Bill to expand access to dentistry picks up steam on Beacon Hill

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BOSTON — Claiming momentum in a fierce policy battle, lawmakers who favor a legal expansion of the scope of dentistry work so that more patients can be served say they are gaining ground on Beacon Hill.

"I'm very proud that the fact is the dentists are at the table with us, talking about this," said Rep. William "Smitty" Pignatelli, D-Lenox, who represents many rural communities in Berkshire County, hearing on legislation authorizing a new type of professional, a dental therapist. "This wasn't happening a year ago, but it's happening today. This mid-level practitioner, no pun intended, will fill the gap for so many folks who are in need of health care."

Supporters of the bill say 47 percent of children on MassHealth, or 290,000 kids, did not see a dentist in 2014, while scores of low-income individuals, including seniors, are going without care and losing their teeth.

Health and Human Services Secretary Marylou Sudders said at the hearing that establishing the new mid-level practitioner is "the right thing to do." She told the Joint Committee on Public Health it would yield "modest savings" and help people avoid expensive, stressful emergency room visits for oral health.

Gov. Charlie Baker proposed creating a mid-level dental therapist position in an amendment to this year's budget, and Sudders said the administration prefers Baker's language but "fully supports the intent of" Sen. Harriette Chandler's bill.

"The differences are primarily technicalities, and we know that by working together, we can resolve this," Sudders said.

Separate legislation, backed by the Massachusetts Dental Society, poses a different approach to creating a dental therapist program. One sticking point between the two bills is the level of supervision for dental therapists.

The society's bill, sponsored by Rep. Peter Kocot, calls for direct supervision, with a dentist present, while Chandler and Pignatelli's allows dental therapists who have completed a year of residency or worked under direct supervision for at least 500 hours to practice under general supervision, which does not require the dentist's physical presence.

A poll released in May and commissioned by the dental society found 73 percent of respondents were not comfortable with remote supervision for dental procedures.

Dr. Todd Belfbecker, who testified alongside dental society President Dr. David Lustbader, offered an anecdote to illustrate why he favors direct supervision. He told of an 18-year-old patient of his who came in on the day of his high school graduation, dealing with pain from an infected tooth. Belfbecker said the quickest solution would have been to extract the tooth, but he decided to instead perform a root canal and put on a crown so the young man could keep his tooth.

"If I didn't have training to perform a root canal, I may not have known that that tooth could be saved or may not have even considered saving that tooth as an option," he said. "This is my fear when it comes to providers with less education performing irreversible procedures without any supervision. Once that tooth comes out, it's out."

The Chandler/Pignatelli bill, a version of which was unanimously approved by the Senate last year, also had support from some dentists.

Dr. Samantha Jordan said dental therapists can help decrease wait times, particularly at community health centers, and allow dentists more time with medically complex patients. She said general supervision — as opposed to direct supervision — would allow a practice to be open on nights or weekends and for dental therapists to travel to nursing homes and schools.

"Dentists should be allowed to provide ongoing, consistent supervision in the way that serves our patients best," Jordan said.

Sen. Jason Lewis, who co-chairs the Public Health Committee, said he was "very hopeful" agreement could be reached this session on the differing proposals.

He said there are "important differences" between the pieces of legislation, which represented opportunities to "look for compromise."

The Chandler and Pignatelli bills are also backed by the Pioneer Institute, which called the legislation "a great start toward expanding access toward quality dental services," and the Massachusetts Health and Hospital Association.

Michael Sroczynski, the association's vice president for government advocacy, said in a statement that passing the bill "is a necessary and appropriate step that will increase access to needed dental services for all residents of the commonwealth."

Michael P. Norton of State House News Service contributed to this report.

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