Letter to the Editor: Massachusetts Dental Society Bill Seeks to Make Dental Care More Accessible and Affordable

A recent article in the Jamaica Plain News regarding oral health care for underserved populations (“Councilor O’Malley Supports State Bills to Improve Oral Health Care for Those in Need,” August 3, 2017) raises an important question: Why don’t underserved populations in urban communities like Jamaica Plain and rural areas like Western Massachusetts receive preventive and restorative dental treatment that would improve their overall health?

A substantial volume of research tells us that dental care for low-income and elderly populations is disproportionately influenced by poverty, geography, lower levels of oral health education, language or cultural barriers, and even fear of dental care.

That’s why the Massachusetts Dental Society (MDS) has a bill pending before the legislature that not only seeks to make dental care more accessible and affordable, it also offers the comprehensive approach that Massachusetts needs if it wants to successfully provide basic dental care to its neediest citizens.

The MDS bill introduces a new mid-level oral health care provider to increase access to care. It also includes several measures to promote routine preventive care, increase awareness about the scientifically-proven benefits of community water fluoridation, and help people connect with caregivers in their local communities. The legislation would require a new staff position at the Department of Public Health to oversee coordination of routine preventive care, including guidance for people who have difficulty scheduling and keeping dental appointments. It will also require oral health screenings of every child prior to kindergarten.

Unfortunately, the legislation supported by Councilor O’Malley and the Boston City Council only seeks to create a new mid-level dental provider license that will not, by itself, solve the problem of oral health care for underserved populations. In fact, the recent creation of a Public Health Dental Hygienist (PHDH) license in 2009 made no difference in addressing a well-known public health crisis. The goal behind the PHDH initiative was increased access for routine preventive care, especially for children in communities like Jamaica Plain. At the time, a survey touted by supporters of the new certification claimed 30 percent of licensed hygienists in the state—more than 2,000 providers—were likely to become PHDHs by 2016.

As of 2014, just 33 PHDHs were licensed to provide services in Massachusetts.

Moreover, despite claims by The Pew Charitable Trusts and other advocates that mid-level dental providers significantly reduce the “access gap” for underserved populations, there is no peer-reviewed evidence that mid-level providers substantially increase access to care. The one operational mid-level program in Minnesota has raised serious questions about its effectiveness. Minnesota, which introduced mid-level dental therapists in 2009, is instructive. Today, approximately 60 people are licensed to practice. Officials expected to produce savings as a result of the mid-level program, but Minnesota’s program has yet to deliver: the state continues to report a high rate of Medicaid patients who seek dental care in the emergency room. Researchers at the Mayo Clinic in Rochester, Minnesota and at St. Louis University independently reviewed a recent Minnesota study that claimed significant benefits associated with mid-level dental providers. Both analyses found fundamental flaws in the study, including overestimated employment rates for mid-level providers due to double or triple-counting of therapists.

Unfortunately, the introduction of mid-level dental providers cannot reduce the cost of dental care for underserved populations. Medicaid reimbursement rates are exactly the same for dentists and dental therapists.

It’s also important to note that the legislation supported by Councilor O’Malley and the Boston City Council does not provide thorough safeguards for public safety because it would allow mid-level therapists—including those with as little as three years of post-high school education— to perform irreversible procedures such as drilling and extraction of teeth. A recent statewide survey of registered Massachusetts voters conducted by the MassInc Polling Group revealed that 73 percent of respondents did not feel comfortable allowing mid-level dental practitioners to perform irreversible procedures without direct supervision from a dentist.

The survey results confirmed what dentists in Massachusetts have heard directly from patients—future mid-level dental professionals must be directly supervised when performing irreversible procedures. There is a substantial volume of Massachusetts residents with complex oral health care needs, particularly underserved populations, so direct supervision by a licensed dentist is extremely important.

To effectively treat this patient population, it is essential that mid-level dental practitioners have the highest possible level of education, training and supervision. The MDS bill would ensure appropriate treatment by requiring mid-level dental professionals to attain the exact same credentialing standards for licensure requirements set forth for physician assistants and nurse practitioners. The MDS legislation also seeks to ensure that newly licensed mid-level practitioners treat underserved populations by requiring that they only work in areas of the state that are officially designated as dental practice shortage areas or in federally qualified health centers.

The MDS firmly believes that Massachusetts has a real opportunity to address a longstanding oral health care problem. But this can only happen by broadening the focus from an unproven mid-level provider “solution” to a wide-ranging law that addresses the root causes of dental care gaps in the Commonwealth.

Dr. David Lustbader is the president of the Massachusetts Dental Society.

  • There is no credible evidence that taking fluoride in water has ever prevented a single dental cavity. The forced-fluoridation fanatics often try to claim that the low rates of dental caries in western European countries which do not have artificially fluoridated public water supplies are due to naturally occurring fluoride in water, or some other kind of artificial fluoridation such as salt fluoridation. They are lying. They also rely on studies which do not measure individual fluoride exposure, are not randomised, are not blinded, are not clinical trials, do not properly account for confounding factors, are highly prone to systematic error, and are typically funded by corporations such as Colgate-Palmolive.


    • McKenzie Delta

      There is credible evidence of safety and effectiveness of community water fluoridation. From the Centres for Disease Control in Atlanta: “Many research studies have proven the safety and benefits of fluoride. For 70 years, people in the United States have benefited from drinking water with fluoride, leading to better dental health.

      Drinking fluoridated water keeps teeth strong and reduces cavities (also called tooth decay) by about 25% in children and adults. By preventing cavities, community water fluoridation has been shown to save money for families and for the US health care system.

      Oral health in the United States is much better today than it was many years ago. But cavities are still one of the most common chronic diseases of childhood. Community water fluoridation is the most cost-effective way to deliver fluoride to people of all ages, education levels, and income levels who live in a community.”

      • James Reeves

        Here are reports by four dentists on the dangers of fluoride. There are many more just like them.

        “The evidence that fluoride is more harmful than beneficial is now overwhelming… fluoride may be destroying our bones, our teeth, and our overall health.” – Dr. Hardy Limeback BSc, PhD, DDS, former President of Canadian Association of Dental Research, former head of Preventative Dentistry at the Univ of Toronto, 2006.

        National Research Council panelist (2007)
        “If teeth are the only reason why you like fluoride, you better come up with a different reason. Fluoride hurts teeth, bones, brain, nerves, etc.” – Michael Taras, DMD, FAGD (2015)

        “When I looked at the research, it was like a knee in the gut. My bias was I thought (fluoridation) was safe and effective because I had not looked at the research.” – Dr. Bill Osmunson, DDS, MPH (2016)

        “Fluorides make the germs in the mouth sick, and they’ll make the kid sick, too.” – Dr. David Kennedy DDS MPH, 3rd generation dentist and past president of IAOMT (2016)

        • McKenzie Delta

          Some physicians don’t recommend vaccination either. Such decisions do not make them heroes but rather failures to read and absorb the significance of the peer reviewed evidence and harmful to their patients.

          • James Reeves

            The typical reaction when serious scientists differ is to quit adding the toxic waste fluoride until a resolution is reached. Tradition and big profits in selling it will not allow it this time.

            Of course, fluoride is the only drug forced on EVERYONE..
            Yet, yet, there is not one scientific study to prove fluoride (hydrofluorosilicic acid) is safe and effective for all members of the public, fetuses, infants, children, sensitive, kidney problems (pre-diabetics & diabetics), elderly, etc.

            This is immoral and should be illegal.

          • McKenzie Delta

            Serious scientists are those who can convince the major public health bodies of the quality of their evidence, such as the Centres for Disease Control, and the American Dental Association (which would benefit from lack of fluoridation because lack of fluoridation creates more business from dentists). Fluoridation is safe and effective. Just as in sports, there are good players and not so good.

          • James Reeves

            Politics and big money, not science, keeps fluoridation afloat.

            Follow the money. Industries profit $200 million annually by selling their toxic waste fluoride to communities

            The 70 year old science of forced fluoridation is simply wrong and dangerous, but other big money schemes with the wrong science hung on for years, like tobacco, DDT, lead in paint and gasoline, Red Dye No. 40, and asbestos.

            We eventually learned the truth in each case.
            Because something has been used for years is no reason to keep using it after evidence of its potential harm to people, animals, or the environment.

          • McKenzie Delta

            There is more money in keeping fluoride out of the water. Dentists will have more work. Fluoridation is safe and effective. It is supported by all major public health organizations including the World Health Organization and the United States Public Health service. https://www.cdc.gov/fluoridation/faqs/public-service-recommendations.html

          • James Reeves

            It is instructive that only 5% of the world and only 3% of Europe fluoridates water (U.S. 74%). China and Japan rejected it many years ago.

            The fluoride issue is very simple.
            Remove the fluoride from drinking water and put as much as you wish in your own glass of water.
            The rest of us then won’t be forced to consume it. Everyone will be happy with freedom of choice.

          • McKenzie Delta

            You don’t live in the community in Massachusetts where this newspaper is. Your glass of water is elsewhere. You write this stuff no matter what community you hurt. Real people suffer from tooth decay. Let the people of Massachusetts make their own decisions based on peer reviewed and assessed evidence presented by qualified Massachusetts public health officials, not people who have nothing more to do than write comments on small newspaper fori.

          • James Reeves

            I consider the truth a public service.
            For the people, I leave one more comment which was published recently.

            “Where is the physician who will impose a lifelong prescription for an (FDA unapproved) untested toxic substance (fluoride), without proven clinical benefit, on a patient he/she has never met, interviewed or examined and without an opportunity to treat side effects?”

            “Such dubious behavior would extract appropriate censure from the licensing authority of the physician involved, on the basis that it is unscientific, unscrupulous, unethical, and therefore unacceptable.”

          • McKenzie Delta

            This man, James Reeve, is trying to scare you with outrageous words such as “toxic”. Salt is toxic if you take too much of it. So is water. People reading these pages should refer to the Centres for Disease Control recommendations written by people qualified to assess complicated peer reviewed articles. The Centres for Disease Control along with legions of public health agencies throughout the world assert that fluoridation is safe and effective when monitored to remain in the required range of parts per million.

          • James Reeves

            CDC? Oh you mean the which covers up the truth such as with the MMR vaccine?
            You can read about it in many places like this.

            Vaccine bombshell: CDC whistleblower reveals cover-up linking MMR vaccines to autism in African-Americans.


          • Marty

            umm, that last comment is suspect…why only African Americans with autism?

          • James Reeves

            Well, the research was conducted about the MMR vaccine on black children.

            Additional research should be conducted for all children. Very little research has occurred on any vaccine compared to all other drugs on the market.

          • David Fierstien

            What a laugh. Give us something else from Natural News, James.

          • James Reeves

            Actually promoters of fluoride may laugh, but EVERYOVE being forced to consume this toxic waste chemical, hydrofluorosilicic acid, without consent can’t laugh much due to serious health effects.

            Politics and big money, not science, keeps fluoridation afloat

          • David Fierstien

            Irrelevant to the point about your nonsensical source, “Natural News.”

            From the link: “I still don’t know whether Adams really and truly believes in the nonsense he promotes. I really don’t and still can’t tell. For example, did Adams relocate to Ecuador because he really believes in the “natural” lifestyle or did he do it to escape those pesky laws in the U.S. that frown on selling unproven remedies. I do know, however, that Adams appears to have an utter contempt for his own readers, as evidenced by his repeating outrageous straw men such as the claim that SBM says that susceptibility to disease is totally random and that there’s nothing anyone can do about it and bizarre falsehoods like his claim in the Vaccine Zombie video above that vaccines can make your testicles fall off.”

          • James Reeves

            Why try to deflect the truth.
            As I said, the CDC corruption was widely reported in many, many places.

            Don’t have a fit. Just go read other reports instead of the ad hominem attacks.

          • David Fierstien

            Yeah, right. It was reported in “many places.” That’s why you chose the “most credible source” you could find to regurgitate it.

            The next time you contract Ebola, I expect you to refuse help from all “corrupt sources.”

          • Marty

            I just followed your link – if you are getting your medical news from this website Mr. Reeves, I suggest you try others and try to verify what is printed there. I am not putting down your concern, however, but personally, I wish your passion and efforts would go towards alleviating the assault on our environment which is the biggest culprit for many of what ails us today.

          • James Reeves

            Thanks Marty. Actually the news of CDC corruption report was spread many, many places.

            Regarding the environment, the EPA and international treaties make it illegal for any company to dump their toxic waste fluoride (from smokestacks) into the environment or the oceans. So, they make hugh profits selling it to communities for drinking water. But people drink only 1% of the water they use and 99% go directly into the environment. Your water manager can confirm this. It makes no rational sense.

      • The CDC is lying. All they have is a bunch of very low quality studies which are really just paid advertising. All the fluoridationists have proven is their own corruption and incompetence.

  • https://forcedfluoridationfreedomfighters.com/a-preliminary-investigation-into-fluoride-accumulation-in-bone/

    Anyone who thinks that delivering any medication by dumping it into public water supplies is scientific is scientifically illiterate. On top of that, fluoride is highly toxic and a cumulative poison, like lead, arsenic, and mercury. I have asked many forced-fluoridation fanatics to tell me how much accumulated fluoride in the body they think is safe. So far not a single one of them has been able to answer the question. It is unlikely to just be a coincidence that the US, Australia, and Ireland, which have had high rates of forced-fluoridation for decades, also have high rates of joint problems, and poor health outcomes in general.

    • McKenzie Delta

      Dan Germouse, Danger Mouse lives in Australia. Exaggerations and false claims are unhelpful and immoral. Salt and water are highly toxic in very high doses. Community water fluoridation in the recommended dose and monitored is safe and effective in preventing tooth decay.

      • That isn’t what “highly toxic” means, airhead.

  • James Reeves

    It is immoral and unethical to force fluoride or any drug on all citizens without their consent.

    A doctor or dentist cannot force that on ANYONE. They would lose their license to practice if they did.

    It should be illegal for the government to force it on EVERYONE without consent.

    Use as much fluoride in your own glass of water as you like. Just leave the rest of us out of being forced to consume it. It must be a matter of choice and informed consent.

    • McKenzie Delta

      It is ethical for democratically elected government to regulate in the best of interests of its citizens especially its most vulnerable. This is how helmet and seatbelt laws were enacted despite opposition to alleged restrictions on liberty.

      • James Reeves

        You make a good point, but those ae quite different from forcing a drug on EVERYONE. It is illegal for a doctor or dentist to do that.

        One serious problem is that there is no control over the dose. Some drink a glass or two of water and some may drink seven or eight glasses. No professional would ever prescribe a drug in this fashion.

        Observe that 95% of the world and 97% of Europe rejects fluoridation:

        • McKenzie Delta

          No one eats a box of salt a day to poison themselves with salt and no one drinks three swimming pools of water every day to poison themselves with fluoride. Community water fluoridation is safe and effective in the recommended dose. In Europe, the countries of Ireland and some regions in Spain and the UK currently add fluoride to drinking water, at levels ranging from 0.2 to 1.2 mg/L. There can be large variation in the levels of fluoride in natural drinking water between and within countries. In Ireland, for example, levels vary between 0.01 parts per million (ppm), or mg/L and 5.8 ppm, in Finland between 0.1 and 3.0 mg/L and in Germany between 0.1 and 1.1 mg/L.

          • James Reeves

            Some say fluoride helps CHILDREN’S teeth as they form. That is certainly questionable, but:
            It is important to ask — exactly why should an ADULT be sentenced to take this toxic chemical, fluoride, in every glass of water every day of life?

            Fluoridation results in slow poisoning over a lifetime which causes premature ageing, thyroid damage, dental fluorosis, lowered IQ, ADHD, brittle bones (broken hips & arthritis), kidney damage, cancer and other health dangers.
            Read this excellent book, “The Case Against Fluoride” authored by three scientists, one an M.D. It contains over 1200 scientific references, over 80 pages.

            So, while 74% of the U.S. is forced to drink fluoridate water, only 5% of the world and only 3% of Europe fluoridate their water.

          • McKenzie Delta

            Community water fluoridation is safe and effective. It benefits children and adults. Among adults, it benefits in particular seniors whose salivary production and manual dexterity decline with age. People over 80 are at high risk of dementia which can seriously affect the ability to care for their teeth. Fluoridation as the recommended amount is beneficial, not toxic, not slow poison but about promoting and preserving the health of populations. Some individuals will always focus only on themselves; population health is about everyone.

          • James Reeves

            There are no scientific studies that show fluoride is safe or effective for anyone.
            There are no studies that shows fluoride has any effectiveness for adults.

            Read this excellent book , “The Case Against Fluoride,” authored by three scientists, one an M.D. It contains over 1200 scientific references (over 80 pages), showing that fluoride results in slow poisoning over a lifetime.
            In it you will see:

            Over 300 recent studies that show the use of fluoride is (may be) bad for humans.

            Over 100 studies show prolonged use can cause brain damage (in animals).

            Over 50 human studies linking moderately high exposure to fluoride with reduced intelligence.
            45 animal studies show that mice/rats that ingest fluoride have an impaired capacity to learn/remember.

            3 human studies have linked fluoride exposure with impaired fetal brain development.

            Etc., etc.

          • McKenzie Delta

            There are always studies and studies. Some take place in China where ground water is contaminated with industrial toxins. If you are so certain of the quality of these studies, then you should attempt to be hired the Centres of Disease Control with excellent health sciences researchers including epidemiologists. Play in the big leagues with serious people who do serious work all day long. They don’t have time to be writing on every community newspapers’ site that public health officials don’t know what they are doing. The role that you and Danger Mouse and others are playing is the equivalent of throwing beer cans from the stands at the major league players.

  • McKenzie Delta

    Fluoridation is safe and effective. Fluoridation is a public policy matter to be decided by citizens of the Commonwealth of Massachusetts in consultation with their public health officials, who are well trained to assess the safety and efficacy of community water fluoridation, one of the greatest public health advances of the 20th Century. Children and seniors suffer most from lack of fluoridation. The already vulnerable are hardest hit by dental infection and decay that can be prevented by safe and effective water fluoridation.

  • GoatWatch

    Why are we so concerned with the fluoride in the water when the government is pumping fertilizer into the grass seeds to turn goats gay???

    It’s all part of their anti-Castro blaaaaaack flag operation to pull a reverse-Bay of Pigs. If the goats stop procreating, the grass will get taller and taller, allowing insurgents to sneak into El Oriental and steal all the pork needed for those tasty Cuban sandwiches. Next thing you know, everyone is eating at Clover and we’re all vegetarians, growing weaker and weaker until we have no energy left to fight.