By Jeff Woodburn
“The worse case,” Penny McKinnon starts, her words drawing me closer and peaking my interest. As a School Nurse at Littleton’s Lakeway Elementary School, she sees a lot and it’s not all good. “A student’s teeth were so bad that he couldn’t eat,” she said, “he lost a lot of weight.”
Hard to eat, I think, impossible to learn. This elementary school student is not alone – many New Hampshire children aren’t getting the oral health care they need because Medicaid payments aren’t enough to entice the state’s dentists to do the work. This leaves Medicaid money on the table and children without important care – and all the while, little cavities lead to creeping decay and infection.
There is a legislative effort to fix this imbalance – by allowing trained and qualified public health dental hygienists to provide some of rudimentary and restorative services that presently by law can only be performed by dentists. The bill currently being considered in the senate (SB284) could establish a pilot project that will empower and train a few dental therapists to provide additional services under the watchful eye of employing dentist. This concept is used in Alaska and being studied by several other states that experience similar gaps in services. It’s a small step – best on established practices, common sense and best of no outlay of state money.
New Hampshire dentists are among the most lavishly paid in the country and it’s instinctive for them to want to limit access to their profession, but government must ensure quality and accessibility. And the current system is failing many children who are properly insured but still left out. This is idea is a win, win situation. Kids get care, providers get paid.
As we now know, oral health is essential to overall health and unattended dental problems grow into major burdens to our health care, education and criminal justice system. As a teacher, I know poor health is a gateway to big problems – and few opportunities.
Consider this — emergency room are seeing more patients ravaged with tooth decay; fragile teeth cause people to rely on diets of over-processed unhealthy food that lead to conditions like obesity and diabetes; tourism and service jobs rarely value a toothless grin.
But smiles will be hard to come by as these young children grow to adulthood. Society ridicules toothless people, so they learn to keep their mouths tightly shut. Men have the advantage of growing moustaches to hide their shame. Imagine trying not to smile because it will reveal a secret that seals your future.
New Hampshire has a great opportunity to look at mid levels to address these problems. A dental therapist can work in rural parts of the state that a dentist won’t. What’s wrong with a trial demonstration project to see if it can make a difference? When public and private entities work together for the common good, everyone can smile.
(Jeff Woodburn, of Dalton, is a teacher, writer and Executive Director of the state council for Children with Chronic Health Conditions)