WHILE MANY NEW YORKERS TAKE THEIR TRIPS TO THE DENTIST FOR GRANTED, THE ABILITY TO ACCESS DENTAL CARE IS A REAL CHALLENGE FOR LARGE PORTIONS OF THE STATE, SO WE WANTED TO EXAMINE THE OBSTACLES TO ORAL HEALTH CARE AND CONSIDER WHAT POLICYMAKERS CAN DO TO BREAK DOWN BARRIERS.

ALL THAT, COMING UP NEXT, ON CONNECT NEW YORK.

♪ ♪ ♪ ♪ >> WELCOME TO CONNECT-NEW YORK, I'M DAVID LOMBARDO.

ON THIS MONTH'S EPISODE WE'RE DISCUSSING ACCESS TO ORAL CARE IN THE EMPIRE STATE.

TO TALK ABOUT THE BARRIERS AND HOW THEY CAN BE ADDRESSED, I'M JOINED BY DOCTOR MAURICE EDWARDS, PRESIDENT OF THE NEW STATE DENTAL ASSOCIATION, MARY ZELAZNY, CEO OF FINGER LAKERS COMMUNITY HEALTH, DOCTOR SEAN MCLAREN, MEDICAL DIRECTOR FOR THE EASTMAN INSTITUTE OF ORAL HEALTH, MARLYCE JAMES, PRESIDENT OF THE NEW YORK HYGIENISTS ASSOCIATION, AND JANE HAMILTON, MANAGER OF SCHOOL-BASED HEALTH FOR THE BASSETT HEALTH CARE NETWORK.

SO MAURICE, I WANT TO START WITH YOU AND KIND OF GET A SENSE OF WHAT DOES A HEALTHY DENTAL CARE ACCESS LOOK LIKE?

WHAT SHOULD WE BE GETTING IN OUR LIFE TO MAKE SURE OUR TEETH AND OUR MOUTHS ARE HEALTHY?

>> WELL, WHAT WE FOUND OUT IS THAT ONE OUT OF EVERY SIX PATIENTS HAVEN'T RECEIVED DENTAL CARE THAT NEEDED IT IN THE PAST YEAR.

SO ACCESS TO CARE WOULD BE EVERY TIME YOU NEEDED TO SEE A DENTIST OR EVEN IF YOU DIDN'T, BUT TWICE A YEAR YOU GO SEE A DENTIST AND THEY CAN TAKE CARE OF THE MINOR PROBLEMS BEFORE THEY BECOME MAJOR PROBLEMS.

SO ACCESS TO CARE IS THE ABILITY TO GO TO YOUR DENTIST, HAVE WORK DONE WHEN IT'S MINOR VERSUS GOING TO AN EMERGENCY ROOM TO HAVE THE TREATMENT DONE WHEN IT COSTS A LOT MORE.

>> SEAN, WHAT ARE THE REPERCUSSIONS OF NOT HAVING ACCESS TO PREVENTATIVE CARE OR MAYBE NOT HAVING TIMELY CARE TO PREVENTATIVE CARE?

>> THESE REPERCUSSIONS CAN BE ENORMOUS, DAVID.

FIRST OF ALL, THANK YOU FOR INVITING US HERE AND BRINGING SOME LIGHT TO THIS REALLY IMPORTANT SITUATION.

>> THANKS FOR TRAVELING TO SYRACUSE.

>> SO IN ROCHESTER WHERE I'M LOCATED, AT THE DENTAL CENTER, AT THE EASTMAN DENTAL CENTER, WE HAVE ABOUT 35,000 PATIENTS ON A WAITLIST JUST TRYING TO GET DENTAL CARE.

AND WE HAVE EVERY SINGLE DAY ABOUT 100 PATIENTS THAT COME INTO OUR URGENT CARE CENTER BECAUSE THEY'RE IN ACUTE PAIN.

PATIENTS ARE COMING FROM 55 DIFFERENT COUNTIES ACROSS NEW YORK STATE BECAUSE THEY CAN'T FIND ACCESS IN THEIR LOCAL COMMUNITIES.

SO THAT IS THE REPERCUSSIONS OF NOT HAVING ROUTINE DENTAL CARE, NOT TO MENTION HOW MANY RURAL HOSPITALS AND OUR OWN HOSPITAL IN ROCHESTER HAS DENTAL PATIENTS ADMITTED BECAUSE OF THE SEVERE INFECTIONS BECAUSE THEY HAVEN'T HAD ACCESS TO DENTAL CARE.

>> MARY, IN YOUR NECK OF THE WOODS, AS A COMMUNITY-BASED HEALTH CENTER, YOU ARE SERVING AREAS THAT ARE SAY, UNDERSERVED MORE BROADLY BY THE MEDICAL PROFESSION.

SO WHAT IS IT ABOUT THESE POPULATIONS THAT MEANS THAT THEY CAN'T NECESSARILY ACCESS HEALTHCARE AND IN THIS CASE DENTAL CARE ON A REGULAR BASIS?

IS IT ABOUT LACK OF PROVIDERS?

IS IT ABOUT LACK OF MONEY TO PAY PROVIDERS?

WHAT ARE SOME OF THE CHALLENGES YOU ARE SEEING WITH THE POPULATIONS THAT YOU SERVE PARTICULARLY?

>> WELL, WE HAD A PRETTY GOOD SYSTEM GOING FORWARD THROUGH AND THEN COVID HIT, RIGHT?

COVID WAS A REAL DISTRACTION AND DID A REAL NUMBER, PARTICULARLY ON DENTAL PRACTICES BECAUSE WE WEREN'T ALLOWED TO USE HIGH SPEED DRILLS AND ALL THAT BECAUSE OF STUFF THROWING IN THE AIR.

ONCE WE CAME OUT OF THAT, WE HAVE, AS A COMMUNITY HEALTH CENTER PROGRAM, THERE ARE 70 OF US ACROSS NEW YORK STATE THAT SERVE COMMUNITIES, 66 OF US PROVIDE DENTAL CARE.

WE HAVE NOT BEEN ABLE TO FIND DENTISTS THAT WILL COME WORK AT OUR PRACTICES.

OUR MODEL OF CARE IS ONE STOP SHOPPING, MEDICAL, DENTAL, BEHAVIORAL HEALTH, ALL IN ONE FACILITY.

SO WE UNDERSTAND, AS MAHER-- MAURICE HAS POINTED OUT, HOW IMPORTANT IT IS TO HAVE ACCESS TO THE CARE BUT PEOPLE DON'T HAVE TRANSPORTATION, THEY MAY NOT HAVE MONEY TO PAY FOR ONGOING, YOU KNOW, LIKE BIG WHEN YOU ARE HOW OLD, GETTING OUT OF SCHOOL, YOU WANT TO BUY A HOUSE, YOU WANT TO GET A CAR.

YOU CAN'T AFFORD IT.

>> DEFINITELY TALK ABOUT THE WORKFORCE IN A SECOND, BUT JANE, I ALSO WANT TO LOOK TO YOU, AND YOUR NECK OF THE WOODS.

WHAT IS THE BARRIERS THAT YOUR CLIENTELE ARE FACING WHEN IT COMES TO ACCESSING DENTAL CARE?

IS THERE ANY SORT OF COMMON TRAITS THAT YOU ARE HAVING TO DEAL WITH?

>> ABSOLUTELY.

SO MY POPULATION IS SCHOOL AGED CHILDREN.

WE ACTUALLY DO-- WE ARE IN FOUR COUNTIES IN CENTRAL NEW YORK.

EXCUSE ME.

AND WE DO A SURVEY.

IT IS VERY DIFFICULT FOR US TO FIND DENTISTS THAT HAVE PRACTICES THAT ARE OPEN THAT ARE TAKING NEW PATIENTS.

FEWER YET THAT TAKE NEW PATIENTS THAT ARE CHILDREN AND FEWER YET THAT TAKE NEW PATIENTS THAT ARE CHILDREN ON MEDICAID OR MEDICAID MANAGED CARE.

SO THAT'S A HUGE BARRIER.

WHAT WE ARE ABLE TO DO THOUGH IN THE SCHOOL-BASED HEALTH CENTER, IS WE PROVIDE BOTH PREVENTATIVE AND RESTORATIVE CARE.

JUST TO GO BACK TO A MOMENT WHEN SOMEBODY WAS TALKING ABOUT THE RAMIFICATIONS.

THERE WAS A GREAT PIECE WRITTEN ABOUT A VERY DEAR LITTLE BOY.

HE WAS NINE OR 10 YEARS OLD.

HIS NAME WAS DAMANTE DRIVER, IN THE STATE OF MARYLAND.

HE ACTUALLY DIED, DIED, BECAUSE HE DID NOT HAVE A-- THE MOLAR ABSCESSED AND TURNED INTO ENCEPHALITIS AND HE DIED.

THERE IS PAIN AND ILLNESS BUT THERE IS DEATH RELATED TO THIS SO IT IS THAT IMPORTANT.

>> LET'S TALK ABOUT WORKFORCE AND MAR LEASE-- MAR LEASE, I KNOW PEOPLE HAVE THE MOST INTIMATE RELATIONSHIP WITH THEIR HYGIENIST.

ANYBODY GOING TO THE DENTIST, THAT'S WHO YOU SPEND THE BULK OF YOUR TIME WITH.

DO WE HAVE ENOUGH HYGIENISTS?

>> WE HAVE ENOUGH HYGIENISTS IN NEW YORK.

WE SEE NUMBERS TRENDING UPWARD, ESPECIALLY IN 2024 WAS THE HIGHEST NUMBER OF NEW HYGIENISTS WE HAD IN NEW YORK STATE.

IT'S MORE ABOUT DISTRIBUTION OF HYGIENISTS THROUGHOUT THE STATE.

LIKE SHE WAS SAYING, MANY TIMES WE SEE HYGIENISTS WANT TO GO FOR THE HIGHER PAYING POSITIONS THAT MAY NOT BE IN COMMUNITY HEALTH CENTERS.

SO WHEN WE LOOK AT HYGIENISTS THEY MAY NOT GO TO THE RURAL OR UNDERSERVED AREAS AS MUCH AS THE URBAN OR MORE POPULATED AREAS.

>> HUGE PAY DISCREPANCY, QUALITY OF LIFE?

>> IT IS A HUGE PAY DISCREPANCY.

WHEN IT COMES TO SOME OF THE COMMUNITY HEALTH CENTERS THEY DO NOT PAY AS WELL AS MORE OF THE PRIVATE PRACTICES OR CORPORATE ENTITIES.

SO WE ARE SEEING THAT A LOT OF HYGIENISTS GO TOWARDS THE PRIVATE PRACTICES AND CORPORATE ENTITIES FOR THEIR EMPLOYMENT.

>> AND MARY, IS THAT JUST A PRODUCT OF THE COMMUNITY-BASED HEALTH CENTERS RELYING ON MEDICAID RATES PRIMARILY FOR THEIR POPULATION?

AND MEDICAID DOESN'T COME CLOSE TO COVERING THE COST OF CARE?

>> MEDICAID DOES NOT COME CLOSE TO COVERING THE COST OF CARE.

WE KNOW THERE WAS A STUDY DONE ON COMMUNITY HEALTH CENTERS ABOUT A YEAR AND A HALF AGO.

WE ARE GETTING ON MEDICAID PATIENTS, ABOUT 70% OF OUR COSTS REIMBURSED.

SO WE ARE NOT EVEN BREAKING EVEN AND WE SEE A LOT OF PATIENTS-- IN ADDITION TO OUR GENERAL COMMUNITY, WE SEE A LOT OF PEOPLE THAT ARE UNDER INSURED OR UNINSURED AND, YOU KNOW, YOU CAN'T CHARGE THEM A LOT OF MONEY BECAUSE THEY CAN'T AFFORD IT.

SO-- AND NOT EVERYBODY HAS MEDICAID.

SO IT IS A PROBLEM OF BEING ABLE TO SERVE THOSE PEOPLE.

BUT THE RAMIFICATIONS CAN BE SO JARRING BECAUSE OF HEALTH CONCERNS IF PEOPLE DON'T GET DENTAL ACCESS, ESPECIALLY KIDS.

>> WELL, MAURICE, THERE IS THE ISSUE WITH MEDICAID IN FACT THAT IT DOESN'T COVER THE COST AND GROUPS LIKE THE COMMUNITY-BASED HEALTH CENTERS ARE TAKING THOSE PATIENTS BUT I THINK ABOUT A THIRD OF DENTISTS ACCEPT MEDICAID.

IS THAT OKAY?

SHOULD DENTISTS BE FORCED TO TAKE MEDICAID PATIENTS AND TRY TO MAKE UP THE DIFFERENCE WITH PRIVATE INSURANCE PATIENTS?

WHAT SHOULD THAT RELATIONSHIP BE?

>> WELL, WE DEFINITELY WANT TO SERVE THE COMMUNITY.

SO I THINK IF YOU ASK ANY DENTIST, THEY DEFINITELY WANT TO BE ABLE TO PARTICIPATE WITH WHATEVER PROGRAMS ARE GIVING US MORE ACCESS TO THE PATIENTS; HOWEVER, DEPENDING ON WHERE YOU LIVE, IT DETERMINES HOW MUCH YOU CAN CHARGE FOR A PROCEDURE.

IT COSTS A CERTAIN AMOUNT FOR TO YOU PAY YOUR RENT IN NEW YORK CITY VERSUS IF YOU ARE IN ROCHESTER OR ALBANY OR BUFFALO.

SO THEY'RE TRYING TO BREAK EVEN FIRST.

AND THAT COULD BE HALF OF THE PATIENTS THAT YOU SEE FOR THE YEAR COULD TAKE FOR TO YOU JUST BREAK EVEN, AND THEN IT BECOMES, YOU KNOW, WHAT CAN WE DO FOR THE COMMUNITY AND WHAT DO THEY NEED?

ONE OF THE THINGS THAT WE DO UNDERSTAND IS THAT SINCE COVID, YOU USESSED TO BE ABLE TO-- YOU USED TO BE ABLE TO LOOK AT SPECIFIC AREAS AND KNOW THAT THOSE PATIENTS WERE UNDERSERVED AND THEY NEEDED HELP.

SIBS COVID-- SINCE COVID HIT AND HAS GONE, IT IS EVERYWHERE.

THE SAME PEOPLE LOOKING FOR HELP IN ALBANY AND IN THE HUDSON AREA ARE ALSO LOOKING FOR HELP IN NEW YORK CITY.

WE DO WHAT IS SCALD "GIVE KIDS A SMILE" THE FIRST FRIDAY IN FEBRUARY AND WE SEE OVER 500 CHILDREN IN THE SCHOOLS IN NEW YORK CITY IN MANHATTAN AND WE SEE RAMPANT DECAY.

WE SEE INFECTIONS.

WE SEE, YOU KNOW, LACK OF TREATMENT THAT IT COULD HAVE BEEN SOMETHING AS SIMPLE AS A FILLING AND NOW YOU ARE GOING TO HAVE TO DO AN EXTRACTION AND, YOU KNOW, DO SOMETHING TO MAINTAIN THE SPACE.

SO IT'S NOT GETTING BETTER.

IT'S ONLY GETTING WORSE.

AND THE FACT THAT MEDICAID ISN'T EVEN TRYING TO KEEP UP WITH, YOU KNOW, THE COST OF LIVING, LESS AND LESS DENTISTS WANT TO PARTICIPATE BECAUSE NOT ONLY ARE YOU NOT GETTING PAID WHAT YOU SHOULD GET PAID JUST TO RECOUP FROM YOUR PRODUCTS, YOU ARE ALSO NOT HAVING THE ABILITY TO DO MORE OF THE TECHNOLOGY THAT IS OUT.

SO LET'S SAY THAT YOU CAN DO AN EXTRACTION AND DO A BRIDGE WHERE YOU ARE DAMAGING TWO OTHER ADJACENT TEETH, WHERE COULD YOU JUST DO AN IMPLANT, BUT MEDICAID POTENTIALLY WON'T ALLOW TO YOU DO THE IMPLANT BECAUSE THE PATIENT RUN OUT OF BENEFITS AS SOON AS THEY HAVE A CLEANING AND ONE FILLING.

THERE ARE A LOT OF PROBLEMS THAT ARE GOING ON.

WE ARE TRYING TO TACKLE THE ISSUE OF ACCESS, BUT IT'S NOT THAT THERE ARE NOT ENOUGH DENTISTS.

IT'S JUST THAT THE DISTRIBUTION IS THE PROBLEM.

THEY'RE NOT IN THE AREAS WHERE THERE IS CONCENTRATION OF MEDICAID PATIENTS THAT NEED IT AND THEN THEY HAVE TO TRAVEL A COUPLE OF HOURS UP TO ROCHESTER AND BUFFALO AND THEY ONLY GET TO BE SEEN ONCE AND HOW MUCH WORK CAN THEY DO IN THAT ONE VISIT BEFORE THEY HAVE TO MAKE ANOTHER APPOINTMENT THAT IS SIX MONTHS, NINE MONTHS AWAY.

>> I WANT TO FOLLOW UP ON THE ISSUE OF MEDICAID RATES BECAUSE I THINK IT HAS BEEN MORE THAN A DECADE SINCE THERE HAS BEEN A MEANINGFUL CHANGE IN THE MEDICAID RATES HERE IN NEW YORK STATE AND I KNOW IT'S A BIG ISSUE FOR YOUR ASSOCIATION.

WHAT IS THE ROAD BLOCK THAT YOU ARE RUNNING INTO IN ALBANY WHERE NURSING HOMES, HOSPITALS SEEM TO GET THOSE MEDICAID RATE CHANGES EVERY YEAR BUT DENTISTS-- WE HAD A BIG SIGH FROM MARY THERE, SEEM TO BE ON THE OUTSIDE LOOKING IN?

DID YOU DO SOMETHING?

MAKE SOMEBODY MAD?

>> ALBANY, AS WE KNOW IT HAS A LOT OF BUREAUCRACY, SO IT TAKES US EIGHT, NINE MONTHS JUST TO GET A BILL THROUGH THE HOUSES AND BY THE TIME IT GETS THROUGH AND CAN POTENTIALLY GET TO THE GOVERNOR'S DESK, THE SESSION ENDS AND THEN WE HAVE TO TART BACK OVER WITH THE NEW SESSION.

SO THERE ARE ELECTIONS AND NEW PEOPLE COMING IN AND... >> SURE, SURE, BUT NURSING HOMES DO WELL, HOSPITALS DO WELL.

DID LIKE ANDREW CUOMO AND KATHY HOCHUL HAVE A BAD EXPERIENCE AT THE DENTIST THAT WE DON'T KNOW ABOUT THAT THEY'RE NOT PRIORITIZING YOU GUYS?

>> WE ARE NOT SURE WHAT THE PROBLEM IS.

WE ARE WORKING ON TRYING TO FIND OUT WHAT THE PROBLEM IS, BUT IT'S TRUE, FOR WHATEVER REASON, DENTISTRY IS THE LAST THING THAT GETS ALLOCATED MONEY FROM THE BUDGET, YOU KNOW, THE WAY IT NEEDS TO BE ALLOCATED.

SO IF YOU HAVE ANY KIND OF CLUES FOR US TO HELP, YOU KNOW, GET BETTER REIMBURSEMENT, WE ARE ALL FOR IT.

BUT EVERY YEAR WE DO THE SAME THING.

>> IN FAIRNESS TO MAURICE, TOO, I'M PART OF THE DENTAL ASSOCIATION AND PART OF AN ACADEMIC DENTAL CENTER.

MARY IS PART OF THE QUALIFIED DENTAL HEALTH CENTERS.

ALBANY IS GETTING THIS FROM MULTIPLE DIFFERENT DIRECTIONS, GETTING IT FROM THE DENTAL ASSOCIATIONS, THE ACADEMIC DENTAL CENTERS, AND QUALIFIED CENTERS AND THEY'RE STILL NOT MOVING ON THIS.

CAN YOU IMAGINE, WE LOSE ABOUT $100 A PATIENT THAT WE SEE AT THE DENTAL CENTER.

CAN YOU IMAGINE SOME TRADER ON WALL STREET LOSING $100 EVERY TRADE?

HOW LONG IS THIS GUY GOING TO BE IN BUSINESS FOR?

BUT WE ARE EXPECTED TO FUNCTION LIKE THAT AND WE HAVE BEEN EXPECTED TO FUNCTION LIKE THAT FOR 12 OR 13 YEARS, I THINK IS THE LAST TIME WE HAD A RAISE.

IT'S UNSUSTAINABLE AND AT THE DENTAL CENTER NOW, WE USED TO HAVE OTHER MEANS TO KIND OF CLOSE THAT GAP.

WE HAVE RESEARCH, WE HAVE TUITION DOLLARS.

NOW WITH FEDERAL LEGISLATION THAT HAS GONE THROUGH, THEY'RE CAPPING THE AMOUNT THAT STUDENTS CAN HAVE FOR LOANS.

THEY'VE DRASTICALLY CUT THE NIH, THE NIDCR, FUNDING RESOURCES, CUT THE INDIRECTS THAT HELP US KEEP THE LIGHTS ON.

THERE IS A TRUE DENTAL CRISIS EMERGENCY IN THE STATE OF NEW YORK NOW.

>> JANE, I WANTED TO GET YOUR PERSPECTIVE ON THE ACTION BY THE FEDERAL GOVERNMENT WHETHER IT'S THE SO CALLED BIG BEAUTIFUL BILL THAT BECAME LAW OR OTHER ACTIONS THAT HAVE BEEN TAKEN SINCE THE TRUMP ADMINISTRATION TOOK OVER OR THE G.O.P.

TOOK COMPLETE CONTROL OF THE CONGRESS.

HAVE THERE BEEN TRICKLE DOWN RAMIFICATIONS FOR THE WORK THAT YOU DO?

>> NOT YET.

BUT WE ARE PREPARED.

ABOUT 60% OF THE KIDDOS WE TAKE CARE OF ARE ON MEDICAID OR MEDICAID CARE.

THERE IS A REAL FEAR THAT SOME OF THEM WON'T BE ELIGIBLE FOR THAT BUT THE BOTTOM LINE IS THEY'RE STILL GOING TO HAVE CAVITIES AND NEED THE CARE AND WE ARE GOING HAVE TO PROVIDE IT OR THEY WILL END UP IN THE EMERGENCY ROOM OR WORSE, SO, YOU KNOW, WE DON'T QUITE KNOW WHAT IT LOOKS LIKE YET BUT WE ARE PREPARING.

>> AND JANE, I WANT TO FOLLOW UP ON THE DELIVERY OF CARE A LITTLE BIT BECAUSE YOU GUYS FOCUS ON THE INTEGRATION OF ORAL CARE INTO, YOU KNOW, THE BROADER HEALTHCARE DELIVERY.

HOW DOES THAT GO ABOUT PLACE OF BUSINESS MAKING CARE MORE ACCESSIBLE AND POTENTIALLY CHEAPER, FINGERS CROSSED?

>> FINGERS CROSSED.

YOU KNOW, OUR FOCUS IS REALLY ON PREVENTION, SO OUR TEAM, WHEN KIDDOS GO FOR MEDICAL CARE WHICH THEY DO FREQUENTLY, THEY'RE NOT IGNORING THE MOUTH, THEY'RE NOT IGNORING THE TEETH AND THEY'RE REGULARLY MAKING REFERRALS TO OUR DENTAL TEAM.

AND I TALK TO MY FRIENDS IN PEDIATRIC CLINIC AND, YOU KNOW, IF A KIDDO COMES IN AND THEY LOOK IN THEIR MOUTH AND THEY HAVE SOME CAVITIES, THEY SAY MOM, BE SURE TO MAKE AN APPOINTMENT WITH THE DENTIST.

THEY COME IN AND LOOK AT THEIR LEG AND IT LOOKS LIKE THERE IS A PROBLEM, THEY GO OUT AND TELL THEIR ASSISTANT TO MAKE AN APPOINTMENT FOR THIS KIDDO WITH AN ORTHOPEDIST.

SO IT'S A DIFFERENT LEVEL OF PRIORITY.

BUT I THINK WE'VE INCREASED THE PRIORITY OR HELPED EDUCATE OUR TEAM THAT ORAL HEALTHY SENGS AS MENTAL HEALTH, ALL THE REST OF THE SOMATIC HEALTH.

PREVENTION IS DEFINITELY WHAT OUR MAIN FOCUS IS.

WE PROVIDE RESTORATIVE SERVICES BUT GETTING THE SEALANTS ON, DOING THE FLUORIDE, WE DO FLUORIDE VARN ISSUING ON THE PRIMARY SIDE SO OUR NURSE DOZEN THAT SEVERAL TIMES A CREAR AND THEY SEE THE HYGIENIST AND THE DENTIST.

IT'S A ONE STOP SHOP.

>> THE HEALTHCARE NAVIGATORS BASICALLY THAT YOU GUYS HAVE SEEM CRITICAL TO CONNECTING PEOPLE WITH CARE AND THE IDEA OF HYGIENE INSTRUCTION SEEMS REALLY IMPORTANT.

MARY, HOW DOES THAT COMPARE TO WHAT YOU ARE DOING FOR A BROADER CLIENTELE?

>> WE DO THE SAME THING FOR ALL OF OUR PATIENTS, EITHER AT OUR SCHOOL-BASED DENTAL PROGRAM OR WITHIN OUR HEALTH CENTERS BECAUSE IT IS-- IN ORDER FOR PEOPLE TO HAVE BETTER HEALTH OUTKU78S, THEY HAVE TO GET THROUGH THE SYSTEM.

THEY HAVE TO GET WHATEVER THEY NEED EITHER FROM THE DENTAL SIDE OF THE HOUSE, MEDICAL, BEHAVIORAL HEALTH, THEY HAVE TO BE ABLE TO GET INTO THE CARE THAT THEY NEED FOR A-- FOR A DIABETIC, IF THEY DON'T GET NUTRITION COUNSELING AND THEY DON'T MAYBE TALK TO SOMEBODY ABOUT SOME OF THE OTHER ISSUES THAT ARE ASSOCIATED WITH DIABETES, INCLUDING DENTAL CARE, THEY'RE NOT GOING TO HAVE GOOD OUTCOMES AND IT'S GOING TO COST THE ENTIRE SYSTEM A LOT OF MONEY.

IT'S MORE EXPENSIVE TO PROVIDE CARE TO PEOPLE DISJOINTEDLY.

GOOD ACCESS TO CARE IS A CONTINUUM AND ALLOWS PEOPLE TO CONTINUALLY WORK ON BETTERING WHAT THEIR ISSUES ARE AND LEARNING HOW TO, YOU KNOW, HOW DO YOU DEAL WITH DIABETES AND HOW DO YOU DO IT THE RIGHT WAY?

WE HAVE SOME HUGE PROBLEMS IN THIS COUNTRY, CHRONIC HEALTH ISSUES AND I THINK DENTAL IS ONE OF THEM BECAUSE OF OUR DIET AND THE FACT THAT WE DON'T HAVE A LOT OF ACCESS TO CARE.

AND TO A POINT WHERE YOU ARE TALKING ABOUT EARLIER, I JUST WANT TO SAY, ONE OF THE PROBLEMS WE HAVE IN ALBANY, I BELIEVE, MY OWN OPINION, IS THAT WE ARE TRYING HERE-- WE ARE ALL TALKING ABOUT ACCESS TO CARE AND IF YOU HAVE A PRIVATE DENTIST, GOOD FOR YOU, THAT'S GREAT.

THERE ARE A LOT OF PRIVATE DENTISTS AROUND.

BUT IF YOU ARE DEPENDING ON-- IF YOU ARE A MEDICAID RECIPIENT AND YOU ARE TRYING TO FIND A PROVIDER THAT IS GOING TO GIVE YOU SERVICE THROUGH MEDICAID, THOSE PEOPLE DON'T VOTE IN A LOT OF CASES AND THEY HAVE A TON OF BARRIERS.

I JUST ALWAYS HAVE FELT THAT WE HAVE TO COLLECTIVELY FIGURE OUT HOW DO WE ENGAGE ALBANY TO SAY THESE PEOPLE MAY NOT BE HERE ADVOCATING FOR THEMSELVES CONSTANTLY, BUT IF WE DO IT RIGHT, WE CAN SAVE THE SYSTEM A LOT OF MONEY.

IT'S A LOT LESS EXPENSIVE TO GET PEOPLE IN AND GET ACCESS TO CARE CONTINUALLY THAN TO HAVE THEM GO TO THE E.R.

ROOM, TAKE UP A BED, WHICH I THINK AT UNIVERSITY OF ROCHESTER, THEY HAVE SOMETIMES EIGHT-HOUR WAITING LISTS AT THE E.R.

AND THEY HAVE A TOOTHACHE THEY CAN'T DO ANYTHING ABOUT.

>> AND THE BILL THAT IS GENERATED FROM THAT E.D.

IS PROBABLY GOING TO BE CLOSE TO $2,000 WHERE MAYBE THE BILL THAT IS GENERATED FROM THE DENTAL CLINIC FOR THE PREVENTATIVE SERVICES OR EXTRACTIONS MAY BE $200, LESS THAN 200.

SO THERE IS AN ENORMOUS DIFFERENCE THAT COSTS THE STATE MORE WHEN THE PATIENTS DON'T HAVE ACCESS.

>> AND I THINK THAT'S ALSO A WAY THAT LEGISLATORS SHOULD LOOK AT IT, YOU KNOW, YOU MADE THE STATEMENT OF, WILL DENTAL FEES GO DOWN?

THE TECHNOLOGY THAT IS ALSO, YOU KNOW, DEVELOPING, AS WELL AS THE RESOURCES AND THINGS THAT WE NORMALLY USE TO TREAT THESE PATIENTS, THOSE KIND OF STAY STAGNANT.

WE ARE ALREADY SAYING THAT WE ARE NOT GETTING WHAT WE WERE SUPPOSED TO GET JUST TO COVER THAT.

SO THE PRICES PROBABLY WON'T GO DOWN.

THE SAVINGS COMES WHEN WE STOP PEOPLE GOING TO THE EMERGENCY ROOM BECAUSE THEY HAVE A TOOTHACHE AND ALL THEY'RE GOING TO DO IS GET AN ASPIRIN OR A REFERRAL TO A DENTIST THE NEXT DAY.

>> OR WORSE, AN OPIOID.

>> RIGHT.

SO IF WE CAN FIND A WAY TO FUNNEL THEM FROM THE EMERGENCY ROOM OVER TO THE DENTAL OFFICE OR ONE OF THE CLINICS SO THEY CAN ACTUALLY GET DEFINITIVE CARE, THAT'S GOING TO SAVE A LOT MOVER MONEY IN THE BUDGET THAN IT WOULD FOR A DENTIST TO CHANGE THEIR FEES AND DROP IT BY 5 OR 10%.

>> THINKING ABOUT THE COST OF CARE AND ISSUES BEING DEBATED IN ALBANY, IT MAKES ME THINK ABOUT SCOPE OF PRACTICE ISSUES AND, YOU KNOW, THIS IS ONE OF THE AREAS THAT DOESN'T REALLY GET A LOT OF MOVEMENT IN THE CAPITOL, EXPANDING WHAT DENTAL HYGIENISTS CAN DO.

CAN YOU TALK ABOUT WHAT YOU WOULD LIKE TO SEE AS MAYBE AS PART OF THE PURVIEW OF DENTAL HYGIENISTS IN THE FUTURE AND HOW IT COMPARES TO WHAT THEY DO NOW?

>> GREAT QUESTION.

>> I THOUGHT YOU MIGHT LIKE THAT ONE.

>> I REALLY DO.

>> WE'LL SEE HOW MAURICE FEELS ABOUT IT.

>> WELL, YOU KNOW WHAT, THE NEW YORK STATE DENTAL ASSOCIATION HAS SUPPORTED US SO MUCH THIS YEAR.

I MEAN IN THE PAST ESPECIALLY, BUT THIS YEAR WE HAVE SEEN A LOT OF SUPPORT FROM THE DENTISTS SO WE ARE REALLY APPRECIATIVE OF THAT.

AND THERE ARE A COUPLE BIG THINGS HAPPENING AS FAR AS HYGIENISTS AND SCOPE OF PRACTICE GO.

WE ACTUALLY HAD A BILL PASS IN BOTH-- IN THE LEGISLATION, BOTH THE ASSEMBLY AND THE SENATE, THAT HAS TO DO WITH COLLABORATIVE PRACTICE.

SO COLLABORATIVE PRACTICE HAS ALWAYS BEEN AVAILABLE TO HYGIENISTS IN THE STATE OF NEW YORK AND THAT ALLOWS THEM TO WORK IN FEDERALLY QUALIFIED HEALTH CENTERS.

BUT WE HAVE HAD AN EXPANSION TO THAT BILL, WHICH ALLOWS US TO WORK IN OTHER AREAS OR OTHER FACILITIES OUTSIDE OF THOSE ARTICLE 28 FACILITIES.

SO THAT WILL ALLOW TO US GET INTO NURSING FACILITIES, DOMESTIC VIOLENCE SHELTERS AND, YOU KNOW, MORE AREAS AROUND THE STATE.

THAT MIGHT ACTUALLY HELP SOME OF OUR DISTRIBUTION ISSUES THAT WE HAVE SEEN WITH HYGIENISTS IN THE PAST.

IT GIVES US A BIT MORE INDEPENDENCE WITH OUR PRACTICE.

WITH COLLABORATIVE PRACTICE, WE ARE STILL CONNECTED TO A DENTIST WITHIN THE STATE.

AND WE REFER ALL OF OUR PATIENTS TO THE DENTISTS FOR THEIR RESTORATIVE CARE AS NEEDED.

WE PROVIDE PREVENTATIVE CARE IN THE COLLABORATIVE PRACTICE ARRANGEMENT.

BUT WE ARE ALSO HOPING TO SEE EVEN MORE EXPANSION OF OUR SCOPE OF PRACTICE AND MAYBE A NEW PROFESSION WHICH IS DENTAL THERAPY.

WE ARE SEEING THAT OUT IN THE WEST.

THERE ARE A FEW DENTAL THERAPY PROGRAMS THAT ARE ON THE WEST COAST,.

>> ABOUT A DOZEN STATES HAVE DENTAL THERAPIST LICENSES.

>> IT IS A GREAT PROGRAM.

AND WE HAVE ADVOCATED FOR THAT IN THE PAST BUT WE FIGURED IT WOULD BE A BETTER MOVE TO BRING SOME OF THE RESPONSIBILITIES INTO OUR COLLABORATIVE PRACTICE ARRANGEMENTS AND THEN, BECAUSE IT MIGHT BE A BIT EASIER TO DO THAT INSTEAD OF THE LONG HAUL OF CREATING A NEW PROFESSION IN THE STATE OF NEW YORK.

BUT WE ARE EXCITED TO SEE MOVEMENT ON BOTH OF THOSE FRONTS.

>> CAN YOU EXPAND THOUGH ON WHAT A DENTAL THERAPIST WOULD POTENTIALLY BE ABLE TO DO THAT A DENTAL HYGIENIST DOESN'T DO RIGHT NOW?

>> HYGIENISTS FOCUS PREVENTATIVE CARE.

THEY DO A LOT OF THE ASSESSMENT AND THE.

DENTAL THERAPISTS HAVE LIGHT RESTORATIVE FUNCTIONS THAT THEY CAN DO.

-- >> LIKE FILLINGS?

>> >> RESTORATIVE WOULD INCLUDE FILLINGS.

IT'S NOT AS MUCH SAY Dr. EDWARDS MIGHT DO IN HIS OFFICES BUT IT DEFINITELY HELPS TO BRING THAT ACCESS OF CARE TO MORE PATIENTS, ESPECIALLY IF WE ARE BRINGING IT INTO DIFFERENT FACILITIES OUTSIDE OF THE FQHC, WHICH IS THE FEDERAL QUALIFIED HEALTH CENTERS.

SO WE ARE EXCITED TO SEE THAT HAPPENING.

WE DON'T KNOW WHEN IT WILL HAPPEN.

BUT WE WILL CONTINUE TO ADVOCATE FOR IT AND WE LOVE HAVING THE SUPPORT OF THE STATE DENTAL ASSOCIATION ALONG WITH US.

>> SO DOES A DENTAL THERAPIST EQUATE TO QUALITY CARE AT A LOWER PRICE OR DOES THAT CARE END UP COSTING THE SAME AS IF IT WAS DELIVERED BAY BABY A DENTIST AND ARE THERE QUALITY ISSUES THAT SOMEBODY SHOULD BE CONCERNED ABOUT.

I DON'T WANT MY FILLING FROM A DENTAL-- >> THE STANDARD OF CARE WOULD BE VERY HIGH.

DENTAL THERAPISTS GO THROUGH MUCH MORE TRAINING THAN HYGIENISTS SO THEY RECEIVE THE APPROPRIATE TRAINING.

IF THAT WERE TO HAPPEN HERE IN NEW YORK STATE, WE MAKE SURE WE HAVE THE PROPER TRAINING FOR THE DENTAL THERAPISTS SO IT WOULD BE THE SAME STANDARD OF CARE AS DENTISTS IN THE STATE OR THE RESTORATIVE CARE THAT THEY'RE PROVIDING.

>> SLAWN AND MAURICE, SOUND GOOD TO YOU GUYS?

>> SO, MEMO OF SUPPORT?

WOULD YOU LIKE TO ISSUE ONE NOW?

>> WHAT I CAN SAY IS THE DENTISTS IN THE STATE, WE DEFINITELY ARE OPEN TO FINDING WAYS TO SOLVE THE ACCESS TO CARE.

THE ISSUE IS STILL GOING TO BE WE DON'T WANT TO TAKE THE DENTIST OUT OF THE RELATIONSHIP WITH THE PATIENT BY HAVING SOMEBODY ELSE GO BETWEEN THEM.

YES, IT MIGHT BE A WAY TO GIVE CHEAPER CARE, SO TO SPEAK, DENTAL CARE BECAUSE THEY WON'T BE CHARGING AS MUCH AS A DENTIST IN NEW YORK CITY OR IN UP WITH OF THE OTHER BIGGER CITIES; HOWEVER, IF WE HAVE ANY KIND OF COMPLICATIONS WHETHER IT'S QUALITY CARE, OR AN INFECTION, AN EMERGENCY THAT THEY'RE NOT TRAINED TO TREAT, THAT'S GOING TO BE PUSHED INTO THE DENTAL PROFESSION ANYWAY AND THEN IT'S GOING TO COST A LOT MORE.

LIKE WE SAID, IT'S A LOT BETTER IF YOU ARE DOING PREVENTATIVE VERSUS ANY KIND OF OTHER WORK, ESPECIALLY IF IT IS EMERGENCY WORK.

SO, YOU KNOW, FROM OUR STANDPOINT, YOU KNOW, THERE IS NOTHING BETTER THAN A DENTIST FOR THE PATIENT WHEN IT COMES TO DENTISTRY.

BUT IF THERE ARE WAYS TO DO THE QUALITY CONTROL, WE WOULD BE OPEN TO LISTENING TO THAT, AND ALSO UNDERSTAND THAT RIGHT NOW IN NEW YORK STATE, FOR YOU TO PRACTICE DENTISTRY AS A DENTIST, IT'S ACTUALLY FIVE YEARS.

YOU DO FOUR YEARS IN DENTAL SCHOOL AND THEN HAVE YOU TO DO AT LEAST ONE YEAR IN RESIDENCY JUST TO GET A LICENSE.

SO DENTISTS ARE DOING FIVE YEARS AND DENTAL SCHOOLS ARE ALSO TALKING ABOUT MAKING IT FIVE YEARS TO DO IT.

SO HOW ARE YOU GOING TO HAVE SOMEBODY THAT IS DOING EVEN LESS TRAINING AVAILABLE TO DO, YOU KNOW, THE DENTISTRY IN NEW YORK STATE.

THAT'S OUR ISSUE WITH SOME OF IT.

>> ISN'T THIS THE SAME ARGUMENT THAT THE DOCS HAD WITH THE MID LEVEL PRACTICE BECAUSE THE PROBLEM IS WE WANT-- THOSE OF US THAT ARE CENTER ADMINISTERING HEALTHCARE PROGRAMS, I WANT YOU AS MY DENTIST, ABABLE TO WORK TO THE TOP OF YOUR LICENSE.

YOU DON'T NEED TO DO THE EXAM NECESSARY OR A SIMPLE FILLING WHEN SOMEONE CAN BE TRAINED TO DO THAT AND TRAINED BY A DENTIST.

THAT'S PART OF THE WHOLE PROGRAM.

>> WHICH IS A PRIORITY FOR THE DENTAL ASSOCIATION TO WORK AT THE FULL SCOPE OF THE PRACTICE.

>> CORRECT.

>> I STILL THINK AN EXAM SHOULD BE DONE BY THE DENTIST.

>> I AGREE.

>> I KNOW ALL DENTISTS THINK THAT.

>> AS WE SHOULD BECAUSE YOU ARE ULTIMATELY RESPONSIBLE FOR THAT PATIENT.

SO YOU ARE NOT GOING TO ALLOCATE THAT RESPONSIBILITY TO SOMEBODY ELSE IF YOUR LICENSE IS ON THE LINE TO DO IT.

>> I MIGHT SEE A P.A.

FOR MY PRIMARY CARE VISIT OR AN RN AND I IMAGINE DOCTORS WEREN'T SUPER HAPPY ABOUT THAT WHEN THAT TRANSITION HAPPENED, BUT IT SEEMS LIKE KIND OF PAR FOR THE CARS AT THIS POINT.

SO SHOULD WE BE GOING BACKWARDS ON THAT PRIMARY CARE?

SHOULD WE ONLY BE SEEING DOCTORS OR DOES THAT NATURAL EVOLUTION MAKE SENSE IN DENTISTRY AS WELL?

>> THE EVOLUTION MAKES SENSE.

THE ISSUE IS WHAT IS THAT EVOLUTION.

I DO LIKE, LIKE THE COMMUNITY DENTAL HEALTH COORDINATORS GETTING PEOPLE INTO ACCESS TO CARE.

WHEN WE LOOK AT SOME OF THE OTHER STATES THAT HAVE HAD THE DENTAL THERAPISTS, WHERE THEY HAVE FALLEN DOWN I THINK A LITTLE BIT IS ALL OF THE THERAPISTS TEND TO GO RIGHT TO THE CITIES.

AND THE DISTRIBUTION OF THOSE ISN'T WHERE WE NEED THE DISTRIBUTION.

SO MAYBE IF WE WORKED COLLABORATIVELY TO TRY TO FIGURE OUT A WAY TO DISTRIBUTE THAT WORKFORCE, BECAUSE WHAT HAPPENS IS LOOK AT WHAT HAPPENED IN MINNESOTA, THEY ALL WENT INTO THE TWIN CITIES, RIGHT?

AND THE WHOLE POINT OF DEVELOPING THE PROGRAM WAS TO GET THEM OUTSIDE OF THE TWIN CITIES.

AND WHEN YOU GO BACK AND LOOK AT IT, THEY ALL WORK INSIDE RIGHT INSIDE WHERE THE POPULATION IS, RIGHT?

IT'S THE SAME... >> THAT'S TRUE FOR ANY PRACTICE.

WE CAN'T GET DOCTORS, DENTISTS-- >> BUT FUTURE-- BUT IF WE ARE TRYING TO GET THEM INTO THE RURAL AREA, THE LICENSE IS THERE BUT ONLY GOOD IN THE RURAL AREA OR SOMETHING LIKE THAT.

>> THAT'S EXACTLY WHAT I WAS GOING TO SAY.

HERE IS THE THOUGHT.

WITH CENTERS LIKE HERS, YOU CAN LOOK AT, IF WE ARE HAVING COLLABORATIVE PRACTICE AGREEMENTS THERE, WHY CAN'T WE PUT THE DENTAL THERAPISTS IN THE SAME UNDER SERVED OR RURAL AREAS.

IT WOULD BE UP TO THE STATE, RIGHT, TO DECIDE WHERE THESE PROFESSIONALS CAN WORK ONCE THEY CREATE THE PROFESSION.

SO THAT CAN BE A RESTRICTION THAT WE PUT ON THAT PROFESSION TO BEGIN WITH.

>> I WILL LET YOU GUYS HASH THAT OUT OFF LINE, BUT NOW I WANT TO TAKE A BREAK FROM THIS CONVERSATION TO HIGHLIGHT A PUBLIC POLICY THAT IS IMPORTANT FOR PEOPLE WITH LIMITED ACCESS TO DENTAL CARE.

WATER FLUORIDATION.

THIS EVIDENCE-BACKED PUBLIC HEALTH TOOL HAS BECOME A LIGHTNING ROD, FOLLOWING THE PROLIFERATION OF FRINGE SCIENCE, SO WE WANTED TO EXPLORE EFFORTS TO MAKE IT MORE WIDELY DEPLOYED IN NEW YORK.

CONNECT NEW YORK PRODUCER ALEC AMBRUSO HAS THAT STORY.

>> I THINK THERE HAS ALWAYS BEEN CONCERNS FROM THE START OF FLUORIDE IN THE 1940S IN THIS COUNTRY.

FLUORIDE IS A NATURALLY OCCURRING MINERAL.

IT'S ACTUALLY A MIRACLE MINERAL IS WHAT WE CALL IT.

THE MINERAL ACTUALLY HELPS TO STRENGTHEN AND HARDEN THE ENAMEL IN YOUR TEETH.

SO IT IS ADDED TO OUR WATER AS A PREVENTATIVE MEASURE THAT IS THEN INGESTED SO IT'S SYSTEMIC.

IT WORKS WHEN YOUR TEETH ARE FORMING SO IT BENEFITS WHEN YOU ARE A CHILD TO ACTUALLY HAVE THE FLUORIDE BE IN THE MATRIX OF THEY NAMEL-- THE ENAMEL OF THE TOOTH.

IT IS ALSO TOPICAL SO WHEN YOU INGEST IT, IT HELPS TO REMINERALIZE THE TEETH THAT ARE IN YOUR MOUTH AND HELPS TO PREVENT THE BACTERIA THAT ARE IN YOUR MOUTH FROM PRODUCING ACID WHICH CAUSE DECAY.

THERE HAVE ALWAYS BEEN POCKETS AND AREAS THAT HAVE CONCERNS BUT THERE HAVE BEEN MULTIPLE STUDIES ON TOWNS THAT ARE SIDE BY SIDE THAT HAVE FLUORIDATION VERSUS NON-FLUORIDATION AND THE FLOOR FLUORIDATION-- >> ALBANY IS THE CAPITOL OF NEW YORK STATE, ONE OF THE LAST LARGE CITIES NOT TO HAVE FLUORIDATION IN THEIR WATER.

WHEN I HEARD MY OWN SON ALMOST LOST HIS ADULT TOOTH BECAUSE OF THE LACK OF FLUORIDATION, I KNEW SOMETHING HAD TO BE DONE.

I HAD TALKED TO THE MAYOR ABOUT IT.

BUT IT WAS SUCH A HOT ISSUE.

IT WAS A TOUGH ONE.

THE MAYOR DECIDED NOT TO RUN AGAIN.

SO AT THE BEGINNING OF HER LAST TERM, SHE DECIDED THAT, YES, I WILL TAKE THIS ON.

I TALKED TO THE WATER COMMISSIONER, JOE COFFE Y.

HE WAS FOR IT BUT POLITICALLY IT WAS A TOUGH ROAD TO GO DOWN.

>> HEALTH AND HUMAN SERVICES SECRETARY ROBERT F. KENNEDY SERVICES WANTS THE CENTERS FOR DISEASE TO STOP RECOMMENDING FLUORIDE IN AMERICA'S DRINKING WATERED O. MONDAY KENNEDY PRAISED UTAH FOR BECOMING THE FIRST STATE TO BAN FLUORIDE IN THE WATER SUPPLY AND SAID HE HOPES OTHER STATES FOLLOW SUIT.

THE ENVIRONMENTAL PROTECTION AGENCY ALSO SAID IT WOULD WORK WITH THE H.H.S.

TO REVIEW THE EFFECTS OF FLUORIDE.

KENNEDY HAS MADE MULTIPLE CLAIMS ABOUT FLUORIDE BEING LINKED TO SEVERAL HEALTH ISSUES BUT MANY EXPERTS SAY IT IS SAFE AND PROVEN BENEFITS FOR DENTAL HEALTH.

>> SO WE HAVE FEARS THAT THERE MAY BE A CANCER CAUSING AGENT OR LOWERS THE I.Q.

OF A PERSON.

THEY HAVE FEARS 9 IT CAUSES A PROBLEM WITH THE BONES.

SO THEY HAVE FEARS ALSO ABOUT STAINING OF THE TEETH.

AND ALL THOSE ARE UNJUSTIFIED FEARS.

WE HAVE 75 YEARS OF SCIENTIFIC EVIDENCE THAT FLUORIDE WORKS AND FLUORIDE IS NOT HARMFUL.

SO THERE IS NO HEALTH RISK IF IT IS USED AT THE 0.7 PARTS PER MILLION AT THAT RECOMMENDED DOSAGE.

WE DO DO NOT SEE HEALTH RISKS HAPPENING.

>> I THINK IT'S THE MISINFORMATION.

ONE OF THE THINGS THAT THEY'RE BRINGING OUT IS ARE THE STUDIES DONE THAT FLUORIDE CAN LOWER THE I.Q.

WELL, THERE IS REALLY NO GOOD STUDY SHOWING THAT.

I KNOW THERE WAS A STUDY DONE IN CHINA BY SOME HARVARD RESEARCHERS THAT THE LEVEL OF FLUORIDE IN THE WATER WAS WAY BEYOND WHAT IS ACCEPTABLE.

AND YOU KNOW, IN CHINA, SOME AREAS, IT'S NATURALLY OCCURRING THAT THERE IS A HIGH LEVEL OF FLUORIDE.

AND SO I THINK FOR THAT STUDY, YOU KNOW, IT'S DEFINITELY, YOU KNOW, THROWING PEOPLE OFF.

>> IN THE AREAS THAT FLUORIDE HAS BEEN BANNED, AND IS, YOU KNOW, CONTROVERSIAL, WE WILL SEE THAT THE AMOUNT OF DECAY IS GOING TO RAPIDLY INCREASE.

WE WILL SEE THAT WITHIN FIVE YEARS.

WE ALSO HAVE STATISTICS FROM THE AMERICAN DENTAL ASSOCIATION THAT AFTER FIVE YEARS, IT WILL HAVE A $10 BILLION EFFECT ON, YOU KNOW, INCREASING COSTS TO HAVE DENTAL CARE BECAUSE OF THAT.

THERE HAVE BEEN SEVERAL CITIES THAT HAVE BANNED FLUORIDE AND THEN AFTER FIVE TO EIGHT YEARS, THEY HAVE REIMPLEMENTED IT BECAUSE OF THE OBSCENE, HOW MUCH DECAY HAS COME BECAUSE THERE IS NO FLUORIDE AND ALSO THE COST TO THE AREA BECAUSE OF THAT.

YOU WILL SEE IT IN THE COST OF WHAT YOU HAVE TO LAY OUT AS FAR AS PAYING FOR MORE DENTAL CARE ON ALL LEVELS OF SOCIETY.

>> I WANT TO PIVOT NOW TO WHERE DENTAL SERVICES ARE DELIVERED.

AND I HAVE BEEN FORTUNATE ENOUGH TO BE GOING TO THE SAME DENTAL OFFICE FOR, I DON'T WANT TO SAY HOW MANY DECADES NOW.

BUT JANE, IN TERMS OF MEETING PEOPLE WHERE THEY ARE, HOW IMPORTANT IS THAT AS A WAY OF MAKING SURE THAT PEOPLE HAVE ACCESS TO DENTAL CARE?

>> YOU KNOW, IT IS THE ANSWER, RIGHT?

WE NEED TO MAKE IT AS EASY AS POSSIBLE.

I ONCE READ WHEN PEOPLE THINK ABOUT GOING TO THE DENTIST, THEY THINK OF THREE THINGS.

ONE, IT HURTS, TWO, IT'S EXPENSIVE AND THREE THEY'RE GOING TO TELL ME EVERYTHING I'M DOING WRONG.

SO IF WE CAN BREAK DOWN SOME OF THE BARRIERS, THAT IS A GOOD THING.

AND THAT'S WHAT WE ARE ABLE TO DO IN SCHOOLS.

SO WE ARE RIGHT THERE WITH THE KIDS IT ISN'T A SCARY EXPERIENCE.

WE MAKE IT AS MUCH FUN AS WE POSSIBLY CAN.

AND, YOU KNOW, WE ARE REALLY SEEING THAT KIDS UNDERSTAND, YOU KNOW, WE TALK A LOT ABOUT ALL THOSE, YOU KNOW, NOT DRINKING THE SUGAR SWEETENED DRINKS AND THE ORAL HYGIENE.

SO MAKING IT EASY AS POSSIBLE.

BUT I DO WANT TO DOVE TAIL BACK TO A FEW MINUTES AGO.

SOME OF OUR CHILDREN-- AND AGAIN WE ARE IN CENTRAL NEW YORK-- BECAUSE WE CAN'T FIND A PLACE FOR THEM, WE ARE SENDING THEM ALL THE WAY OUT TO ROCHESTER TO EASTMAN FOR CARE.

THAT'S TOUGH BECAUSE MANY, MANY FAMILIES ANYMORE ARE NOT TRADITIONAL FAMILIES.

MANY CHILDREN ARE LIVING WITH THEIR GRANDPARENTS AND DRIVING FROM, YOU KNOW, CENTRAL ON THE OLE ON THE SEEING OWE-- COUNTY, THE SIMPLER WE CAN MAKE IT, THE MORE LIKELY PEOPLE ARE GOING TO USE THOSE SERVICES.

>> STICKING WITH THE WORK THAT EASTMAN IS DOING, I KNOW THERE ARE EFFORTS TO SPEND STATE HEALTH TRANSFORMATION DOLLARS, EXPANDING THE NUMBER OF CHAIRS.

CAN YOU TALK A LITTLE BIT ABOUT WHO YOU GUYS HAVE TO GET CREATIVE WITH THE DELIVERY OF CARE CONSIDERING THERE ARE A LOT OF PEOPLE WHO RELY ON YOUR SERVICES AND NOT JUST IN ROCHESTER.

>> I'M A PEDIATRIC DENTIST AND I SEE SOME OF JANE'S PATIENTS IN THE OPERATING ROOM.

THE CREATIVE WAYS THAT THE EASTMAN AND COMMUNITY HEALTH COMMUNITY HEALTH CENTER HAVE, FOR, I THINK WE ARE ON YEAR 14, COLLABORATED IN A TELEDENTISTRY PROGRAM.

>> HOW DOES THAT WORK?

>> SO WHAT HAPPENS IS THE GENERAL DENTIST THAT WORK WITH MARY AT FINGER LAKES SEE A CHILD AND THAT CHILD HAS NEEDS THAT THEY CAN'T MEET OR ARE NOT COMPORT FOR THE-- ARE NOT COMFORTABLE DOING SO THEY WILL SET UP A TELEHEALTH DENTISTRY THAT I AND TODAY I WILL SEE 13 PATIENTS IN THE ZOOM LINK AND GET THEM INTO THE SYSTEM IN ROCHESTER.

IT SAVES THEM A TRIP INTO ROCHESTER.

SAVED THE MEDICAID DOLLARS OF TRANSPORTING THEM FOR THE INITIAL CONSULT AND THE ONE TIME THEY DO COME TO ROCHESTER, IF THEY NEED TO GO TO THE OPERATING ROOM, WE GO RIGHT TO THE OPERATING ROOM, EVERYTHING IS TAKEN CARE OF AND THEY GO BACK AND THEY'RE SEEN BACK IN THEIR HOME DENTAL OFFICE.

SO WE HAVE PUBLISHED SOME REPORTS ON THIS.

THEY USED TO HAVE A 15% COMPLETION RATE.

CURRENTLY WE ARE DOING 90% OF THE TREATMENT PLANS GET COMPLETED IN THE OPERATING ROOM.

THESE ARE THE SICKEST OF THE KIDS SICK TO ME AS A DENTIST.

WE ARE DOING THAT.

I THINK YOU SEE LIKE THERE ARE CREATIVE WAYS THAT ALL OF US ARE OUT THERE TRYING TO FIGURE OUT.

WE ARE NOT JUST SITTING THERE ASKING THE GOVERNMENT TO GIVE US MORE MONEY.

>> THAT WOULD BE NICE THOUGH.

>> IT WOULD BE GREAT.

IT WOULD BE GREAT.

>> DON'T READ THIS THE WRONG WAY, POLICYMAKERS.

WE WANT MORE MONEY.

>> BUT WE HAVEN'T GOTTEN IT IN 13 YEARS IN DENTISTRY.

SO WE ARE COMING UP WITH MORE EFFICIENT WAYS.

WE ARE CHANGING THE WAY WE LOOK AT DENTAL CARE, TECHNOLOGY, WE ARE DOING ALL THAT STUFF TO DECREASE THE COST BUT WE STILL ARE HEMORRHAGING.

LIKE I THINK THAT WHAT YOU HAVE HEARD HERE, YOU KNOW, TO ME, I'M AT THE POINT WHERE IT'S DONE TALKING.

WE NEED TO GET THE LEGISLATORS IN THE ROOM WITH US.

WE NEED TO HASH THIS OUT.

THIS IS, YOU KNOW, A PROBLEM.

WE BROUGHT UP DAMANTE DRIVER.

WE DON'T NEED A CHILD DYING IN NEW YORK STATE.

THIS IS ONE OF THE GREATEST STATES IN THE UNION, RIGHT?

MAINLY BECAUSE OF THE BUFFALO BILLS, RIGHT?

WE ARE GOING TO GET TO THE SUPER BOWL THIS YEAR.

BUT THIS IS ONE OF THE GREATEST STATES IN THE UNION.

WE SHOULD HAVE THE POLICYMAKERS HERE WITH ALL OF US DOING THIS WITH THE MULTIPLE DIFFERENT ENTITIES THAT ARE DOING THIS.

MULTIPLE DIFFERENT SIDES AND SIT DOWN AND HASH THIS OUT.

YOU KNOW, THEY'RE MORE THAN WELCOME, Mrs. HOCHUL DRIVES BY ROCHESTER TO GO HOME.

SHE IS MORE THAN WELCOME TO STOP IN THE DENTAL CENTER.

I WILL SHOW HER HOW HARD OUR PEOPLE ARE WORKING.

I WILL LET HER TALK TO THE PATIENTS.

AND SEE HOW HARD IT IS FOR THEM TO GET CARE.

HOW LONG THEY HAVE BEEN IN PAIN BEFORE THEY WALK INTO OUR URGENT CARE CENTER AND LET THE LEGISLATORS, THE GOVERNOR, LET THEM HEAR SOME OF THE STORIES THAT NEW YORKERS ARE LIVING WITH ON A DAILY BASIS BECAUSE WE CAN'T FIX THIS PROBLEM.

THIS IS A FIXABLE PROBLEM.

>> JANE, YOU WANTED TO ADD SOMETHING.

>> I WANTED TO DOVE TAIL ON THAT AND Dr. McLAREN, YOU USED A GREAT WORD.

THEY'RE SICK.

IT IS AN ILLNESS.

WE FORGET ABOUT THAT.

THE PUBLIC DOESN'T THINK ABOUT IT.

WE TALK ABOUT IT ALL THE TIME.

DENTAL CARE IS THE MOST COMMON CHRONIC ILLNESS AMONG CHILDREN.

THEY DON'T THINK OF IT AS AN ILLNESS.

SO I THINK SOMETIMES IT'S OUR LANGUAGE WE NEED TO KIND OF READJUST.

>> MAURICE, WE TALKED ABOUT INSURANCE AND THE PERSPECTIVE OF THE PATIENTS BUT INSURANCE IS ALSO SOMETHING THAT DENTISTS HAVE TO DEAL WITH IN TERMS OF THEIR INSURANCE COVERAGE.

HOW MUCH OF A PROBLEM IS THAT IN TERMS OF DRIVING UP COSTS BECAUSE WE HEAR ABOUT, SAY, MALPRACTICE INSURANCE FOR HEALTHCARE PROFESSIONALS MORE BROADLY AS BEING A BIG COST DRIVER.

IS INSURANCE AN ISSUE FOR THE ENT RIFT INDUSTRY AS WELL?

>> DEFINITELY.

AND ONE OF THE BIGGEST THINGS IS THAT IT'S A BARRIER BETWEEN US AND OUR PATIENTS.

IF THE PATIENTS DON'T HAVE THE INSURANCE, I CAN'T TELL YOU HOW MANY TIMES THEY CAN COME INTO MY OFFICE.

I'M AN ORAL SURGEON.

I DON'T DO FILLINGS OR CLEANINGS.

I GET THE WORST OF THE WORST.

I GET THE INFECTIONS.

AND WHEN THEY COME IN, A PATIENT WILL BE IN PAIN.

THEY'RE SWOLLEN AND I'M TELLING THEM WHAT THEY NEED TO HAVE DONE.

AND THE ONLY THING THEY CARE ABOUT IS HOW MUCH IS IT GOING TO COST ME.

I GET THAT.

AND AT THE SAME TIME I'M LIMITED WHAT CAN I DO FOR THEM AND WE TRY TO WORK WITH THEM BUT INSURANCE DEFINITELY IS A BARRIER.

IF IT WAS A LITTLE MORE EQUITABLE TO WHAT WE WOULD CHARGE FOR OUR REGULAR FEES, IT WOULD MAKE IT A LOT EASIER FOR TO US SWALLOW THE LOSS AND KEEP TREATING THE PATIENTS.

IF YOU THINK ABOUT IT, I'M SHIER YOU KNOW SOMEBODY WHO LOVES THEIR DENTIST.

WHY DO THEY LOVE THEIR DENTIST?

BECAUSE THEY GO TO THEM WHEN THEY NEED TO GO TO THEM.

THE ONLY TIME THEY SEE THEM IS FOR THEIR ROUTINE CHECKUPS TO GET X-RAYS AND A CLEANING.

IF THAT'S ALL HAVE YOU TO DEAL WITH WITH YOUR DENTIST, YOU ARE GOING TO BE HAPPY TO SEE THEM BECAUSE YOU ARE NOT IN PAIN.

THE PEOPLE WHO DON'T LIKE DENTISTS ARE THE ONES WHO CAN'T GO WHEN THEY WANT TO GO.

THEY ONLY GO WHEN THEY HAVE TO.

SO THEY'RE ALREADY IN PAIN AND THEN THEY WALK IN THERE AND THE PATIENT IS SAYING THIS HURTS.

CAN YOU TAKE CARE OF IT.

ANYTHING THAT I DO FOR THEM OR THAT ANYBODY DOES FOR THEM IS GOING TO HURT.

SO THEY HATE THE DENTIST.

BUT IF WE COULD JUST SWITCH EIGHT ROUND TO-- SWITCH IT AROUND TO WHERE IT USED TO BE DENTISTRY WAS A FAMILY THING.

YOUR FAMILY AND YOUR FAMILY'S FAMILY AND EVERYBODY WOULD GO TO THE SAME DENTIST FOR YEARS AND YEARS AND YEARS.

>> LOMBARDO FAMILY.

>> WHEN THAT HAPPENS, YOU DON'T HAVE THE BIG PROBLEMS BECAUSE THEY SEE THE LITTLE THINGS AND THEY TREAT IT EARLY AND SOME OF IT IS TREATED WITH JUST FLUORIDE.

YOU DON'T HAVE TO DRILL INTO A TOOTH, BUT IF YOU HAVE TO WAIT FOR INSURANCE AND INSURANCE HAS-- IT'S NOT EVEN DENTAL INSURANCE.

IT'S YOU GET $1500 WHICH GETS YOU X-RAYS, A CLEANING, MAYBE A FILLING AND THEN EVERYTHING ELSE IS OUT OF POCKET OR HAVE YOU TO WAIT ANOTHER YEAR BEFORE YOU CAN USE ANOTHER $1500.

SO YOU PROBABLY PAY MORE IN PREMIUMS THAN YOU GET IN SERVICE.

>> INSURANCE COMPANIES TOOK THE MOUTH OUT OF THE BODY.

IT WASN'T THE DENTIST.

>> THAT'S THE BEEN.

>> -- THAT'S THE PROBLEM.

>> AND FOR SOME REASON THAT'S ACCEPTABLE.

AND I CAN'T FIGURE OUT WHY.

>> I WANT TO COME BACK TO THE IDEA OF PROHIBITIVE COSTS ADDED ALONG THE WAY IN TERMS OF THE DELIVERY OF CARE.

ARE THERE RULES AND REGULATIONS THAT YOU FACE THAT YOU FEEL LIKE MAYBE DON'T BENEFIT ANYONE?

THEY DON'T BENEFIT THE PATIENTS?

THEY DON'T BENEFIT THE PROVIDERS?

AND THEY ULTIMATELY ADD TO THE COSTS OF DELIVERING CARE?

OR IS DENTISTRY ONE OF THE FEW AREAS WHERE GOVERNMENT HASN'T ADDED ANOTHER LAYER OF BURDEN?

>> WELL, THE WHOLE ISSUE WITH MEDICAID PATIENTS WITH PRIOR AUTHORIZATION ON A LOT OF THE STUFF AND THAT IS, SO HAVE YOU SOMEBODY THAT COMES IN, THEY HAVE A PROBLEM IN THEIR MOUTH.

AND IF THEY HAVE MEDICAID, HAVE YOU TO GET PRIOR AUTHORIZATION TO FIX THAT.

AND THAT'S NOT A FAST THING ALL THE TIME.

AND MEANWHILE PEOPLE ARE IN PAIN.

SO IF A DENTIST SAYS TO, YOU KNOW, THE PEOPLE THAT ARE DENTISTS HAVE GONE THROUGH DENTAL SCHOOL AND THEY'RE QUALIFIED F. THEY SAY THIS GUY NEEDS A ROOT CANAL, THE GUY PROBABLY NEEDS A ROOT CANAL.

AND YET HAVE YOU TO GO TO THE INSURANCE COMPANY BECAUSE THEY'RE GOING TO DETERMINED IF THEY ARE GOING TO PAY FOR IT OR NOT.

AND THAT'S FOR PEOPLE WHO HAVE INSURANCE.

MOST OF OUR PATIENTS DON'T-- IF THEY DON'T HAVE MEDICAID, THEY DON'T HAVE DENTAL INSURANCE.

IT'S NOT LIKE MEDICAL INSURANCE WHERE EVERYBODY PRETTY MUCH HAS SOMETHING.

>> HERE IN NEW YORK.

>> IT'S VERY DIFFERENT.

AND TO SEAN'S POINT, WE HAVE SEPARATED THE MOUTH FROM THE REST OF THE BODY.

BUT WE KNOW-- EVEN STUDIES NOW ARE SAYING THEY THINK THERE IS A LINK BETWEEN POOR DENTAL CARE AND DEMENTIA LONG-TERM COGNITIVE ISSUES.

I MEAN YOU ARE STARTING TO SEE A WHOLE LOT OF RESEARCH COME OUT ABOUT THE IMPACT OF POOR DENTAL CARE AND IT'S JUST EVERYTHING IS GOING TO BE MORE EXPENSIVE AND NOW WE DON'T HAVE INSURANCE AND NOW THEY'RE GOING TO BE CUTTING A LOT OF PEOPLE OFF MEDICAID.

SO WE ARE ALREADY SEEING A WHOLE GENERATION OF LITTLE KIDS THAT DO NOT HAVE ACCESS TO DENTAL CARE.

AT OUR SCHOOL-BASED HEALTH CENTER, WE HAD PARENTS TRYING TO SIGN UP AND NOT SAY THEIR AGE BECAUSE THEY WANTED TO COME TO US FOR DENTAL CARE.

THEY COULD NOT FIND A DENTIST.

WE ARE LIKE NO, WE CAN'T TREAT YOU.

WE CAN ONLY TREAT YOUR CHILD.

THERE IS SUCH DEMAND PENT UP DEMAND, IN SO MANY COMMUNITIES, PARTICULARLY RURAL COMMUNITIES.

BUT I TALK TO A LOT OF MY HEALTH CENTER PEOPLE BEFORE I CAME ON THIS TO FIND OUT WHERE THEY WERE AT.

EVERYBODY IS LOOKING FOR DENTISTS.

SOME LOOKING FOR HYGIENISTS.

LONG WAITING LISTS.

SOME PEOPLE AREN'T TAKING NEW PATIENTS.

IT'S A REAL PROBLEM AND IT'S JUST NOT GETTING BETTER BECAUSE THE STOT IS NOT REALLY ADDRESSING IT.

>> DID YOU WANT TO ADDING?

>> I WANTED TO MAKE SURE I SAY DURING THIS DISCUSSION IS THAT THERE ARE 10 DENTAL HYGIENE SCHOOLS ACROSS NEW YORK STATE.

THERE IS GOING TO BE AN 11th OPENING UP IN EXFALL.

AT THESE HYGIENE SCHOOLS, THERE ARE MAYBE 50-60 DENTAL HYGIENE STUDENTS THAT ARE BEGGING FOR PATIENTS.

BEFORE THE END OF THEIR PROGRAM WITHIN THE TWO YEARS THAT THEY'RE IN THE CLINIC, THEY SEE ABOUT 40 TO 50 PATIENTS.

ALL OF THE SERVICE FOR THE MOST PART IS FREE IN THESE DENTAL HYGIENE PROGRAMS.

SO Dr. EDWARDS MENTIONED YOU USE UP ALL OF YOUR INSURANCE BENEFITS FOR YOUR EXAMINATION, FOR YOUR ASSESSMENT, YOUR FLUORIDE, SEALANTS WHEN YOU CAN GET ALL OF THAT FOR FREE AT A DENTAL HYGIENE SCHOOL ACROSS THE STATE.

AND THEN SAVE THOSE BENEFITS FOR WHEN YOU NEED TO SEE THE BIG GUY OR WOMAN.

>> I JUST WANTED TO CHIME IN ON THE QUESTION YOU ASKED ABOUT INSURANCES.

IN NEW YORK STATE THERE IS SOMETHING CALLED NON COVERAGE SERVICES.

BASICALLY, INSURANCE COMPANIES CAN TELL A DENTIST WHAT THEY CAN CHARGE FOR A PROCEDURE THAT THE INSURANCE COMPANY IS NOT EVEN GOING TO COVER.

WHAT IT ALLOWS THEM TO DO IS TELL THEIR PRESCRIBERS-- THE SUBSCRIBERS THAT THEY CAN HAVE ALL OF THESE THINGS WITH THEIR INSURANCE, THEIR DENTAL INSURANCE, EVEN THOUGH THEY DON'T COVER IT.

SO THEY'RE TELLING A DENTIST THAT WE ARE NOT GOING TO PAY YOU FOR THE WORK THAT YOU DO, BUT WE ARE GOING TO TELL YOU WHAT YOU CAN CHARGE FOR IT AND YOU CAN-- AND THE PRICE THEY GIVE IS ALMOST MEDICAID OR LESS THAN MEDICAID FOR THAT PROCEDURE.

BUT THEY'RE NOT COVERING IT ANYWAY.

SO THERE HAS BEEN A PUSH FOR A COUPLE OF YEARS TO STOP INSURANCE COMPANIES BECAUSE I WANT TO SAY IT'S 47 STATES ALREADY DON'T ALLOW INSURANCE COMPANIES TO DO NON-COVERAGE SERVICES BECAUSE IT'S JUST A TACTIC FOR THEM TO GET MORE SUBSCRIBERS EVEN THOUGH THEY'RE NOT GIVING A BENEFIT.

THEY'RE HOLDING THE DENTIST HOSTAGE.

IF YOU WANT TO SEE OUR PATIENTS THAT HAVE SOME INSURANCE PLAN, YOU ARE GOING TO HAVE TO ACCEPT THE FACT THAT YOU CAN'T CHARGE MORE THAN $25 FOR AN X-RAY OR $5 FOR A CLEANING EVEN THOUGH THEY'RE NOT GOING TO COVER IT REGARDLESS.

SO THAT'S SOMETHING THAT IS STRICTLY FOR THE INSURANCE COMPANY THAT DOES NOTHING FOR THE DENTAL SERVICE AND IT DOES NOTHING FOR THE PATIENT.

>> SEAN, WITH THE TIME WE HAVE LEFT, I WANT TO COME BACK TO THE IDEA OF WORKFORCE.

IN TERMS OF GROWING THE NUMBER OF DENTISTS HERE IN NEW YORK, ARE THERE SOME EASY SOLUTIONS OR IS THIS GOING TO BE LIKE TURNING A TANKER AROUND AND WE ARE TALKING ABOUT YEARS OF INVESTING IN EDUCATION AND OTHER WAYS TO REBUILD THE POIP LINE.

>> I REALLY DO THINK IT'S TURNING THE TANKER AROUND.

RUNNING A DENTAL SCHOOL IS NOT A CHEAP PROCESS.

DENTAL SCHOOLS, IF THEY HAD TO EXPAND, MOST OF THEM ARE ALREADY BURSTING AT THE SEAMS, SO YOU ARE TALKING ABOUT CAPITAL INVESTMENTS, NEW BUILDINGS, WE'VE GOT A FEW DENTAL SCHOOLS IN NEW YORK CITY, NEW BUILDINGS IN NEW YORK CITY ARE GENERALLY NOT CHEAP.

THEY'RE NOT CHEAP IN ROCHESTER OR BUFFALO EITHER.

>> OR SYRACUSE, EITHER.

>> SO I THINK IT IS-- I THINK THERE ARE PEOPLE WORKING ON IT.

THERE HAS BEEN A NEW DENTAL SCHOOL THAT OPENED FIVE OR SIX YEARS AGO.

I KNOW THERE HAS BEEN TALKS IN OTHER CITIES, TOO OF OPENING DENTAL SCHOOLS BUT IT'S NOT A QUICK, SIMPLE EASY FIX TO PRODUCE MORE DENTISTS.

>> ALSO REMEMBER THERE REALLY ISN'T A DENTAL-- THERE IS NOT A DENTIST SHORTAGE.

IT'S A DISTRIBUTION PROBLEM.

EVEN IF YOU GRADUATED ANOTHER THOUSAND DENTISTS IN NEW YORK STATE, THE ISSUE IS GETTING THEM TO THE AREAS THAT NEED THEM.

>> HOWEVER, THERE WAS A BILL THAT WENT THROUGH TO THE LEGISLATURE THAT WE PUSHED TO ALLOW FOREIGN DENTISTS WITH PROVISIONS, THEY HAD TO HAVE CERT SKILL SETS, LICENSURE TRAINING, ET CETERA, TIME IN THE FIELD, TO COME TO NEW YORK BECAUSE RIGHT NOW THEY CAN'T PRACTICE.

AND WE HAVE-- I HAVE A DENTIST RIGHT NOW.

SHE HAS A 15 YEARS UNDER HER BELT AT HER OWN DENTAL PRACTICE IN HER HOME COUNTRY AND SHE CANNOT PRACTICE IN NEW YORK STATE UNLESS SHE GOES TO DENTAL SCHOOL AGAIN AND YOU KNOW, TO ME, THAT IS A WAIT OF HER SKILL SETS.

SHE SHOULD BE ABLE TO PRACTICE DENTISTRY.

I'M DESPERATE FOR DENTISTS.

A LOST OF THE HEALTH CENTERS ACROSS THE STATE, PEOPLE IN THEIR SHOPS THAT-- THEY WERE DENTISTS IN THEIR HOME COUNTRY AND THEY CAN'T PROO HERE.

>> MY COLLEAGUE, DAVID ROBINSON HAS DOCUMENTEDDED SOME CUBAN AMERICANS WHO HAVE BEEN DENTISTS FOR YEARS AND THEY'RE HYGIENISTS HERE.

IS THERE A SYSTEM OF RECIPROCITY WE SHOULD IMPLEMENT?

DOES IT NEED TO BE BASICALLY YOU HAVE TO START FROM SQUARE ONE AGAIN TO PRACTICE HERE IN NEW YORK?

>> THERE IS A DISCUSSION GOING O.

THE BIGGEST RESTRICTION IS THAT WE HAVE PGY-1.

IN ORDER TO PRACTICE AND GET YOUR LICENSE, HAVE YOU TO DO A ONE-YEAR RESIDENCY.

WHY IT IS CRITICAL IS BECAUSE A LOT OF THOSE RESIDENTS ARE IN HOSPITAL-BASED PROGRAMS AND THOSE ARE THE PEOPLE THAT ARE SEEING THE MEDICAID AND THE UNDERSERVED.

SO WE DO NEED THAT WORKFORCE TO STAY IN TACT.

WE ARE LOOKING TO POTENTIALLY FIND A WAY FOR FOREIGN TRAINED DENTEDDIST-- DENTISTS TO COME TO NEW YORK STATE, POSSIBLY WORK IN A CERTAIN AREA FOR A NUMBER OF YEARS AND IN RETURN, THEY CAN GET THEIR LICENSE FOR IT.

THAT'S ONE OF THE THINGS WE ARE TRYING TO WORK ON WITH ALBANY NOW.

AGAIN, THAT'S LEGISLATION THAT HAS TO BE SIGNED.

THE OTHER WAY WE ARE GETTING DENTISTS IN THE AREA IS TO ALLOW NEW GRADUATES TO WORK OFF SOME OF THEIR FINANCIAL DEBT BY PRACTICING FOR A COUPLE OF YEARS AND GETTING A CERTAIN AMOUNT OF DOLLARS REPAID FOR THEM SO THEY DON'T HAVE TO WORRY ABOUT THAT BIG BURDEN ONCE THEY GRADUATE.

SO WE ARE LOOKING AT DIFFERENT WAYS TO BRING DENTISTS INTO THE AREAS THAT NEED IT.

AND AGAIN JUST LIKE WE SAID EARLIER, HOW DO YOU KEEP THEM IN THAT AREA?

BECAUSE IF YOU JUST GIVE THEM THE LICENSE, THEORY VENTLY GOING TO GO TO THE BIGGER CITIES ANYWAY AND HAVE YOU DONE NOTHING.

IF WE CAN GET THEM TO STAY IN THE AREA FOR FIVE YEARS.

IF YOU BUILD A PRACTICE FOR FIVE YEARS, IT IS LESS LIKELY YOU ARE GOING TO GET UP AND GO SOMEWHERE ELSE.

IF WE CAN GET THAT PROGRAM STARTED.

THAT'S ONE WAY OF NOT REINVENTING THE WHEEL BUT IT'S NOT GOING TO HAPPEN OVERNIGHT EITHER.

>> WHAT ABOUT BRINGING PEOPLE IN FROM OUT OF STATE.

SO IF THEY WANT TO PRACTICE AS A HYGIENIST OR DENTIST, DO WE HAVE AN INTERSTATE COMPACT WE SHOULD BE THINKING?

>> THERE IS A PUSH FOR THE INTERSTATE COMPACT THAT IS GOING O.

THE PROBLEM IS THAT PGY-1 THAT RESIDENCY GETS IN THE WAY BECAUSE BOTH COMPACTS ARE TOGETHER FOR BOTH DENTISTS AND DENTAL HYGIENISTS BUT LIKE Dr. EDWARDS MENTIONED A COUPLE TIMES, IT'S ABOUT DISTRIBUTION.

THERE IS NOT A HYGIENIST SHORTAGE IN NEW YORK.

WE NEED TO FIND CREATIVE WAYS TO GET HYGIENISTS INTO THE UNDERSERVED AREAS.

SOME ARTICLE 28 FACILITIES, FOR...

BUT WE ARE HOPING THAT THE DISCUSSION CONTINUES ON THAT.

>> WE ARE GOING TO RUN OUT OF TIME SOON HERE BUT I WAS CURIOUS IF YOU HAVE ANY ADVICE ABOUT FOAM AND THEIR OWN ORAL HEALTH PRACTICES AT HOME.

IS THERE ANYTHING THE VIEWERS SHOULD BE DOING ASIDE FROM, YOU KNOW, WHAT THE DENTISTS MIGHT SCOLD THEM ABOUT ON THE REGULAR VISITS?

>> THAT'S THE BIGGEST THING.

>> DO YOU ENCOURAGE US TO LIE ABOUT OUR FLOSSING?

>> WE KNOW.

>> THE BLOOD GIVES IT AWAY.

>> I THINK THAT'S THE BIGGEST THING.

AND AGAIN, WE SAW ON THIS THING WITH THE FLUORIDE, USE FLUORIDE TOOTH PASTE.

THIS IS NOT A CONSPIRACY.

WHAT PROFESSION IN THIS COUNTRY ADVOCATES SO MUCH FOR SOMETHING THAT IS GOING TO MAKE US LESS MONEY?

RIGHT?

I THINK THAT SAYS SOMETHING ABOUT THE TYPES OF PEOPLE AROUND THIS TABLE, ABOUT THE PROFESSION IN GENERAL.

WE ARE DOING THIS FOR THE PUBLIC.

AND THAT'S A BIG, HUGE THING.

>> HOW MANY TIMES A WEEK DO I ACTUALLY NEED TO FLOSS?

>> EVERY DAY.

>> MORNING AND EVENING?

>> YOU GIVE ME ONCE A DAY, DAVID, WE WILL BE HAPPY.

>> DO YOU HAVE A REFERENCE WHEN I SHOULD FLOSS?

THE END OF THE DAY, THE MORNING?

>> I'M NOT GOING TO BE SELFISH AND SAY YOU SHOULDN'T FLOSS SO YOU CAN COME TO ME AND I CAN TAKE YOUR TEETH OUT.

>> DO YOU GUYS PRACTICE WHAT YOU PREACH?

DO YOU GUYS FLOSS... >> WE TRUE.

>> I DO IT AT NIGHT.

>> I WOULD RECOMMEND TO ALL MY PATIENTS FLOSS AT NIGHT TIME AFTER HAVE YOU EATEN THREE MEALS FOR THE DAY.

>> MARY, HOW ARE YOU ON FLOSSING?

>> I'M GOOD BUT I'M NOT GOING TO TELL YOU YOU HAVE TO DO IT TWO TIMES A DAY.

NO ONE DOES THAT.

EVEN PROBABLY EVEN THESE GUYS.

>> I SAID ONCE.

I'M NOT GOING TO PRETEND.

>> I APPRECIATE THAT.

>> SOMETHING TO STRIVE FOR.

>> EXACTLY.

>> HAVE A GOAL.

>> AND UNFORTUNATELY, THAT'S ALL THE TIME WE HAVE TODAY.

MY THANKS TO OUR PANELISTS, DOCTOR MAURICE EDWARDS, PRESIDENT OF THE NEW STATE DENTAL ASSOCIATION, MARY ZELAZNY, CEO OF FINGER LAKERS COMMUNITY HEALTH, DOCTOR SEAN MCLAREN, MEDICAL DIRECTOR FOR THE EASTMAN INSTITUTE OF ORAL HEALTH, MARLYCE JAMES, PRESIDENT OF THE NEW YORK HYGIENISTS ASSOCIATION, AND JANE HAMILTON, MANAGER OF SCHOOL-BASED HEALTH FOR THE BASSETT HEALTH CARE NETWORK.

AND IF YOU WANT MORE CONNECT NEW YORK CONTENT - VISIT W-C-N-Y DOT ORG SLASH CONNECT NEW YORK AND MAKE SURE TO CHECK OUT OUR YOUTUBE PAGE.

AND FOR MORE STATE GOVERNMENT COVEARGE, INCLUDING MORE DISCUSSIONS ABOUT ACCESSING DENTAL CARE, YOU CAN FIND ME AT CAPITOL PRESSROOM.ORG, OR WHEREVER YOU DOWNLOAD PODCASTS.

ON BEHALF OF THE ENTIRE TEAM AT WCNY - I'M DAVID LOMBARDO - THANKS FOR WATCHING.

REMINDING YOU TO FLOSS, BRUSH, AND THANKS FOR WATCHING.