The dentist who laid down his drill (copy)

Dentist Andrew Walls looks over the teeth of an 11-year-old patient at Advantage Dental Clinics in La Pine in 2016.

Oregon is facing a dental health epidemic, and a lack of access to care is at the root of the problem for many children, rural residents and low-income families.

Legislators will consider improving access to education and services in schools, as well as create licensing for a new type of practitioner who can complete many of the same tasks as a dentist, but at a lower cost.

In the House, the Oregon Community Foundation has partnered with state Rep. Cedric Hayden, R-Roseburg, and Rep. Alissa Keny-Guyer, D-Portland, to pass the Healthy Teeth, Bright Futures campaign. The program would direct Oregon school districts to include age-appropriate dental health instruction as part of their health education.

It would also create the Community Dental Health Coordinator Pilot Program under the Oregon Health Authority to bolster school dental health services.

According to a study published by the Oregon Health & Science University, 40% of Medicaid-enrolled children didn’t receive any dental services in 2018. Access to service varied between counties, and the study shows a 21% difference between Malheur and Columbia counties. They represent the highest and lowest percentages of children with no dental care.

The study also showed black children in Oregon have the least access with just 45% of Medicaid-enrolled kids receiving any dental services.

According to Melissa Freeman, the community foundation’s director of strategic projects, Oregon is struggling from an oral disease epidemic with 49% of children having a cavity by age 9. And two in every nine children have untreated cavities.

“Unfortunately, 17,000 children in Oregon have rampant decay as classified by the Oregon Health Authority, which means seven or more untreated cavities,” Freeman said.

Those numbers are even more dire among children of color, children in rural areas and of low income, according to Chris Coughlin, legislative director at nonprofit children’s advocacy group Children First for Oregon.

“There are still real barriers keeping families from getting the preventative dental care that kids need to be healthy and do well in school, and we know specifically that certain populations are impacted most,” Coughlin said.

The issue is important in the context of helping Oregon’s kids remain in school. According to the community foundation, dental pain is a leading cause of absenteeism for school children in Oregon and nationwide.

“Eating, sleeping, concentrating at school are all difficult with a cavity problem,” Freeman said.

Several years ago, the foundation started awarding grants for school-based dental health services. So far, 275 schools across 22 counties have benefited.

The foundation wants the expansion now to implement school-based dental health services in all Oregon schools.

The group began working with lawmakers like Hayden in September and have recruited support from more than two-dozen legislators.

Hayden worked in the 2019 session in an unsuccessful effort to expand oral health education.

“Rep. Hayden spent his professional career as a dentist before joining the Legislature and now sits as the vice chair of the House health care committee, so he has always been involved with health care bills and, specifically, dentistry since his first session in 2015,” said Austin Parrett, Hayden’s chief of staff. “There is lots of support, and we are not expecting any issues.”

In the Senate, Sen. Laurie Monnes-Anderson is shepherding her own bill to allow the Oregon Dentistry Board to issue dental therapy licenses and allow dental therapy education programs to be built throughout the state.

Dental therapists are midlevel practitioners, similar to a physician’s assistant in medicine. They provide a range of critical routine and preventative services such as oral evaluation and assessment, treatment plan formulation and nonsurgical extraction of diseased teeth.

The concept of dental therapy has been around for more than a hundred years in foreign countries such as New Zealand, and was first brought to the United States 15 years ago.

Two pilot programs in Oregon currently exist. One is administered by the Northwest Portland Area Indian Health Board. The other is based at Pacific University in Forest Grove and sponsored by Willamette Dental Group and the Ford Family Foundation.

Dr. Miranda Davis is a Washington dentist with the Puyallup Tribal Health Authority who helps oversee the native effort in Portland.

She believes the new licensing could give many Oregonians access to lower-cost dental health services, especially in rural areas.

According to Davis, dental therapists can meet most dental needs in small communities where residents otherwise have to drive hundreds of miles for care. She pointed to the success of the program started in Minnesota back in 2009. Minnesota has since licensed more than 100 dental therapists.

“It’s an efficient model of care where you have specially trained staff to complete these smaller tasks,” Davis said.

The urgency is that untreated dental problems can turn into emergency room visits. When a child or adult visits an emergency room for dental pain, treatment is often limited to prescribing opioids or antibiotics. Both legislative proposals are intended to curb such costly visits.

“Access and cost are extreme barriers to (dental health services),” Monnes-Anderson said. “These pilot programs are making a difference, and the tribal communities really want this because they’ve been very successful in their pilot programs.”

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