Short of Dentists, Maine Adds Teeth to Doctors’ Training

Short of Dentists, Maine Adds Teeth to Doctors’ Training

FAIRFIELD, Me. — Cindy Merrithew was nervous about having her teeth pulled, mainly because a doctor would be doing the work.

“I was skeptical,” said Ms. Merrithew, 47, a nurse’s assistant whose mouth is filled with damaged, brittle teeth. “I didn’t know if they knew much about the dentistry field.”

Dentists are in such short supply in Maine that primary care doctors who do their medical residency in the state are learning to lance abscesses, pull teeth and perform other basic dental skills through a program that began in 2005.

“Doctors typically approach the mouth from a distance,” said Dr. William Alto, a physician at the Maine Dartmouth Family Practice Residency here in rural Fairfield, which conducts one of two dental clinics for medical residents (the other is at Maine General Hospital in Augusta).

“They say ‘say aah,’ take a look at the back of the throat and are done,” Dr. Alto said. “Many physicians, even family physicians, have given up that part of the body because they don’t have the skills.”

Maine has one dentist for every 2,300 people, compared with one doctor for every 640, and the gap is expected to widen as both dentists and doctors retire over the next decade.

Nationally there is one dentist for every 1,600 people.

Maine has trouble recruiting dentists because many young graduates do not want to work in rural areas. The shortage is much less acute in Portland, the state’s largest city. Maine also does not have a dental school — the closest are in Boston, about 50 miles from the state’s southernmost town.

Last year the American Dental Association and the American Academy of Pediatrics announced a program to train pediatricians to apply fluoride and look for signs of tooth decay, a step already taken by some other states, including Illinois, Iowa, North Carolina and Washington.

In Maine, training physicians in dentistry provides a dental safety net for the rural poor who have never had one, doctors and dentists said. About two-thirds of the residents who have trained at the dental clinic now practice in the state, many in rural areas.

“I see dental complaints all the time from people who come into the E.R.,” said Dr. Andrew Fletcher, who learned dentistry at Maine Dartmouth during his residency. He now works at Northern Maine Medical Center in Fort Kent, on the Canadian border. “It’s mostly Medicaid patients who don’t have money to see dentists.”

Maine Dartmouth’s office here is emblematic of the chasm between medicine and dentistry in the state: the office has 31 physicians in a county with only 12 dentists.

Ronald Smart, 51, who had not been to a dentist in five years, came to the Fairfield clinic on a Wednesday to have an infected tooth pulled; he has had three teeth pulled here before, and most likely will have more.

“It’s hard when you don’t have insurance,” Mr. Smart said. The severe decay of teeth like Mr. Smart’s can make simple dental procedures difficult.

Natalie Karishev, a third-year resident, pulled the tooth with Dr. Alto’s assistance. Dr. Karishev injected a painkiller in Mr. Smart’s gums and cheek, loosened the tooth and started to pull. Mr. Smart yelled; the painkiller was not working.

After injecting three more syringes of painkiller and applying a nerve block, Dr. Karishev was able to extract the tooth.

“It hurt, and I have a high tolerance for pain,” Mr. Smart said. “But once it numbed, it was fine.”

He has no issues with doctors pulling his teeth. “I don’t mind at all,” Mr. Smart said. “I think it’s great. It’s convenient.”

The doctors must also step in for dentists in urging patients to break bad habits — namely smoking and drinking soda.

Nicholas Noyes, 24, recently quit smoking and is trying to kick his two-liter-a-day soda habit.

“It’s so hard for me not to drink Mountain Dew every day,” said Mr. Noyes, who came to the Augusta clinic for tooth pain. He, like all the patients here, was referred to the dental clinic by his primary care doctor.

But after hearing Dr. James Schmidt, the co-founder of the dental training program, and the resident, Katje Musgrave, warn Mr. Noyes that he was in danger of losing all his teeth, Mr. Noyes decided to mend his ways.

“When they said I wouldn’t have teeth by the time I’m 34, that’s a biggie,” Mr. Noyes said.

Ms. Merrithew, unfortunately, is close to losing all her teeth. She needed three pulled on a recent afternoon. They were the first teeth Dr. Mark Winiecki had ever extracted.

Under the direction of Dr. Alto, Dr. Winiecki applied a topical anesthetic to Ms. Merrithew’s gums and palate, then started loosening a tooth.

“That’s good,” Dr. Alto said. “I like how you’re doing this. It’s going to save you work later.”

The doctors were only able to extract two of Ms. Merrithew’s teeth. The third kept shattering as Dr. Winiecki tried to loosen it, and they made an appointment for her with an oral surgeon.

After finishing the procedure, Dr. Winiecki was thrilled and relieved. “I’m excited,” he said. “It’s another tool in the doctor’s kit.”

While the Maine Dental Association supports the program, its executive director, Frances Miliano, said it would prefer to recruit more dentists to the state.

“Medical residents are only going to be doing this in really dire circumstances,” Ms. Miliano said. “They’re not going to be the alternatives to dentists in rural areas. It’s not a total solution by any means.”

Other places are trying similar approaches. The University of New Mexico School of Medicine runs a yearlong residency program for dentists, and medical residents are allowed to participate to learn basic dentistry.

“If that is a skill they would like to have in practicing medicine, we by all means want them to have that skill,” said Mark Moores, president of the Ne

w Mexico Dental Association.

Here in Maine, Dr. Alto and Dr. Schmidt, president of the Maine Dental Association, see the program continuing to train doctors, even as dentists move to the state. It helps both patients and doctors, they said.

“If you want to be a real doctor, you have to know how to do all the simple things in the field and refer out as appropriate,” Dr. Alto said. “We try to give experience not only looking in the mouth, but with all the things you can do.”

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