PORTLAND – Faced with a shortage of dentists, some Mainers are finding it difficult to get dental care, a problem that hits hardest at the poor, children, and residents of rural parts of the state.

“If you’re poor you have a huge problem,” said Kevin Concannon, commissioner of the Maine Department of Health and Human Services, “but even if you’re not so poor there’s a limited supply of dentists in Maine.”

Maine had 581 dentists in 1998, of whom 64 percent are 45 years old or older, and they are not being replaced fast enough by young graduates of dental schools.

More dentists practice in southern Maine and along the coast than in rural, inland areas. According to the state’s Oral Health Program, in Cumberland County there is one general-practice dentist for every 2,286 people. The numbers drop off dramatically in western and northern Maine. In Aroostook County, for example, there’s one dentist for every 5,507 people.

Poorer Mainers particularly lack access to dental care, but the problem is not limited by income. Even in southern Maine, appointments can be hard to come by.

“The economy is good,” said Dr. Barry Saltz, a Portland dentist who is president of the Maine Dental Association. “There’s a higher dental IQ, and people are taking advantage of their insurance and seeking dental care. Some practitioners don’t see children. Some aren’t taking new patients.”

Concannon says there are only a couple of dentists in Aroostook County who are accepting any Medicaid patients. These low-income patients sometimes have to travel as far as the Portland area to get dental care, if they get it at all.

Low reimbursements and paperwork do not fully explain why as many as 40 percent of Maine dentists will not accept Medicaid patients. Only 15 of the 300 dentists who responded to a state survey last year said they would be able to take more Medicaid patients – even if the state paid them 130 percent of their customary charge.

“It isn’t just a function of what we reimburse,” Concannon said. “Their practices are full.”

The problem is even worse in pediatric dentistry. Maine has only six full-time specialists who can take care of the special dental needs of children, Saltz said.

“There are a few of them here, but these guys are booked months ahead of time,” Saltz said. “They’re just inundated.”

A new federal report projects that the number of dentists in the United States will grow 8 percent by 2006, but there is no growth at all projected for Maine.

Fewer people are graduating from dental school, and new dentists tend to graduate with a heavy debt load.

Nationally, the country produced 3,000 dentists a year in 1980, but that number has now dropped to 2,000, Concannon said. Maine has no dental school of its own, and attracting graduates here from other states can be a challenge.

“I think we could compete on quality-of-life issues with just about anywhere in the country in terms of safety, affordability, the natural environment, that sort of thing,” Concannon said. “But what may on paper scare potential dentists off is we’re 36th in per-capita income, so they may think there are limited economic opportunities.”

Concannon said he would like to improve access to dental care in the state by finding a way for dental hygienists to practice in more public-health settings, such as hospitals, clinics, schools and nursing homes, where they could do more prevention work.

“We know that for many children who are in school, their only contact with the health care system may be with a school nurse, and that’s kind of a safety net,” Concannon said. “Well, if we had school dental hygienists for school systems where they focused on teaching kids early in their life on proper brushing and nutrition and flossing – all of the things that we know make a huge difference – that would have a huge beneficial effect on thousands of children in our state.”

Dental hygienists are allowed to go into some of these settings now, but only as volunteers. And they must be supervised by a dentist, says Mary-Lynne Murray Ryder, president of the Maine Dental Hygienists Association.

The Maine Dental Association has been working on its own strategies to alleviate the shortage, including an education loan program that offers incentives to Maine students who come back after graduation and practice in underserved areas.

The group also is trying to bring a dental residency program back to Maine. In the past, half the residents who trained in Maine under a similar program ended up staying in the state.