Dental Health Professional Shortage Areas


More than 45 million Americans live in dental health professional shortage areas (HPSA), where there are not enough dentists to adequately serve the population. An aging and shrinking dental workforce and a low number of graduating dental students wishing to practice in rural or urban underserved areas contribute to dental HPSAs. Without access to routine, preventive dental care, simple dental issues can lead to more severe conditions and expensive treatments.

Some states are establishing policies to reduce barriers to dental services and improve access to care for underserved populations. For example:

The District of Columbia and 33 states have publicly or privately funded dental loan repayment programs to attract graduating dental students to underserved areas.

Thirty-six states allow dental hygienists to perform some services without the specific authorization of a dentist, such as applying fluoride and sealants, enabling them to practice in settings such as schools and nursing homes. Sixteen states also allow Medicaid reimbursement directly to dental hygienists for certain services.

2009 Minnesota Senate File 2083 created new types of mid-level dental providers—known as Dental Therapists and Advanced Dental Therapists—to administer services, such as fluoride varnishes and local anesthesia, under a supervising dentist. In 2003, Alaska created mid-level Dental Health Aide Therapists to deliver services, including teeth cleanings and sealants, to Alaskan native people in rural areas with poor access to dental care.

2011 New Mexico House Bill 187 allows Community Dental Health Coordinators—under the general supervision of a dentist—to provide dental health education and basic preventive services, such as giving medications and collecting diagnostic data, in nontraditional settings.

In parts of California, Virtual Dental Homes electronically link dentists with dental hygienists and assistants who perform preventive services and screenings in schools, nursing homes and community centers. Dentists view records remotely, develop treatment plans and refer patients to dental offices for further care.

Sources: Pew Children’s Dental Campaign, 2013; U.S. Department of Health and Human Services, 2013; American Dental Hygienists Association, 2013.

Percentage of State Population Living in a Dental Health Professional Shortage Area (HPSA)

United States map of Percentage of State Population Living in a Dental Health Professional Shortage Area (HPSA)

According to the Health Resources and Services Administration, a dental HPSA either has a population to dentist ratio of at least 5,000:1 or a ratio of at least 4,000:1 with unusually high needs for dental services, or an insufficient capacity of existing dental providers.

Sources:  The Pew Charitable Trusts, 2012; National Conference of State Legislatures, 2014.

Additional Resources

Improving Access to Medicaid Dental Benefits
National Conference of State Legislatures, LegisBrief, February 2014

Oral Health Workforce: Policy Options to Meet Increased Demand
National Conference of State Legislatures, Webinar, December 2013

Oral Health Overview
National Conference of State Legislatures, Health Care Safety-Net Toolkit for Legislators, September 2013

Oral Health Workforce
National Conference of State Legislatures, LegisBrief, March 2013

Dental Health Care Professional Shortage Areas (HPSAs)
Kaiser Family Foundation, State Health Facts, April 2014

Expanding the Dental Team
Pew Charitable Trusts, Report, February 2014

In Search of Dental Care: Two Types of Dentist Shortages Limit Children's Access to Care
Pew Charitable Trusts, Issue Brief, June 2013

Expanding the Dental Safety Net: A First Look at How Dental Therapists Can Help
Pew Charitable Trusts, Report, July 2012

Improving Access to Oral Health Care for Vulnerable and Underserved Populations
Institute of Medicine, Report, July 2011

This webpage was adapted from an NCSL postcard published in May 2014.