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A dentist shortage in rural Pennsylvania has been a consequence of population loss, how dental students are chosen, and the differences between dentists and other medical workers.
Advocates view the problems of dental health access as similar to mental health access.
“Just from a provider availability issue and stigma — stigma’s something that with oral health it’s almost similar to the mental health piece where you’re thought of as lower class if you are having trouble getting access to dental care,” said Helen Hawkey, executive director of the Pennsylvania Coalition for Oral Health.
Access to Medicaid providers is also limited, Hawkey said. The commonwealth has half as many dentists in rural areas per capita compared to urban areas, and dentists participate in Medicaid at much lower rates than other doctors.
Roughly 90% of pediatricians, primary care physicians, and OB-GYNs accept Medicaid, but only about 25% of dentists accept it. That difference makes it harder for low-income patients to get dental work.
Dentists are reluctant to accept Medicaid partially due to economic factors: with a shortage of dentists, they already have a lot of patients who pay full cost. By accepting Medicaid, there’s less profit in each visit due to lower reimbursement rates. Some doctors can require cash payment and not accept insurance at all.
Dentists who do take Medicaid patients also complain of missed appointments and other problems that can waste time or make their jobs harder.
Graduating more dental students to grow rural access isn’t so simple. Pennsylvania has three dental schools in two cities: Philadelphia and Pittsburgh. Graduates tend to stay in the cities or suburbs, and getting admission is very competitive.
“How do you not only get more dentists, but specifically put them in the spots where you need them to address the problems?” Hawkey asked.
One approach has been to target high school students in rural school districts and encourage them to enroll in dental school, as rural students are more likely to move to rural areas after graduating.
“We really see a need to focus on high school students as really being a long-term solution to our shortages,” Hawkey said.
She also pointed to Ohio’s approach of awarding scholarships for rural students to attend dental school, or rewarding dental schools for accepting rural students.
Broadband expansion to make telehealth more accessible is another possibility, as is expanding the scope of practice for dental assistants to do more dentistry work without the supervision of dentists. That approach is similar to expanding health care access through nurse practitioners, as The Center Square previously reported.
Beyond focusing on dental workers, two other approaches could help: local water fluoridation and school-based health centers.
“You decrease cavities by 25% when the water is fluoridated,” Hawkey said.
However, in Pennsylvania, it’s estimated that 45%-60% of people have access to fluoridated water. Fluoridating water supplies would have a greater impact on poorer Pennsylvanians, she argued.
“Yes, if you are properly trained and eat the right diet and don’t share germs and you use fluoridated toothpaste and you go to the dentist every six months, you can 100% prevent every cavity. Not a problem,” Hawkey said. “But water fluoridation is not for those people. Water fluoridation is for the 50% of kids on Medicaid who don’t get to the dentist at all or the 80% of adults on Medicaid who don’t go to the dentist at all. “
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