Solving the Crisis of 'Dental Deserts' Across America

By Genni Burkhart

Approximately 70 million Americans live in areas without enough dental providers. In 2022, the U.S. average patient-to-dentist ratio was 1,538:1. In some places in the Southern U.S., that ratio jumps to 20,000:1 or even zero. This situation has created an access-to-care crisis in America, leaving people without dental care due to a shortage of dentists, especially in rural areas and marginalized urban communities. In addition, many dentists don't accept Medicaid, making it difficult for low-income individuals to access dental care even if a provider is available.

In December 2022, the federal Advisory Committee on Training in Primary Care Medicine and Dentistry issued a comprehensive government review of dental therapy. The report concluded that dental therapy improves access to dental care, decreases oral health inequities, and creates a more representative workforce, and therefore recommends further federal funding to train and deploy more dental therapists across the U.S.

In this article, we'll dive into the data surrounding dental deserts and how some states want to increase dental therapist licensing to solve this oral health crisis.

Data on Dental Deserts

According to a 2022 report at Byte.com (1) reviewed by Dr. Jay Khorsandi, DDS on county-by-county data across the United States, rural counties in the South have the worst access to dental care.

The top five worst counties for access to dental care are in:

• Georgia
• Texas
• Virginia
• Mississippi
• Tennessee

The top five worst states for access to dental care are: (all five states average a patient-to-dentist ratio of 2,000:1)

1. Arkansas
2. Mississippi
3. Alabama
4. Delaware
5. Georgia

When it comes to delays in dental appointments:

• 17% experienced difficulty in obtaining a dental appointment.
• 20% skipped or put off going to the dentist because it was too hard to get an appointment.
• 30% waited 30 days or more for a dental appointment.
• 18% delayed an oral health issue due to scheduling.

The states with the best access to dental care are:

1. Massachusetts (one dentist for every 1,048 people).
2. New Jersey
3. Connecticut
4. California
5. New York

The data reviewed by Byte also focused on transportation, a significant disadvantage of rural communities. In these communities, 1 in 10 people surveyed stated that getting to the dentist was difficult and expensive. For example, it takes people living in rural communities an average of 23 + minutes to get to the dentist compared to 18 minutes for those in suburban areas. In addition, when seeing an orthodontist or oral surgeon, 17% of people living in rural areas had to wait three months or more for an appointment. This has led to an increase in teledentistry in rural communities.

Colorado's Push for Dental Therapists to Fill the Gap

In Colorado, five counties don't have a single dental provider, creating dental deserts or hardships in finding oral healthcare. According to a March 2023 article by the Colorado Sun (2), 53 of Colorado's total 64 counties have dental health professional shortages, leading to adults in rural areas having double the loss of teeth compared to those in urban areas.

Looking to fill the gap in these rural communities, Colorado passed a law in 2022 to authorize dental therapists to work in the state. However, it may be years before they can impact the oral health of Coloradoans.

Starting May 1, 2023, Colorado will issue licenses to people with dental therapy degrees, military experience, or licenses from 13 other states where their work is legal. Unfortunately, colleges in Colorado do not offer dental therapy degrees. So, for now, people interested in the profession must train elsewhere. Only Alaska, Minnesota, and Washington have dental therapy education programs. As part of its efforts to implement Senate Bill 219, Healthier Colorado is looking to work with Delta Dental, the American Academy of Pediatrics, and the Colorado Community Health Network to develop statewide dental therapy education.

Washington State's Access to Appropriate Dental Care

On March 7, two dental care bills, HB 1678 and HB 1466, sponsored by Rep. Marcus Riccelli (D-Spokane), passed out of the Washington state House and are now under consideration in the state Senate. (You can track those bills here.)

HB1678

This bill aims to expand the scope of practice for dental therapists in Washington state (in limited settings). This includes working under the supervision of a dentist to perform procedures such as filling cavities and performing emergency services (as authorized by a dentist). Currently, dental therapists are only authorized to work in tribal communities in the state. HB1678 would restrict where dental therapists can practice, including:

• Federally qualified health centers.
• Places where their patient base is at least 35% Medicaid, low-income, or uninsured, and clinics that serve an area designated by the federal health resources and services administration as dental professional shortage areas.

HB1466

This bill would rename the "limited dental hygiene license" to a temporary license, extending it from 18 months to 5 years. This change would allow dental hygienists more time to obtain a license while working in their field.

In Conclusion, a Letter to the Editor

In the "Letters to the Editor" section in the Seattle Times (3), Alex Narváez, DDS, vice president of Dental Affairs and Chief Dental Officer, Sea Mar Community Health Centers, Seattle, writes, "There are thousands of people in Washington state facing difficulties accessing dental care. That challenge is worse for low-income families. In my 40 years as director of Sea Mar's dental services, meeting the demand for oral health care has remained challenging. It has always been difficult to recruit dentists to work in remote, rural areas…." Dr. Narváez continues, "The dental therapist model adds a provider to the dental care team to offer routine services and preventive care, freeing dentists to attend complex dental procedures that patients need."

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References:

1. Khorsandi, Jay DDS (2022, August 30) Dental Deserts: Rural Areas Struggling With Lack of Dental Care in the U.S. Byte Community Initiatives. https://www.byte.com/community/resources/article/lack-of-dental-access/
2. Flowers, Tatiana (2023, March 10) Colorado will soon start licensing dental therapists to help expand oral health care options. The Colorado Sun. https://coloradosun.com/2023/03/10/colorado-dental-therapy-expand-oral-…
3. Narváez, Alex DDS, (2022, September 16) Health equity: Dental therapist model helps expand care. The Seattle Times. https://www.seattletimes.com/opinion/letters-to-the-editor/health-equit…

Author: With over 13 years as a published journalist, editor, and writer Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides on the western shores of the idyllic Puget Sound, where she works as the Editor in Chief for the Incisor at DOCS Education out of Seattle, WA.