Attracting dentists

More than one person in 10 in rural America has never visited a dentist, according to the American Dental Association, a figure produced in part, perhaps, from habit and in part from poverty, but certainly also in part from a nationwide shortage of dentists. Sen. Susan Collins, observing Maine’s struggles with trying to solve its own shortage, has proposed a valuable amendment to increase the number of dentists, particularly in rural areas, and improve oral health care.

The national shortage of dentists and the location of their practices are reflected in Maine. Regions go on a federal high-risk list when the ratio of the general population to dentists exceeds 4,000 to 1. In the Portland area, the ratio is 2,286 to 1; in Aroostook County, it is 5,507 to 1. The absence of regular dental care can lead not only to an increased number of cavities or incidences of gum disease but also to other diseases. A U.S. Surgeon General’s report not long ago concluded that problems in the mouth can indicate such diseases such as diabetes, leukemia and anemia.

The Collins amendment would provide $50 million over five years to help states attract new dentists through forgiving loans for those who practice in underserved areas. States could also establish a dental residency program if, like Maine, a state lacks a dental school and they could expand community dental facilities. States would be required to provide a 40 percent match. Equally important for Maine, the amendment expands a dental scholarship pilot program that encourages graduates to practice near the schools. The program is not currently available in New England, but all 55 accredited U.S. dental schools would qualify under the amendment, greatly enhancing Maine’s opportunity to attract new dentists.

The amendment is part of the Health Care Safety Net bill, which reauthorizes the National Health Service Corps and the Consolidated Health Centers programs being considered by the Senate Health, Education, Labor and Pensions Committee. The amendment, which was accepted unanimously, began with broad, bipartisan support, including from Republican Sens. Christopher Bond and John Warner and Democratic Sens. Ted Kennedy and Paul Wellstone. The ADA and the Maine Dental Association also support it.

The Maine Legislature last session struggled to develop its own response to the state’s shortage of dentists and the resulting inability of Medicaid patients to get care. A lack of money restricted more ambitious plans, but some funds were approved to advance the idea of a Maine residency program for dentists and some for a student-loan program. The MDA is taking a more direct approach. Last year, it visited New England dental schools and told students about opportunities in Maine, and it plans to contact high schools in Maine this year to encourage students to think about a career in dentistry. Make that a career in dentistry in Maine.

The Collins bill helps these efforts because the funding is fairly flexible – it even allows the loan-forgiveness programs to apply to dentists who would like to work part time, doubling the commitment time from two to four years. The amendment could make an important difference in Maine and in rural places nationwide. It deserves strong support as the Health Care Safety Net bill moves through Congress.