Column: Time to Improve Access to N.H. Dental Care
It became very clear to me early in my career as a pediatrician that perhaps the most profound and preventable impact on children’s lives was that resulting from untreated cavities, oral abscesses and other oral health problems. Too many children miss school days because of oral pain, and too many parents or caregivers must miss work, not to mention deal with other consequences of inadequate dental care such as speech articulation issues, problems with chewing, low self-esteem, and misdiagnosed development and learning disabilities.
Unfortunately, too many of these children end up in emergency rooms because they are unable to find a dentist to provide routine care. In fact, a New Hampshire study found a 45 percent increase in ER visits due to dental ailments between 2001 and 2005. Between 2005 and 2009, dental-related ER costs totaled $32 million — and much of these costs wound up being shouldered by taxpayers or other hospital consumers. What’s worse is that often all that can be done in an emergency room setting is to give patients pain medication and a note referring them to a dentist to get the underlying problem fixed.
It’s not that my patients want to wait until pain gets so bad that they have to go to an emergency room. They end up there because many weren’t able to get care in the first place. Thousands of New Hampshire residents lack dental insurance, and 28,000 live in areas in our state that are confirmed to have a dentist shortage. That is about the same as the number of people living in Newport, Claremont, Sunapee and New London combined. In addition, Medicare doesn’t cover dental services for seniors, and many dentists don’t treat low-income patients who are enrolled in Medicaid — leaving limited options.
There is legislation (Senate Bill 193) being considered in the Legislature that would help dentists increase the reach of their services, extending a more comprehensive system of care to families without additional costs to government. How? It follows the example of what physicians did long ago, which was to expand their medical teams. Decades ago, it was you, your doctor and a nurse. Now, you have EMTs, nurse practitioners, physician’s assistants and others.
Senate Bill 193 would add what is called a dental hygiene practitioner to the dental team — working under the supervision of dentists. Two other states with significant rural areas — Minnesota and Alaska — have these practitioners already. Canada has used them for years. They perform preventive care, but they also get extensive training to do a small number of the most routine and common procedures that only dentists do now such as filling cavities and placing crowns.
Extending the reach of the dental team with an additional provider would mean two things. First, more people would get the care they need, which would help prevent cavities from turning into toothaches that become expensive problems. Second, dentists would be able to focus on more complex procedures.
New Hampshire cannot afford to delay passage of SB 193. In the coming decade, a large number of dentists will retire. According to the New Hampshire Board of Dental Examiners, nearly half of active dentists in New Hampshire are 55 or older. The dentist shortage in our state is worse than the numbers suggest because many dentists, nearly 19 percent, work only part-time.
Our state has a reputation for making common sense, smart choices on the front end to save costs for taxpayers down the line. Passing Senate Bill 193 and extending the dental team’s reach would do just that by providing care in the smartest, most cost-effective locations — dental offices and clinics — instead of expensive emergency rooms. And it would make a very positive difference in the lives of my patients and their families.
Steven H. Chapman, M.D., is director of the Boyle Community Pediatrics Program and associate director of child health at the Center for Primary Care and Population Health at the Dartmouth-Hitchcock Medical Center. He is a member of the board of directors for New Hampshire Kids Count (formerly the Children’s Alliance of New Hampshire), which has organized a broad coalition called the New Hampshire Dental Access Alliance to improve access to dental care. The alliance helped draft and now advocates for SB 193.