A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Senate Bill Moves Massachusetts Toward Oral Health Equity

Senate Bill Moves Massachusetts Toward Oral Health Equity

November 14, 2017

Despite being completely preventable, dental disease is a major cause of illness in the US. Millions suffer from painful untreated dental issues due to an inability to access dental care, which impacts their ability to eat, talk, gain or retain employment and maintain good overall health. Low income children and families, older adults, people with disabilities and communities of color face the greatest barriers to accessing care.

Dental access is a severe problem in Massachusetts. A 2016 Massachusetts Health Policy Commission study highlighted the severe access problem for low-income people. It found that only 56% of low-income adults saw a dentist in the past year, compared to 82% of high-income adults.

The lack of access to dental care is also evidenced by the large number of ER visits for preventable dental issues. In Massachusetts, for example, ER use by children covered by Medicaid for preventable oral health conditions was 3.4 times that for kids with commercial coverage. For non-elderly adults, the rate of ER visits by Medicaid members was a stunning 16.6 times that of those with commercial coverage.

These disparities affect many – adults of color, people with disabilities and older adult communities face significant social, structural, cultural, economic and geographic barriers in accessing care and have high rates of oral health problems.  The current dental delivery system is not overcoming these barriers. This is why health care advocates across the country keep pushing to add dental therapists, licensed midlevel dental providers to the dental team. Dental therapists could immediately bring care to millions of underserved people nationwide and address oral health disparities.  In Massachusetts, the Senate’s recently passed health care bill includes authorization for dental therapists.

Dental therapists work with the dental team similar to the way physician assistants work on the medical team—they are early intervention and prevention dental professionals who are trained to provide a limited scope of services under the supervision of a dentist. They have been working worldwide since the 1920s and have been part of the US dental team for over a decade. Specifically designed to work in underserved areas, dental therapists are practicing safely, effectively and increasing access to care in Alaska, Minnesota, and the Swinomish Indian Tribal Community in Washington, and were also recently authorized in Vermont and Maine.

Several dental therapy programs are recruiting providers directly from the communities where oral health needs are the greatest. Utilizing community-based providers who understand the history, culture, and language of their patients enables the dental team to deliver culturally competent, patient-centered care and mobilizes the strengths of underserved communities.

In addition to delivering patient centered care, dental therapists are proving to relieve the financial burden on dental practices who have limited resources for oral health services for vulnerable and underserved populations. Since dental therapists are less expensive to hire, dental practices are able to provide care for more Medicaid patients, even with lower reimbursement rates, and still be profitable. These are critical components to being able to remove some of the systemic barriers that prevent underserved communities from accessing dental services, and building the community’s health care delivery capacity to improve oral health outcomes.

Access to dental services and good oral health should not be treated as novelties reserved for those lucky enough to live near a dentist, have dental insurance and afford to receive treatment. These are critical components to overall good health, and it is imperative that we address the structural barriers that cause oral health disparities. Dental therapists can address these disparities by expanding and bolstering the current dental delivery system to serve these underserved communities. Dental therapy is an evidenced-based solution that has increased access to care in Alaska and Minnesota, especially for hard-to-reach populations, and can do the same in Massachusetts.

                                                                                                                                       -- Kristen McGlaston, Community Catalyst