New training for hygienists could expand dental care

Jan. 09--BOSTON -- Elderly and low-income residents are not getting adequate dental care, according to health care and anti-poverty advocates, and it's costing the state big bucks.

A coalition advocacy groups say the solution lies in training and licensing a new class of dental hygienists to provide routine but critical care such as filling cavities, placing temporary crowns and extracting teeth.

Supporters of legislation likely to be filed this year say stepped-up training for hygienists will fill gaps in care for low-income residents, minority groups, people with disabilities, seniors and those in rural areas and inner-cities.

"We've made a lot of progress to expand healthcare coverage, but we still have huge unmet dental needs as a state," said Myron Allukian Jr., president of the Massachusetts Coalition for Oral Health, which is pushing for the changes. "People are falling through the cracks."

Brian Rosman, a lobbyist for the nonprofit group Health Care for All, said low-income patients often cannot find a dentist who accepts public insurance, or they are unable to get to a dental office. Others are uninsured and cannot afford treatment.

When dental problems become serious, he noted, patients go to emergency rooms for help.

From 2008 to 2011, MassHealth, the state's Medicaid program, paid more than $11.6 million for emergency room dental care for adults, according to state data.

Fewer than one in five private dentists accept Medicaid, according to supporters of the proposal.

"This isn't just about clean teeth," Rosman said. "We know there's a direct connection between oral health and good health. Things like diabetes, heart disease and low-weight babies have all been attributed to poor oral health."

But training and licensing "dental hygiene therapists," as they would be called, is opposed by the Massachusetts Dental Society, which represents more than 5,000 licensed dentists.

Scott Davis, the society's spokesman, declined to say why dentists don't support the plan. In an emailed statement, he said the group "looks forward to working with the Legislature in the new session so that every resident in the commonwealth has access to appropriately trained and supervised oral health professionals."

The society reported spending more than $145,000 to lobby state officials on issues related to dental practitioners, according to records kept in Secretary of State William Galvin's office.

Allukian, a former dental director for the city of Boston, said dental hygiene practitioners will cost less to train than dentists and could operate outside traditional dental offices, bringing care closer to patients in schools, assisted living centers or community health centers.

Several schools -- including Harvard School of Dental Medicine -- have signed onto the effort.

"You don't have to be in dental school for eight years to do a simple filling," Allukian said.

Legislation backed by a bipartisan group of lawmakers -- including Sens. Bruce Tarr, R-Gloucester, and Barbara L'Italien, D-Andover -- was approved last year by the Senate as part of a budget proposal. It didn't pass the House.

Katherine Pelullo, a veteran hygienist who handles legislative advocacy for the Massachusetts Dental Hygienists' Association, said supporters of the plan will soon make a major push this year.

"I'm hopeful that we can get it passed this time around," she said. "We have a lot of support."

Gov. Charlie Baker, a former health care executive, hasn't said if he backs the proposal.

Advocates say the state's most vulnerable residents are slipping through coverage cracks.

About 47 percent of adults with special needs had untreated tooth decay in 2010, while about 59 percent of seniors in long-term care facilities had untreated decay, according to the Massachusetts Health Council.

In 2014, nearly half of MassHealth patients ages 1 to 21 -- more than 290,000 individuals -- did not see a dentist, according to the U.S. Department of Health and Human Services.

Massachusetts is one of 39 states allowing dental hygienists to provide care outside of dental offices, according to the American Dental Hygienists Association.

But only a handful -- including Minnesota, Alaska and Maine -- have designated a special class of practitioners similar to what advocates are seeking in the Bay state.

The effort has produced mixed results elsewhere.

Maine approved similar legislation in 2014, creating a new class of dental practitioners to help serve an aging rural population and reduce the state's healthcare costs.

But the state hasn't licensed a single practitioner, according to a spokesman for the Maine Dental Society.

Allukian said he believes there is demand in Massachusetts.

He hopes dentists will work with health care advocates, instead of lobbying lawmakers to "water down" the proposal.

"They're not going to be competing against dentists," he said. "They would be complementing the work they provide and helping improve the state's overall dental health in the process."

Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group's newspapers and websites.

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