Dental Therapists Provide the Oral Health Benefits Massachusetts Deserves
Oral health matters. Adequate oral health reduces emergency department utilization and enhances health equity. Knowing these benefits, Governor Baker included an amendment in the proposals he sent to the legislature in connection with his budget vetoes that authorizes dental therapists in Massachusetts, a proposal we strongly support. By allowing mid-level dental therapists (DTs) to deliver basic but critically necessary care, this amendment would increase access to dental coverage for underserved Massachusetts residents. At Tuesday's hearing on the health provisions of the budget veto amendents, we urged the legislature to support the Baker administration and approve this much-needed reform:
Oral health is integral to overall health, and poor oral health is a risk factor for diabetes, heart disease, stroke and low-birthweight children. Yet, one in ten Massachusetts residents lives in a dental shortage area. As a result, about half of our children do not get annual dental care, and some 60% of our seniors in long-term care have untreated tooth decay. Qualified, trained, professional dental therapists can fill this gap by providing basic oral care in vital locations such as in schools, in senior centers, and in community health settings, all under a dentists’ supervision. Dental therapists would increase access to oral health care, improve overall health and save money.
Although almost everyone in Massachusetts has medical coverage, many struggle to access dental care. Common obstacles include the inability to find a dentist that accepts public insurance, the prohibitive cost of dental care, or challenges in traveling to a dentist’s office. Dental Therapists can help with all of these issue. Access to good dental health is major problem for low-income people in Massachusetts. Dr. Don Berwick outlined oral health disparities in the Boston Globe:
Kids on Medicaid visited emergency departments for preventable oral health problems six times more often than commercially insured children; for MassHealth adults, the figure is seven times. Over half of the residents in Massachusetts nursing homes have untreated dental decay. In 2014, low-income seniors in Massachusetts were seven times as likely to have lost all their teeth as those with means. Nearly a third of adults with special needs are missing six or more teeth.”
EOHHS Secretary Sudders also testified in favor of the proposal, pointing out that in addition to improving care, dental therapists would provide savings to the state by reducing inappropriate use of emergency rooms for preventable oral health issues:
The Health Policy Commission (HPC) has been examining some of these cost drivers including avoidable emergency department visits. The most recent data published by HPC indicates that 40% of all ED visits could be avoided if there was greater access to care. In 2014, there were more than 36,000 visits for preventable oral health issues, costing the state upwards of $36 million. MassHealth was the primary payer of these oral health emergency department visits that year, paying upwards of $17 million. Emergency department visits for oral health complaints represents suboptimal use of a very costly setting.
DTs would work under the general supervision of a dentist, using technology to share X-rays and patient records with the dentist and consult on complicated cases. This would allow DTs to deliver critical dental services directly to people in schools, nursing homes, and other community settings.
Moreover, DTs offer low-cost interventions that could prevent more costly illnesses. They would be reimbursed by MassHealth, which would expand access to dental care for people who have some coverage but are still unable to receive appropriate oral health care.
We urge the state legislature to follow Governor Baker’s lead and prioritize the oral and overall health of Massachusetts residents by adopting the DT amendment included in the Governor’s recommended budget amendments.
-- Ben Agatston