I work for a foundation that has been part of a group of funders addressing oral health issues for more than 15 years. We’ve been at it that long — remarkable for philanthropies, which have a notably short attention span — because the problem of dental disease is stubborn and persistent, especially in rural states like Maine.

The reasons for poor oral health in rural areas are many. A recent report by the Pew Charitable Trusts notes that rural children are less likely to have dental insurance, and even though many children in rural areas qualify for Medicaid, it does not ensure that children actually receive the covered dental services. Barriers in rural areas also include transportation, lack of dentists (especially those taking Medicaid), and cost.

One of the top reasons for visiting the emergency room in Maine is, yes, dental pain. In fact, it was the top reason among both MaineCare and uninsured young adults, according to a 2010 report from the Muskie School of Public Service. National studies also confirm that rural children are more likely to receive care for dental problems in ERs than urban children.

A major contributor to poor oral health practices is cultural perception — oral health is not thought of as part of overall health. Dental appointments are considered discretionary expenses, particularly by low- or moderate-income people. Nearly everyone understands the importance of well-child visits at the doctor’s office, particularly because vaccinations are needed. But periodic preventive visits to the dentist are not as ingrained, proving worse in adulthood. Even my three adult children — professionals all — do not remember to schedule annual dental exams into their busy lives.

Payment is a key point of divergence between medical and dental care. Dental insurance is not nearly as prevalent as health insurance — around 40 percent of Americans lacked dental insurance at the end of 2012, according to the National Association of Dental Plans. That’s compared to about 13 percent without health insurance.

And while nearly everyone, with some difficulty, can get some medical care in hospitals, no such universal safety net exists for dental care, save for the charitable impulses of individual dentists.

The frustrating part of the challenge with dental care is this: tooth decay is so preventable. It is one of the chronic diseases most responsive to preventive efforts. Dentists were some of our original prevention pioneers. They began advocating for fluoridation in the late 1950s after a large study in Grand Rapids, Michigan, showed a 60 percent drop in tooth decay in children after several years of city water fluoridation. Dentists initiated one of the century’s great achievements in public health.

Given the problems rural Maine families face with dental care and given the potential for prevention to improve their lives, the Maine Oral Health Funders decided to develop a community-based effort to decrease cavities in children. The funders were motivated in part by dismay with 10 or more years of decline in state funding for children’s oral health programs, coupled with the current administration’s decision to essentially eliminate the Maine Oral Health Program office.

The funders encouraged their six community grantees to adopt the most evidence-based interventions to improve kids’ oral health. These included school-based programs to apply sealants and fluoride varnish to students’ teeth, identification of the most at-risk kids and families for care, encouraging pediatricians to do oral health assessments and apply fluoride varnishes in their own office, parent education and coaching on the proper care for their child’s mouth (including at day care, Head Start, and WIC sites), and referral to a dental home.

Private contributions by these seven foundations will total at least $1.2 million over the five years of the initiative.

Three years into this work, we are experiencing the realities of the external environment — state cutbacks of funding for community health coalitions and school health coordinators, further declines in school sealant program funding, while federal funds are being left on the table. These cuts caused sudden changes in grantee staff and delays in programming.

Still, important learning is emerging from this community-based initiative. Some of the most successful work so far is the increased use of sealants in some of the communities’ schools. Connections with medical doctors to apply fluoride varnishes during well-child visits is also increasing. Use of a community health outreach worker in one funded program is proving effective in reaching and educating young parents.

One of the most important takeaways, however, is that even private funding to communities needs to build on a modest backbone of staff and services, funded in part by the state. That is the platform that Healthy Maine Partnership coalitions provided through use of tobacco settlement funds. That system has been defunded by the state and it is now immeasurably harder for communities to attract foundation, corporate, and federal funds to serve the health needs of their citizens.

Lisa Miller, of Somerville, is a former legislator who served on the Health and Human Services and Appropriations and Financial Affairs committees.

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