Snapshot Workforce Strategies to Improve Access to Oral Health Care

Nearly 70 million Americans live in dental health professional shortage areas, which are defined as areas with a population-to-provider ratio of at least 5,000 to one, or 4,000 to one if there are unusually high needs in the community.

Rural Americans are more likely to experience tooth decay (caries) and twice as likely to lose their adult teeth as their urban counterparts. Caries is the most common chronic disease in U.S. children, affecting approximately 23% of children ages 2 to 5.  

Patients may be more comfortable receiving care or information from a provider of their own race or a member of their community. In 2020, nearly seven out of 10 dentists were white, with disproportionately lower representation of Black, Hispanic and Native American dentists.

The high student debt resulting from the cost of dental education may drive the distribution of the oral health workforce, increasing the likelihood that graduates will choose to practice in affluent areas. Dentists typically have the highest debt among major health professionals (approximately $300,000).

Today’s oral health workforce consists of more than 750,000 professionals, including dentists, dental hygienists, dental therapists and community dental health coordinators. Those professionals serve 55% of the U.S. population, including those with commercial insurance, Medicaid and self-pay.

Support dental schools and incentivize students to practice in dental health professional shortage areas.

• In 2022, Tennessee’s budget included $11.8 million to expand the class sizes at the state’s dental schools and to recruit and retain dentists through loan repayment programs.
• Maine permits eligible dentists practicing in certain dental health professional shortage areas and medically underserved areas, including rural areas, to receive up to $25,000 in loan forgiveness.

Diversify the oral health workforce by tapping into community leaders who may help facilitate access to care.

• Arizona created a licensing and regulatory structure to allow dental therapists to fill cavities, place temporary crowns and perform certain tooth extractions. Practice is limited to certain entities.
• Illinois regulates community health workers, frontline public health workers who can help with language, cultural and trust barriers for clients navigating the health care system. Through a grant from HRSA, the state trains these workers on the basics of oral health promotion in collaboration with local community colleges.

Consider opportunities for health care professionals to reach children outside of the dentist’s office, such as through primary care or school settings.

• Most states permit dental hygienists to practice in schools or community settings. For example, Georgia authorized licensed dental hygienists to perform certain functions under general supervision in certain settings.

Extend dental services to those in oral health shortage areas via teledentistry or mobile dental clinics.

• Connecticut addresses rural access to oral health services by allowing a mobile dental clinic to submit claims for Medicaid reimbursement for services within 30 miles from the fixed dental location associated with the clinic.
• Montana requires insurers to cover teledentistry services if that same service would be covered during an in-person visit.

Increase incentives for providers to treat publicly insured patients. Several states have adopted policies that provide financial incentives or remove barriers that may prevent dentists from providing care to low-income patients.

• For example, Virginia’s 2022-2024 budget included a 30% fee increase in dental provider Medicaid reimbursement rates.