'I just did surgery on myself.' Michigan dentist shortage leaves some in lurch
- Michigan has nearly 8,000 dentists, but needs at least 400 more to meet the needs of Michiganders
- Dentists are lacking most in rural parts of the state and in Detroit
- Many Michiganders have to wait weeks or months to get in to see a dentist
When Alpena’s Jan Prentice had two painfully cracked and infected teeth, it took her four months to find a dentist — 40 minutes away — who accepted her insurance and could take new patients.
When she got home from having the teeth pulled, she said she found a couple pieces of tooth that the dentist didn’t completely extract.
She pulled those pieces out herself.
“No sense in calling to try to get help, because it might be another couple months,” she said last week. “So I just did surgery on myself last night.”
While Prentice’s experience is unique, 1.6 million Michiganders — especially those in rural northern parts of the state — lack adequate access to dentistry services, the state’s latest Oral Health Plan says. At least 400 new dentists are needed to fill gaps that have some residents waiting weeks, months, or longer for care that often comes too late.
Compounding the problem is a lack of dental insurance coverage that means even Michiganders lucky enough to get into a dentist’s chair often can’t afford to pay for it. A congressional Republican spending plan that could force Medicaid cuts has health care providers worried that the problem could get worse. Medicare doesn’t cover dental services.
State and oral health care officials working to solve the problem have launched mentorship programs to encourage dental students to move to areas of shortage, have lobbied for expanded college loan forgiveness programs so dentists can afford to open clinics, have invested in alternative treatment options such as dental therapists and low-cost dental clinics linked to public health departments, and have worked to open a new dental hygienist school in the Upper Peninsula.
For the first time in three decades, the state in 2023 raised the Medicaid reimbursement rates for oral health care to encourage more dentists to accept patients who have that insurance.
But everyone who spoke to Bridge Michigan for this story said it will take years for any of those efforts to bear real fruit.
And, until then, the shortage “could very well get worse,” said Christine Farrell, oral health program director for the Michigan Department of Health and Human Services.
A third of the workforce gone
Elise Bur, director of Northern Michigan University’s Center for Rural Health, worked hard to advocate for a bill guaranteeing every Michigan kindergartner receives an oral health screening. But, when the bill finally passed in 2023, her friends in the state health department weren’t smiling.
“They looked so deflated,” Bur said. “They said, ‘We’re now going to identify more children who need services, and there’s no one to provide it.’”
Michigan has nearly 8,000 dentists and more than 10,000 dental hygienists, but those professionals do not work everywhere they’re needed.
Fifty-eight of Michigan’s 83 counties are considered shortage areas, said Farrell, of the state health department. That includes all of the Upper Peninsula, most of the counties north of the Thumb in the Lower Peninsula, and parts of west Michigan. Parts of Detroit also lack enough dentists, according to a state map based on US Department of Health and Human Services data from September.
It’s a nationwide problem.
The US needs nearly 3,400 more dentists and 21,000 more dental hygienists to meet all of the current need, federal data says. By 2037, the country will be short nearly 12,000 dentists and nearly 30,000 hygienists.
Northern Michigan University’s Bur said her own dentist in Marquette just had to close because the dentist couldn’t find enough hygienists to staff the office. Farrell said some clinics have offered as much as $60 an hour plus bonuses to try to recruit hygienists, with little luck.
Eric Knudsen, an Escanaba dentist and immediate past president of the Michigan Dental Association, said he can’t accept new patients now because he doesn’t have the staff to care for any more people.
My Community Dental Centers, clinics linked to public health departments and designed to reach underserved Michiganders, closed six of its 34 locations last year because of staffing issues, said Kimberly Singh, chief of community and governmental affairs for the clinics.
Restrictions and requirements meant to stop the spread of COVID-19 hit dentists hard, Farrell said. Many dentists elected to retire or simply closed shop during the pandemic.
“I’d say we lost about 30% of the dental hygiene workforce,” Farrell said, “and it has not reached pre-pandemic levels.”
While dental schools are pumping out more dentists — the number of graduates grew 4% between 2020 and 2024, according to the American Dental Association — those students often leave school with as much as $500,000 in student loan debt, Farrell said. Startup costs for a new clinic range from $350,000 to $500,000.
Facing that kind of burden, many dentists eschew their own clinics in favor of joining existing clinics, Farrell said, and those who open their own clinics often open in more populated areas and areas with higher rates of insurance coverage.
That exacerbates rural shortages.
‘A team effort’
Michigan’s health department has worked to address the oral health workforce shortage since the pandemic, Farrell said. The state recently hired a rural oral health consultant who will over the next few months develop a plan to get more dentists and hygienists where they’re most needed.
The state has discussed encouraging the state’s two dental schools — at the University of Michigan and University of Detroit-Mercy — to launch rural dentistry tracks, as medical schools have already done.
The state has numerous scholarships and loan forgiveness programs for dentists, but has discussed expansions.
The state in 2018 passed a law to allow dental therapists who can perform routine dental procedures under the supervision of a dentist, but so far no school in Michigan offers a dental therapy program and no therapists have been licensed in the state. It wasn’t immediately clear why Michigan schools haven’t launched dental therapy programs. The American Dental Therapy Association — which did not respond to a message seeking comment for this story — says there are only four such programs in America — one in Alaska, one in Washington state, and two in Minnesota.
And the state continues to spread the word about the improved Medicaid reimbursement rates in the hopes that more dentists will welcome those patients.
“It is slow,” Farrell said. “You have to remember we’re talking 30-plus years of probably very lackluster dental reimbursement rates and administrative burden. It’s slowly improving, but it’ll take time to educate those dentists.”
Meanwhile, in the UP, Bur’s Northern Michigan University has begun laying the groundwork for a possible new dental hygienist program. The closest existing program is 350 miles south, in Big Rapids. Students who leave the area for school are less likely to come back, NMU’s Bur said, so the hope is that a UP school would keep more hygienists in the UP.
“This is gonna be a team effort,” Bur said. “It really is gonna need people to understand and invest across the board.”
Other work is underway — with mixed results.
Knudsen, the Escanaba dentist and former Dental Association president, said he recently hosted a dozen dental students, trying to encourage them to begin their practice in the UP.
“None of them took us up on it,” he said. “That’s about the only way you can do it is to recruit them from dental schools,” because dentists with existing practices aren’t likely to relocate into rural areas.
Right now, the dental school at the University of Michigan has five students from the UP, and Knudsen’s hopeful at least some of them will return to their hometowns to practice.
“Getting people from the area, it’s easier to get them to return,” he said.
Knudsen’s son is also a dentist, as is his son’s girlfriend, who’s currently working in a residency in rural Virginia through a program that the state created to address its own oral health care shortage. Knudsen’s hopeful his son will someday return to Escanaba to take over his practice, the way Knudsen took over the practice from his father.
“We’ll see if they come back,” Knudsen said. “We’re keeping our fingers crossed.”
My Community Dental Centers could be a way to meet some of the needs, said Singh, the centers’ chief of community and governmental affairs.
Established in 2007, the nonprofit clinics are linked to public health departments, specialize in serving Medicaid patients, and open where public health officials see a need.
But, despite the reform, Medicaid reimbursement rates still haven’t kept up with the growing costs of doing business, including the higher costs of recruiting and retaining staff, Singh said. She said Michigan needs to invest further on that front and should offer financial incentives for dentists to move to rural areas where they’re needed.
Overcoming the workforce shortage will “require a multi-faceted approach and I think it’s not going to be a quick fix,” Singh said.
‘Could have been saved’
While those efforts play out, hundreds of thousands of Michiganders have to wait for care.
Prentice, the Alpena woman who had to drive 40 minutes to get treatment for infected teeth, said she’s now lost fillings in a couple of other teeth. They’re not infected, yet, but she fears it’s coming.
“I was a model when I was young,” she said. “I don’t wanna lose my teeth.”
The soonest she could get back into the Atlanta clinic was the end of March.
“By this point, I think one of my teeth may be able to be fixed, but two more teeth are going to get lost, I know it,” Prentice said. “It’s teeth that could have been saved. All of them could have been saved if I had been able to get care when I needed it, but it seems really impossible to a lot of people.”
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