New Mexico's biggest free dental clinic is scheduled this year for Farmington, Sept. 12-15. It's called the Mission of Mercy, run by the New Mexico Dental Foundation, the charitable affiliate of the New Mexico Dental Association.

This will be the third such event in New Mexico; the first was in Albuquerque in October 2010, the second in Las Cruces in March 2012. The Foundation reports that the past two events served 3,722 patients, provided more than $2.2 million in free dental treatment and involved 3,200 volunteers.

The outpouring of generosity, commendable though it is, is a drop in the bucket in meeting New Mexicans' needs for dental care. For some, the problem is economic; for others it's geography.

A recent report from the Pew Charitable Trusts says New Mexico has the fourth worst dentist shortage in the country. The report found 24.2 percent of residents live in underserved areas; five counties do not have a single practicing dentist (Guadalupe, Harding, Hidalgo, Mora and Union); three counties (Catron, De Baca and Quay) have only one dentist in the county.

The report noted – in case we needed more bad news – that 45.5 percent of New Mexico dentists are older than 55, implying they may be approaching retirement.

The New Mexico Department of Health says the ratio of dentists to population in this state is 1 to 3,297. The federal standard is 1 to 1,050.

The 2013 legislative session addressed the dental health problem with House Bill 17, which attempted to create a new midlevel of practice called a dental therapist. Not surprisingly, the bill was sponsored by Rep. Dennis Roch (R), whose district encompasses parts of Colfax, Curry, Harding, Quay, Roosevelt, San Miguel and Union counties. The Senate version was sponsored by Sen. Carlos Cisneros (D) of Questa, whose district also includes far-flung small communities.

The bill proposed to allow these therapists to perform procedures that now only dentists may perform. The advocates pointed to similar programs in Alaska and Minnesota. Health Action New Mexico, leading advocate for the bill, says on its web site, "Zero (is) the number of studies that have revealed problems with the quality of care given by dental therapists and other midlevel dental providers." In fairness, though, Minnesota's was the first and it's only been in existence since 2009.

The Dental Association opposed the bill. One dentist said to me, "Until you do the procedure, you can't tell whether it's going to be simple or complex." The Regulation and Licensing Department agreed, according to the HB17 Fiscal Impact Report. The report expressed a number of concerns with the proposed scope of practice in relation to the amount of education required. The Dental Association supported an alternative, HB367, which proposed a pilot project using therapists under a dentist's supervision.

Dr. Larry Lubar, a former president of the New Mexico Dental Association and leading organizer of the first New Mexico Mission of Mercy, recently retired, says the best solution would be for small communities to build dental clinics (some already have them) and work out arrangements for dentists to ride circuit within a region. It is well understood that the small communities cannot support a full-time dentist. Lubar says the circuit-rider option might be attractive to young dentists who graduate dental school with six-figure student debt, especially if financial incentives are added to sweeten the deal. The communities within a region would have to coordinate and, of course, figure out who pays for the extra incentives. They are beyond the scope of Medicaid.

The argument will continue. Meanwhile, unknown numbers of low-income and rural New Mexicans will go to bed tonight with toothaches for which they can't access treatment, and we can expect long lines in Farmington on Sept. 12.

 

Merilee Dannemann is an independent public policy professional in Albuquerque. Contact Merilee Dannemann through triplespacedagain.com.