Albuquerque-Bernalillo County Water Authority To End Fluoridation: What Does This Mean For Oral Health?

Attention, residents of Albuquerque and Bernalillo County:  You and your families will soon be at higher risk for tooth decay.   In a surprising move, the Albuquerque Bernalillo County Water Utility Authority Board in January voted to stop adding fluoride to the public water supply by the end of the year.

Although our water supply contains some naturally occurring fluoride, fluoride levels are too low in most of the county to prevent tooth decay.   The U.S. Department of Health and Human Services has determined the optimum level of fluoride in water to be 0.7 mg/liter.  Yet only 35% of Bernalillo County’s water distribution zones meet this level.   (See this map of ABQ-Bernalillo County’s naturally occurring fluoride levels.)

Fluoridating public water supplies and using fluoride dental products can improve oral health and produce several benefits:

  • Fewer cavities and less severe cavities.
  • Less need for fillings and tooth extractions.
  • Less pain and suffering associated with tooth decay.

Thirty-four percent of New Mexico’s third-graders suffer from untreated tooth decay, compared to the national rate of 23%.  Hispanic and Black children and those living in families with lower incomes have more decay. Reducing water fluoride levels could make that worse.

The water utility board’s action recently was brought to the attention of the New Mexico Oral Health Advisory Council (NMOHAC), of which I am a member.  The NMOHAC includes dental health care providers, state officials and others committed to improving oral health and access to dental services. The NMOHAC is considering how to address this issue.

Under the federal Safe Drinking Water Act, public water supplies must contain no more than 2.0 mg/liter of fluoride.  There is no federal minimum for water fluoride levels.

For more information on fluoridation and the nationally recommended standard:

Local Hygienist Barbara Posler Receives National Award for Excellence

The American Dental Hygienists’ Association (ADHA) recently named Albuquerque dental hygienist Barbara Posler, as the recipient of the ADHA Award for Excellence sponsored by Johnson & Johnson. She was honored during the ADHA President’s Luncheon at ADHA’s 88th Annual Session in Nashville in June.

With this award, ADHA and Johnson & Johnson recognize individual dental hygienists who have made “outstanding accomplishments that have a significant impact on the practice and future of the dental hygiene profession.” The recipients have at least 10 years of membership in ADHA, demonstrate an active involvement in the association, and were nominated by a colleague for their outstanding accomplishments.

On receiving the award Posler said, “I know that the practice of dental hygiene will continue to evolve.  It has been my personal experience that dental hygienists can effect positive change for the profession and for the public we serve.”

“Barbara [Posler] is such an important part of our association at the local, state and national level,” said colleague Glenelle G. Butler, RDH.  “She has given so much energy, time, and commitment to the issues of standard of care and education of New Mexico hygienists.   She is an admirable advocate for the citizens of New Mexico because of her working for the best care as well as adequate access to care for our population.  I am proud to call her a friend and so happy that she has been recognized at a national level for her commitment as a professional.”

In 2004, Posler received the ADHA Distinguished Service Award for her community as well as legislative work. She helped to organize and participated in the annual Healthy Smiles clinic, sponsored by the New Mexico Dental Hygienists’ Association, which offered an average of 130 children oral health exams, treatments, sealants and instruction. Along with other hygienists, she has also contributed to the Special Olympics program by helping create mouth-guards for the athletes and providing oral health education.  On several occasions, Posler has worked with Senator Bingaman and his staff, giving input on federal legislation affecting oral health and the role of dental hygienists. She has been involved in state legislation to improve access to dental hygiene services to the underserved, and in advancing the profession of dental hygiene.

Posler earned her certificate in dental hygiene from the University of Detroit Mercy in Detroit, Mich. in 1970. She has been a member of ADHA for 40 years, and served as state president of the New Mexico Dental Hygienists’ Association (NMDHA). She is currently serving as the NMDHA legislative committee chair.

NM Oral Health Advisory Council Covers Topics Important to Improving Oral Health & Access at Recent Meeting

Members of the New Mexico Oral Health Advisory (NMOHAC) brought to light many items impacting the oral health of New Mexican’s at its most recent meeting.  The NMOHAC is comprised of dental healthcare providers, state officials and others committed to improving oral health and access to dental services in New Mexico.

Chair of NM Dental Board Predicts at Least One Year for Dental Bill Regulations to Go Into Effect – While Governor Susana Martinez signed HB 187 a bill to amend the NM Dental Health Care Act into law on April 7, the NM Dental Board has yet to review and begin drafting regulations that make the provisions in HB 187 a reality, according to Jessica Brewster, DDS current chair of the NM Dental Board.  Hygienists and others at the meeting expressed concerns that a year was too long. They felt that some provisions could be enacted sooner and shouldn’t be held up by other more complex provisions.  Dr. Brewster agreed to look into whether the regulations could be enacted in sections so that less complex provisions could be finalized and enacted before other provisions.

Provisions of HB 187 include:

  • Slightly expanding dental hygienist scope of practice to allow hygienists to provide anesthetic services without the supervision of a dentist and allows hygienists to assess for sealants.
  • Creating a community dental health coordinator (CDHC) who are not providers, and can only provide prevention awareness information and can transport patients to dentists.
  • Creates an opportunity for dental assistants and dental hygienists to with additional training provide additional services beyond their scope under the in-person supervision of a dentist.
  • Allows for a temporary 3-day public service licensure for out-of-state dentists and hygienists to participate in charity dental service events such as Mission of Mercy.

Exciting New Changes for UNM’s Dental Programs

  • UNM’s dental services and dental hygiene divisions are now under their own new dental department, the UNM Department of Dental Medicine.  Previously they were housed under the UNM Department of Surgery.
  • New Facility for UNM Dental Residency Program opened its new state of the art training and clinical facility late in August located near UNM Hospital.
    • After completing their one-year residency, most of UNM’s residency program’s graduates stay in the state and practice in the area of public health.

HB 187 Regulations Will Determine if NY Medical Center Can Place Dental Residents in NM –  For a number of years the Lutheran Medical Center based in New York has wanted to place dental residents in New Mexico.  The medical center and others including the NM Primary Care Association argue that allowing these residents to practice in NM would increase access to dental services in our state and hope that the regulations in HB 187 will allow this to happen.   While HB 187 allows dental residents to obtain a 12-month temporary public service licensure to practice in NM, the law states that the dental residents must be “in a residency program in the state.”  The sticking point is how to define “a residency program in the state.”  Must it be like UNM’s dental residency program or would a dental resident practicing in the state meet this requirement?  Some expressed concerns about whether there would be enough NM licensed dentists who are trained to appropriately supervise out-of-state residents who are practicing in rural and remote parts of our state.

State and Bernalillo County to Apply for CDC Community Transformation Grant – This grant would provide communities with funds to pursue and provide clinical health prevention programs in their communities.  If awarded, the NM Office of Oral Health hopes to use some of the grant funding to support its oral health prevention programs for elementary school-age and adolescent children.

Oral health news roundup

Here is a look at some recent news stories on dental health and dental access issues. I’ll regularly post news roundups like this. If you have any news stories you’d like me to highlight, let me know!

Palm Beach Post: Ignoring dental care, a popular way to economize, can come at high price

July 6, 2011

Sonja Isger talks about the dramatic and dangerous costs of putting off dental care. As the article explains, many people give up dental visits to cut costs when money is tight. Isger highlights some surprising dental access and cost statistics for both the nation and Florida.

Huffington Post: Why Oral Health Leads to Overall Health

July 5, 2011

Too often, dental care is viewed as a luxury or purely cosmetic. In this piece, Glenn Braunstein explains the connection between oral health and overall health and that there are links between dental disease and chronic disease. You can’t have a healthy body without a healthy mouth. That’s why access to dental care is so important – it’s critical to have routine exams to prevent problems and catch the signs of any infections or disease early.

Columbus Dispatch: Dental practitioner would benefit Ohio

July 4, 2011

In a letter to the editor, an Ohio resident says the state needs a midlevel provider to help meet the needs of people in Ohio. As I’ve said before, I also believe midlevel providers, particularly dental therapists, could help expand access to dental care in New Mexico. It’s interesting to see the Ohio perspective.

Los Angeles Times: Tooth decay is prevalent among poor children

July 1, 2011

In this article, Amanda Marscelli looks at the severe dental issues facing poor children in Los Angeles and across the country. The disparities are devastating. The piece includes some pretty shocking statistics; for example: one-fourth of the nation’s children have 80% of the nation’s tooth decay. As you’ll read in the article, poor children have the hardest time accessing dental care and they’re the ones who need it most.

Minneapolis Star Tribune: Students find a subject worth sinking their teeth into

June 27, 2011

Jeremy Oslon profiles a student from the first class of students to complete a dental training program at the University of Minnesota that introduces at-risk high school students to the field of dentistry and supports them in earning their diplomas. I’m impressed by this innovative program. It’s encouraging to see that the University of Minnesota is trying to expand access to care while introducing these teenagers to a promising and important career.


New Curriculum Guidelines Published by AAPHD Offer States a Model for Training Dental Therapists

The American Association of Public Health Dentistry (AAPHD) recently published a compelling series of papers that established curriculum guidelines for the training of a new workforce model, dental therapists.

AAPHD is the nation’s largest membership organization of dentists, dental hygienists and others committing to improving the oral health of the public.  It believes that adding dental therapists as members of the dental team may help meet growing U.S. oral health needs, particularly among underserved populations.  The papers are the work of an academic panel whose 11 members were selected for their expertise, experience and in-depth knowledge of dental education.

For New Mexico, one of the states that is pursuing the dental therapist model, this means we have a template on which to build an education program that would produce quality dental providers who can meet the needs of our remote and underserved population.

This compelling series of papers also includes the following:

  • Principles on which a dental therapy program should be based;
  • Recommended length of training programs;
  • Competencies required for graduates; and
  • General curriculum content of such programs.

The proposed model curriculum is based on a two-year, post-secondary training program.  The panel reviewed the course of study for dental therapists in programs already in the United States (Minnesota and the Alaska Native Tribal Health Consortium/University of Washington program) and throughout the world.  The dental therapist designation is a professional, accredited position in 55 countries.

The entire collection of papers is available online and will be published in a special issue, June 2011 issue of peer-reviewed Journal of Public Health Dentistry.

In a guest editorial introduction to the special issue, panel convener Caswell Evans Jr., DDS, MPH, Associate Dean for Prevention and Public Health Sciences at the University of Illinois at Chicago, noted that the absence of a nationally recognized program of study for dental therapists could result in a “patchwork of responsibilities and varying scopes of practice for dental therapists that could lead to confusion by the public.”

The panel’s proposed curriculum should help to answer questions about the training and education for dental therapists and will likely become a model for other states, including New Mexico.

In addition, AAPHD President Diane Brunson, RDH, MPH, said that the recommendations will help establish “a career path for entering the profession to best serve the oral health needs of all populations.”

“We believe that the expert panel recommendations, used as a model to build on, will assure that curricula from school to school and state to state are consistent, of high quality and will pave the way for national accrediting,” she added.

Integrating Medical and Dental Care Can Improve Access and Health of New Mexicans

Oral health is essential to overall health. Yet, for decades, the medical and dental professions have practiced in their own separate spheres, rarely working together to coordinate to improve care for their patients.

My hope is that may be changing – at least here in New Mexico.

Recently, at the New Mexico Health Resources (NMHR) annual provider retreat in Taos, I was struck by how many presenters — medical and dental professionals alike — focused on opportunities for medicine and dentistry to work together in diagnosing and treating patients. I’m encouraged that we will see more action among healthcare professionals, provider groups, payers and others to collaborate on improving the health of all New Mexicans and expanding access to these necessary healthcare services.

Following is a quick summary of several key presentations from the retreat.

Diabetes Management & Treatment at the Dentist’s Office - According to Gary Cuttrell, MD, DDS, JD, University of New Mexico division chief for dental services, 60% of Americans see a dentist once a year. For many people, this is more often than they see their primary care physician. This presents a unique opportunity for dentists, hygienists and other dental professionals to use their training and education to provide basic non-invasive diabetes screenings for diagnosing, referring and helping patients manage diabetes.

Application of Fluoride Varnish In Primary Care Settings – Many presenters suggested that, with some additional training, health professionals in primary care medical practices could apply fluoride varnish to patients’ teeth to prevent further tooth decay and ultimately avert the long-term health problems of obesity, cardiovascular disease and diabetes that can be caused by poor oral health.

Perinatal Dental Care Coordination between Obstetricians and Dental Practices - Irene Hilton, DDS, MPH, presented compelling reasons for obstetrical and dental professionals to collectively reach out to and treat women early in their pregnancies. From the start, a pregnant woman passes on whatever dental disease she may have to her child. Ideally, a woman will have seen a dentist before she is pregnant, but, if not, she should see one within the first 10 weeks.

According to Dr. Hilton, pregnant women are more open to seeking care and following a care plan. This is a good opportunity, for the obstetrician and dentist to collaborate on reinforcing good oral health habits for the mother, who hopefully will instill them in her child. Unfortunately, some women may not see a dentist until the end of their pregnancy and, as a result, they may fail to get all the treatments they need. This is particularly problematic for women covered by Medicaid, because once they give birth, they no longer have their own dental coverage.

I am encouraged by these discussions, and I’m sure there are other opportunities for medical and dental professional to work together for the benefit of their patients.  Let’s break down those silos, so that all New Mexicans can enjoy good health!

In a Dental Emergency, Kids Insured by Medicaid Frequently Can’t Get Care

Kids in need of emergency dental care stand a poor chance of getting it if they are covered by Medicaid, according to a new study published online in the journal Pediatrics.

Posing as mothers of a 10-year-old boy with a fractured front tooth, six research assistants phoned 85 dental practices in Cook County, Ill., twice, four weeks apart, requesting an appointment.  Each time they told the same story, with one difference:  health insurance.  In one call, the boy was covered by Medicaid; in the other, Blue Cross.

In Illinois, even non-enrolled dentists can be reimbursed by Medicaid for providing emergency dental care.  Still, the disparities in access were startling.  While nearly all (95.4 percent) of kids with Blue Cross insurance got an appointment, only about a third (36.5 percent) of Medicaid-covered children did.  Even among dental practices enrolled in Medicaid, children with Medicaid were still 18.2 times more likely to be denied an appointment than their counterparts with private insurance.

The study authors note that the scenario they came up with – of a boy with a fractured upper front tooth and pain after falling off a bike – was chosen by a pediatric primary care provider and dental consultants “as a common dental condition warranting timely treatment to optimize outcomes.”  A crown fracture of a permanent front tooth – which the reported symptoms indicated – “requires urgent dental care, ideally within 24 hours,” the authors observe.

That nearly two-thirds of Medicaid kids in this situation were denied care is distressing.  Another concerning finding:  One-fifth of calls to Medicaid-enrolled practices on behalf of children covered by Medicaid resulted in appointments requiring cash payment – even though Illinois prohibits dentists from collecting cash for services rendered to Medicaid patients.  Doing so is a violation of the dentist’s contract with the state dental administrator.

What’s clear here is that Medicaid coverage is no guarantee that a child with a dental emergency will get the care he needs.

So what’s the answer?

The study authors conclude:  “Although removing provider barriers may not eliminate all oral health disparities, finding dental providers willing to accept public insurance and serve children from low-income families is arguably the first vital step toward improving the oral health of our nation’s children.”

Organized dentistry says the solution is to increase Medicaid reimbursement.  Raising Medicaid rates for dentists can help, especially in states where payment rates are far too low.  When paid appropriately for their services, dentists are more likely to accept Medicaid patients.  However, higher reimbursement rates are not a fix-all.  And, in the current economy, it is unlikely that states will raise their reimbursement rates.

We need to make it easier for dentists to treat more Medicaid enrollees.  Interestingly, a 2010 report by the Pew Children’s Dental Care Campaign shows that, by bringing in new types of dental care providers – such as a dental therapist or a hygienist-therapist – most private dental practices could serve Medicaid patients without sacrificing their profits.  In fact, according to Pew, solo private practices, where most dentists work, could even increase their profitability while expanding access to dental care.

In New Mexico, not only do we have a major shortage of dental care providers, but very few dentists treat significant numbers of Medicaid patients as part of their practice.  Less than half our Medicaid-covered kids get any dental care at all in a given year.  I hate to think what might happen to any of them in a dental emergency.

A dental therapist model could help solve this problem.  Employed at half the cost of a dentist and able to provide some of the most commonly needed dental care services, dental therapists could make Medicaid financially feasible for many dental practices.  Plus more kids would get the dental care they need.

That’s a win-win all around.

I welcome your thoughts.

This Los Angeles Times story provides some more background on the study. You can also read the study abstract on the Pediatrics web site.

When a “B” Isn’t Good Enough: Dental Scorecard Shows NM Children Not Receiving Care

A new scorecard from the Pew Center on the States downgraded New Mexico from an “A” to “B” since last year for its efforts to improve children’s oral health.

Some may think a “B” is just fine, even if it is a step down.  But the Pew scorecard assigns grades based on policy efforts to improve oral health – not the results of those policies.  Unfortunately, if grades were based on results, New Mexico would get a much lower mark, because too many of our kids aren’t getting the dental care they need.

As the report shows, just over half our Medicaid-enrolled kids received no dental care whatsoever in 2009.  That’s over 100,000 New Mexican children in low-income families – kids who are already at high risk for poor oral health – not getting any dental care at all.  (American Academy of Pediatrics, Children’s Health Insurance Status and Medicaid/CHIP Eligibility and Enrollment, 2008, State Reports.  Sept.2009. p10.)

We are doing these children a terrible disservice.

Good oral health is critical to kids’ overall health, as well as to their ability to learn.  Failure to get routine oral health care services early in life can set kids up for a lifetime of poor oral health and increase their risk of developing serious conditions like heart disease and diabetes.

We need policies that will bring needed dental care services to all kids as quickly as possible – and to do that, those policies must address our state’s severe dental care shortage head-on.  Some 40 percent of our population – more than 780,000 New Mexicans – live in federally designated dental health professional shortage areas where there just aren’t enough dentists.

These communities need more frontline providers so that people can get routine, affordable dental care before their dental problems turn into dental emergencies.

One promising solution that I mentioned in my first post involves bringing in dental therapists to expand the reach of the dental care team, so that everyone can get affordable dental care when they need it, where they live.

A dental therapist is trained to work with a dentist, usually at a different location, to provide preventive and routine dental services such as cleanings, fillings and simple extractions.  Because they don’t have to work in the same office with the dentist, dental therapists can help bring some of the most commonly needed dental care services to children and families who currently can’t get them.  However, dental therapists are supervised by dentists, and many independent evaluations have shown that dental therapists provide the same quality of care as dentists for the routine services they perform.

Dental therapists can help save the system money, too.  Because they don’t provide all the services a dentist does, their training is highly focused on performing a narrow scope of routine services, which they do over and over.  This approach allows them to provide care at a lower cost to the system.  Obviously, this is very important at a time when the state is strapped for cash and is considering cuts to Medicaid and other programs that provide dental care for children of low-income families.

As I reported last week, the state legislature this past session considered – but did not pass – a bill that would allow dental therapists to practice in New Mexico.  I’m hopeful that our lawmakers will reconsider this proposal next year.

Too many of our poorest, most vulnerable children aren’t getting the dental care they need.  Bringing in dental therapists could help us solve that problem – and earn us an “A,” not only for effort but results, too.

Welcome to Word of Mouth NM

If you live in Union County, New Mexico, and have a toothache, your closest viable option for dental care is a two-hour drive away, in Amarillo, Texas. Chances are you’ll have to wait months for an appointment.

Why is it so hard to see a dentist? Because there isn’t one in Union County. Getting routine dental care is a major challenge. And that’s the reality for thousands of New Mexicans who live in rural, tribal and underserved communities where there aren’t enough dentists.

New Mexico faces devastating dental access problems. With this blog, I want to show the depth of the problem and highlight efforts in our state to solve it. I’ve been exposed to these issues through my work at Health Action New Mexico, where I work with the government, the nonprofit community and the public to raise awareness of dental access issues and shape programs and policies that expand access to dental services.

So many of us have seen firsthand how the state’s dental access problems affect everyone, but especially children and families in rural areas, where dental care is hardest to get. According to federal estimates, 29 of our 33 counties don’t have enough dentists – including six that don’t have any.  As a result, more than 780,000 New Mexicans live in areas without enough dentists.

Behind those numbers are real people — children and adults — who suffer unnecessarily and miss school and work because they can’t get dental care when they need it. Sometimes their dental problems turn into dental emergencies, and they have no recourse but the hospital emergency room, where care is exorbitantly expensive. (For more on this issue, check out the KRQE segment below.)

New Mexico is not the only state struggling to address dental care shortages; this is a nationwide problem. Fortunately, awareness of this issue is growing and efforts are underway across the country and in New Mexico to expand access to dental care.

Health Action New Mexico and our partners are particularly encouraged by a model that would create a new kind of practitioner: a dental therapist, who would be trained and certified to provide a narrow scope of commonly needed dental care services such as cleanings, fillings and simple extractions under the supervision of an off-site dentist. For the first time, a bill to bring dental therapists to New Mexico was introduced to the state legislature this year. Although the bill didn’t pass, legislators now have a better understanding of our state’s dental care crisis and this possible solution.

Dental therapists are just one proposal on the table to help expand access to care. Despite the seriousness of the problem, it’s exciting to see momentum building in New Mexico and across the country for greater dental care access.

That’s why I started Word of Mouth NM. This blog will serve as a forum for exploring efforts in New Mexico and other states to expand access to dental care and for driving discussion on dental access issues. I’m looking forward to a hearty conversation. Although I will be the primary blogger for the site, we will also have guest posts from other oral health advocates and experts. Please send your comments, suggestions and questions. I’d love your feedback and participation.

With that, welcome, and let’s get started!