As a longtime dentist practicing in Rutland and former president of the Vermont State Dental Society, I can attest that dentists work very hard to provide dental care to Vermonters. We are community-oriented health care providers and care deeply about our patients.
I compliment Sen. Bernie Sanders on his recent hearings to explore the oral health needs of Vermonters and on his efforts to expand federally qualified health centers (FQHC) nationally to complement the work of private practices and other primary care, mental health, and oral health providers. With federal funding support, FQHCs provide services within a defined geographic area to individuals, regardless of their ability to pay or health insurance status. Thus, they are an important component of the health care system.
I agree with Sen. Sanders that there are barriers to care that must be addressed. These public hearings provided a forum to identify some of the major barriers to oral health and highlighted the complexity of these issues. Individual behaviors (e.g., diet), self-care, prevention, education/awareness, and access to clinical care are all factors in oral health outcomes. A host of barriers prevent people from accessing comprehensive dental care and prevention, such as:
Financial (may or may not include insurance/benefits coverage), out-of-pocket costs.
Insufficient financial support of state/federal programs, especially for adult oral health care (for example, the $495 annual cap on adult Medicaid reimbursements; in 1989, 23 years ago, the cap was $500).
Lack of an established dental home.
Lack of understanding of the importance of oral health and its impact on overall health and wellness.
Lack of robust and consistent oral health awareness and prevention education (dental disease is a preventable disease).
Absence of community water fluoridation.
Cultural and language barriers.
Lack of transportation (often cited as the reason for missed appointments).
Lack of community health care navigators and services to help Vermonters problem-solve based on their unique situations and connect with dental practices and appropriate programs.
As a private oral health care provider, I have diligently been working on these problems for years.
For example, I, along with many Vermont dentists, volunteer on various committees, boards, and workgroups dedicated to these issues and solution development. We support dental hygienists in the Vermont Department of Health's Tooth Tutors program. In Rutland County, this program has been successful in assessing the oral health of Rutland's children and educating them about prevention. Tooth Tutors play a major role in referring children without a dental home to our dental practices for comprehensive dental preventative care and treatment.
The Head Start program also works to ensure that children have dental homes, and an early start for prevention and developing sound, lifelong oral hygiene habits.
In recent years, Vermont established a very aggressive dentist recruitment program to ensure that we have an adequate number of dentists appropriately distributed geographically around the state to deliver care.
These efforts and others, enable Vermont to lead the country in the oral health of children.
We have not stopped there.
This year, dentists have helped to draft and support legislation that would:
Enhance dental benefits for Medicaid-eligible pregnant women and mothers with children up to five years and address baby bottle tooth decay.
Increase access to oral health care by utilizing Community Dental Health Coordinators.
Expand community water fluoridation.
Address adult Medicaid reimbursement limitations.
These provisions and others are examples of the continuous efforts and advocacy by dentists to increase dental care access and improve the oral health of all Vermonters.
Dentists are oral health care leaders and recognize that there are barriers to care and will continue to work collectively and collaboratively to ensure that Vermonters have access to care. I am glad that this important issue is gaining attention and look forward to working closely with stakeholders to ensure that our neighbors, family and friends have their oral health needs addressed.
Dr. Judith M. Fisch works in Rutland.