1. Introduction—The Crisis in Oral Health Equity
The U.S. faces an oral health crisis of unprecedented scale. 130 million Americans lack access to dental care annually, with underserved populations—veterans, seniors, and minorities—bearing the brunt of this inequality. Despite ongoing efforts, the crisis persists, compounded by a significant shortage of dental providers. As someone who has dedicated decades to dental education and clinical practice, I have seen firsthand how systemic barriers are blocking the solutions we desperately need. Among the most underutilized solutions are foreign-trained dentists, many of whom already reside in the U.S., fully capable of bridging this gap.
By focusing on integrating foreign-trained dentists, we can address this crisis immediately and provide underserved populations with the care they deserve.
2. Dental Workforce Shortage
The dental workforce shortage is a key driver of the oral health crisis. As of 2023, the U.S. is facing a shortage of 50,000 dental providers, with rural areas and low-income communities being disproportionately affected. According to the Health Resources and Services Administration (HRSA), over 10,000 dentists are needed to fill shortages. (Sources: The Dentist Dilemma: Addressing America’s Growing Shortage » DentalPost and Dental Workforce Shortages | American Dental Association)
Additionally, reports from the American Dental Association (ADA) indicate that to address the shortage in Health Professional Shortage Areas (HPSAs), the U.S. would need approximately 26,000 dentists to meet the demand, particularly in underserved areas. (Source: ADA HPIBrief_0521_1.pdf)
This growing shortage is further exacerbated by geographic disparities, particularly in rural regions, where nearly 33% of the population lacks access to adequate dental care. (Source: ADSO Dental Industry Analysis.pdf)
3. Factors Contributing to the Shortage
- Geographic Disparities: Northern states and rural areas are among the most affected, where the dentist-to-patient ratio is at an all-time low. This leaves patients in these regions without timely access to care.
- Workforce Attrition: A wave of retirements and attrition in the dental workforce is further straining the system, with new graduates unable to fill the gap quickly enough.
- Educational Bottlenecks: While new dental schools are opening, the number of graduates still falls short of addressing the ever-growing demand. Efforts such as loan repayment programs and expanding the scope of practice for dental hygienists and therapists have provided some relief, but more is needed.
4. Dental Health Crisis
- The U.S. is currently facing a severe dental health crisis, with 130 million people lacking access to dental care annually. This shortage of dental providers disproportionately affects vulnerable populations—veterans, seniors, and minorities.
- As I often reflect, “the most profound form of discrimination is the unequal access to healthcare.” Through my work in community dentistry, I have developed practical, scalable solutions to address these disparities.
- As of November 20, 2023, approximately 102 million people live in a primary care Health Professional Shortage Area (HPSA), and 77 million people live in a dental health HPSA. (Source: HRSA, State of the Health Workforce Report 2023.pdf)
- Even before the COVID-19 pandemic, one-third of U.S. adults went without dental care. (Source: UPI, One-third of U.S. adults went without dental care)
- A recent report shows that 68.5 million adults in the U.S. currently don’t have dental insurance, projected to rise to 91.4 million by the end of the year. (Source: Aegis Dental Network, New Report on Dental Insurance)
5. The Economic Impact of Ignoring Oral Health
The consequences of this crisis aren’t just clinical; they’re financial. Each year, $2 billion is spent on emergency room visits for preventable dental conditions—visits that often provide only temporary relief with antibiotics or pain medications but fail to address the underlying problems. The cost of these visits is a burden on both patients and the healthcare system, as they divert resources from preventive care that could solve the problem at a fraction of the cost. (Sources: CareQuest Institute and Dentistry Today)
In addition, the economic impact of untreated oral health issues goes even further. $45 billion in productivity is lost annually due to missed workdays and reduced efficiency caused by dental-related issues. These preventable conditions result in pain, discomfort, and lost productivity, affecting individuals and employers alike.
By addressing these issues at their root and integrating preventive care, not only could we reduce emergency room costs, but we could also recapture billions in lost productivity—a win for the economy, employers, and the American workforce.
Lost productivity due to untreated dental disease costs an estimated $45 billion annually, according to the report, “The Hour of Need: Productivity Time Lost Due to Urgent Oral Health Needs.” (Source: $45 Billion: Oral Health Problems Cost Productivity – Tufts Dental Central)
6. Licensure Barriers—The Case for Foreign-Trained Dentists
One of the most glaring issues exacerbating the dental crisis in the U.S. is the licensure barrier that prevents skilled, foreign-trained dentists from practicing. 95% of the 100,000 foreign-trained dentists currently residing in the U.S. are prevented from entering the workforce due to outdated licensure regulations. This system forces these highly qualified professionals into unnecessary debt and redundant education, perpetuating a counterproductive policy, even as the solution to the dental care shortage exists within our borders. These outdated regulations harm the very communities most in need of oral care and represent a vast, untapped resource for addressing the provider shortage.
Foreign-trained dentists, particularly from Latin America and Europe, often have more comprehensive clinical training than their U.S.-trained counterparts. However, they are forced into redundant education and financial burdens just to prove their qualifications again. Instead of utilizing this untapped resource to address the dental care shortage, the system sidelines these highly skilled professionals, depriving underserved communities of much-needed oral care.
As the shortage of dental providers worsens each year, and underserved communities bear the brunt, the failure to integrate foreign-trained dentists represents a missed opportunity to improve access to care and oral health equity.
7. The False Dichotomy—'Licensed-Qualified' vs. 'Skill-Qualified'
U.S. dental licensure policies create a false dichotomy between 'licensed-qualified' and 'skill-qualified' professionals. Foreign-trained dentists, though highly skilled, are forced into unnecessary additional education and burdensome debt to prove their qualifications again. These regulations rest on the flawed assumption that foreign dental degrees are inferior, despite many foreign-trained professionals—particularly from Latin America—having significantly more clinical experience than their U.S.-trained counterparts upon graduation.
Dentists from Latin America and Europe often face a prolonged and costly process to re-earn a degree they already possess. This process does not assess their clinical skill but instead reinforces bureaucratic hurdles. Passing the U.S. Dental Boards is merely one step in a repetitive cycle that limits these professionals from contributing to the U.S. workforce.
- Foreign-trained applicants must spend thousands of dollars on transcripts, evaluations, and translations—a process that can take up to 18 months—just to be eligible to take the Dental Board exam.
- The Dental Board exam costs $1,500, yet passing it does not immediately allow these professionals to practice. They are still required to undergo an additional (2)two years of education and expenses before they can apply for licensure.
8. Bureaucracy Over Competency—A Broken System
As of 2015, out of an estimated 100,000 foreign-trained dentists in the U.S., only 5,000 were practicing clinically. The rest are trapped in a cycle of redundant education, exams, and licensure fees. This system prioritizes bureaucracy over competency, worsening the shortage of dental providers—particularly in underserved communities that are in urgent need of care.
At the same time, U.S. dental graduates often lack sufficient clinical training, contributing to an ill-prepared workforce. Meanwhile, highly skilled foreign-trained dentists remain sidelined, despite being ready and qualified to address the shortages impacting underserved populations.
9. A Glaring Contradiction—Foreign-Trained Dentists vs. Dental Therapists
One of the stark contradictions in the current U.S. dental system is the comparison between foreign-trained dentists and dental therapists. In the U.S., dental hygienists can now become dental therapists, licensed to perform various procedures, including administering anesthesia, providing restorative care, and even extracting teeth. In contrast, foreign-trained dentists—with significantly more clinical training—are barred from performing the same tasks.
While U.S. dental schools heavily focus on theory and basic procedures, foreign-trained professionals from Latin American countries—from Mexico to Argentina—graduate with the expertise to handle complex clinical cases immediately. Yet, these highly qualified professionals are forced to repeat training they have already mastered to prove their worth in the U.S.
For years, I have trained recent U.S. graduates in procedures such as extracting impacted wisdom teeth and performing dental implants. Many U.S.-trained dentists, though licensed, are often underprepared, while foreign-trained dentists—who possess the necessary skills—remain sidelined. (Source: States Expand the Use of Dental Therapy | The Pew Charitable Trusts)
10. Workforce Integration—A Clear Path Forward
To resolve this critical shortage, systemic reform is essential. Workforce integration of foreign-trained dentists into the U.S. healthcare system can provide immediate relief for underserved communities. This can be achieved through temporary licensure programs or modified state licensing that allows foreign-trained professionals to work in Health Professional Shortage Areas (HPSAs), which are disproportionately affected by the provider shortage.
In addition to addressing regulatory barriers, the healthcare system must also embrace a Whole-Person Dental Care model. This model connects oral health with patients' broader physical, mental, and emotional well-being. By focusing on holistic patient care, dental professionals can work alongside other healthcare providers to develop comprehensive treatment plans that treat oral health issues and address the underlying systemic conditions often associated with poor oral health.
This workforce reform, paired with holistic dental care, would improve both the quality of care and access to services in underserved communities.
11. Periodontal Disease—another Public Health Crisis
Periodontal and peri-implant diseases are prevalent public health issues with significant implications for individuals and communities.
As people live longer and retain their natural teeth for extended periods, there is a growing preference for fixed dental solutions like implants over removable dentures, which can often be uncomfortable and unstable. Due to the chronic nature of periodontitis, which builds up over a person’s lifetime, more individuals are likely to experience this condition as they age. This includes those with natural teeth as well as dental implants, who are also increasingly susceptible to peri-implantitis.
According to the Centers for Disease Control and Prevention (CDC), 47% of adults aged 30 and older in the U.S. suffer from some form of periodontal disease, and the incidence rises to nearly 70% among adults aged 65 and older. Furthermore, the prevalence of periodontal disease disproportionately impacts impoverished regions, with the highest rates of periodontitis observed among individuals living at or below the federal poverty level. Socioeconomic factors also play a critical role, as adults with lower levels of education are more likely to experience severe forms of the disease.
Addressing periodontal and peri-implant diseases as public health issues is essential. By recognizing their broader impact on overall health, implementing preventive measures, and ensuring that underserved communities have access to quality dental care, we can significantly reduce the burden of oral disease and improve overall health outcomes for individuals and communities alike.
Dr. El Chaar, E. (2024). Periodontal and Peri-Implant Oral Diseases as a Public Health Crisis. Journal of Oral Implantology, 50(4), 297-298. (Source: Periodontal and Peri-Implant Oral Diseases as a Public Health Crisis | Journal of Oral Implantology)
12. The Role of Technology in Addressing Oral Health Gaps
Guided Biofilm Therapy vs Old Hygiene Treatment Video
13. Call to Action—Reforming the System for a Sustainable Future
The urgency of reforming U.S. dental licensure policies and integrating foreign-trained dentists cannot be overstated. Without immediate action, the dental care crisis will continue to disproportionately affect the most vulnerable populations, widening the gap in oral health equity. Dr. Alan Arturo Zarzar, through his combined expertise in healthcare consulting and dental education, is committed to driving systemic change through policy advocacy and workforce reform.
By removing restrictive licensure barriers, expanding workforce capacity, and adopting holistic care models, we can ensure that underserved communities receive the skilled care they need. The time to act is now, and through collaboration between policymakers, healthcare leaders, and educational institutions, a more equitable dental care system is within reach.
14. Conclusion—Bridging the Divide in Oral Health Equity
Oral health disparities are a pressing issue that must be addressed through a combination of; workforce reform, improved dental access, and technological advancements yet to be incorporated into everyday dental practice.
The solution is within reach. By integrating foreign-trained dentists into the U.S. healthcare system and focusing on preventive oral care for All Americans, we can expand access to dental care, reduce emergency room costs, and restore oral health equity for millions across the nation.
As we look toward the future, the message is clear: reform is not optional; it’s necessary!
Now is the time to bridge the divide and ensure that every American, regardless of socioeconomic status, has access to the quality dental care they deserve.
Oral Health Equity Beyond Licensure: Because Access to Dental Care Shouldn’t Be a Privilege, It Should Be a Right!