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Doherty’s program includes caseworkers who follow up with families. Gilmore, who began in the public health program with a $10,000 grant from the University of Massachusetts Medical School to help her and a business partner purchase the portable equipment they needed, refers the children she sees who have signs of decay or other problems to a dentist. Later, she can look back at MassHealth records to see if they actually visited one and talk with families who return to her about any obstacles.
Several other portable dental programs have grown up in Massachusetts since Doherty began. The ForsythKids program, part of the Forsyth Institute in Cambridge, began sending dentists and hygienists to schools in 2003. Hygienists and assistants affiliated with Tufts University School of Dental Medicine and its partners work at 240 schools and community sites.
Kathy Eklund, a hygienist and patient advocate for ForsythKids, said she expects that the growth of such programs and other changes — for example, physician assistants and other medical providers now can apply fluoride varnish — has improved dental care for Massachusetts children in recent years. Still, she said, “there is a lot of need.”
One major obstacle is that only 3 or 4 out of every 10 dentists practicing in the state serve people on MassHealth. The number has grown considerably since 2007, from 797 to 2,295 last year. The Massachusetts Dental Society has been campaigning to get more dentists enrolled. And after consumer advocacy group Health Care for All and its partners sued the state 12 years ago over poor access to dental care for low-income children, MassHealth increased payments to dentists and allowed them to limit the number of Medicaid patients they serve in order to persuade them to accept any.
One area of need mostly unaddressed in the public health program is among low-income adults. MassHealth covers adult cleanings but very few of the procedures needed to treat dental disease. Governor Deval Patrick’s proposed budget, released last week, would cover all dental needs for low-income adults, if approved.
Lawmakers in several nearby states could soon consider proposals to create a new licensed dental profession that advocates say would help provide more treatment. Sometimes called a “dental practitioner,” it could be similar to a nurse practitioner, allowing hygienists with additional training to do more of the basic restorative work now performed by dentists.
In New Hampshire such a measure was defeated last year, opposed by the state dental society, but advocates are considering proposing it again. Similar efforts are underway in Vermont and Maine. There are no plans for such a change in Massachusetts. Martin said there may not be a need for it.
“The public health dental hygienist program is still a new program and represents a new type of dental health provider,” he said. “We need to give it time to get established. I’m confident that we will see continued progress because of the work of these hygienists.”