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The home for VPR's coverage of health and health industry issues affecting the state of Vermont.

Albright: Dental Woes

When I was a little girl living in Pennsylvania, my dentist, Dr. Miller, was a curmudgeon. If he happened to spot you in the local diner about to stick your fork into a piece of pie, he would whisk away the dessert plate and replace it with a piece of fruit. It cost, as I recall, four dollars to have your teeth cleaned by his very thorough assistant, Miss Castleberry. She always ended the appointment by showing you a film strip featuring an x-ray of a horse’s mouth chewing on an apple. As the equine teeth rocked up and down, you could actually see them get cleaner, scrubbed by apple skin and pulp - a natural toothbrush. She also toured classrooms with a giant toothbrush and chompers, to demonstrate home hygiene.

I still brush often and eat a lot of apples, and that’s paid off. But going to the dentist has changed, in good ways and bad. Dentists have technology and knowledge they never had before, and that can prevent and limit decay. But the cost of good dental health is therefore going up. Just a simple exam is so pricey these days that you really need dental insurance, which in Vermont is likely to be Northeast Delta Dental. But a growing number of dentists are dropping out of the network, saying that reimbursements are too low. So my dental insurance covers only a portion of the cost of even a basic exam. I can only assume that the insurance executives who pull in hefty salaries can afford to pay that difference out of pocket.

If I were on Medicaid, it would be even more difficult to find a dentist in Vermont willing to submit my insurance claim. 85 percent of Vermont dentists are enrolled as Medicaid providers, but only about 29 percent bill the program to any significant degree. Few are accepting new Medicaid patients, saying that reimbursements from the feds are too low. Add to that a shortage of dentists practicing in rural Vermont, and it’s no surprise that emergency rooms are seeing more and more dental crises.

In a way, I’m glad Dr. Miller isn’t around to witness all this. He died in his sleep many years ago - leaving, by the way, his dentures in a dish. That must be why he was a crusader for strong teeth. Legislators are considering a bill that would license dental therapists, to make basic dental care more accessible and affordable. I think Dr. Miller would be all for that. And I am sure his assistant, the formidable Miss Castleberry, would be, too.