Editor’s note: This commentary is by Dr. Chuck Seleen, who is a dentist for 40 years and the director of Vermont Dental Care Programs in Winooski.
[W]hen a patient comes to me in pain, I rely on years of training and experience to get them back to good oral health.
Dental disease can be a traumatic event in someone’s life. It is troubling that some Vermonters are suffering with pain that could easily be relieved. And it is particularly frustrating that much of this pain, like the vast majority of dental disease, could have been prevented.
To be clear, Vermont is doing many things right when it comes to oral health. We are a national leader in children receiving dental care, and in the rate of residents who have access to a dentist, which includes a robust network of free and nonprofit dental clinics. But we must do more.
According to a 2014 national study by the American Dental Association Health Policy Institute, 23 percent of adults said they either were unsure or did not plan to visit a dentist in the next year. More than one-third of that group said they probably won’t go because they don’t believe they need to. In a separate survey, 40 percent of dentists said they have capacity to treat more patients.
Fixing Medicaid and changing each Vermonter’s approach to prevention will take time, but there are ways to improve access today.
To bridge this unacceptable gap, Vermont’s dentists are advancing an 11-point Vermont Action for Dental Health plan, to break down barriers to dental care and strengthen prevention programs in schools, nursing homes, community clinics and federally qualified health centers.
Our plan helps build a more fair and equitable system of care. Other ideas in Montpelier, such as licensed dental practitioner legislation, are too narrow in scope and raise too many concerns. Underserved communities can’t wait another decade for a new curriculum, school and bureaucracy, to slowly produce new practitioners that add complexity and overhead costs to the oral health care system.
More importantly, Vermont should not create a system where underserved Vermonters are transferred to practitioners with limited training, experience, and scope of services. Every Vermonter deserves to receive care from a fully trained and licensed doctor of dentistry.
To achieve this goal, we must address the real barriers to care – transportation and cost. Medicaid, for example, only reimburses for about half of what private insurance pays. In many cases, this is less than the dentist’s cost of providing care. Many of my colleagues and I want to treat as many Medicaid patients as possible, but it would be difficult to keep practices operating when not covering the cost of care on every one of these patients. Last year alone, Vermont dentists provided about $20 million in uncompensated care to Medicaid patients. If the state would fund Medicaid adequately, more dental practices could see more Medicaid patients.
Patient awareness is another consideration. Currently, we are treating most Vermonters for disease that could have been easily prevented. We must better prioritize prevention — Vermont will never drill, fill and extract its way to optimum oral health.
Fixing Medicaid and changing each Vermonter’s approach to prevention will take time, but there are ways to improve access today. Dentists will continue to do their share, in part by donating a significant amount of care to people in need and exploring new ways to reach patients. We are providing resources and expertise to public dental health awareness campaigns, free dental care days, visits to schools and other volunteer contributions to the health and wellness of their neighbors.
We also propose adding community dental health coordinators and more nationally accredited expanded function dental assistants to our system, and expanding the Tooth Tutor program for kids. These improvements would help patients navigate the dental health care system in a way that meets their needs and help patients learn how to prevent costly and painful oral diseases.
Through measurable results offered in the Vermont Action for Dental Health plan, we can help every Vermonter gain access to preventive, restorative and continuous dental care from a dentist.
