Advancing oral health in rural America

By Kathleen Walker, Director, Marketing & Communications, Northeast Delta Dental

Almost one-fifth of the U.S. population lives in rural areas, but the oral and overall needs of these communities are often poorly understood. Rural populations are less likely to visit the dentist than peers and are more likely to have their teeth removed due to decay or gum disease. Barriers like geographic isolation, lack of adequate transportation, poverty, and provider shortages often drive these disparities.

I recently spoke with Jon S. Ryder, D.D.S., M.S., Dean of the College of Dental Medicine at the University of New England (UNE), to learn more about oral health among rural communities and discuss the educational opportunities for dental school graduates who practice in rural areas.


Q: Given your experience serving the oral health needs of rural communities, what types of unique challenges do these communities face?

There are many challenging barriers to accessing healthcare in rural communities. These include finding a provider within a reasonable driving distance, finding a provider who accepts your specific dental coverage, whether Medicaid or other, and having the ability to pay for services. For patients who have special needs or complicated cases, the barriers are magnified exponentially. Longstanding cultural beliefs, where community members do not understand the importance of good oral health, are also challenging.  


Q: How can we solve some of the challenges rural communities face in accessing oral health care? What types of programs or resources have been successful in improving oral health in rural communities?

We are encouraged by the variety of new ideas and programs addressing access and health equity issues including teledentistry, engaging non-profits to target specific patient groups such as special needs, integrating oral healthcare into primary care, mobile delivery of care, and addressing access issues within the dental school curricula. These innovations, along with sustained efforts to recruit permanent providers into rural areas, are promising.


Q: UNE operates a Dental Education Loan Repayment Program for Maine, with support from Delta Dental Plan of Maine. How did this program come about, and what kind of impact has it had?

We developed the program to assist new graduates that choose to practice in underserved communities. This is a win-win for both the dentist and patients by helping to reduce the financial burden of the new graduate, which can be a barrier to practicing in an underserved area even for those who want to. Sustaining a viable business practice and earning a living has to make sense for a new graduate to set up a practice. The program significantly helps students located in areas of need by lowering their financial burden, while also increasing the number of dentists in areas that have historically faced critical shortages of healthcare providers.

Q: Do you have a patient or dental student story you can share that highlights the importance of the work that UNE College of Dental Medicine does for rural communities?

Dr. Dustin Nadeau, an alumnus from the first graduating class (2017) has a wonderful story to share. He actually worked on the construction crew that built the Oral Health Center and was accepted into the inaugural class while completing the building in his hard hat! Dr. Nadeau was a high-quality student and one of UNE's first Delta Dental Plan of Maine Student Loan Repayment Program recipients. He has since purchased his own practice in a Dental Health Professions Shortage Area and has grown the practice to the point of now hiring another recent alumnus. "Practicing in this region has allowed me to fulfill a mission that I care strongly about and one that the UNE dental program was founded upon: to improve oral health in rural and underserved areas of Northern New England," he says.

Dr. Dustin Nadeau

Q: What are the top three things that should be known about oral health care for rural populations?

Residents of rural areas face acute provider shortages. Sixty percent of the nation's Dental Health Professional Shortage Areas are in rural America. Rural residents face geographic isolation and lack adequate transportation.

In addition, rural areas have a higher percentage of people over age 65, who are more likely to live below the poverty line and less likely to have dental coverage as they are not generally employed.

Q: What trends or innovative programs are impacting oral health in rural communities in the next decade?

Certainly, the increased use of technology and emerging technologies are making a difference. Teledentistry extends a specialist's knowledge to places that otherwise might not be possible. I also believe that the integration of oral healthcare into primary care is a key to sustainable improvements in oral health. Working together in interprofessional healthcare teams can be a practical and efficient way to provide targeted compressive care from a single location or through a connected network that also addresses transportation barriers.


Q: Why should oral health programs prioritize the needs of rural communities?

Access to healthcare is a right, not a privilege. A healthy life means having a healthy mouth, whether you live in your state's biggest city or its most rural township.


Jon S. Ryder, D.D.S., M.S., is Dean of the College of Dental Medicine at the University of New England (UNE).

Kathleen Walker is Director of Marketing and Communications at Northeast Delta Dental, which is part of Delta Dental's national network and serves Maine, New Hampshire, and Vermont. Northeast Delta Dental is a values-driven company that successfully balances profitability and community involvement.

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