-level dental therapists would be licensed to do more dental work than hygienists are permitted to do, but would not be as highly trained as dentists. For instance, a dental therapist would be allowed to fill cavities, but not perform root canals.
The new position’s status in relation to a dentist would be similar to the one between a nurse-practitioner and a doctor.
Supporters said the bill would allow hygienists to receive additional training to do as many as 53 procedures. Licensed dentists, with eight years of training, can do more than 500 procedures.
Dental therapists would receive a minimum of four years of training and as many as six years. They also would need 1,000 hours of clinical training with a licensed dentist before becoming certified. Supporters of the bill said dental therapists would operate under the supervision of a licensed dentist.
Sen. John Patrick, D-Rumford, said the bill would increase dental care for the poor and Mainers in rural areas. He noted that only 12 percent of the state’s dentists now accept patients enrolled in MaineCare, the state’s Medicaid program.
With about 600 practicing dentists, Maine has the fewest dentists per capita in New England, and 40 percent of Maine’s dentists are approaching retirement, according to a coalition of the bill’s supporters, which include the Pew Research Center and the American Dental Hygienists Association.
The Maine Dental Association is lobbying against the bill, arguing that there is no shortage of dentists and that the new dental school at UNE will help offset any future shortfalls.
Dr. Jonathan Shenkin, a pediatric dentist in Augusta, said walk-in dental clinics around the state accept MaineCare recipients, but they aren’t being used. He said there’s nothing to indicate that patients would turn to hygienists in higher numbers if they were allowed to do more complicated procedures.
“If we have clinics right now that are complaining that they don’t have patients coming in the doors, having more providers doesn’t solve that problem,” Shenkin said. “Creating more systems isn’t going to solve the fact that people aren’t calling.”
Shenkin also noted that students at UNE’s dental school are supposed to staff clinics around the state, including some in rural areas, when they are in their third and fourth years of school. He said legislators should allow that system, which will begin in two or three years, to work before setting up a different system for handling some procedures.
Shenkin said costs for procedures done by dental therapists wouldn’t necessarily be lower because hygienists and dentists have similarly high overhead for equipment, and many hygienists graduate from school with high levels of debt, as do dentists.
But Bernadette Kozak, an independent hygienist practitioner in Fryeburg, said many communities are significantly underserved in dental care.
In her town, she said, her practice and a dentist’s practice are the only two places that people can go for dental care for miles around. Without allowing hygienists to do more, she said, “it’s leaving a gap for people.”
She said she has been able to build her practice to about 1,300 patients over a three years since opening in 2010. She said the dentist in Fryeburg doesn’t accept MaineCare and refers those patients to her, and that has grown to be about $30,000 in annual billings.
Kozak said she believes that hygienists are more willing to adjust their hours to accommodate patients, and she thinks that would continue if they were allowed to do more procedures.
Sen. David Burns, R-Whiting, who represents one of the more rural districts in the state, said the bill would greatly benefit his constituents.
Sen. Roger Katz, R-Augusta, said he initially was ambivalent about the proposal, but not any longer. He said the bill wouldn’t force dentists to hire dental therapists, but it could increase profits while expanding coverage if they did.
He said that if two-thirds of the children in the state don’t have a dentist, then the current marketplace is broken.
“The status quo isn’t working,” he said. “This is the right thing for our state.”
Steve Mistler can be contacted at 791-6345 or at:
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