Saturday, April 19, 2014
By Jonathan Shenkin, DDS
AUGUSTA — While most people in Maine have access to high-quality dental care, a substantial minority do not. Adults and children are going without regular preventive and restorative care (procedures like fillings and extractions). And as a consequence, too many are suffering with painful untreated disease.
Jonathan Shenkin, DDS, is a pediatric dentist who practices in Augusta.
The good news is that the Maine Legislature, the dental profession and others are taking on the complex set of problems that created this dental health crisis with a comprehensive set of solutions – solutions that have been proven on the ground in Maine and elsewhere to be actionable and effective.
The bad news is that these efforts are being slowed by a legislative battle funded by an outside interest group that is relentlessly pursuing a one-size-fits-all solution – dental therapists.
Last spring, the Pew Children’s Dental Campaign released a report, “Dental Therapists in New Zealand: What the Evidence Shows,” with the intent of showing that that country’s use of dental therapists had resulted in a much lower rate of untreated dental decay among children than the equivalent measure of U.S. children. I published an op-ed that uncovered some serious errors invalidating the argument Pew disseminated to policymakers and the public.
Pew has long used New Zealand as the model to which to compare the United States. However, this data essentially disproved that expanded surgical care provides any public health benefit.
In fact, the rates of decay among the groups of U.S. and New Zealand children examined in Pew’s report are identical. When the American Dental Association pointed out this egregious error, Pew hastily revised its report, pinning the blame on the U.S. Centers for Disease Control and Prevention.
Indeed, the review and analysis of another Pew report, titled “A Costly Dental Destination,” demonstrates a serious and disturbing pattern by Pew of misinterpreting data.
Pew begins its report with an analysis of data from the federal Agency for Healthcare Research and Quality. Pew analyzed the data on utilization of emergency rooms for dental issues, and reported that between 2006 and 2009 there was a dramatic rise in the use of emergency rooms for dental problems. This finding is one that has been reported by other organizations, including the American Dental Association.
However, Pew cites this finding for the conclusion that ER usage is a growing problem plaguing children, a problem for which Pew’s solution is the dental therapist. But Pew’s conclusion is clearly flawed.
The data that Pew analyzed shows that children under the age of 17 constitute just under 6 percent of people going to ERs for dental pain and that the trend of ER use among that age group has actually been decreasing since 2006. This is not surprising because in the last decade there’s been a dramatic rise in the number of Medicaid-eligible children who have received access to dental care.
By not reporting to policymakers the decline in children seeking dental services in ERs, and that children actually make up a very small component of the growing number of people utilizing ERs for dental pain, Pew is again mischaracterizing an issue, selectively offering only data that seem to back its apparent single-solution policy agenda – dental therapists.
Meanwhile, the state’s dentists are linking arms with public health officials, educators, hospitals, other health professionals, Head Start programs and other stakeholders to take action now, deploying an array of solutions that actually fit the problems.
Do we need help from the Legislature? Absolutely. Should that help be in the form of training non-dentists to drill, fill and extract teeth? Absolutely not.
Actions in our state by the Pew Children’s Dental Campaign – misinterpreting and even, apparently, misrepresenting facts – are baffling and totally out of keeping with the larger foundation’s reputation for using the best possible data to inform its policy agenda. Its apparent sole policy objective, creating dental therapists, is a solution in search of a problem.
Let’s work together to make good dental health available to all Mainers. But let’s base our policies on facts – not the reverse.
— Special to the Press Herald