SB 284 is only a little step

Recently dental hygienists Kyle Messier and Hope Saltmarsh penned an article in NHBR (“N.H.'s big step forward to improve oral health,” Aug. 24-Sept. 6 NHBR), extolling how the passing of Senate Bill 284 has the potential to significantly improve access to oral care for New Hampshire residents.

The intent of the bill is noble, but the reality is that this bill arose out of The Pew Research Center pushing for "dental therapists" to provide dental care in the state. That was a bad idea from the start and was based on the Pew Foundation's notion that because "dental therapists" seem to make sense in Alaska, that the same model should work in New Hampshire. This bill was I believe, a fallback position and will unfortunately do little to help anyone.

Having just returned from Alaska, I can state for a fact that New Hampshire and Alaska are somewhat different, a fact that the Pew Foundation chose to ignore. Juneau, the capital of Alaska, is not accessible by automobiles, and one must fly in or arrive by boat. Last I checked, Concord, N.H., was slightly easier to get to, as are most dental offices in our state. More importantly, New Hampshire already has one of the highest dental utilization rates by our poorest children, those on Medicaid, when compared to any state, even the non-contiguous ones.

The authors state that the new law will "allow certified public health dental hygienists to provide increased services, most notably temporary fillings, in community settings like schools, WIC clinics, Head Start and programs for those with special needs, senior centers, nursing homes and directly to those who are home based.”

If the ability for dental hygienists to provide temporary fillings in these venues is truly one of the more notable benefits of this bill, as the authors in fact state, then little benefit will be realized by the passing of this bill.

As a pediatric dentist in the state who treats hundreds of children with Medicaid as their dental insurance, I would not put a great deal of faith in the quality of a temporary filling that a certified public health dental hygienist might place on a small child in an elementary school, a WIC center or a Head Start program. In fact, I am pretty sure that without something that looks reasonably like my dental office, I could not do passable work if trying to place a temporary filling on a 4-year-old in a WIC clinic.

And remember, you must "First, do no harm.”

So I do agree that there is room for improvement, concerning access to quality oral health care for New Hampshire's children, adults and seniors. Unfortunately, SB 284 simply does not have the "potential," as the authors claim, to "significantly improve" access to oral health care for New Hampshire's citizens. I wish it were otherwise.

Jon Wendell

Categories: Letters to the Editor