CONCORD – State Sen. Peggy Gilmour, D-Hollis, said her ambitious legislation to let someone other than a dentist fill, clean and pull teeth would lower costs, expand access to care and make the profession more efficient.

“This is not a substitute or a mini-dentist. When people who are well educated and well trained as we have seen in medicine, there are many aspects nurse practitioners can take on with a high degree of quality and high degree of patient satisfaction,” Gilmour said.

“I see this as a natural extension for the practice of dentistry as we look at the future needs of our health care system.”

Local and state leaders in the dental industry counter that there have been great strides made to improve access to care and Gilmour’s bill (SB 193) could discourage future graduates of dental school to return or settle in New Hampshire.

“Just throwing in another provider is not necessarily going to solve your problem,” said Dr. Kevin Wilson, of Milford, whose practice has given $136,000 of free or reduced care to patients.

“The bottom line is that access is not a work force issue in our view. It’s about many other factors from transportation and funding to the education of families about the importance of good oral health.”

This simmering controversy is about whether the Legislature should create a dental hygienist practitioner.

If adopted, NH would be only the third state the nation where someone other than a dentist can perform a wide range of services from filling cavities to pulling teeth that aren’t infected.

A broad coalition of advocates for children and the poor support Gilmour’s bill.

They point to surveys that show roughly half of the state’s dentists are enrolled in Medicaid, the health insurance program for the poor and disabled.

Only about 25 percent of all those dentists actively see Medicaid patients.

They further cite recent federal studies that confirm a shortage of dentists in the rural North Country and some small towns near Plymouth in Grafton County.

“Without enough dentists located where families need care, people have to travel further and take more time off work – something that is especially challenging for low-income families who often work multiple jobs,” Ellen Fineburg, executive director of the NH Children’s Alliance, wrote in an op-ed piece last month.

“New Hampshire can help solve this problem by expanding the types of professionals providing routine dental services to people, especially children, closer to where they live by passing SB 193.”

Opponents counter that more dentists have come to under-served areas and the unfilled need amounts to only five more dentists in these rural pockets of the state.

“All of us admit we still have a ways to go, but we don’t think this solution is going to help us in our state,” said Jim Williamson, executive director of the New Hampshire Dental Society.

“To address the access problem there are other critical factors that we’ve already been addressing.”

Many dentists will perform services for the low-income for free rather than deal with the low reimbursement and burdensome paperwork that comes with Medicaid, Williamson continued.

Both sides have data backing up their cause.

In June, the Pew Charitable Trusts ranked New Hampshire as third best in the country for access to child dental care, behind only Nebraska and New Jersey. Utah and Virginia were not scored in the study.

This followed a study a year earlier that rated New Hampshire’s program that brings dental services by vans directly to public schools as one of the nation’s top five.

Meanwhile, those advocating this dental reform point to results of a New England College poll from mid-July revealed 89 percent of those surveyed would support legalizing a dental hygiene practitioner in the state.

The scope of practice described in the poll – “fillings and cleanings” – was more narrowly defined, however, than this bill would allow.

On a related topic, 59 percent said access to dental care was a “major” or “moderate” problem while 41 percent said it was a “minor” or “no problem at all.”

Dentists and their supporters have criticized the change going statewide and not just to poorly served areas of the state, as Minnesota has done with its law.

Senator Gilmour said there’s no reason to limit the innovation.

“Why would you take a good model and isolate it geographically with an under-served population,” Gilmour asked rhetorically.

“If it works, you should be to use it anywhere and at the end of the day, the market will figure out where that happens.”

Williamson with the Dental Society also tried to debunk Gilmour’s comparison to a nurse practitioner.

This legislation would require a hygienist practitioner have at least three years of study after high school.

But a nurse practitioner typically has to attend at least six years of schooling after high school, Williamson noted.

Further, dentists routinely perform surgery on teeth and this bill would let a hygienist do that as well.

Yet in the medical field, nurse practitioners or advanced practice nurses aren’t permitted to perform any surgeries that medical doctors do, he continued.

“To equate the two, we don’t see how they can because they are not even close,” Williamson said.

Gilmour’s bill is pending in a State Senate committee. By the end of this year, the panel must make a recommendation on what the Senate should do with it in 2014.

“For those who say we’ve done enough already, I would challenge us not to stop but rather build on that success and continue to be creative,” Gilmour concluded.

“We know we have a system that cries for change in many arenas.”

Kevin Landrigan can reached at 321-7040 or klandrigan@nashua
telegraph.com. Also, follow Landrigan on Twitter (@Klandrigan).