Our Opinion: A laudable compromise on dental health care bill

There is a consensus among state legislators and the state's dentists that a way to provide dental care to the underserved must be provided. It appeared however, that disagreements about how to provide this care could foil this effort in spite of that consensus. Happily, that is not the case, and the bill that resulted is a tribute to that all-but-forgotten art of compromise.

Earlier this week, a bill crafted in the House by state Representative Smitty Pignatelli, a Lenox Democrat, and combined with a Senate version, was reported favorably out of the Joint Committee on Public Health with the full endorsement of the Massachusetts Dental Society (MDS). The bill will not only benefit adults and children in need of dental care but should lower health care costs by encouraging prevention and discouraging costly treatment in emergency rooms.

Representative Pignatelli has from the start advocated for the creation of a new position of dental hygiene practitioner, a position beyond that of dental hygienist who would perform routine procedures, freeing dentists for more complex procedures. This person would be able to provide care in schools, nursing homes and other community settings, reaching people who otherwise may have fallen through the cracks. The MDS worried that this practitioner would not be adequately trained and argued against any new position that would not be directly supervised by a dentist. The two sides could have retreated to their bunkers Washington D.C. style and nothing would have been accomplished.

Happily, all parties kept working toward a compromise and achieved one. A mid-level position of dental therapist will be created and therapists will be required to have both a bachelor's and master's degree and pass a clinical examination. After a period of training, the dental therapist will be allowed to perform many procedures, such as placing space maintainers and fabricating mouthguards, under "general supervision" of a dentist, which Representative Pignatelli regarded as "imperative" for the plan to reach as many people, from children to the elderly, as possible. Direct supervision would be required for more advanced procedures, such as extractions.

The bill mandates that all dental therapists include MassHealth beneficiaries as at least half of their total patient base, guaranteeing care for many who are not receiving it.

"All good legislation means compromise," said Representative Pignatelli in a statement, crediting Representative Kate Hogan, chairwoman of the Public Health Committee, state Senator Harriette Chandler, who began sponsoring the Senate version before she became Senate president, and the elected members of the Dental Society for overcoming obstacles to find that compromise.

This compromise between lawmakers and members of the medical profession shows that it is possible to overcome initial differences in a way that not only improves health care for many but reduces health care costs by addressing prevention before problems that are expensive to treat emerge. If it can be done in Boston, maybe it can be done in Washington as well.


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