July 06, 2008--Albuquerque Journal--D'Val Westphal---It's not as universally painful as high prices at the pump. And it's not as high-profile as universal health care coverage. But the painfully high cost of dental care, and the even higher cost of not getting it, will be front and center during the next session of the New Mexico Legislature. At least, that's the plan of the New Mexico Dental Association. The group's “Five Points to a Brighter Smile” legislative package covers prevention, education, cost and patient rights. If you've got dental insurance or are blessed with healthy teeth and gums and think it doesn't affect you, think again. Because it takes dental care to promote dental health. Not all patients have a dentist in their area. Dental care is expensive. Not all caregivers are created equal under dental insurance policies. And dental problems can turn into medical emergencies, run up life-changing debt and have a negative effect on everything from an individual's productivity to a hospital's bottom line. The association's package starts by tackling dental care early. It proposes legislation that ensures every child visits a dentist before they start school to ward off problems early and start a practice of good oral hygiene. The plan does include an opt-out provision for parents who can't/don't want to take their kid to the dentist. Step two aims to get more dentists and dental hygienists practicing in New Mexico, especially in underserved, rural areas. It would increase educational grants, encourage dental schools to recruit students from rural New Mexico, could require more recipients to practice in rural areas and provide incentives to do so and would encourage dentists to fully utilize hygienists in their practices. Dr. Thomas Schripsema says the state needs “more incentives to bring people in and stay.” Those could include state or community partnerships that help dentists set up shop or defray equipment costs and loan forgiveness for buying or establishing a practice. Step three would remove the state's gross-receipts tax on dental and medical care to help bring the cost to patients down. Mark Moores, the association's executive director, says surrounding states don't charge sales tax on those services and HMOs here are already exempted. Schripsema says the removal could be phased in to mitigate the $14.7 million impact on the state's general fund. Step four would establish a patients' bill of rights simplifying dental insurance benefits for all New Mexicans by dropping the tiered approach that restricts which providers patients can see. It would allow patients to see the dentist of their choosing, require provider networks to include dentists near the insured, provide the full, allowable benefit no matter which dentist a patient chooses, and clearly explain what's not covered. Step five would increase the Medicaid reimbursement for preventive dental care so treatment is given before small problems become major health and financial crises. The NMDA will be on a road show of sorts in the coming months, promoting the importance of dental care and the legislative agenda. Both Moores and Schripsema agree the effects of little or no dental care can be seen every day. A recent report from the Centers for Disease Control says tooth decay in baby teeth is up among children under age 5. Untreated oral disease complicates medical conditions like heart disease and diabetes, not to mention endangering proper nutrition. And many New Mexicans go without or practice “dental tourism,” heading south of the border where prices are lower. I've known several people that have had work done in Juarez simply because they couldn't afford it here. One practice distributes a flier with the distance from Texas and New Mexico cities to its office, and says vans will pick patients up at the El Paso airport, take them to their hotels and then ferry them across the international bridge. It lists services complete with what it would cost in the United States vs. in Juarez, with a set of porcelain dentures running $1,600 to $1,800 here vs. $399.50 there. You can see why what for some would be a choice of where to have dental work done could for others be the ability to finally have it done because they can actually afford it. But Moore cautions that getting care where the educational standards and licensing are different, there's no malpractice insurance and little to no recourse if something goes wrong mean buyers have to beware. One man I know had a terrible experience, with an infection that ended up spreading and eating away his upper palate. But a woman I know had a great experience, with 24 porcelain crowns that would have run $25,000 in the United States put in for just $5,250. Now granted, the door to the office she went to was unlocked when she showed up and remained locked the entire time she was there. Patients were told this has been done since a band of thieves targeted the office and robbed patients from across the border. Schripsema says in his 25 years of dentistry he's seen too many “moderate problems go catastrophic” because of substandard, out-of-the-country care and he worries patients “are not going to get the kind of care they need.” Ensuring they do requires a hard look at availability and affordability. The association's '09 legislative proposals won't bring dental care to every New Mexican. But they promise to put it in closer reach of many.