At least five Alabama counties lack dentists, says former dental association director

Rural Alabama needs more dentists.

Dr. Zack Studstill, former executive director of the Alabama Dental Association, told the legislative Healthcare Workforce Task Force on Thursday that at least five counties in Alabama do not have a dentist serving the area.

“People have to drive anywhere from 45 minutes to an hour for a dental appointment,” Studstill said, adding that transportation is also an issue preventing rural Alabama from accessing dental care.

Studstill, a member of the task force, said that retiring rural dentists can’t find dentists to take over their practices.

“The bottom line is we have to deal with what the situation is, and we need to find a way to get more dentists who have graduated into rural Alabama,” he said. “Because it’s a crisis there.”

Rural residents are less likely to get dental care, according to the Centers for Disease Control and Prevention (CDC). Rural residents are also more likely to receive restorative, oral surgery services or emergency dental services than those residing in urban areas due to untreated dental issues. The percentage of adults who have visited the dentist at least once in the past year was higher among those residing in urban areas (66.7%) than those in rural areas (57.6%).

Studstill said that the shortage in rural dentistry can be attributed to a decline in dental school graduates since the 1980’s, when the federal government began slashing funding to schools of dentistry because it overpredicted the need for health care workers. Dentistry schools began to close in the 1980’s while others had to restructure financially.

As those dentists who graduated before the 1980’s began retiring in the last few years, due to the decrease in dental training after the 1990’s, it has become harder to replace dentists in rural areas.

For example, in 2016, an estimated 40% of US dentists were aged 55 or older compared with 27% in 2001. Data suggest that more than 50% of dentists in Alabama are 50 or older, who are expected to retire in the near future.

“They were replaced pretty well in metropolitan areas, but again, in rural Alabama, they were not being replaced,” he said.

Rural areas in general struggle to attract health care providers. Rural physician shortages are projected to get worse in the next 10 years, according to a 2023 article published in the Journal of General Internal Medicine. The shortage of physicians could go up from about 20,000 in 2019 to anywhere between 37,800 and 124,000 by 2034.

One initiative provides a loan for up to the annual cost of in- state tuition and required fees at the University of Alabama at Birmingham School of Dentistry. In return, the newly graduated dentists must agree to work full-time in a clinical practice as a licensed dentist in an area of critical need for five years and participate in the state Medicaid program.

According to a 2021 report from the Alabama Commission on the Evaluation of Services (ACES), the Board of Medical Scholarship Awards, which provides scholarships to medical students, have had a 93% success rate, whereas the Board of Dental Scholarship Awards had a success rate of 10%.

Dental school loans were awarded to 90 individuals in the old loan program, and only nine dentists have fulfilled the loan requirement since 2010. None in the 22 counties with a defined need. The majority opted to pay back the forgivable amount.

By comparison, ACES found that the medical school loans were also effective at keeping physicians in Alabama after their obligations were fulfilled. Over 60% of award recipients were still practicing medicine in their original locations after they completed their obligations and over 90% remained in Alabama.

The difference between the two loans was that loans for dental school were only partially forgiven in its initial program, whereas the loans for medical schools were fully forgiven after a certain amount of years depending on the size of the community in which the student served.

The Board of Dental loans are now fully forgiven after 4 to 5 years of serving a rural community, depending on community characteristics.

Studstill said that with more funding in the last 5 years, the program already has three dentists practicing in areas with high need. There are 12 who are under contract working towards graduation, with 5 waiting for the contract to be finalized.

“This is beginning to really move. It’s taken a long time and we had to get funding first, and then we had to work with the [UAB] School of Dentistry to get the program really off the ground running … It’s going to take time,” he said.

This story was updated at 4:42 p.m. to clarify that Dr. Zack Studstill is a former Alabama Dental Association president.