Dental care

Need is real, but ‘shortage’ also demographic fluke

The idea that Colorado could face a shortage of dentists in the coming years is a legitimate concern. Dental health is a crucial component of any individual’s overall wellness. That some Colorado counties now lack dentists, however, is neither an indicator nor a cause of such a problem.

As the Associated Press reported last weekend, two trends are contributing to the problem. On the one hand, Medicare, Medicaid and Obamacare are, or will be, dramatically adding to the number of people with dental benefits. But at the same time, their reimbursement rates are such that fewer and fewer dentists will be willing to accept such patients.

That nine of the state’s counties have no dentists at all, as the AP also pointed out, is not really part of the problem. That fact is less representative of a shortage of dentists than a description of Colorado.

Colorado has about 3,600 dentists. With a state population of slightly more than 5 million, that works out to about 1,400 people per dentist. That ratio is enough to keep them all busy. But as things stand now, only about 1,000 of those accept Medicaid. That puts those who do accept it at a further disadvantage.

It gets worse with time. About 335,000 adults with Medicaid will gain dental benefits next spring. Thousands more will be covered as Medicaid is expanded under the Affordable Care Act. How to make that work is the issue.

There are several actions possible. One would be to improve reimbursements. In today’s economic and political climate, however, that seems unlikely.

Another is to urge all dentists to accept a larger number of needy patients. The Colorado Dental Association already is asking that each dentist take on at least five Medicaid patients or families in the next year.

Still another response would be to address this the way Colorado does with so many other issues – by counting on the state’s climate and beautiful scenery to attract the needed number of dentists. If that seems passive, it also is the most likely outcome.

What none of this will address, however, is the dispersal of Colorado’s population. The AP seemed taken by the fact that nine of the state’s 64 counties have no dentists. (San Juan County is one of the nine.) But it is probably the case that one could find nine Colorado counties that are lacking in just about any one criteria – including people.

Living in Southwest Colorado, it is hard to remember that this state is highly urbanized. While Colorado justly is famous for its mountains and scenic views, 86 percent of its people live in cities. At least 80 percent of Coloradans live within about 10 miles of Interstate 25, and probably half of the remainder are within a similar distance of I-70. The rest of the state is sparsely populated, and some parts are all but uninhabited. Dental care is only one of a number of things not available in those areas.

The coming expansion of dental benefits is a welcome development. More people should see a dentist more often. Dental health can affect the whole body in ways that are only just becoming understood.

That such an expansion also will burden Colorado dentists, particularly those who accept Medicaid, is a real issue. So, too, is the idea that there simply are not enough dentists to handle the expected load. And those questions need more attention and more thought.

But neither this state’s demographics nor the economics of health care are amenable to ensuring that every town has at least one of everything we want, including dentists.