Dental hygienists want the Legislature to enact a first-in-the-nation
program that would let them provide more comprehensive care for poor people who lack regular access to dentists.

The trade association for dentists says it will oppose the bill when a
legislative committee takes it up at a public hearing on Friday.

Both groups acknowledge that there is a shortage of dentists in Maine and that the problem is especially severe in some rural counties. Also, some dentists refuse to participate in the government-funded Medicaid program for the poor and disabled, partly because they view state reimbursements as inadequate.

But the two disagree on whether hygienists can be trained properly to help fill the gap or whether the solution is to recruit more dentists, relieve them of routine office duties and pay them more to serve Medicaid patients.

A bill backed by the Maine Dental Hygienists' Association would instruct the state Board of Dental Examiners, which oversees dentists and hygienists, to create a program that, in the words of the proposed law, would "allow dental hygienists certified by the board to provide dental care outside of a dental office to low-income persons" and to Mainers who are covered by Medicaid.

The legislation would not specifically prohibit hygienists from doing
additional work in dentists' offices, but it is geared toward helping people elsewhere, such as children in schools.

The bill would require that participating hygienists be licensed by the
state, complete a one-year internship with a dentist or an already certified hygienist, and receive additional training in an accredited school. With those credentials, they could provide a range of services that hygienists cannot provide now, such as removing baby teeth, filling cavities and removing exposed nerves to control pain.

If the bill becomes law, hygienists "would be able to help the underserved in the state of Maine," said Michelle Gallant of Rockport, president of the hygienists' association.

Gallant said the bill would expand what hygienists can do for children in public-health settings, such as schools, pediatricians' offices and Head Start programs.

"We see so many children with serious dental problems and they have no place to go," Gallant said. "The need is overwhelming."

The Maine Dental Association, which represents dentists, counters that the bill would not give hygienists enough training to do what they want to do. That association says dentists are taking steps to relieve the shortage of dentists by training dental assistants to handle more in-office duties, freeing up time for dentists to see more patients.

"A one-year internship with a dentist is just not long enough," said John Bastey of the dentists' group. Although the bill also calls for more formal training in a school setting, Bastey said there is no established curriculum for such training because there is no precedent in any other state for what the hygienists' association wants to do in Maine.

Nationally, there is one dentist for every 1,700 Americans, according to the state Department of Health and Human Services. In Maine, each active dentist served an average of 2,252 people in 2006, according to state statistics, and that number varies dramatically from county to county.

For example, Knox County had one dentist for every 1,465 people in 2006. The ratio was one dentist per 1,478 residents in Cumberland County. There were far fewer dentists, per capita, in Somerset and Waldo counties. The number of people per dentist topped 4,200 residents in each county.

Maine dentists provided about 42,000 hours of free dental care last year, according to Bastey, but more than 40 percent refuse to participate in the Medicaid program. He said Medicaid reimbursements fail to reimburse dentists adequately for their costs, there is a "paperwork nightmare" associated with filing Medicaid claims, and ongoing problems with the state's Medicaid billing system have made some dentists leery of participating.

It is hard to predict how the Legislature will respond to the bill, because a public hearing has not yet been held and because the bill would break new ground in Maine dental care.