Oral health is part of overall health. However, many Americans, especially in rural areas, struggle to access routine, preventive dental care. Compared to those living in urban or suburban settings, people living in rural areas are less likely to have seen a dentist in the past year or have dental insurance, and they are more likely to rate their oral health as poor.
Dental provider shortages, limited provider acceptance of Medicaid, and lack of affordability all influence access to dental services. Given access challenges and the bi-directional impact on overall health, a number of states have prioritized developing strategies to expand rural access to oral health services. This includes investments to strengthen the rural dental health workforce and expanding partnerships to integrate dental care into a variety of clinical, school, and community settings.
Key Takeaways
- Many rural Americans struggle to access routine oral health care compared to their urban and suburban counterparts.
- States are leveraging innovative strategies to increase access to oral health care and improve outcomes in rural communities by investing in the dental workforce and expanding access to dental services in community, school, and primary care settings.
- The Rural Health Transformation Program (RHTP) also serves as a funding opportunity for states to use to improve dental access and oral health among their populations.
Oral Health and Rural Health
States are implementing a number of strategies to meet the unique needs of rural communities in their states. Examples include:
Using Telehealth to Bridge Care Gaps
Telehealth is a recognized strategy that can virtually connect patients with providers. This can be especially helpful for patients living in rural areas with limited access to care.
- Colorado has numerous initiatives to address gaps in oral health care focused on medical-dental integration, collaborating with the state primary care association, community health centers, local public health agencies and other community-based care settings, and teledentistry. Specifically, the state developed a teledental roadmap, which is a virtual on-demand training that also includes a readiness assessment and resources to aid implementation. This roadmap received positive feedback from the state primary care organization and community health center affiliates. Contact the Colorado Department of Public Health and Environment Oral Health Unit for more information.
Expanding the Dental Workforce to Increase Access
Dental provider workforce shortages create additional barriers to accessing dental care in rural areas. As of December 2024, only 32 percent of the country’s dental workforce needs were met. States are adopting a variety of strategies to retain, bolster, and bridge workforce gaps.
- Wisconsin is developing several models to address these shortages, including the passage of licensure for dental therapists in Wisconsin on January 31, 2024. The state is also working with local community health workers (CHW) to develop oral health trainings that provide resources and education for rural and underserved communities.
Medical-Dental Integration
Because rural communities experience limited access to both medical and dental services, integrating these services, especially in primary care settings, can provide additional access points for patients.
- North Carolina’s Into the Mouth of Babes program trains medical providers to conduct early oral health screenings for young children and provide preventive treatments such as fluoride varnish. Recent evaluations found that children receiving oral health services through this program had reduced hospitalization rates for dental treatment and lower incidence of cavities, and the program had reduced disparate rates of dental decay among low-income children.
Oral Health Opportunities through the Rural Health Transformation Program
States have opportunities to improve access to dental services through the RHTP, which can support new partnerships, infrastructure, and care delivery models that integrate medical and dental services in a variety of settings.
Improving oral health was a key part of many state RHTP applications. Proposed initiatives across states include school-based care, workforce development, expanded scope of practice, dental equipment, mobile services, telehealth, and integrating value-based payment strategy. As states work to implement rural health transformation plans, leveraging or scaling effective models for integrating dental services can address disparities in oral health outcomes for rural communities.
Check Out Our Rural Health Transformation Program Blog Series
- CMS Announces Rural Health Transformation Awards to States
- Rural Health Transformation Program: State Focus on Community Health Workers
- Rural Health Transformation Program: State Focus on Aging
- Rural Health Transformation Program: State Focus on Behavioral Health
- Rural Health Transformation Program: State Focus on Primary Care
- Rural Health Transformation Program: State Focus on Maternal and Child Health
Based on NASHP’s internal scan of state RHTP applications, at least 24 states included oral health initiatives: Alabama, Arkansas, Connecticut, Georgia, Idaho, Iowa, Kansas, Massachusetts, Maryland, Maine, Montana, Nebraska, North Dakota, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Washington, Wisconsin, and Wyoming.
Acknowledgments
This work was supported by the CareQuest Institute for Oral Health. Please reach out to Megan D’Alessandro (mdalessandro@nashp.org) with any questions about NASHP’s oral health work.
