The United States has a significant and growing dentist shortage, particularly outside major cities. More than 63 million people live in federally designated dental health professional shortage areas, and projections show the gap widening through at least 2038. The problem isn’t simply that there aren’t enough dentists in the country. It’s that dentists are concentrated in urban and affluent areas, leaving rural communities and low-income populations with far fewer options.
The Shortage by the Numbers
There are roughly 202,500 professionally active dentists in the U.S. as of 2024, which works out to about 59.5 dentists per 100,000 people. That national average masks enormous variation. The federal government currently recognizes 7,443 dental health professional shortage areas across the country. To fully staff those areas, an estimated 10,744 additional dentists would be needed.
Federal workforce projections paint a worsening picture. By 2038, the U.S. is expected to be short nearly 20,000 general dentists and over 33,000 dental hygienists. These aren’t worst-case estimates; they’re baseline projections from the Health Resources and Services Administration, accounting for current training pipelines and expected retirements.
Why Rural Areas Are Hit Hardest
The distribution gap between cities and rural communities is stark. In urban areas, there’s roughly one dentist for every 1,470 people. In rural areas, that ratio drops to one dentist for every 3,850 people. A 2024 spatial analysis published in JAMA Network Open found that rural areas were nearly 24 percentage points more likely to experience dental care shortages than urban ones. Rural counties were also significantly more likely to have unequal access to dental clinics even within their own borders, meaning some neighborhoods in already underserved areas have it far worse than others.
By 2038, the projected shortage of dentists in non-metro areas is expected to reach 46%. That means nearly half of the dental workforce needed in rural America simply won’t be there. For people in these communities, the nearest dentist may already be an hour or more away. That travel burden turns routine cleanings into logistical challenges and emergencies into crises.
What’s Driving the Shortage
Several forces are converging. Dental schools graduate about 6,870 new dentists each year, a number that hasn’t kept pace with population growth and retirement losses. A large share of the current workforce is aging. Research on dentist retirement patterns shows that about half of dentists aged 65 to 74 are projected to retire, jumping to nearly 80% for those 75 to 84. As the baby boomer generation of dentists exits practice over the next decade, the pipeline of new graduates won’t fill the gap.
Student debt plays a major role in where new dentists choose to practice. The average dental school graduate in the Class of 2025 carries $297,800 in educational debt. With that financial pressure, most new dentists gravitate toward higher-income urban or suburban areas where patients can afford out-of-pocket costs or carry private insurance. Setting up a practice in a rural or low-income community, where reimbursement rates are lower and overhead can be proportionally higher, is a tough financial proposition for someone nearly $300,000 in debt.
The Medicaid Access Problem
Even in areas where dentists are physically present, access can be limited for people on public insurance. Only about 1 in 3 U.S. dentists treat Medicaid patients, according to the American Dental Association’s Health Policy Institute. That’s lower than previous estimates, which had placed participation at 43%. Low Medicaid reimbursement rates are the primary reason. In many states, Medicaid pays dentists a fraction of what private insurance or out-of-pocket patients pay for the same procedure, making it financially unsustainable for many practices to accept a high volume of publicly insured patients.
This creates a two-tiered system. You might live in a city with plenty of dental offices, but if you’re on Medicaid, your options shrink dramatically. For children covered by Medicaid or CHIP, the situation is somewhat better in states that have invested in children’s dental benefits, but adult dental coverage under Medicaid remains limited or nonexistent in many states.
How Dental Therapists Are Expanding Access
One of the most promising responses to the shortage is the growing use of dental therapists, mid-level providers who can perform routine procedures like fillings, extractions of baby teeth, and preventive care under a dentist’s supervision. Thirteen states and several Tribal nations now authorize dental therapists in some form.
The strongest evidence comes from Alaska and Minnesota, where dental therapy programs have been running long enough to measure results. In Alaska, dental therapists embedded in Tribal communities have produced significant improvements in the oral health of Alaska Native populations, reaching communities where a full-time dentist was never a realistic option. In Minnesota, 100% of dental therapists reported serving low-income or uninsured patients daily. Ninety-two percent served Medicaid recipients, 85% treated racial or ethnic minority patients, and 81% served patients with disabilities.
The impact on practice capacity is measurable. When Apple Tree Dental, a nonprofit community provider in Minnesota where over 80% of patients have public insurance, introduced dental therapists, the organization saw statistically significant increases in the number of children served, Medicaid patient visits, and total dental procedures per treatment day. Dentists at those practices were freed up to handle more complex cases, effectively multiplying the clinic’s capacity without adding another dentist. Research across multiple states has consistently found that dental therapists provide safe, high-quality care with strong patient satisfaction.
What This Means for Patients
If you’re having trouble finding a dentist who’s accepting new patients, or if the nearest office is far from where you live, you’re experiencing a real structural problem, not just bad luck. The shortage is most acute if you live in a rural area, are on Medicaid, or both. Wait times for appointments in shortage areas can stretch to months, and emergency dental needs often end up in hospital emergency rooms, where doctors can prescribe antibiotics and pain medication but generally can’t perform dental procedures.
Community health centers are one practical option. Federally qualified health centers operate dental clinics in many underserved areas, accept Medicaid and offer sliding-scale fees, and are specifically funded to fill gaps in shortage areas. Dental schools also provide lower-cost care through their teaching clinics, though availability depends on proximity to a dental school. In states that have authorized dental therapists, clinics employing them are often located in exactly the communities facing the worst access problems.
The shortage is projected to get worse before it gets better. Training more dentists takes years, given the length of dental education, and expanding dental schools requires significant investment. Broader adoption of dental therapists, loan repayment programs that incentivize rural practice, and improved Medicaid reimbursement rates are all policy tools that could help close the gap, but none of them offer an overnight fix for the 63 million people currently living in areas without enough dentists.