Lawmakers are considering two bills that attempt to increase access to dental care in Maine by studying ways to establish specialist residency programs in the state and creating a new license tier with lower educational requirements, a measure that multiple dentists opposed.

LD 2206 would establish an associate dentist license, which would allow a dentist without the equivalent of a U.S. doctoral degree in dentistry — such as a dentist with a bachelor’s degree who trained outside of the U.S. — to practice dentistry under supervision of a licensed dentist. 

Under this new license, associate dentists would have a pathway to full licensure if they were in good standing for six consecutive years. There is currently a pathway for foreign-trained dentists to work in Maine, but it requires additional education.

The bill comes as access to Maine dentists has declined. The ranks of dentists decreased from 590 in 2019 to 530 in 2023. Most children in Maine don’t get an annual checkup and cleaning from a dentist, according to a study last year from the University of Southern Maine Muskie School of Public Service and Catherine E. Cutler Institute.

Penobscot Community Health Care, Maine’s largest federally qualified health center, brought the issue to lawmakers after two “very highly qualified” dentists the center hoped to hire were denied licensure by the Maine Board of Dental Practice because they didn’t meet current educational equivalency requirements.

The health center estimated those dentists could have provided 8,000 appointments with patients, according to testimony from Lori Dwyer, president and CEO of Penobscot Community Health Care.

Penobscot Community Health Care, which said it operates the largest dental center in Maine and has a network of 51 workspaces for dental care, emphasized that federally qualified health centers are subject to strict federal oversight, reporting requirements and high standards.

“[Penobscot Community Health Care] would never support a pathway that compromises safety, and they would never hire a clinician that would provide unsafe treatment to patients,” Dwyer wrote in testimony that was read on her behalf to the Legislature’s Health Coverage, Insurance and Financial Services committee.

Northern Light Health also submitted testimony in support, saying the bill would help address workforce shortages and reduce emergency room visits for dental conditions.

“Like most hospitals in Maine, Northern Light Health members are challenged with inappropriate utilization of our emergency rooms by individuals seeking care for dental/tooth pain,” Lisa Harvey-McPherson, vice president of government relations, wrote in her testimony. “Patients generally present with cracked teeth, abscesses, dental caries or tooth eruptions, leading to thousands of emergency room claims for dental related diagnosis codes each year.”

Multiple dentists and dentistry representatives testified against the bill, arguing that there are existing pathways for foreign-trained dentists and that lower standards could set up a two-tiered system in which poorer and more rural residents receive care from dentists with less training.

Dr. Kailee Jorgenson, a licensed dentist who is the clinical director at Portland-based Mainely Teeth and president of the Maine Oral Health Centers Alliance, said the patients most likely to receive care under the proposed pathway are MaineCare recipients, rural residents and children. These patients often have the most complex needs, she said.

“Maine should not create one standard of dentistry for those with resources and another for those without,” Jorgenson told the committee.

Jorgenson and others who testified against the measure said they instead support a second bill, LD 2209, which would study how to expand access to dental care.

LD 2209 would direct the Maine Department of Health and Human Services to consider how to establish dental specialist residency programs in Maine, including for pediatric dentists, oral surgeons and orthodontists. The bill would also require the department to study ways to create a hub-and-spoke model to expand access to services across the state.

“We have a shortage of specialists in Maine, and it doesn’t matter how you’re trying to pay,” said Therese Cahill, executive director of the Maine Dental Association, which represents dentists. “To see an oral surgeon, to see a periodontist, to see an orthodontist, or a pediatric dentist, you’re waiting.”

No one spoke against the bill or submitted testimony in opposition.

The committee will consider both bills during upcoming work sessions when it will decide whether to forward them to the full Legislature. The work sessions had not been scheduled as of Wednesday.

This story was originally published by The Maine Monitor, a nonprofit and nonpartisan news organization. To get regular coverage from The Monitor, sign up for a free Monitor newsletter here.

Nicholas Jacobs is the Goldfarb Family Distinguished Chair in American Government at Colby College, where he also serves as the inaugural director of the Bram Public Policy Lab. 

I love a good poll as much as the next person.

It’s why I’ve relied on them throughout my research and teaching. Surveys offer a rare glimpse into attitudes that are otherwise difficult to observe, and in competitive races they can help orient both journalists and voters to what appears to be unfolding. And this Senate race in Maine — it is competitive. I’m itching for clarity.

Polls matter beyond our general academic curiosity. They actually shape the race and our expectations. The findings out of the University of New Hampshire about Graham Platner’s meteoric rise in the Democratic primary have already begun to shape how observers are talking about the Senate race, subtly altering expectations about competitiveness and early advantage. No doubt, donations will follow the topline finding.

But a word of caution is warranted. Polling in Maine is unusually difficult. And yes, you can simply refuse to “trust the polls,” but let me also suggest you don’t have to even go that far: just look at what the pollsters are and are not telling you each time they report results.

Most anyone who cares about polling results knows a few things to check, none more important than the all important margin of error. It offers a useful reminder that polls estimate rather than measure, and that even well-executed surveys contain uncertainty.

Try telling me who’s ahead with just a few dozen people and you’ll see a margin of error in the double-digits; everyone knows know you might as well stop reading. But a small margin of error only reflects precision, not representativeness — and a survey can be statistically tidy while still overlooking meaningful variation within the electorate.

You can get a representative snapshot of what Maine, on average, thinks with a modest sample — about 1,000 of our neighbors. Yet that is rarely what readers or campaigns are focused on in moments like this. We are not just asking what “Maine” thinks. We are asking what primary voters, independents or late-deciding voters think. And that is where interpretation becomes harder.

As attention shifts to those subsamples, the number of respondents quickly shrinks and the margin of error widens. That mechanical inflation is familiar and usually reported. What is discussed far less is whether those smaller groups meaningfully reflect the diversity of voters they are meant to represent — geographically, politically and in terms of engagement with the race. Because, as is often the case, the initial goal was not to survey, say, young people in Maine, but all people in Maine. That distinction creates problems.

When looking at subsamples, the relevant question is not simply how large the margin of error becomes, but how much confidence we should have that the subsample itself captures the electorate we care about. One way researchers evaluate this is by looking beyond sample size to how heavily responses must be weighted and adjusted to reflect that diversity — a process captured in what survey methodologists call “design effects.”

When those adjustments are substantial, the survey contains less independent information than the respondent count suggests, meaning apparent precision can mask deeper uncertainty about how accurate the estimates really are.

Again, the latest UNH survey in Maine offers a useful illustration.

Buried in the methodology statement, the researchers report a design effect of 2.3 and note that they did not adjust their margins of error for what is a pretty major acknowledgement that their sample, however large, needed some help in representing the broader Maine electorate. Put plainly, a design effect of 2.3 means those 1,120 likely voters function statistically more like a sample of about 500 — making the apparent precision of the results considerably overstated.

If the effective sample size is cut substantially, the true uncertainty around candidate support widens. What was a margin of error of about ±2.9 grows quick, to ±4.5. Of course, this might mean that Platner’s lead over Collins in the general election is higher than what the poll estimated, but it also means that, in this case, his lead could be as small as two points.

Specific to the one finding that is drawing substantial media attention, it also means that Platner’s “advantage” among Maine independents is a statistical fantasy. That is because once you start looking at sub-samples, the “penalty” that a design effect has on a poll’s margin of error is even greater.

To begin with, there are only about 164 independents represented in the full sample — a testament to the large design effect, because the poll seems to have captured way more partisans than proportionally exist in the state. The baseline margin of error for that group, to begin with, is ±7.

And then once weighting and design effects are taken into account, the effective number of independent respondents becomes smaller still — in this case, giving us estimates that have an equal chance of being 12 points higher (Platner leads with 59% of independents!) or 12 points lower (Collins has a 15 point advantage!). We just don’t know.

Now, I realize this may sound like unwelcome news to those eager to read the poll as
confirmation of a decisive shift in the race. I look forward to the emails I will receive telling me my “academic caution” is masquerading as excuse-making for Sen. Collins.

But, if anything, the statistically rigorous takeaway remains quite interesting. The same issue with independents I describe above (an ever-shrinking sample size) is just as true for analyzing the subset of Democratic primary voters. Even after accounting for the design effect here, functionally inflating the margin of error on the Democratic primary, Platner’s lead is unequivocal.

Even the most generous read, given that uncertainty, gives Mills just about a third of Democratic primary voters in the survey. The margin may be less precise, and there are still questions about whether the poll captured the broad swath of likely voters, but the signal is unmistakable: he is a credible and competitive challenger.

Statistical caution does not weaken that conclusion, even as it tempers claims of an inevitable victory for one candidate or party.

Platner’s emergence is real. So is the uncertainty surrounding everything beyond it. Acknowledging that uncertainty, though, is the difference between careful interpretation and wishful thinking. And when uncertainty is translated into premature conclusions, the narrative can begin to influence the election before voters do.

Six years ago, reports about a new coronavirus outbreak on the other side of the globe had been percolating through the news for several months. And then, right about this time, as the winter morphed into spring, the COVID-19 pandemic hit here in Maine. If you were paying attention up to that point, those halcyon days we called normal life were officially over in an unprecedented way. 

There was stress and anxiety enough to go around, and the only thing certain in those early days of the rapidly spreading virus was more uncertainty. “Social distancing,” “self-quarantine,” “shelter-in-place,” and “flattening the curve” became part of our daily lexicon. Fortunately, many Mainers were able to find a measure of solace by escaping into the outdoors, something that was thankfully encouraged by our government leaders.  

A statement from Gov. Janet Mills declared: “[…] the great outdoors is still open. Please enjoy it safely.” And from Judy Camuso, Maine’s Inland Fisheries and Wildlife commissioner: “During these times, getting outside and enjoying the outdoors is a wonderful way to recharge, while maintain social distancing practices.” I was walking my neighborhood trails daily to keep from going completely stir crazy, so this was easy advice to follow. 

People from the urban centers around the state took flight, as did many from the heavily populated regions outside of Maine; all were seeking the wide open spaces, the fresh air, clear skies and healthy sunshine as far from the city as possible. And just like that, the Acadia National Park trailheads here on Mount Desert Island were overflowing. In March, no less. You may have experienced the same where you live. 

Too much of a good thing is often, well, too much. My wife and I decided this might be a good opportunity to explore further Down East, beyond Acadia, where there were plenty of trails that few people know about, many we had never even hiked ourselves. And so, trying to make the best of a terrible situation, that’s exactly what we did for many weeks to come, hiking pretty much everything in the region. 

Down East Maine encompasses all of Hancock and Washington counties, an area of 4,409 square miles area ranging from Penobscot Bay to the Saint Croix River on the border with New Brunswick. Across this sparsely populated region, at least 10 land trusts have protected lands, and built and maintained trails, in addition to the swaths of state and federal properties that are also available for public recreation. 

The Crabtree Neck Land Trust oversees 400 acres in Hancock, and there we found six preserves featuring some 14 miles of hiking. We enjoyed this close-to-home-but-never-been adventure so much that we hiked everything over a couple days. The out-and-back on the Old Pond Railway Trail was by far our favorite, but we also really liked the Ice Pond Preserve and the Carter Beach Corridor. 

Scattered over the Down East region are 21 Maine Coast Heritage Trust preserves, most sporting hiking trails. Among these many beauties are two standouts, in my humble opinion, and both are in Lubec. The rugged environs of Boot Head were all about rocky headlands, peat bogs and cobble beaches, while Hamilton Cove was home to all that, plus precipitous cliffs. At each, we reveled in huge views over the Grand Manan Channel. 

The hike at Schoodic Bog in Sullivan is a Frenchman Bay Conservancy project that circumnavigates the scenic wetland with fine views of Schoodic Mountain en route. At Ingersoll Point in South Addison, we enjoyed hiking to Carrying Place Cove and Wohoa Bay, thanks to the Downeast Coastal Conservancy. And among the Blue Hill Heritage Trust’s extensive inventory was the sweet figure-eight hike along Patten Stream in Surry. 

The COVID pandemic wreaked havoc on every aspect of our society, but if there’s a bright spot to recall from that dark period, it may be the unexpected chance many of us had to recreate in the great outdoors. The wonders my wife and I discovered as we wandered about Down East during those unsettling times remain today, and I invite you to visit and experience some of this amazing beauty for yourself this spring. Enjoy, and leave no trace. 

Carey Kish of Mount Desert Island is a Triple Crown hiker, freelance writer and author of three hiking guides. Connect with Carey on Facebook and Instagram and at [email protected].