April 25, 2013

Maine Voices: Ask the dentists how to improve access to dental care

The state should change MaineCare treatment rules and the reimbursement rates, among other steps.

By MICHELLE MAZUR-KARY, DEMITROULA KOUZOUNAS and ROB BERUBE

MANCHESTER - Most Maine dentists would agree with the first sentence of your April 16 editorial ("Our View: Measure would fill gaps in access to dental care") that "too many low-income Mainers go without adequate dental care."

As health care professionals, we want all Maine children and adults to receive quality dental care. That is why we continue to work on programs and policies that address the issue.

Unfortunately, after the first sentence, you obscure the true barriers to increasing access for people not able to afford dental care. Most notably, you fail to mention the severely limited scope of MaineCare adult dental benefits -- only acute care, pain management and tooth extractions are covered.

Instead of talking to dentists like us, who take care of kids' teeth every day, you chose to simply repeat distorted information. Since you did not take the time to talk to Maine dentists about the access issue, please allow us the opportunity to clarify the information you presented.

All children with MaineCare have their dental checkups, fillings, extractions and other services covered under the program. Where can they get these services?

There are 15 Federally Qualified Health Center dental clinics and 11 nonprofit clinics along with many volunteer clinics established as safety nets and located across the state. All are accepting MaineCare and new patients. All but one of the state's 15 pediatric dentists accept MaineCare, and all have openings. In addition, there is a federally funded residency program in pediatric dentistry in Bangor; its first class of specialists will graduate in June.

Ninety-five percent of Maine dentists have openings and, despite low reimbursement rates, nearly 50 percent provide services to MaineCare patients, ranking us in the top 20 states for dentists' participation. Private-practice dentists continue to provide the majority of dental services to Maine citizens.

We need to get more children to these clinics and practices. Many dentists work with schools and programs, such as Head Start, to educate children and provide care in and out of the classroom. We also are working to establish a dental module so Community Care Teams will direct children to appropriate care.

These efforts have paid off.

The Pew Center on the States awarded Maine "A" grades in its 2011 and 2012 reports analyzing children's dental health programs in all 50 states. Maine is one of two states to receive the highest grades from Pew two years in a row.

Recent data submitted to the U.S. Centers for Disease Control by Maine show our level of untreated tooth decay is the second lowest in the nation among third-graders.

This is the benchmark that helps us determine how to best improve access to dental services. And it indicates that we do not need more surgical treatment for children, we need better prevention, which can be done with existing dental provider types.

MaineCare coverage is drastically different for adults than children. Comprehensive dental benefits for adults are not covered under the program. That is the reason so many people with dental pain are forced to go to hospitals for relief. Because they cannot afford to pay, they often do not have a regular dental provider. Adding a new provider type will not change this.

Millions of dollars can be saved by moving people away from emergency rooms and into dental clinics and private dental offices. Maine dentists are working to expand just such an initiative.

But the crux of the problem remains: The state must first change the MaineCare program in order to cover dental treatment for adults. Reimbursement rates need to be included in any serious discussion about access to care. Our access rates for children are often compared to Massachusetts' or Connecticut's, but these states pay almost double the amount MaineCare pays for many of the more common dental procedures.

Let's not forget that in May 2017, the University of New England's College of Dental Medicine will graduate its first

class of 60-plus dentists educated in Maine. Maine residents will enter the college this fall. Maine voters supported a $5 million dental care bond, with the promise that the dental school would expand access to low-income populations and replace retiring dentists.

Yet, rather than focusing on solutions such as increased utilization and prevention, the new dental school, emergency room diversion and reimbursement rates, we are talking about adding another provider type to a list already larger than any other state's.

If you want a better understanding of the access issue, talk to the people who seek to expand access every day -- talk to Maine dentists.

Dr. Michelle Mazur-Kary of Auburn is president of the Maine Dental Association, Dr. Demitroula Kouzounas of Scarborough and Skowhegan is president-elect, and Dr. Rob Berube of Augusta is vice president. They wrote this on behalf of 55 Maine dentists.

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