Anthony NM resident Maria Alvarez's insurance doesn't cover the dental care she needs. So she gets relief from her dental health issues using a home pain relief remedy- Cooking cloves soaked in water.
By SIMON THOMPSON of krwg.org
New Mexico has the third worst dental care professional shortage in the nation following Mississippi and Louisiana. Some advocates are pushing the state to allow dental therapists to perform basic procedures now done by dentists. While this could improve access to dental care some dentists say it would risk safety and the quality of care.
According to 2012 Bloomberg data New Mexico has the third worst dental care professional shortage in the nation following Mississippi and Louisiana. Almost 40 percent of New Mexicans live in a Dental Desert; an area where there is a shortage of dental health care professionals. Some advocates are pushing the state to allow dental therapists to perform basic procedures now done by dentists. While this could improve access to dental care some dentists say it would risk safety and the quality of care.
Every morning after Maria Alvarez flosses and brushes her teeth- she dulls the pain of the two cavity ridden molars throbbing on each side of her mouth with cooking cloves she soaks in water- she says it is an old Mexican remedy she learned in Chihuahua, before she moved to Anthony New Mexico.
“It is a small herb that serves like an anesthetic. So if you have pain you place it on the molar that has a hole or and it stays there and then you bite the clove when you chew it and it starts too anesethize that place and it will take the pain away” Alvarez said
Alvarez hasn’t always had to resort to old Mexican remedies to deal with tooth pain that keeps her awake at night and aches through her shifts at work. Alvarez, like many New Mexicans living near the border, used to cross into Juarez with her two sons and husband to get dental work done.
“It is better to go to Juarez. Because over here I don’t have enough money for the consultation“ Alvarez said.
But the drug war that engulfed Juarez and much of the state of Chihuahua took the lives of a number of Alvarez’s family and friends- and she doesn’t ever want to go back or relive the suffering- she says the tales of her friends being attacked and threatened, even when they were just there for dental work- are still on her mind.
“They went to the dentists and the violence entered the place where they and they assaulted some people, they were scared and threw themselves on the ground and I’m scared, that’s why I don’t go to Juarez” Alavaerez said.
Since the Affordable Care Act went into effect Alvarez’s two sons been able to access better dental treatment. But as an adult Alvarez says her insurance doesn’t cover enough of the cost for her to go to a dentist in New Mexico.
Health Action New Mexico policy director Pam Blackwell says close to 40% of New Mexicans are living in dental health care professional shortage areas or “dental deserts”. Where basic preventive care is less accessible and basic dental issues are more likely to turn into major health issues like heart diseases.
“We have absolutely an oral health crisis" Blackwell said.
While New Mexico already has dental hygienists a dental therapists program would be license to perform other basic procedures.
“They would be able to fill cavities, they would be able to do basic extraction, they would be able to take radiographs and also really diagnose within a dental therapists scope of practice, so it is really routine in basic care” Blackwell said.
President elect of the New Mexico Dental Association Dentist Dr. Michael Law is concerned about some of the procedures dental therapists would be able to use on patients after 24 months of training without direct supervision.
“A dentist doesn’t even have to be in the same area for them to be able to perform things like surgery it is just dangerous! If something were to go wrong with that surgery and they don’t know how to handle it, I am 200 miles away from them” Law said.
A 2014 report by the Minnesota legislature on that state’s program found that
“Dentist therapists appear to be practicing safely, and clinics reported high patient satisfaction with dental therapist services”
He says a better way to improve access and affordability would be to raise the state Medicaid reimbursement. Currently less than half of New Mexico dentists are taking patients on Medicaid.
“The reason I do not is purely and simply because the reimbursement is so poor, we couldn’t function. I mean we couldn’t do what we do every day on that. Now if they were to raise it and reevaluate it and possibly be able to start accepting it and providing care for those patients” Law said.
“It is turf and unfortunately what happens in these turf arguments is that consumers are forgotte, patients are forgotten and those communities who are underserved are forgotten” Blackwell saud
According to the 2014 Minnesota state report
"Clinics employing dental therapists are seeing more new patients that are largely from underserved communities."
But would dental therapists actually improve access and lower the cost of dental care for underserved patients in New Mexico like Maria Alvarez?
Potentially, but not necessarily. Karen Hall is a spokesperson for La Clinica De Familia; a non profit provider of dental care to low income and Medicaid patients. Hall says adding dental therapists would NOT lower the per procedure cost to patients. But the savings on lower salaries for dental therapists could increase access. More patients could be seen with shorter wait times, longer hours and better facilities.
Alvarez says lower income patients like her need more options. La Clinica de Familia is the only dental clinic in the Anthony area that takes Medicaid patients. The clinic also adjusts its fees based on income for patients who do not have insurance. But Alvarez says she became concerned about the clinic following an infection scare in 2013 the clinic told KRWG it was resolved and is no longer an issue. Still Alvarez says she is going to just keep using the cloves and water while she looks for other options.
“I need the to get the tooth pulled, but it helps and I feel better right now” she said
To expand care for patients like Alvarez advocates for expanding the practice of dental therapists have attempted to pass bills in the New Mexico legislature during the last five sessions. This year the House approved the legislation but the bill died in the Senate.
A note from HANM's Executive Director, Barbara Webber: Dental therapy is not a profession in its infancy. Dental therapists have been practicing for over 90 years in 53 countries, including Canada, Britain, etc. They have been practicing for almost 10 years in Alaska serving over 42,000 persons who previously did not have access to services.