Dentist shortage in Maine has some pediatricians working to prevent
tooth decay
[October 10, 2025]
By ROSE LUNDY
Maine is grappling with such a shortage of dentists that some doctors
are adapting to treat early tooth decay themselves.
Most children in Maine don’t get an annual checkup and cleaning from a
dentist. Even having dental insurance doesn’t guarantee access: Only a
third of children with any type of insurance get both a checkup and a
cleaning each year, according to a study last year from the University
of Southern Maine Muskie School of Public Service and Catherine E.
Cutler Institute.
The most commonly proposed solutions are to train more dentists and
increase MaineCare rates to make it more affordable for dentists to
accept lower-income patients, said Becca Matusovich, executive director
of the Children’s Oral Health Network of Maine.
Indeed, the ranks of dentists are declining, from 590 in 2019 to 530 in
2023. The Children’s Oral Health Network of Maine is an advocacy
coalition focused on improving prevention, education and treatment tools
for children’s oral health.
However, Matusovich said potential solutions shouldn’t be limited to
adding more dentists and increasing reimbursement.
“We are so far from the scale we need that just training more dentists
won’t get us where we need to be,” she said.
In response, her organization is working to expand access to oral health
treatment beyond the dentist’s office. These early intervention options
can stop cavities from getting worse and help alleviate the backlog for
dentists, leaving them to focus on more advanced treatment, Matusovich
said.
One example is a treatment called silver diamine fluoride, which more
pediatricians in Maine have started using in recent months as training
programs have ramped up. Dentists have used the treatment much longer.
The World Health Organization in 2021 added the treatment to its Model
List of Essential Medicines, and the American Academy of Pediatrics has
issued guidance on using it in the medical setting. The solution is a
mixture of silver and fluoride.
Dr. Brian Youth, a pediatrician at MaineHealth and president of the
Maine Chapter of the American Academy of Pediatrics, was one of the
first in the state to incorporate silver diamine fluoride treatment into
his primary care practice, first at the Pediatric Residency Clinic at
Maine Medical Center and now also at MaineHealth Pediatrics in
Westbrook.
Most pediatricians already offer fluoride varnish during well-child
visits as a preventive measure, Youth said. Now, when he finds a cavity,
he can offer silver diamine fluoride to essentially petrify the decay
and kill the bacteria.
Youth said it’s a fairly easy process. First he dries the tooth. Then he
uses an applicator that looks similar to a Q-tip to press the treatment
to the decay for 30 to 60 seconds. He then follows up with the family at
another appointment four to six weeks later to see if they need a second
application and to check if they can see a dentist for further
assessment.
[to top of second column]
|
 “Pediatricians have so much on their
plate that they need to cover with families at different visits, and
some might see this as an additional task that pediatricians are
taking on because patients can’t get the dental care that they
need,” Youth said. “But I would say this is an important one because
of the morbidity associated with dental (decay) in our patients.”
Cavities and tooth decay can cause infection, be painful for
children and could make them less likely to attend school, Youth
added.
Since he started offering silver diamine fluoride treatment last
fall, Youth and his colleague Dr. Laura Blaisdell have treated more
than 70 patients at the Pediatric Residency Clinic at Maine Medical
Center. They have also taught pediatric residents in training on the
application of silver diamine fluoride.
Matusovich, with the Children’s Oral Health Network of Maine, said
some potential downsides of the treatment can be that it can stain
the teeth brown or black where the decay is addressed, and children
with silver allergies should check with their doctor first. She
added that it’s not recommended if the cavity is too far along.
More pediatricians could soon join Youth. In recent months, the
Children’s Oral Health Network of Maine funded training events on
silver diamine fluoride conducted by the primary care program From
The First Tooth, including a recent one in Washington County. And a
pilot program that wrapped up this summer trained six school nurses
and one school-based health center in Maine to identify early signs
of decay and apply silver diamine fluoride.
Silver diamine fluoride is one of many ongoing solutions, Matusovich
said. Another program, piloted with Head Start, had a dental
hygienist do cleanings and early interventions in the school
setting, and then use telehealth visits for dentists to remotely
review X-rays and other documents.
The pilot wrapped up last year, but Matusovich said the initial
participants are continuing the program, and her organization
received additional funds to expand into new communities.
And a bill introduced last session, Legislative Draft 1746, would
have required the Maine Department of Health and Human Services to
develop a model for additional preventive oral health and disease
interventions in schools and provide at least one mobile dental
services provider in each public health district. It also would have
required DHHS to train primary care providers on minimally invasive
treatments for children.
That bill was carried over and will be considered in the upcoming
session.
“Prevention is key for sure, but what these new tools and new
strategies are giving us is also the ability to stop cavities very
quickly,” Matusovich said. “There’s this step in between where now
we have silver diamine fluoride and other minimally invasive care
options that can be much more available outside of the dental
office.”
___
This story was originally published by the Maine Monitor and
distributed through a partnership with The Associated Press.
All contents © copyright 2025 Associated Press. All rights reserved |
