Health Care

Medicaid won’t pay for cavity treatment? Cheaper solution proposed

On Wednesday, January 11 at 9 AM, the VT Board of Dental Examiners (BDE) will hear HealthHUB’s own Dr. John Echternach (and others) ask the BDE to expand the scope of practice for Registered Dental Hygienists (RDHs) to allow them to provide Medical Management of Caries* (MMC) restorative care, not just preventive care.

What’s the big deal?

Well, there are 170,000 Vermonters (27% of total VT population) eligible for Medicaid benefits and those benefits don’t pay dentists enough per cavity for most dentists to be willing to drill and fill all those cavities. So, for all practical purposes, Medicaid beneficiaries don’t get any dental care.

But MMC is a well-established treatment that can be applied very quickly to a cavity, much faster than drilling and filling it. If you put that speedy treatment together with the lower wages RDHs earn, it creates a whole new financial calculus that makes getting a healthy mouth financially possible for the first time ever for all 170,000 Medicaid beneficiaries…and a whole bunch of other low-income Vermonters, too.

Having a healthy mouth, without the infections that cause cavities, helps keep the whole body healthy because those infections don’t travel to infect other organs in the body. That’s a very big deal and you can ask any physician about it. HealthHUB is building two mobile dental operatories to take MMC to residents and school children in a dozen towns around South Royalton…if the BDE approves.

The BDE meeting is via zoom and is open to the public (you can ask questions). An explanation of MMC is below and Dr. Echternach can provide you with a more complete explanation. And at least 170,000 Vermonters (plus every medical/dental professional in VT) will be vitally interested in how the BDE rules on the request to “increase the scope of practice for Registered Dental Hygienists.”

Vermont Board of Dental Examiners (802-828-2390) is located at National Life Building, Montpelier, Vermont 05620-3402. Corey Young at the BDE is a good one to call to learn the best way for you to participate.

*How Medical Management of Caries works: Peripheral areas of the decayed tooth can be gently removed with a non-mechanical hand tool or a low-speed drill, which does not require an anesthetic or use of a high-speed drill. Silver Diamine Fluoride (SDF) will be applied painlessly to the cavity to kill the infection and begin to remineralize the damaged tooth structure.. A filling material called “Glass Ionomer” will painlessly fill the cavity, binding itself to the tooth and this material also helps to re-mineralize the decayed area. That prevents the infection from spreading to other teeth, stops further/deeper penetration of the lesion into the tooth, and makes the decayed area stronger. The resulting reduction of infection contributes significantly to patients’ overall health.

For more information contact Rebecca Foulk, MD, South Royalton,, 763-8426.

Categories: Health Care

3 replies »

  1. Question: how long does it take to get in to get your teeth cleaned some patients are telling me it has been 18 mos and they can not get in? Some need to be seen every 3 months to prevent tooth loss. There is a severe shortage of dental hygienists in Vermont mostly due to the pandemic(hygienists retired and the Medicaid rolls doubled) and failed dental therapy program. You know the one that pays hygienists way less to do what dentists do because you really don’t need a doctoral degree to do surgery on someone. So the legislature approved such a program years ago but now don’t want to wait until they are trained to know what to do?
    The cost itself is another issue. Tell that dentist who graduated with $500,000 in debt he can’t charge enough to pay back his loans! That’ll fix it. Most dentists only charge what insurance allows them to charge. Why aren’t the FQHC’S taking care of this issue? They get paid more for every visit by a Medicaid patient than a private dentist. They also get kickbacks from suppliers to help lower their costs.
    Help us educate and fix the system instead of pointing fingers at healthcare providers!

  2. Proper dental care is essential medical care ! I hope they can straighten this out.

  3. Affordable healthcare, including dental and eye care, will be at the discretion and control of the government on behalf of the New World Order. You will have no choices, no options, and no providers outside of their system. They will control your healthcare with all intentions of controlling every facet of your existence.