In just three years, states like Vermont, Maine and Arizona will have more dentists retiring than graduating from schools to replace them. New Hampshire also has issues over access to primary dental care in parts of the state, but whether a shortage is on the horizon is unclear.But with the increasing emphasis placed on oral health as an integral part of overall health, the issue has become all the more critical to address."Across the country, the number of dentists per 1,000 population is the lowest it's been in 100 years," said Tom Raffio, chief executive of Northeast Delta Dental, a dental insurance company in Concord. "In 2013, more dentists will be retiring than graduating. This will peak in 2023, with a net loss of 1,706 dentists nationwide, and it doesn't correct until 2030."According to an Aug. 2 article in ADA Now, a publication of the American Dental Association, New Hampshire and some 20 other states across the country are already experiencing some type of dentist workforce issue.Two questions emerge: How many practicing dentists are there in New Hampshire? How old are the dental practitioners?According to the New Hampshire Board of Dental Examiners, the state's dental licensing body, there were 1,014 "licensed and active general practitioners" in the state as of Sept. 17.But Lisa Bujno, head of the state Bureau of Population, Health and Community Services, said it's difficult to get an accurate picture of New Hampshire's dentist workforce because, unlike other states, the Granite State doesn't have an ongoing data collection system that definitively tells who's working and where at any given time."We need to have a better system of collecting data to aid us in figuring out shortage areas," she said. "Right now, we have to survey the area periodically."Striking differencesVirtually all surveys only provide a snapshot of a sample population."Dental Services and Workforce in New Hampshire," a January report by the New Hampshire Center for Public Policy Studies, based its data on a state Board of Dental Examiners' figure of 757 "licensed and active" dentists as of September 2009, and reported some 5.8 dentists per 10,000 residents statewide.The national average is 5.5 dentists per 10,000 population.But one of the biggest concerns is that the dental profession in New Hampshire - like the rest of the state's population - is aging.According to the policy center's January dental workforce study, from 1998 through 2007 (the most recent data available), the number of New Hampshire dentists aged 55 and older increased from 24 percent to 41 percent. Dentist aged 44 and younger dropped from 36 percent in 1998 to 29 percent in 2007.Indeed, a recent survey conducted by the state Department of Health and Human Services and the Bi-State Primary Care Association found that 51 percent of the 500 dentists responding said they were over 55.The "2010 Survey of Actively Licensed Dentists," also said that some 40 percent responded that they intend to leave their practice within 10 years."The profession is definitely aging, like the rest of New Hampshire, and it's going to get worse," said Raffio. "With the economy, some older ones might be working longer. Younger dentists are more aware of work-life issues and might just work a few days a week or for corporate dental clinics instead of having a solo practice."There are some striking differences in dental workforce numbers when viewed at the county level.According to the policy center study, Hillsborough County has the greatest concentration of dentists, at 6.3 per 10,000, as does Grafton County, and is closely followed by Rockingham at 6.2 and Merrimack at 5.9.Sullivan County, however, has half that, at just 3.3 dentists per 10,000 residents.Interestingly, Coos County also has 6.3 dentists per 10,000, which may actually suggest an oversaturation in a market that is typically under-served by medical care.According to Raffio, Vermont is also experiencing the same "maldistribution," and "Maine has both issues - 4.7 dentists per 100,000 population overall and maldistribution."Dental schoolsDoes the Granite State's maldistribution of dentists and an aging workforce necessarily spell a shortage?James Williamson, executive director of the New Hampshire Dental Society, the state's professional association, doesn't think so."We do have some problems with maldistribution, and that will continue. But it's not a shortage, though," he said. "North of Concord, trying to fill some positions will be difficult. But overall, a shortage won't be the case for New Hampshire."Dr. Gary Lindner, a dentist and orthodontist in Bedford, agreed, and said he sees a bit of a workforce surplus."I don't see an abrupt change even over 10 years. I don't see a shortage. Today's graduates are actually having rough times getting a position because of the economy," he said.Lindner, a member of both the New Hampshire and the Massachusetts Dental Societies and the American Association of Orthodontists, said today's dentists have tightened their belts in weathering the economy, like most businesspeople. In doing so, they have not taken on associates or expanded their solo practices - traditional routes for new graduates to enter into practice.Lindner said, if anything, the state and country are under-served in primary care, but over-served in specialists.To illustrate his point, he said when he began his practice some 25 years ago, his was the only orthodontic clinic in the area."Now there are three or four within walking distance," he said.One issue that many believe may have an impact on the future of the New Hampshire dentist workforce is the lack of a dental school in the Granite State.There are several degree programs and technical schools for dental hygienists and dental assistants, but none conferring a doctor of dental surgery (DDS) or doctor of dental medicine (DMD) degree.The closest programs are currently located at Boston University, Tufts University and Harvard University in Massachusetts, with several more in New York.The dental society's Williamson said the expected 2012 opening of a dental program at the University of New England in Portland, Maine, may help add dentists in New Hampshire.But, Bujno said, "We don't know how we can attract new dentists without a dental school in the state."Raffio agreed, saying, "The fact that we don't have a school of dentistry does hamper New Hampshire somewhat in being able to predict or plan for fluctuations in the dental profession within the state. If we had a dental school in northern New England, the graduates would probably stay."Lindner doesn't see a school as a panacea for the state's care access problems, though."People stay close to where they received their training, and go where they want to live, but not necessarily where need is," he said.In an effort to ease some of the maldistribution, Raffio said that the dental school at the University of New England will offer externships in New Hampshire.He said Northeast Delta Dental also has had conversations with the dental college at Tufts about loan forgiveness if the graduate decides to practice in New Hampshire.For now, access to dental care in the more rural parts of the state is and probably will remain something of a concern, but an overall shortage is not something most of those in the profession see as imminent.Added the dental society's Williamson: "We will have some difficulties, but New Hampshire is a good place to practice dentistry."Cindy Kibbe can be reached at firstname.lastname@example.org.
This article appears in the November 5 2010 issue of New Hampshire Business Review