Dentists and Public Health Advocates Push to Close Gap in Care in Massachusetts

Editor’s note: In December, the bill was favorably reported out of the Joint Public Health Committee and is now known as S. 2076.

This piece was updated Nov. 19, 2015, to correct the number of Medicaid patients served.

Last week, I had the opportunity to testify before Massachusetts’ Joint Committee on Public Health to express Pew’s support for S. 1118/H. 249, legislation to authorize midlevel providers called dental hygiene practitioners in the state. This bill would increase dental access for vulnerable populations and make care more affordable.

The bill’s sponsors, Senator Harriette Chandler and Representative Smitty Pignatelli, outlined the need for better access to oral health care in Massachusetts. Sen. Chandler, who represents Worcester, highlighted The Boston Globe’s editorial in favor of the bill, which said that almost half of children covered by MassHealth—47 percent, or more than 290,000—did not see a dentist in 2014.¹ Rep. Pignatelli, from Lenox, said that the creation of a new class of providers in the state “could be an attractive career path” that might draw more people to the western part of the state.

I emphasized three points in my testimony: 

1. Dental hygiene practitioners, working under the supervision of dentists, will bring care directly to patients. This is critical because, as several witnesses explained, people with transportation or mobility issues can have difficulty seeing a dentist in a traditional office setting. Research shows that in 2009, 59 percent of seniors in long-term care suffered from untreated tooth decay.² In addition, 33 percent of adults with disabilities had not seen a dentist in the past year, compared with 22 percent of those without a disability, according to a 2012 survey.³
2. This is a financially sustainable model. According to a Pew case study, a private-practice dentist in Minnesota who employs a provider similar to a dental hygiene practitioner made an additional $24,000 in profit and served 500 Medicaid patients in the provider’s first year.⁴
3. The evidence demonstrating the effectiveness and quality of care provided by midlevel dental providers is clear. One of the greatest testaments to the growing demand for dental hygiene practitioners is a recent vote taken by the Commission on Dental Accreditation, the accrediting body for all dental education programs in the United States, which recently voted to implement national education standards for the profession. This action came after three years of evaluation during which the commission determined that a body of established, substantive, and scientific dental knowledge supports the discipline. 

Several witnesses presented compelling data on the dental access challenges in Massachusetts. And some, such as Dr. Lisa Simon, a dentist and Harvard School of Dental Medicine instructor, added personal stories from their experience to bring these facts to life. According to coverage of the hearing in The Republican, “[Dr. Simon] has seen patients who have removed their own teeth with pliers, unable to take the pain anymore. … All her patients have something in common: They are usually young men who are scared and in pain.”

More than a dozen individuals and organizations also offered testimony in support of the legislation, including:

• Dr. Huw Thomas, dean of Tufts University’s School of Dental Medicine
• Dr. R. Bruce Donoff, dean of the Harvard School of Dental Medicine
• Dr. Kerry Maguire, director of the ForsythKids program
• Dr. Leon Assael, dean of the University of Minnesota’s School of Dentistry

Massachusetts has a problem with access to dental care—especially among low-income families, seniors, and people with disabilities and other special needs. Dental hygiene practitioners are a proven way to close the gap in care for those who need it most. The evidence is overwhelming: This is the right model at the right time because it addresses a critical issue facing the people of Massachusetts.

Help improve access to dental care in Massachusetts. Sign our petition to let state legislators know that you support S. 1118/H. 249.

Endnotes

1. Utilization was calculated as a percentage of individuals ages 1 to 21 who are eligible for the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit and received any dental service. U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Annual EPSDT Participation Report, Form CMS-416 (State) Fiscal Year: 2014, accessed July 29, 2015, http://www.medicaid.gov/medicaid-chip-program-information/by-topics/benefits/downloads/fy-2014-epsdt-data.zip

2. Massachusetts Department of Public Health, Office of Oral Health, The Commonwealth’s High-Risk Senior Population: Results and Recommendations From a 2009 Statewide Oral Health Assessment (July 2010), http://www.mass.gov/eohhs/docs/dph/com-health/oral-health/senior-oral-health-assessment-report.pdf.

3. Massachusetts Department of Public Health, A Profile of Health Among Massachusetts Adults, 2012: Results From the Behavioral Risk Factor Surveillance System (April 2014), http://www.mass.gov/eohhs/docs/dph/behavioral-risk/report-2012.pdf.

4. The Pew Charitable Trusts, Expanding the Dental Team: Studies of Two Private Practices (February 2014), http://www.pewtrusts.org/en/research-and-analysis/reports/2014/02/12/expanding-the-dental-team.