Need for More Dentists Extends Statewide

As a children's heart specialist, I found that a stethoscope was the most valuable tool when I examined a child.  But you might be surprised to learn the next most important tool was the tongue depressor I used to inspect my young patients' teeth and gums.

The health of our teeth and gums goes far beyond just having a pretty smile. Heart doctors know that life-saving heart operations can be totally unraveled by problems arising from poor oral health.

Yet, medical leaders and policymakers have ignored the fact that the health of the mouth can significantly affect overall health for us all – not just patients with heart problems.

Here in Maine, thousands of people aren't getting the dental and oral health care they need – primarily because there aren't enough dentists to go around. In some areas of the state, children in the state MaineCare (Medicaid) program have to wait more than a year to get needed dental services.

Timely and affordable dental care is our state's No. 1 unmet health need. And getting appropriate dental care is not just about teeth cleaning and filling cavities. Unmet dental issues can result in severe pain and disability. Imagine waking up every morning in constant pain because more than 20 of your teeth need to be pulled.

Dr. William Alto, a physician at Maine Dartmouth Family Residency in Fairfield, took care of a patient with exactly this problem. ER personnel mistakenly thought her frequent visits were a way to get pain killers. But the real reason she returned was that there was nowhere to go to get the dental care she needed.

Finally, Dr. Alto, who trained as a resident to do tooth extractions, pulled 22 teeth from the woman's mouth, and then referred her to an oral surgeon for additional, more complicated extractions. According to Dr. Alto, she was "very happy."

Because he has seen this situation over and over, Dr. Alto established a residency program at Maine Dartmouth to train young doctors in providing basic dental care, such as exams and extractions.

But there are still many people in serious need. Poor oral health forces people like Dr. Alto's patient to live in unremitting and unnecessary pain. It causes adults to miss work, and it keeps children home from school. Lack of proper dental care can lead to malnutrition, lower performance in school, and serious infections.

One reason is a shortage of dentists, especially acute in rural, remote areas. Our state's ratio of dentists to residents is 1 to 2,552, significantly worse than the nationwide ratio of 1 to 1,700. Despite statewide and local efforts to attract more dentists to Maine, we're competing with nearly every other state for dental school graduates. Clearly, more needs to be done.

In 2007, Gov. Baldacci appointed a task force to address ways to expand access to oral health care. The task force proposed recommendations ranging from increasing payment rates for dental care to helping dentistry students repay their education loans, and to establishing a dental school in Maine (currently there is none).

In addition, policymakers in Maine and many other states are examining ways dentists, hygienists, denturists and other trained dental professionals can work collaboratively to improve efficiency, expand access and ensure people needing care can get the high quality services they desperately need.

At the national level, the possibility of health reform provides a golden opportunity for our national leaders to address this need. Better coverage is a key part of the answer, but we must also keep working on building the dental workforce. Otherwise, we will be unable to meet national needs for dental care if health reform advances.

Maine is lucky to have representatives in Congress who understand the importance of this problem. As Congress gets back to business debating how to overhaul the nation's health care system, let's hope our leaders remember to put some teeth into reform.