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:

• Community Water Fluoridation: Questions and Answers:
  • http://www.cdc.gov/fluoridation/fact_sheets/cwf_qa.htm#12
  • http://www.cdc.gov/fluoridation/guidelines/index.htm
• Press Release on HHS/CDC recommendation:  http://www.hhs.gov/news/press/2011pres/01/20110107a.html

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!