I am becoming increasingly involved with the American Student Dental Association (ASDA) as the year progresses. Oral Health Day at the Arizona State Capitol was the first political event I took part in as a dental student. I learned a lot about the legislative process at the state level and got to meet several state senators and representatives.
Today we spent much of our time discussing a state sponsored health care program called AHCCCS. At issue is a dental benefit that used to cover all adults in the state of Arizona who made less than a certain income. The benefit was limited to only residents under the age of 21 during the recession as a cost cutting measure to reign in the state budget.
The law of unintended consequences
Sadly however, cutting the dental benefit meant that many residents no longer had access to basic dental care. This proved disastrous for the health of thousands of Arizona residents, and it was also very expensive.
Cutting the benefit was expected to save the state several million dollars each year. Instead, ER admissions for dental-related treat and release visits increased by 29%. The charges for those visits spiked by a whopping 69%. And inpatient admissions due to oral health complications cost the state $20.7 million in just 2011 alone, a 40% increase from 2009!
Contributing to existing crises
Patients seen in the ER for dental ailments are often given an antibiotic and an opioid and then told to go home. The problem is, antibiotics will not stop a dental abscess. The abscess has to be drained, and it is possible that the tooth needs to be extracted. Also, the opioid crisis is on the verge of becoming a full pandemic if we are not more careful.
Futile treatment is unethical, and prescribing antibiotics when they alone will not treat the underlying infection is costly and it contributes to antibiotic resistance. Exposing patients to the potent addictive effects of opioids is unnecessary and harmful. Restoring AHCCCS would allow dentists to extract the patient’s tooth for a tiny fraction of the cost ($60) and does not contribute to antibiotic resistance or opioid addiction.
When common sense isn’t
You may think that the solution is a no-brainer. I certainly did! But more than one lawmaker pushed back and said that they can’t get behind more handouts. Even when we pointed out that the state is spending millions more to treat patients in the ER, they wouldn’t budge. This was my first taste of real politics. We were behind closed doors, face-to-face with politicians whose beliefs may not agree with our own.
One of the dentists who accompanied us had a masterful approach to handling the disagreement. He knew how to bridge the divide, find common ground, and relate with the lawmaker as though they were old friends. He didn’t worry as much about the facts presented on our flyer, or the statistics from our study. Instead, he talked around the issue gracefully, as if leading a dance. It was incredible to see him change one lawmaker’s mind without really talking much about the bill in question at all!
The governor supports our position and wants to restore the benefit. Hopefully the budget committee will realize that restoring it will save the state money.
Prenatal dental care
House Bill (HB-2242) is provides prenatal care to mothers on AHCCCS. Currently, AHCCCS covers over half of all live births in the state of Arizona. With so many women using the benefit, we believe that the state should offer prenatal dental care for expectant mothers.
Mothers with poor oral health are more likely to experience premature birth and miscarriage. Treating premature infants costs the state millions of dollars every year. It makes economic sense to prevent the far more costly and dangerous outcome of a premature birth by providing basic oral health care to mothers. Beyond economics, it is also the more humane and compassionate course of action.
The last thing I’ll talk about is dental therapists. The Pew Foundation has been working hard to bring dental therapists to the state of Arizona. These mid-level providers have traditionally obtained a 4.5 year Master’s degree in Minnesota. Here in Arizona they were proposing a program that would license dental therapists with only a couple of years of training post-high school.
It takes a lot of time to master the health sciences, let alone the clinical skills to become a competent dental practitioner. It would be better to incentivize more dentists to practice in rural areas with scholarships and/or loan repayment plans.
We reaffirmed our view that dental therapists would be counterproductive to providing good dental care to Arizona’s residents. A legislative committee voted against dental therapists 8-1 during a sunrise session this year. We know that the Pew Foundation will try to pass this bill again.
The argument that access to care is due to a dentist shortage is simply untrue. According to a recent report from the ADA, 27% of existing dentists are looking to add more patients. Improved funding for Medicaid, and reinstating AHCCCS dental coverage is a much better solution. At least that would allow patients to take advantage of what is already there – a pool of trained dentists ready to serve them.
ASDA affords students a lot of great opportunities. The National Leadership Conference in Washington D.C. happens at the end of March. There we will be able to speak to US Senators and Representatives in the U.S. Congress. One topic of discussion will almost certainly be skyrocketing tuition at professional schools across the nation. Many of us will be paying more than $400,000 to become dentists!
I think that being involved with ASDA and the ADA is important to protect our profession for future generations. Not everyone will agree with everything that these organizations do, but that’s fine. I didn’t like every meal my mother cooked, but if I didn’t eat it then I went hungry. In this time of rising inequality, financial hardship, and increasing debt, we have to stick together and find a way through it all.