Eric McMaster remembers once sticking a paper clip into a cavity as a kid because it was the only thing that made his tooth feel better.

McMaster, a dental hygienist with his own practice in Gardiner, said he sees people in similar situations — suffering with tooth decay because they can’t afford to go to a dentist.

Additional Photos

Eric McMaster, an independent-practice dental hygienist, recently opened Healthy Smiles on Water Street in downtown Gardiner. Staff photo by Joe Phelan

He supports a bill probably going before the Legislature this week that would allow him to provide more services that dentists do, such as filling cavities and pulling teeth.

The bill, which has divided the dental industry in Maine, would create a new category of hygienists called dental hygiene therapists who, after graduating from a dental therapy program, could do some procedures similar to a dentist .

House Speaker Mark Eves, D-North Berwick, said he’s sponsoring L.D. 1230, to provide greater access to dental care to children in rural parts of the state.

Eves said he expects the bill will be brought up in the House of Representatives this week, with the goal of passage before the session ends on Wednesday.

Dentists have been strong opponents of the bill, saying it will give too much responsibility to a second tier of dental professional with less training than dentists.

Others have said it fails to address problems leading to poor oral health — limited funding from MaineCare for dental services and a lack of dental education.

Dental hygienists, for the most part, have supported the bill.

McMaster said creating the mid-level practitioner degree would allow him and other independent dental hygienists to provide services to people who otherwise wouldn’t be able to afford them.

“It would definitely save them a whole lot of problems and probably save them a whole lot of teeth,” McMaster said.

He opened his downtown Gardiner business, Healthy Smiles LLC, at the end of January, and provides preventive dental care such as cleanings and sealants for significantly lower fees than dentists do.

McMaster said providing services such as fillings and extractions at lower costs than dentists hopefully would change the mind-set of some people who go to a dentist only if a tooth hurts.

He refers patients to low-cost clinics for additional work such as fillings, but some people can’t make the appointment because of transportation problems and not being able to take time off from work, he said.

“There are a lot of barriers to the people that just don’t get any help,” McMaster said.

He said most of his patients are children on MaineCare, which doesn’t cover preventive dental care for adults. Not all dentists accept children on MaineCare either, he said.

Independent-practice dental hygienists such as McMaster can do cleanings, fluoride treatments, sealants, temporary medicated fillings and inspections of teeth.

There are about 58 independent-practice dental hygienists in Maine, but fewer than 20 practice on their own, according to Doug Dunbar, spokesman for the state Department of Professional and Financial Regulation.

Some dental professionals oppose the dental therapists bill because they think the expansion of preventive care and education for children would be more effective at improving the state’s oral health.

Dental hygienist Susanne LaVallee has been operating a nonprofit program that provides preventive care for children in 36 schools in the area.

The Winthrop-based organization, Maine Dental Health Out-Reach Inc., travels from Jay to Richmond to do screenings and cleanings and apply sealants and temporary fillings.

She is a dental hygienist with public health supervision status, meaning she can serve in nontraditional practice settings such as schools, community centers or nursing homes.

“I’d rather see us going down a different road,” she said of the bill. “Anything’s going to help, but my focus is prevention.”

LaVallee said she probably would have supported a dental therapist license when she started her program 11 years ago, but the results of her preventive work in students’ mouths have changed her mind.

Children who have been seen by LaVallee and her program have less than 30 percent of the tooth decay found in those being seen for the first time, she said.

“It’s mind-boggling, what this program does,” LaVallee said. “This is the answer. Prevent the disease. Don’t treat it.”

She thinks the state should use its resources to fund more preventive care for children, like her program, instead of creating another dental position. She said her organization isn’t reimbursed for about 35 percent of the services it provides.

MaineCare reimburses the nonprofit for children’s cleanings but not screenings, temporary filling placements or resealants on permanent tooth if the sealant is less than three years, LaVallee said.

Dr. Jonathan Shenkin, a pediatric dentist in Augusta, agrees with LaVallee that more prevention and education are the key.

“The most effective way of reducing tooth decay is reducing it in childhood,” Shenkin said. “And you don’t do that with a drill. You do that with prevention.”

He said oral health needs to be addressed more like obesity, which health care professionals try to fight using preventive means in childhood, not treatment.

Shenkin also doubts that dental therapists would be able to provide cheaper services than dentists or that they would set up shop in the underserved and rural areas, contrary to what the bill’s supporters say.

Eves said he doesn’t know yet how the state could motivate dental therapists to serve in rural areas.

“The committee talked a lot about that, and I think this a bill that’s going to serve the entire state,” he said.

Eves cited the fact that 15 of state’s 16 counties have federally designated dentist shortage areas as evidence that there’s a need across the state.

McMaster said he think dental therapists would practice in underserved areas because that’s the reason for going for the license in the first place.

“If you want to be in the same echelon, go to dentist school and charge their fees,” he said.

“Did I sign on for this job because I only wanted to get paid, or did I sign up for this because I wanted to help people?” McMaster added. “You’ve got to ask yourself that.”

Paul Koenig — 621-5663
pkoenig@mainetoday.com

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