Access to rural dental care remains sparse

Dentists and public health officials in rural Southeast Tennessee and North Georgia say that although dental care is a critical part of overall health, professional dental services are still out of reach for many who live in sparsely populated areas.

Public health agencies offer mobile dental clinics or dental services at rural county health departments. But traditional dental practices are rare outside of cities.

"I don't think there's a shortage, but probably like all goods and services, it's more of a maldistribution," Tennessee Dental Association Executive Director David Horvat said. "We still have pockets where people find dental care to be less than fully accessible, but in a lot of cases it's a matter of choice and indicative of whether they perceive dental care to be part of good health."

According to a recent report from the Tennessee Commission on Children and Youth, all Southeast Tennessee counties have fewer dentists per capita than the state average of 48.72 per 100,000 population.

For instance, Grundy County, Tenn., has one dentist who works part time. Dr. Bruce Baird said his Sewanee practice serves many Grundy County residents. He said it's become increasingly rare for dentists to practice in small towns like he does.

"The majority end up going to more urban areas because that's where the money is," he said.

Sandy Baird, Dr. Baird's wife, manages his practice and is a consultant for rural dental practices.

"We were taking a big chance when we came here," she said. Running a rural practice is challenging and different than running a city practice, she said. Patients may have widely varying incomes, and collecting bills can be awkward in a small town, she said.

Dr. Baird's patients also are more likely to ask him to remove a tooth rather than drive to a bigger city to consult with a specialist about a serious problem, she said.

"We have a lot (of patients) that don't choose the best dental care because they can't afford it," she said. "And their dental IQ is a little bit lower; they just aren't as knowledgeable about the importance of dental care."

Dr. Baird said one contributor to a lack of rural providers has been a declining number of students graduating from dental school, including the University of Tennessee where he was trained.

In 1986, 87 dental students graduated from the UT College of Dentistry, compared to 78 in the most recent class, UT Health Science Center spokeswoman Sheila Champlin said.

She said the college now accepts only 80 students each year because advances in technology and availability of faculty and lab space limit how many students can be trained at one time.

About 75 percent of dentists practicing in Tennessee attended the UT College of Dentistry, she said.

The Tennessee Department of Health operates dental clinics to serve children and adults at health departments in Bledsoe, Bradley, Grundy, Marion, McMinn and Rhea counties, Region Dental Director Dr. Bill Peck said.

Charges are based on a sliding scale. The clinics accept TennCare, which many private dental offices do not, he said, and a staff hygienist travels to schools in high-poverty areas to provide free cleanings and preventive care.

"We're trying to catch kids that have no other options, that wouldn't be able to go to a private dentist," Dr. Peck said.

The North Georgia Health District offers dental clinics for children at health departments in Dalton, Chatsworth and Ellijay, district dental director Dr. Nancy Williams said.