Updated: 2/14/2020 Roughly half of all Americans don’t have dental insurance, and PBS NewsHour correspondent Betty Ann Bowser is calling it a dental crisis. She states in the report that:…

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U.S. Facing What Some Call a Dental Crisis

Updated: 2/14/2020

Roughly half of all Americans don’t have dental insurance, and PBS NewsHour correspondent Betty Ann Bowser is calling it a dental crisis. She states in the report that:

The federal government has identified more than 4,500 areas of this country, like Grundy, Va., where there are not enough dentists. It says nearly 10,000 new providers are needed to meet the need.

The state of dentistry today is at a point where many are calling for change, and soon.

The Dentist Problem

The American Dental Association (ADA) says that the issue is not a general shortage of dentists. The issue, they contend, is that those dentists are distributed unevenly throughout the country. Rural areas often have a shortage of dentists. In these areas, patients often rely on governmental assistance to pay for dental care, but many dentists claim to get the short end of the deal when it comes to being reimbursed by these government assistance programs. This would make it very unappealing for a dentist to practice in an area where they may actually lose money on most of their procedures. As we see in this post by a Florida dentist and the comments other people have made below it, dental school debt is almost a crisis in itself, often resulting in upwards of $200,000 of debt.

Some people accuse dentists of being in the profession simply to make money, and that is surely true of some dentists. As with any career, some will be in it just for the money. However, when your dentist encourages you to brush your teeth and floss, they’re actually trying to prevent you from returning with serious dental issues. Most dentists feel very strongly about promoting oral health.

The Patient Problem

Many of those who never darken the door of a dental office eventually find themselves facing severe, expensive dental problems due to neglect.

Why People Don’t Go to the Dentist

People avoid the dentist for many common reasons:

  • Fear of pain or the unknown at the dental office
  • False belief that the pain will eventually go away (Dental decay is degenerative and will continue destroying the mouth. It does not heal like a cut or move on like a common cold.)
  • Inability to pay for dental service
  • Geographical distance from a dental clinic
  • Not even recognizing the need to go to the dentist

The PBS NewsHour story described a clinic in a rural part of Virginia where people waited in long lines to see a dentist for what may have been their first time in years. Many people in this situation tend to be low-income and have no access to dental insurance.

Results of Neglecting Dental Health

If unchecked, an infection in the mouth can eventually spread to the brain and cause serious damage if not death. ADA President William Calnon, DDS, emphasized that many other diseases (like diabetes and cardiovascular disease) can stem from poor dental health as well. However, while many people recognize the importance of upkeep and prevention as it relates to the body as a whole, many fail to realize that oral health works much the same way. The cost for upkeep is significantly less than the cost to repair broken, decayed or aching teeth, but many people find out the hard way.

State dental policies fail in 1 in 5 children, and 17 million children per year go without dental care in the US (DentaQuest Foundation, Pew Center on the States). Almost 60% of children in the U.S. have dental decay, making it the most common disease among children. Tooth decay also affects between 60 to 90% of teenagers and adults, according to the World Health Organization. If this so-called dental crisis doesn’t show improvement soon, those statistics will only continue to grow.

  • Patients: How do you feel about the accessibility of dental care?
  • Dentists: Weigh in and let us know your side of the story.

Leave us a comment and let us know what you think!

  1. Jay the reason you have to pay for that upgrade is you have to pay your way into the club not because your lack of skills.
    I would suggest people research dental tourism. Im in Canada. Dental isn’t covered by National Health Care. A lot of dentists here evade their taxes. I would never go to a Canadian dentist. Greed……

  2. Hello every one . I am Jay samuel . I am a dentist from India. I have worked in lot of mission hospitals in India. I have been on a mission trip as recent as Nov 2012. It startled me to read that there is a shortage of dentists in USA because I have been trying to get on to the system. with all my 10 year Indian experiance to serve this beautiful country. I have to clear two exams NBDE 1 & 2 and go for two years school. I have already cleared Part 1. and then shell out 200 thousand dollars the process is a exhaustive one but it is rewarding one. wish somebody in the congress thought about dentists like us, to be utilized on a contract basis, in the rural and neglected areas in the phc’s to take care of the basic needs of the neglected population.
    if anyone has a suggestion after reading this
    i am here on immanuelangelo@yahoo.com
    for this beatiful country
    “the land of the brave and free”
    God bless America

  3. Fascinero,

    I see your point about dentist income expectations relative to the majority class’ real income, and I definitely think you have a point. But this dynamic is also changing, is it not? As you point out, the number of dentists has risen, yet the ability of the patient to pay has dropped. I have also seen a research quote recently that dentists in the US average a patient churn rate of 30%. So dentists are exiting school with heavy loans as the post points out, and their operational costs have not improved, yet the demand has dropped. Those in busy areas have steep competition and in rural areas face demand scarcity.

    Don’t get me wrong – dentists as a whole are doing just fine. My point is, dentists are having to re-evaluate their pricing schemas to match the current reality. This is the natural effect in a free, meritocratic market. Demand pressure brings market pricing back in line – whether it’s rural patients driving a ways to reach an affordable dentist, or urban patients driving out. Knowledge and awareness of low-cost options, however, is another issue.

    • Add to that the fact that annual maximums for traditional dental insurance haven’t changed in the last 30 years, and it leaves people wondering if dental care is even a viable option. I agree that awareness of low-cost options could begin to bridge that gap.

  4. There is no shortage of dentists, simply a shortage of people capable of paying (or willing to pay) for services they need.

    A similar alarm was sounded 50 years ago and more dental schools opened up and enrollment rose. But here’s the reality: dental need is very different from dental demand. Increasing the supply of dentists didn’t work to either bring costs down or encourage more people to come to them by other means, that’s why more and more dental schools have been shutting their doors permanently over the last 20 years. Not just minor dental schools, major ones, like Northwestern University Dental School.

    Geography and distance to care is mostly a false concern, as I know of many patients who even fly to other cities to get treated by their favored dentist. Or drive 3+ hours to get to the dentist. Even just for cleanings. The issue is one, and only one, thing: money. Remember, distance equals dollars, especially with $4/gal gas. Yet statistically over half the population is stuck with 1970’s inflation adjusted incomes. Dentist incomes, however, have risen disproportionately relative to the less fortunate half. Dentists are in the upper half of income earners. So dentists’ income expectations have therefore risen disproportionately relative to the incomes of over half the population. That kind of divergence in price expectation could only persist if dental practices were streamlined and turbo charged by mass production techniques, which of course, with minor exceptions, it can not be.

    Or introduce a lot of new must-have elective procedures. But here again, new (read: expensive or medically unnecessary) procedures must necesarily be targeted at those that have money, not those who were left behind. Again, as the majority get poorer, dentists end up chasing the fewer who actually can afford dental services.

    So the real issue which is causing both problems of access in both medicine and dentistry is the disproportionate skewing of income over the last 30 years. Income inequality puts less money in the pockets of those who really need health care services, and it puts more money in the pockets of those who mostly don’t need those services as much. Income inequality is the real root of many of the economic problems in the US.

    • Thanks for stopping by. I do agree that ability (and willingness) to pay is a really big issue. Cost disparities and income inequality are driving wedges between dentists and patients who need them.

      We do talk with a lot of people for whom distance is a really important factor, though; if it’s too difficult to get there, they just won’t go, even if it’s just one or two towns over. This makes me think that a heavy contributor to the issue is simply awareness, or recognizing the need. A lot of people just don’t realize that dental health is not merely a cosmetic issue. It can have serious health repercussions if not properly cared for. This, in turn, loops straight back to the cost issue as well.

      Have you seen any models (either in practice or theory) that might work in this kind of dynamic?

  5. I would add another reason people don’t go to the dentist – it’s the dilemma I find myself in now. I had to leave a very good dentist and need to find a new one I can TRUST. It’s unfortunate that dentists in general have the same reputation as car mechanics.

  6. I never thought of the problem from the dentist’s point of view before. I’ve always lived in the city and so have hundreds of dentists to choose from. I can see how dentists wouldn’t want to be in a rural area if they aren’t getting properly reimbursed for their work, which makes it difficult for those residents to get the help they need. This article has broadened my perspective and reminded me to be thankful for the dental coverage I have.

  7. At Max Dental Care, we tell our patients that many dental ailments can easily be prevented with a little attention to oral hygiene. Here are some simple steps, you can follow:

    Brush your teeth twice a day

    Use a soft-bristled toothbrush

    Change your toothbrush every 3 months

    Rinse your mouth after every meal

    Floss everyday

    Avoid snacks between meals

    Accommodate frequent meetings with your dentist

    Regular Dental Scaling

  8. Its true that most people even do not recognize that they need to visit the dentist, and realize only when it turns into a disease, so one should not ignore any problem related to teeth

  9. nice…this article is pretty interesting. It makes me sad to think of so many people without dental care. I’m glad I have a 1Dental.com plan!

  10. Hi Hannah, I really think the business is somewhat slow these days and yes I agree with the factors that affects to this matter and we can’t blame those people who don’t seek dentists. I also believe that without having our teeth’s check up there will be a lot of complications that will occur and it will become more expensive if they don’t have dental care as soon as possible. How much do dental hygienist make these days? It will also affect their income right.?

    • Thanks for stopping by. I am not sure how much dental hygienists make, as that probably varies greatly from region to region. As you point out, I’m sure it will affect their income as well.

  11. I don’t know that more dentists is really the answer, it seems like a redistribution of the old dentists would be a better approach. I know of some dentists who are really hurting for more work to do. Probably because their are so many other dentists in their area, if they moved to one of those areas with few to no dentists, they would make a killing.

  12. Wow…this article is pretty interesting. It makes me sad to think of so many people without dental care. I’m glad I have a 1Dental.com plan!

  13. This was such an informative article. I know many people that don’t like going to the dentist because they know they haven’t taken care of their teeth & will have to pay too much money to get the cavities filled.

    I enjoyed reading up the reasons why it’s important to get our teeth cleaned regularly. I just took my almost 3 year old daughter to the dentist for the first time to get her used to it. So far, my kids do pretty good at letting me keep their teeth healthy.

    Thanks for this article. It was really helpful!

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