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Monday, April 18, 2011

HANM: Another Legislative Session Without Answers to NM's Dental Access Crisis

This is a guest blog by Pamela K. Blackwell, JD, Project Director, Oral Health Access, Health Action New Mexico.

Lack of access to affordable dental care is a huge problem for thousands of New Mexicans. Although a bill to expand oral health care access did not pass the legislature this past session, many lawmakers were glad to see the issue raised.

Now that they’ve learned more about our state’s dental care crisis, I’m optimistic that they will be better prepared to address it next year. Specifically, I hope they will revisit the bill introduced this session by Rep. Dennis Roch (HB 495) that sought to reduce the severe dental care shortages that are common in rural, remote, and Native American communities where there aren’t any dentists.

These shortages are causing hardship and suffering for many families and children. Twenty-nine of our 33 counties don’t have enough dentists, including six counties that don’t have any.

As a result, far too many New Mexicans -- including children, elders and people with disabilities -- can’t get dental care. They live in pain, miss school or work, develop long-term serious health problems as a result of poor oral health and face life-threatening medical emergencies due to dental infections.

Rep. Roch’s bill proposed adding a new kind of dental practitioner to the dental care team: a dental therapist, who would be trained to work in underserved communities, providing a limited set of basic but commonly needed dental care services, like teeth cleanings, fillings and basic extractions, under the supervision of an off-site dentist.

Dental therapists are selected by their home community to practice in their community when their education is complete. In this way, the dental therapist model actually provides economic and job opportunities for New Mexico’s rural and tribal communities.

Because dental therapists are less expensive to train than dentists, they can provide care at a lower cost. This makes it possible for them to practice in poor, rural and isolated communities where the economics are such that a dentist can’t break even. With lower overhead costs, dental therapists are also in a better position to accept patients with Medicaid and other low-paying coverage.

A dental therapist could have helped a Clayton woman whose toothache turned into a dental emergency because the nearest dentist couldn’t fit her in for three weeks when she called for an appointment. Not only did the woman suffer unnecessarily, but she could have contracted a serious infection. Her trip to the ER cost exponentially more than a regular dental visit would have.

People shouldn’t have to wait weeks and months when they’re in pain and at risk; they shouldn’t have to take a whole day off work so that they can drive two to four hours and across state lines to see a dentist. Everyone should be able to get quality, affordable dental care where they live.

Governor Martinez recently signed a bill (HB 187) that slightly expands the scope of services that dental hygienists can provide and creates a community dental health coordinator. Unfortunately, this law will not make a difference in providing real access to our underserved communities. Dental therapists are trained and educated to provide approximately 27 more necessary, high-quality and billable services than are NM hygienists. Dental coordinators can only provide prevention awareness information and can transport patients to dentists. So where will these coordinators take patients?  Based on the dire shortage of dentists in NM patients will be given a bus ride to nowhere.

To meet New Mexico’s unmet dental needs we need to put a new frontline provider like dental therapists in communities that need them. Working as part of a dental care team led by a dentist, dental therapists can extend the reach of the entire team, providing care where it currently isn’t available.

Dental therapists are just catching on in the United States, but dozens of countries with advanced health care systems have been using dental therapists for more than 80 years to bring dental care to underserved communities. The experience, as reflected in all the research, has been excellent.

Health Action New Mexico is committed to making quality, affordable dental care accessible throughout New Mexico, and we will continue to work for a NM dental therapist model. We invite the dental care community -- dentists and hygienists, healthcare providers, educators, patient advocates, community leaders and others -- to work with us, learn more about the dental therapist model and listen to the voices of those in need.

Working together on a real solution to expand oral health care access, we can meet those needs and improve the oral health and well-being of thousands of New Mexicans.

This is a guest blog by Pamela K. Blackwell, JD, Project Director, Oral Health Access, Health Action New Mexico. To submit a piece for consideration as a guest blog, contact me by clicking on the Email Me link at the upper left-hand corner of the page.

April 18, 2011 at 12:04 PM in Guest Blogger, Healthcare, NM Legislature 2011, Rural Issues | Permalink


This is the kind of remedy to counter ever increasing health care costs in general. This strategy was pioneered by Cuba to provide gynological health care including surgery and midwifery to under served African nations. It can work if our alternative providers can steer clear of predatory health insurance companies. A direct care paradigm from ordinary people to ordinary people has served humanity since ancient times.
We can expect to see a backlash from corporate backed fundamentalist Christians as direct community healthcare fosters genuine wisdom and independence. Knowledge is power and local self-sustainability is not going to make anyone rich.
In particular local self-sustaining practices do not make the people easy to manipulate or control via ignorance. At the onset of any war or dark age, the health care providers on the ground are the first to be slaughtered as a fundamental tenant of teachings from say erstwhile the School of the Americas.
We need to do it.

Posted by: qofdisks | Apr 18, 2011 1:28:36 PM

Have you ever been out of work or broke and needed serious or even basic dental work? If so you know that no dentist will give you service and allow you to pay over time as they used to do. We act like dental services are some frill that is not a part of health care but the opposite is true. Your health can be seriously damaged by neglecting dental work and yet nobody will provide it to people in a jam or the poor in this state. The rich dentists should be ashamed! Why didn't this bill get more attention? It would at least be a start but I also think any dentist allowed to get a license here should be required to provide a certain amount of free care and to offer time payments.

Posted by: Chas | Apr 18, 2011 2:13:31 PM

Even if you have typical dental insurance, it doesn't cover much. Even if you have the privilege of paying that premium, your dental bills are unfordable if you make a municipal wage or work in the service industry. Modern depressed wages do not allow for the cost of dental care for working people.

Posted by: qofdisks | Apr 18, 2011 5:27:21 PM