How States Are Tackling Dentistry’s Workforce Challenges

By Noelle Copeland, RDH

The dental workforce shortage gets talked about as though it's one big problem. It isn't.

In many practices, the challenge is finding enough hygienists and assistants to keep schedules full. In rural communities, the problem often goes much deeper. Some areas have struggled to recruit dental providers for decades, leaving patients with limited access to care regardless of how many open positions exist elsewhere.

Both situations affect patients and practices, but they stem from different problems and require different solutions.

Why Experienced Hygienists Are Leaving

Workforce shortages existed before 2020, but the pandemic marked a turning point. Time away from the operatory led many hygienists to reassess careers that had become difficult to sustain. For some, the physical demands of clinical practice had taken a cumulative toll. For others, burnout, workplace culture, production pressures, family dynamics, or flexibility needs prompted them to consider a different path.

According to the ADA Health Policy Institute's Dental Hygienist Shortage report, hiring hygienists remains one of the most persistent challenges facing dental practices nationwide. Yet focusing solely on recruitment overlooks an important question: Why are experienced hygienists leaving?

Dental hygiene is physically demanding and offers surprisingly little flexibility in return. As pressures and strain accumulate, many veteran clinicians find traditional practice models increasingly difficult to sustain. Life outside the office often influences workforce participation in ways workforce reports rarely capture.

That is a retention problem, and recruitment alone cannot solve it.

A Different Kind of Shortage

For some patients, finding a dental appointment isn't about waiting longer. It's a matter of finding a provider at all. According to KFF's Dental Health Professional Shortage Area data, large portions of the United States continue to experience significant shortages of dental providers. For residents in those areas, accessing routine care can mean taking extensive time off work, traveling long distances, or delaying treatment.

Unlike acute staffing shortages that are hammering private practices across the U.S., rural communities have been dealing with limited access to care for generations. States are now seeking ways to bring providers to underserved communities while retaining experienced clinicians in the profession.

Building the Pipeline

For communities that have long struggled with access to care, the focus is largely on expanding the workforce pipeline. Apprenticeship programs are gaining attention in states like Colorado and Wisconsin because they address affordability. Earn-while-you-learn models combine paid clinical experience with structured instruction, creating a more accessible pathway for career changers and nontraditional students.

Wisconsin launched its first dental assistant apprenticeship program in 2025 with a 15-month pathway that combines paid instruction with more than 2,000 hours of on-the-job training. Similar models are also being used by community health organizations such as CHAS Health in Washington, where the program is recognized as a registered apprenticeship.

Scholarship and loan repayment programs, like the ones in Maine, address a different barrier. Educational debt can influence where clinicians choose to practice, and debt incentives encourage providers to serve in communities for set contract terms. These incentives don't solve every access problem, but they help make service in high-need communities more financially realistic.

Additionally, states are also exploring ways to tap into existing talent pools. Virginia just passed alternative licensure pathways allowing internationally trained dentists to practice dental hygiene, which has gained national attention as policymakers look for ways to expand the workforce.

Expanding the Dental Team

Expanded-function dental assistants (EFDAs) are among the most discussed examples currently. According to the Dental Assisting National Board, 38 states have some level of expanded-function dental assisting. The specific titles, duties, and education requirements vary widely by state, but may include coronal polishing, sealants, topical fluoride, or restorative support, depending on state law.

Supporters believe EFDAs improve efficiency and expand capacity. In states facing serious workforce pressure, that argument is easy to understand.

From a hygiene perspective, expanding preventive responsibilities to assistants, the way Virginia just did by approving dental assistants to scale and polish supragingivally, raises important questions about quality, professional value, and whether the industry is addressing why hygienists are leaving clinical practice. If experienced hygienists are stepping away because of physical strain, burnout, and limited career flexibility, redistributing pieces of their work may improve short-term capacity without solving the retention problem underneath it.

This is an area where dental therapy could offer hygienists alternative pathways. CareQuest Institute describes dental therapists as mid-level providers who work under the supervision of dentists and provide preventive and restorative care, particularly in rural, underserved, and low-income communities. These models remain debated, but they are increasingly part of access-to-care conversations, especially in communities where recruiting enough dentists has been difficult.

Keeping Clinicians in Practice

Expanding clinical pathways may be key to retaining experienced hygienists. States are examining expanded supervision models, direct-access provisions, and alternative practice settings to provide hygienists with greater flexibility to deliver care outside the traditional private practice environment. These policies allow care to be delivered in schools, long-term care facilities, community clinics, mobile settings, and other locations outside a typical model. For some hygienists, greater practice flexibility may create a way to remain active in patient care when the traditional operatory schedule is no longer sustainable. A profession cannot recruit its way out of a shortage if experienced clinicians continue leaving faster than new ones enter.

CareQuest has noted that Rural Health Transformation funding provides states with opportunities to integrate oral health into broader rural health planning, including mobile care, teledentistry, infrastructure, and integrated care models. Those investments may not look like traditional dental workforce policy, but they could influence where and how care is delivered.

What May Make the Biggest Difference?

Apprenticeships will likely strengthen the assistant pipeline, while loan repayment may help recruit dentists into underserved communities. Dental therapy may expand access in communities with persistent provider shortages, while EFDAs may improve service efficiency within practices. And supervision reform with alternative practice models should keep experienced hygienists engaged in patient care longer, if these changes are passed correctly.

States are recognizing the workforce shortage is not one problem. It’s a collection of related problems involving recruitment, access, retention, training, and sustainability. The most effective strategies address all of the equations. Dentistry needs new people entering the field. It also needs experienced clinicians to stay. And patients, especially those in underserved communities, need care delivered in ways that meet the reality of where they live.

States are no longer asking only how to fill today’s open positions. They are beginning to ask how to build a dental workforce that is larger, more flexible, and more sustainable for the future.

Author: Noelle Copeland, RDH, is a health science writer with 30 years of clinical experience in healthcare. Her work focuses on translating complex medical and oral health topics into clear, evidence-based education for professional and consumer audiences.