Collaborative focuses on equity in  oral health services 

By Amy Harris 

“Oral health equity is when each and every person in our community has access to optimal oral health.”  — Rep. Deqa Dhalac, Co-Founder, CCCS 

Good oral health is a critical part of overall health, yet significant barriers keep immigrants and other BIPOC people away from the dentist’s chair in Maine. So two years ago, Cross-Cultural Community Services of Maine (CCCS) founded the Oral Health Equity Collaborative (OHEC) to strengthen the relationship between oral health providers and underserved communities. 

This year the collaborative sponsored Maine’s first-ever Oral Health Equity Conference, which brought together oral health providers, advocates, community members, and policymakers to conceptualize the future of oral health in Maine. The focus of the conference was on equitable access. 

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OHEC partner organizations include the city of Portland, Mainely Teeth, Maine Access Immigrant Network, Community Dental, Greater Portland Health, Children’s Oral Health Network of Maine, the Oral Health Program of the Maine Center for Disease Control and Prevention, University of New England College of Dental Medicine, and Cumberland County Public Health Department. 

In 2022, MaineCare coverage expanded to include comprehensive preventative, diagnostic, and restorative dental services (such as dentures and fillings) for adults ages 21 and over. However, expanded access alone has not proven enough to reduce barriers to care.   

Utilization data from MaineCare’s March 2024 data report indicate that only 11.5 percent of 246,645 eligible adults had received at least one dental care service in the previous 12 months. Courtney Pladsen, MaineCare’s Medical Director, noted that “coverage in and of itself does not mean access.” 

Among the barriers to care is a lack of training on the part of providers. Data gathered by OHEC in focus groups and surveys indicate that only half of surveyed providers had participated in formal cultural sensitivity training, or training in working with BIPOC, immigrant, or LGBTQ+ communities. 

Data indicates that perceived attitudes of practitioners toward clients whose insurance plan is MaineCare can cause some people to avoid going to the dentist. At the conference, CCCS Co-Founder Regina Phillips shared data from OHEC’s inaugural Oral Health Equity Report which revealed that 39 percent of respondents on MaineCare believe they were treated differently because they had MaineCare. 

Kathleen Miller, a community health worker with Presente! Maine, said that cultural and language barriers contribute to oral health inequities among the Latinx population in Maine. For example, she said some women avoid public transportation because they are usually the only Spanish speakers on public buses, and they feel unwelcome there. They also feel unwelcome at healthcare facilities, including dental clinics, because either staff don’t speak their language or interpreters aren’t readily available. 

According to Liz Kovarsky, CCCS’s Health Equity Program Coordinator, an equitable oral health infrastructure in Maine would mean that everyone eligible for MaineCare realizes that their coverage includes dental care; that there are enough dental providers who accept MaineCare to serve everyone eligible; and that clients have transportation, adequate child care, and any other accommodations necessary to make it possible for them to access oral healthcare. 

Conference panelists and speakers called for a community-driven approach to oral health equity, saying that expansion of MaineCare alone will not result in a more equitable system. Speakers Liz Blackwell-Moore (Cumberland County Public Health), Morgan Hynd (The Bingham Program), Katelyn Christianson (Health Program Manager, Maine CDC Oral Health Program), Becca Matusovich (Executive Director, Maine’s Children’s Oral Health Network), Courtney Pladsen (MaineCare Medical Director), and Kathy Kilrain del Rio (Maine Equal Justice Partners) all called for a community-driven campaign focused on inclusion and collaboration. 

Panelists reflected that “dental trauma” – negative experiences at the dentist – can lead to people avoiding routine dental care that might prevent expensive and potentially more painful emergency dental procedures later. Periodontitis, or gum disease, is a chronic disease that worsens if not treated and causes mouth and gum pain, impacting people’s overall quality of life. Dental trauma also results from the stigma people with poor dentition (so-called “bad teeth”) endure. Reports indicate that it is harder to get a job if candidates have poor dentition.