To the editor:
The link between oral health and overall health outcomes is now well established and difficult to ignore. Where we once treated the mouth as a distinct health issue, separate from the rest of the body, we now understand that poor oral health affects the incidence, management and severity of diseases ranging from diabetes to heart disease.
For the elderly and severely disabled adults and children, optimal health outcomes are difficult to achieve without good oral health foundations. For this reason, we should be concerned when so many of our most vulnerable neighbors and loved ones are unable to access routine dental care. And that’s also why we should support current efforts in Concord to expand access to care as Senate Bill 193 seeks to do.
There are many reasons access to dental care is limited, but much relates to ability to pay. Medicaid and Medicare do not offer adult dental coverage, so routine care such as cleanings, exams, screening for oral cancers, or fillings for our most vulnerable adults must either be borne by the patient, or it must be accessed through free and sliding-scale clinics or special dental care days like those offered by some social service agencies. These clinics are wonderful resources for those without the means to pay for care, but often have long waits for care due to high demand driven by many factors: uninsured and low-income children and adults are on their waitlists, as are children who are covered by Medicaid but who cannot find a dentist willing to accept it as payment.
The cost for dental care becomes an expense in limited-income households that is often put off in favor of heating oil, food or medications to address immediate health issues. So, those without the financial means go without dental care. When they can no longer avoid treatment due to pain and infection, many turn to emergency rooms to alleviate that pain and suffering, but that is the extent of treatment they will find there -- they must still must find a dentist willing to deal with their underlying oral health condition. By that point, pulling teeth is often the only option.
Fortunately, there is a way to lower the costs and expand capacity to provide care to more of our elders, disabled and children. Another kind of provider called a Dental Hygiene Practitioner (DHP) is being considered by the New Hampshire Senate. A dental hygienist who wants to be a DHP would go back for additional classroom education and clinical training in a set of common procedures -- such as permanent fillings. Operating under a practice agreement with a licensed dentist (who remains the leader of the team), the DHP could be deployed in a private dental office, health clinic or even a mobile setting to provide both preventative services and limited restorative services (like fillings) that right now only a dentist is allowed to perform. With a DHP in a practice, dentists’ time is freed to treat the most complex cases. This is an efficient, sensible way to provide care that is so badly needed and so out of reach for too many in New Hampshire. And, it’s especially notable because it’s one piece of the solution that doesn’t increase state expenditures and doesn’t force new regulations on current dental providers.
Senators should consider this innovative approach now being practiced in 50 countries worldwide, and in states such as Minnesota and Alaska. Every surrounding New England state is considering similar legislation. New Hampshire should take the lead. To do otherwise is letting our most vulnerable residents suffer needlessly.
SarahCare Adult Day & In-Home Services