Expanding the Dental Workforce

Children should see a dentist whenever possible. However, the ratio of dentists to population is shrinking—in 2010, that ratio was at its lowest level in nearly 100 years.

For low-income children, the situation is even worse. The small number of dentists willing to see low-income patients is creating a major barrier to care in state Medicaid programs. In 2008, fewer than half of the dentists in 25 states treated any Medicaid patients. That same year, only 11 million out of the 28 million Medicaid-enrolled children aged 1 to 18—roughly four in ten—received dental care.

Licensing New Dental Professionals

Pew's work on children’s dental policy is forming partnerships with states to expand dental care for children by adding new types of dental professionals. Unlike the medical workforce, which includes specialists and a variety of practitioners, the current dental workforce is limited to dentists, dental hygienists and dental assistants. A number of states are considering licensing new dental professionals, similar to nurse practitioners, who would increase the total workforce and create more sources for treatment in rural communities. These new providers, who cost less to train than dentists, could work in schools, dental offices or community health centers.To learn more about how these new professionals can help close the access gap, view our infographic on new workforce models or read frequently asked questions about expanding the dental workforce.

Minnesota and Alaska and more than fifty other countries already license providers called dental therapists. Research shows that dental therapists are providing safe and competent care under the general supervision of dentists. Pew is conducting research on the economic impact of several new types of practitioners to demonstrate that adding them to the workforce could expand the capacity of the system would not have a negative impact on dentists’ business models. Download Pew’s guidelines (PDF) for a new provider model.

Minnesota's Story

From 1993 to 2000, Minnesota's dentist-to-population ratio suffered the greatest decline of all 50 states. In 2008, it was estimated that roughly 350,000 low-income Minnesotans see a dentist less often than they should or not at all. To expand access to dental care, in 2009 Minnesota passed a law allowing the licensing of dental therapists. Read Pew's brief on how a broad coalition of public health advocates campaigned successfully for the law. We also offer the following resources for understanding the impact and importance of this law:

• summary of the law and its impact on dental care and training. (PDF)
• column from a Minnesota dentist on why he supports adding new types of dental providers. (PDF)

Improving Reimbursement

Pew is also working in states to expand reimbursement for medical providers who provide dental services. Because most children see doctors and nurses earlier and more often than dentists, states have turned to medical providers to help prevent tooth decay. Medicaid programs in nearly 40 states reimburse medical providers for preventive dental health services for children, including the application of fluoride varnish, a concentrated form of fluoride that is applied to children’s teeth to prevent cavities.

• Read a Pew factsheet on reimbursing physicians for fluoride varnish.