Hal Jeter has been a family dentist in South Point, along the river where Kentucky and West Virginia meet Ohio, for nearly 30 years. He knows the dentist can be scary for kids, so he does his best to make tooth extractions and cavity fillings fun.
On an August day, he put a sealant on a very brave second grader, bringing levity into each prod of her teeth.
“Open up really big, like an alligator,” Jeter said as he began the preventative treatment. “This is magic paint because it goes on pink, and we shine a blue light on it and then it turns white.”
She’s just one of many patients he’ll see on this packed day. His office has lost three dental hygienists in the last year. It’s increased the workload on the remaining staff and limited the amount of Lawrence County residents he can see each day.
“We have unfortunately had to cancel, everyday, 10, 11, 12 patients just because we don't have the hygiene capacity to get them in for their cleanings and their exams,” he said.
It’s not just dental hygienists and assistants in short supply, but dentists themselves. More than 30 Ohio counties don’t have enough dentists to fulfill community needs. That’s especially true in southeast Ohio, where oral health care is harder to access.
Dental care deserts
Their absence hits the state’s rural and poor areas the hardest. Many of Ohio’s Appalachian counties have fewer than 10 providers serving their area.
“We have some counties that do not have a dental provider that takes Medicaid. So for some folks in Southeast Ohio, they're going to have to leave the county they live in to get to a dentist,” said Marla Morse, executive director of Oral Health Ohio, a statewide coalition of oral health care advocates.
Morse said dental shortages force many Ohioans to go without their biannual checkups. The consequences are more serious than bad breath: they’re more likely to develop tooth decay and infections, which are linked to a whole host of chronic issues, including heart disease, diabetes, and respiratory disease.
“You cannot have a healthy body if you do not have a healthy mouth,” Morse said.
Plus, it’s costly. When people miss check-ups, they’re more likely to seek dental care in the emergency room, which drives up health care costs across the state. The Ohio Department of Health estimates the price tag of those visits was $738 million from 2016 to 2019.
Building a new workforce
The current shortage of rural dental services is a lose-lose situation, said Frank Beck, a dental educator in northeast Ohio. Yet, the state has struggled for a long time to fill the gaps.
“Oral health remains the number one unmet healthcare need of Ohioans for the last 25 years,” Beck said.
It’s not an easy problem to solve. It’s expensive to become a dentist, Beck said. Dentistry students graduate hundreds of thousands of dollars in debt, and that makes practicing in low-income and rural areas a less viable economic option.
Beck said there needs to be more incentive to work in those high-need areas. He’s working with Northeast Ohio Medical University to open a new dentistry school next fall. Students at the Bitonte School of Dentistry will train at rural community health centers and, hopefully, stay in when they graduate.
“If you embed students in rural, vulnerable and underserved population areas, they're far more likely to remain and retain there,” Beck said. “So that’s the silver bullet.”
Beck’s not the only one working on the problem, though. The Ohio Dental Association has launched a dental loan repayment program, and some Ohio counties are using a flurry of state funding for the Appalachian region to create dental support staff training programs.
Dental hygienist April Floyd hopes some of those investments begin to pay off soon. She’s worked for 25 years at Jeter’s practice in Lawrence County.
“I would like to at some point start slowing down a little bit,” Floyd said. “But I feel that, right now, I can't do that just because I would not be able to serve our patients.”
She said if she retires now, their months-long waitlist will only grow.
