AUGUSTA — A proposal to add a less expensive level of dental care in the state, and whether it would have a negative impact on both Maine’s residents and the economy, was discussed at a forum Wednesday.

Proponents of allowing a new level of dental care provider, dental therapists, as a pilot program say it’s a way to provide more access to dental care quickly and efficiently to more Mainers. Dental therapists would work under the supervision of a dentist and perform mid-level care.

Opponents fear testing a new way of providing care on actual patients could put their health at risk, make it harder for dentists to make enough money in their practices to pay off student loan debt and would bring a lesser level of care to poor patients.

A panel of experts, state officials, dentists and legislators chewed on the topic at a forum, “The Economics of the Lack of Dental Care,” hosted by the Maine State Chamber of Commerce at the Augusta Civic Center. Proponents intend to introduce a bill in the Legislature soon.

Frank McGinty, executive vice president and treasurer for MaineHealth and chairman of the board of the Maine State Chamber of Commerce, warned that dental health problems can lead to many other major health issues, in turn causing workers to be less productive, out sick more often or not able to work at all.

“We can’t afford to have people who are unproductive because of poor health,” McGinty told about 40 people at the forum. “It’s an issue we need to be worried about, for sure, from an economic perspective. We need to increase access. We need to do it safely. And we also need to figure out how to accelerate the progress.”

Mike Saxl, a former state legislator and now a consultant with Maine Street Solution, who was representing the PEW Charitable Trusts, said Maine has a shortage of dentists and allowing dental therapists to perform some lower level tasks now performed by dentists could provide more access, faster and cheaper. About 55 percent of children don’t have access to dental care, he said.

However, some dentists don’t agree there is even a shortage of dentists or lack of access to dental care in Maine.

Dr. Robert Berube, a facial and oral surgeon in private practice in Augusta, said the main problem isn’t a lack of access — he said 95 percent of Maine dentists are accepting new patients — it’s getting Mainers to actually go to a dentist to seek the care they need.

“Patients who never seek care never get treated,” Berube said. “We’ve got to increase demand for care, that’s when the numbers (of Mainers receiving dental care) will go up. We have more than enough capacity.”

Dr. James Koelbl, dean of the new College of Dental Medicine under development at the University of New England, said the college, expected to open next year, wants to be part of whatever the solutions are to Maine’s dental health issues.

But he warned against experimenting with people’s health by trying a lower level of care through dental therapists just to save time and money.

“I’d argue poor people deserve the same level of care” as everyone else, Koelble said. “If we’re going to do something, let’s do it right. A single standard of care should exist, no matter who is providing the care.”

Audience member Lisa Kavanaugh, chief executive officer of Community Dental, which operates five dental health centers in Maine, said the panelists and reports on the subject didn’t address one of the most important obstacles to access to dental care by Maine people.

“What’s really missing is, people know it’s important to take care of their dental health, but they don’t have the resources to do it,” she said. “The issue isn’t ‘Build it and they will come.’ They will come if it’s free. And what we do is not free. You’re not addressing the financial piece.”

Koelbl agreed, saying that’s a major challenge without an easy answer. “It’s the elephant on the table,” he said.

Keith Edwards — 621-5647

[email protected]


* A preliminary analysis found that there were fewer dentists per capita in Maine than in most other states. In 2007, there were six dentists per 10,000 people in the United States. In Maine, there were five.

* Maine’s dentists practice mainly in metropolitan areas of the state, with the number of people per dentist varying considerably by county. For example, in 2011, there were 1,361 people per dentist in Cumberland County, and 4,018 people per active dentist in Somerset County.

* In 2006, dental complaints for avoidable oral health conditions was the top reason why MaineCare patients or uninsured patients between the ages of 15 and 44 years old went to an emergency room, generally considered the most expensive way to receive dental care.

* In 2009, 8,091 MaineCare beneficiaries went to an emergency room or other outpatient provider for relief of acute dental pain, at a cost of $6.6 million. Among those treated, 2,256 were younger than age 21 and eligible for dental benefits and could have received covered treatment by an outpatient dental provider. The remaining 5,835 visits were for dental conditions of adults covered by MaineCare who were not eligible for a dental benefit for routine care. The cost of that emergency room care was $4,104,938.

Source: Oral Health in Maine, A Background Report, Center for Health Workforce Studies

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