A recent report from the University of Nebraska Medical Center highlighted the acceleration of a long-time rural health care challenge – the shortage of dental services in rural Nebraska. Access to Oral Health Care in Nebraska found that 44 counties in the state (out of 93 counties) are designated as general dentistry shortage areas. Twenty rural counties are completely without a dentist. Only 39% of the state’s dentists practice in a rural area – a number that has stayed relatively constant since 2008.
A long-term concern expressed in the report was the aging of practicing dentists and more dentists approaching retirement. As the number of dentists in the state decreased, the number of dentists over 60 increased.
The report analyzed several possible options; among them are:
- Giving dental hygienists wider range for preventive and basic practice.
- Using practice sites of other providers (such as physicians or health clinics) for dental services. Dental services in Federally Qualified Health Clinics are increasing, but most of rural Nebraska is not served by such a clinic.
- Increasing the number of graduates at dental schools, though both the state’s dental schools are currently at capacity.
- Increasing student loan reimbursement rates for those dentists who agree to practice in rural and shortage areas. Fifteen years ago the state began offering reimbursement for such new dentists. The program has not kept up with inflation and the increase in student loan debt.
Access to dental services is a major health care issue. The American Dental Association estimates that dental issues contribute to 164 million lost work hours and 51 million lost school hours annually. Oral health deficiencies have been found to contribute to a host of other health issues.
The Nebraska report corresponds to a recent report by the National Academy for State Health Policy estimating 85 million Americans lack dental coverage. The lack of coverage is most acute among low-income adults and due in large part to the decline in Medicaid reimbursement rates.
A lack of dental services is also a critical issue for children, also in large measure to Medicaid coverage and challenges dentists have in participating in the Medicaid system. Read more on this issue here.