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Let’s close the oral health care gap

About the author: Dr. Kerry Maguire is the program director of ForsythKids, which brings preventive dental care to Massachusetts children of all ages at schools, day care centers, neighborhood facilities, summer camps and public events.

In 2002, I traveled to Nepal as a dentist volunteer to care for children at several orphanages in Kathmandu. I was shocked to discover that children living in one of the most impoverished nations in the world had better dental health than some I had recently examined at a school clinic in Lowell.

This dichotomy persists in Massachusetts and throughout the United States. Oral disease — especially cavities — remains a heavy health burden, affecting performance in school and at work, social development, nutritional intake and behavior. Dental decay is a progressive disease that can result in severe infection, pain, and even death. It’s a rare day when I don’t see at least one child point to an abscessed tooth and say, “This hurts.”

Thankfully, our Legislature is working on a bill that would give dentists, including those in safety net programs and private practices, a way to expand their care to more people. It would allow them to hire mid-level dental providers, similar to physician assistants on the medical team, who could take on some of the more routine procedures dentists normally do — such as filling cavities. In other states and many countries around the world, these mid-level providers multiply the number of patients dentists can treat and help ensure that those who struggle to access dental care, such as those covered by MassHealth, benefit from high quality, cost-effective treatment.

This provider, called a dental hygiene practitioner in the Massachusetts bill and a “dental therapist” around the world, would be a tremendous asset to the children served by ForsythKids, a community-based program that aims to close oral health care gaps in the Commonwealth. As part of a network of outreach programs, ForsythKids brings preventive dental care to more than 2,000 children throughout Eastern Massachusetts. ForsythKids operates in schools, day care centers, homeless shelters for families and young adults and other community settings in an ongoing effort to reach as many kids in need as possible.

However, the challenges are as great as the needs. Nearly half of kids and young people covered by MassHealth — approximately 290,000 individuals — did not see a dentist in 2014. There are also racial disparities, with rates for Asian, African-American, and Hispanic students being significantly worse than for white students.

In the ForsythKids program, 30 percent of kids had dental disease that required further treatment during the fall of 2014. Six percent — about one to two kids in every elementary school classroom — had urgent needs including pain, infection, or rampant tooth decay. ForsythKids has an aggressive program to ensure followup with a dentist, but even so, roughly half still are not able to get that care.

The ability to incorporate mid-level providers into our dental team would allow us to bring simple, on-site follow-up care to our patients, just like we already do for preventive services. I urge the Legislature to take this positive step toward improving oral health in Massachusetts. In this day and age, no child in Massachusetts or anywhere in the world should suffer from a toothache.

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