The Politics of Cavities

The Politics of Cavities

Senator Harriette Chandler has been busy in the State House. Besides proposing an increase statewide fines for jaywalking, Senator Chandler has amended the State budget for 2017 to include a new level of dental care. Being proposed by Senate Majority Leader Chandler helped to ensure the approval of the amendment by a 39-0 vote.

The amendment will create an “Advanced Hygienist Practitioner”.   

 “who is a graduate of a registered dental practitioner education program of not more than 18 months provided by an accredited post-secondary institution, who has been certified by the Board to practice as an advanced dental hygiene practitioner pursuant to section 51B; and who provides oral health care services, including preventive, oral evaluation and assessment, educational, palliative, therapeutic, and restorative services as authorized.”

There seems to be some overlap between what a dentist can do and what an advanced hygienist practitioner can do. The amendment is being opposed by the Dentists’ association.  During a telephone survey I had to say “I do not know enough to have an opinion” for many of the questions posed on the issue.

It is clear that Advanced Hygienist Practitioners do not have to go through a dentist to be paid. The amendment specifically establishes that government payments go directly to the advanced practitioners.

“Advanced dental hygiene practitioners shall be directly reimbursed for services covered by Medicaid or the commonwealth care health insurance program.”

However the relationship with a dentist or hospital is required for the Advanced Practitioner, how that works is seeming left to the parties to figure out. 

 An advanced dental hygiene practitioner shall not operate independently of a dentist, except for an advanced dental hygiene practitioner working for a local or state government agency or institution or practicing in a mobile or portable prevention program licensed or certified by the department of public health. 

The amendment seems to imply that the writer of the amendment was not sure if the new Advanced Hygienist Practitioner is needed. There is no evidence that it would improve oral health in the so called poor “underserved” communities. So called “minority” and disabled communities have been mentioned several times in the media as targeted communities.

“The Board of Registration in Dentistry, in consultation with the Executive Office of Health and Human Services, shall develop an evaluation process that focuses on assessing the impact of advanced dental hygiene practitioners in terms of patient safety, cost-effectiveness, and access to dental services. The process shall focus on the following outcome measures: (1) number of new patients served; (2) reduction in waiting times for needed services; (3) decreased travel time for patients; (4) impact on emergency room usage for dental care; and (5) costs to the public health care system.”

I ran into my dental hygienist at a retirement party for a friend.  I found out that besides being a dental hygienist in a dentist office, she worked as a coordinator for families with children at Head Start. She did say that many of the children did not get proper dental care and that she would follow up with the children after they went to the dentist. For these children there was access and affordability.

She said that bad teeth as a child usually means a mouthful of trouble as an adult. The children in Head Start all were required to have their oral health evaluated and cared for as a condition for school.

It looks like the real issue is affordability for adults. Medicaid has restrictive benefits for adult oral care.

MassHealth has limited dental insurance for adults. We bought the Dental Insurance from MassHealth several years ago. It did not cover anything. So, not wanting throw good money after bad, we cancelled the MassHealth dental insurance. Medicare does not have dental coverage.

Senator Chandler’s amendment seems to be noble effort, but details are consequences of it are a little fuzzy.

A program at community colleges will have to be developed. Then the course have to be taken which will be at least 18 months. So there will be no Advanced Practitioner for at least 3 years.

I think it would make as much sense to have Medicaid, Medicare, and MassHealth  increase their coverage of dental care.

An alternate purpose of the amendment might to cut dentists out of the school care loop. Presently as my hygienist said all children in Head Start and on Medicare are referred to a dentist and their parents must provide a certificate of compliance. A visit to a UMASS clinic. Advanced Hygienist Practitioner might do as well at a lower cost.

I am not certain about how this will turn out. I am certain that it will be difficult with our present economic to provide the dental and health care that people need.