More work needed to improve access to dental care

Indicators show the state still has work to do when it comes to children’s oral health

The Pew Charitable Trusts recently issued a report examining the challenges people have getting dental care across the country. Although New Hampshire received some good news, it does not tell the whole story. Unlike the New Hampshire Dental Society, we read other indicators that tell us our state still has work to do. 

First, the study found an incredibly high percentage of low-income kids enrolled in Medicaid who did not receive dental care in 2011: 39 percent, or roughly 4 in 10. Since Medicaid covers dental care for kids, you might ask why so many kids are going without care. One big reason is that many dentists in private practice do not accept Medicaid patients.

This is a serious problem because recent research has linked children’s dental problems to missing school and poor academic performance. In fact, tooth decay is the most common childhood disease – five times more so than asthma. And when cavities don’t get fixed, they can lead to more serious infections and an even bigger impact on kids’ lives.

New Hampshire also just doesn’t have enough dentists to go around, and we need to make sure people in under-served areas, including rural ones, can get more consistent and affordable care.

Pew’s study uses a very conservative way to estimate the dentist shortage – specifically, it counts those who have very little or no chance of getting dental care at all. Those who live more than 10 miles from a dentist or adequate dental care are similar to those living more than 10 miles from a grocery store with fresh produce – often they can’t make the trip to the store or the dentist regularly due to inaccessibility.

The federal government determined that there are many New Hampshire residents who have trouble getting dental care. In fact, 29,000 residents live in areas without enough dentists – including many in the North Country. Most of those people have to drive long distances to reach a dentist or a certified dental practitioner.

Some may think we do not need to take action, but barriers to dental care will only get worse if we don’t. The Pew study cited national data from 2009 showing that a whopping 43 percent of our state’s dentists are close to retirement. That’s much higher than the national average, but more recent data from the state dental board shows this has increased to 46 percent. Specifically, 541 of our state’s 1,179 active dentists are near retirement, and they are not being replaced at a rate equal to that of retirement.

So if dentists cannot meet New Hampshire’s need, who can? New Hampshire legislators took the first step by expanding the role of one of our dental health providers last year. They passed a law that allows certified public health hygienists to conduct dental x-rays and place temporary fillings in schools and other public settings. But we need to do more.

Another solution already under consideration by the Legislature is Senate Bill 193. It would expand the dental team with an additional type of provider just the way that doctors use nurse practitioners, physicians’ assistants, and others to make sure more people can get routine care. SB 193 would do the same for the dental community.

Although New Hampshire would not be the “first in the nation” – Minnesota, Alaska and 50 other countries already use these types of dental practitioners – we could be among the top five states to adopt this innovative approach to providing routine services now only done by dentists including filling cavities.

These new dental workers would be under the supervision of a dentist but could also work remotely in rural areas where dentists do not have offices.

Without enough dentists located where families need care, people have to travel further and take more time off work – something that is especially challenging for low-income families who often work multiple jobs. New Hampshire can help solve this problem by expanding the types of professionals providing routine dental services to people, especially children, closer to where they live by passing SB 193.

Ellen Fineberg is executive director of the Children’s Alliance of New Hampshire.