Ensuring access to dental care, particularly for children, is a significant policy concern in the United States. Many factors affect access on both the provider and patient sides. This study examines one important factor in the ability to access dental care: the distribution and availability of dental health providers. We assess these characteristics of providers across the counties of Pennsylvania, primarily using data from the 2013 Survey of Dentists and Dental Hygienists administered by the Pennsylvania Department of Health (Bureau of Health Planning, 2014).
The U.S. Department of Health and Human Services has established a general guideline that a ratio of less than one full-time–equivalent (FTE) dentist per 5,000 people is a shortage. To identify possible dental provider shortages in Pennsylvania counties, we assess ten indicators of access to dental providers: number of FTE dentists per 1,000 people; number of FTE general, pediatric, and geriatric dentists per 1,000 people; number of FTE dental specialists per 1,000 people; number of FTE hygienists per 1,000 people; number of FTE public health dental hygiene practitioners (PHDHPs) per 1,000 people; number of FTE dental professionals per 1,000 people; number of FTE dentists accepting Medicaid per 1,000 Medicaid enrollees; number of FTE pediatric dentists per 1,000 children under age 10; number of FTE pediatric dentists accepting Medicaid patients per 1,000 Children's Health Insurance Program (CHIP) enrollees under age 10; and number of Head Start enrollments per CHIP enrollee. Head Start ensures that children brush their teeth at least daily during the program; children often receive dental screenings and examinations on site as well.
We find significant variation in our indicators across Pennsylvania counties. For overall dentists, two counties (Potter and Juniata) fall below the guideline; other indicators suggest lack of access in other dimensions. For example, Forest and Elk counties do not have any dentists who accept Medicaid. Children's access to pediatric dentists is an acute issue, both for the general youth population and for the CHIP population; 39 of the 67 counties have no pediatric specialists, and many of these counties border other counties with no pediatric specialists.
For all access indicators except Head Start enrollments per CHIP enrollee, there is less access in counties where population size and population density are low; the highest county quartile of population density has about five times as many dental specialists as the lowest quartile of population density. We find that areas with fewer dentists per capita also have fewer PHDHPs per capita, indicating that the goal of increasing access in rural areas through the creation of this mid-level provider role is not being achieved. Children in the Head Start program are more likely to live in areas that face dental workforce shortages, including those specifically related to children's access to pediatric care. This suggests that the Head Start program is successful at delivering dental care to low-income children who otherwise could face barriers to access.
Bureau of Health Planning, Division of Plan Development, Pennsylvania Department of Health, 2013 Pulse of Pennsylvania's Dentist and Dental Hygienist Workforce: A Report on the 2013 Survey of Dentists and Dental Hygienists, Vol. 6, September 2014. As of December 7, 2015:
The research described in this article was prepared for the Pennsylvania Department of Health and conducted by RAND Health.