In 2015, the American Dental Association conducted a national household survey on oral health status and found some alarming results among young respondents: One-third of young adults aged 18 to 34 were reluctant to smile due to decaying teeth and gum problems while 28 percent believed the poor appearance of their teeth compromised their ability to interview for a job. They were also the age group with the highest rate of untreated tooth decay.

Clearly our entry-level workforce has some anxiety about the appearance of their mouth and teeth, and with good reason — a large proportion of the jobs available in this service economy require face-to-face interaction with a friendly, assertive demeanor. These jobs include many health-related positions, sales and retail, reception/secretarial, hospitality, and personal services.

Problems with dental disease and missing teeth are compounded by residence in rural areas where access to dental services is also extremely limited. Rural residents are less likely than more urban residents to have dental insurance. Additionally, rural adults are more likely to have lost teeth and to have untreated dental decay. Given that our rural counties have a high proportion of MaineCare recipients Washington County is at 31.5 percent compared to 14 percent in Cumberland Country adult dental coverage therefore becomes a critical benefit for rural people seeking jobs.

It is crucial for keeping jobs, too. A growing body of research has noted that low-income individuals have lost the greatest amount work time because of dental issues, as compared to other income groups.

This issue was central to a piece of legislation proposed last session to create a comprehensive adult dental benefit in the MaineCare program that would cover the full range of preventive and restorative care, including dentures. L.D. 1453 made it successfully through committee and was unanimously passed by both the House and Senate but ultimately ran into problems with the Appropriations Committee, which was concerned about costs. Even an amended bill proposing a working group to think through the elements of such a benefit stalled. The bill was carried over because Gov. Janet Mills did not sign or veto it within 10 days of the end of the session.

Evidently, policymakers are cautious about the potential costs of the benefit. But Maine policymakers are also anxious to see low- and moderate-income Mainers successfully enter the workforce. Dental disease is increasingly recognized as a major challenge to seeking and maintaining a job.


Susan Hyde, a dentist and population scientist at the University of California at San Francisco, co-authored a 2006 study regarding severe dental problems and employability among 400 welfare recipients. Study subjects had very high rates of receding gums, missing teeth and tooth decay. When offered dental treatment, remarkable results emerged among those patients who completed the treatment plan; they were twice as likely to get jobs or move off welfare than those who didn’t finish treatment.

It is time to take a new look at the proposed adult dental benefit in the MaineCare program. It should be viewed alongside other state investments to enable Mainers to be ready to work, such as technical education, certificate programs, early childhood education, and expanded opiate treatment. It should be viewed as a strategy to level the playing field for our rural residents as they navigate the working world; as an important tool to help a segment of the chronically unemployed return to the workforce.

The research is clear that when people have dental insurance they more readily can and will get regular dental care. The adult benefit will also serve as an important financial boost to rural dental providers, who serve a disproportionate share of MaineCare patients in their practices.

Perhaps the amended bill proposing a working group was intended to buy everyone some time in Augusta. It will not take long to recognize the value of decent dental care for low-income, working-age adults. If improving conditions for rural job development is a shared goal, then the Legislature and the governor need to get back to the table on the MaineCare dental benefit.

Lisa Miller, of Somerville, is a former legislator who served on the health and human services and appropriations and financial affairs committees. She is a member of the Maine chapter of the national Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. 

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