Oral Health Workforce 101
Gain background information about the professions and occupations that comprise the oral health workforce, the different settings that dental services are provided in, issues surrounding dental insurance, and emerging oral health models of care.
The Oral Health Workforce
Whoâs in the Oral Health Workforce?
Where Is the Health Workforce?
Dental Insurance
Emerging Oral Health Models of Care
The US oral health workforce encompasses various professionals, including dentists, dental hygienists, dental therapists, dental assistants, laboratory technicians, and community dental health coordinators. General dentists are predominant, with some pursuing additional training to become specialists in fields like pediatric dentistry and orthodontics. The workforce aims to address oral health conditions such as cavities, gum diseases, and oral cancer through preventive, diagnostic, and treatment services.
Despite efforts to enhance the nationâs oral health, disparities persist, particularly among vulnerable populations. Access to oral health care is a growing concern, influenced by workforce availability and distribution. The diverse workforce operates in settings such as private practices, dental schools, federally qualified health centers (FQHCs), the armed forces, and government institutions. The overarching goal is to meet the oral health needs of the population, with ongoing initiatives to develop new workforce models and extend existing ones.
Over the past 2 decades, the US oral health care system has undergone significant changes, emphasizing access to dental services for underserved populations, patient safety, and integration of oral health with general health care. The workforce comprises over 750,000 dental professionals and is becoming increasingly diverse in terms of gender, race, and ethnicity. This evolving landscape reflects a commitment to addressing oral health challenges through innovation and inclusivity.
The oral health workforce in the United States includes dentists and various allied health professionals such as dental hygienists, dental therapists, dental assistants, dental laboratory technicians, and community dental health coordinators (CDHCs). These professionals work together to deliver patient care across a variety of settings, including solo and group dental practices, community clinics, academic institutions, hospitals, and government agencies at the federal, state, and local levels.
Click on the tabs to the left to learn more about specific oral health professions.
Dentistsâas the most extensively trained among oral health providersâplay a key role in diagnosing and treating oral diseases, overseeing their patientsâ oral health, providing education on proper oral health practices, and making referrals to other health care professionals when necessary. The educational pathway for dentists typically involves a 4-year undergraduate program followed by a 4-year professional (predoctoral) program accredited by the Commission on Dental Accreditation (CODA). To practice, dentists are required to successfully complete a national written examination and a state or regional clinical licensing examination, with licensing standards varying across states. States also delineate the scope of practice for dentists and stipulate the amount of continuing education necessary to uphold licensure. As of 2023, the American Dental Association (ADA) reported that 202,304 dentists were actively practicing in the US.
Dental specialists are highly trained professionals who focus on specific areas within the field of dentistry, providing specialized care beyond the scope of general dentistry. These specialists collaborate with general dentists and other healthcare professionals to ensure comprehensive and specialized care tailored to the unique needs of each patient.
Click on the tabs to the left for descriptions of several dental specialists and their respective areas of expertise.
Focus: Specializes in community-based oral health promotion and disease prevention.
Services: Works on public health programs, policy development, and community education to improve overall oral health at the population level.
Focus: Specializes in the diagnosis and treatment of diseases and injuries affecting the dental pulp (innermost part of the tooth).
Services: Performs root canal therapy and other procedures to save damaged or infected teeth.
Focus: Specializes in surgical procedures involving the face, jaw, and oral cavity.
Services: Performs extractions, corrective jaw surgery, facial trauma surgery, and surgical placement of dental implants.
Focus: Specializes in the diagnosis and management of diseases affecting the oral and maxillofacial regions.
Services: Examines oral tissues for abnormalities and collaborates with other specialists for comprehensive patient care.
Focus: Specializes in the diagnosis and correction of misaligned teeth and jaws.
Services: Prescribes and oversees the use of braces, aligners, and other orthodontic devices to straighten teeth and correct bite issues.
Focus: Specializes in the oral health of children, infants, and adolescents.
Services: Provides preventive care, early detection of oral issues, and education for parents and caregivers.
Focus: Specializes in the prevention, diagnosis, and treatment of periodontal (gum) diseases.
Services: Performs procedures such as scaling and root planing, gum grafts, and placement of dental implants.
Focus: Specializes in the restoration and replacement of missing teeth and oral structures.
Services: Designs and places dental prosthetics such as crowns, bridges, dentures, and implant-supported restorations.
Dental hygienists are licensed health professionals who often collaborate with dentists, focusing on preventive dental care. They conduct oral health assessments, teeth cleanings, cavity treatments, x-rays, and patient education. Their practice is guided by state regulations, detailing both authorized procedures and required supervision levels.
Typically holding associate or bachelorâs degrees from accredited dental hygiene programs, dental hygienists undergo practical training for hands-on experience. Licensure mandates successful completion of national and state-level board exams.
Dental hygienists operate in diverse settings, including dental offices, clinics, hospitals, schools, nursing homes, community health clinics, and health departments. Their responsibilities encompass oral health screenings, health history reviews, health promotion education, dental radiography, removal of tooth deposits, and application of preventive materials. In some states, hygienists with additional training may perform expanded functions, such as administering local anesthetics and specific restorative services, in accordance with state practice laws.
Dental assistants are essential members of the oral health care team, working alongside dentists and hygienists to ensure smooth dental procedures. Typically employed in dental offices or clinics, they handle various tasks, from preparing treatment rooms and sterilizing instruments to providing chairside assistance during dental procedures. Educational requirements vary, with many completing certificate programs or on-the-job training. Beyond clinical support, dental assistants manage administrative duties like scheduling appointments and handling patient records. They may also take dental radiographs, educate patients on oral hygiene, and assist with dental impressions. As versatile professionals, dental assistants contribute significantly to the overall efficiency and patient experience within dental practices.
Dental therapists in the United States play an important role in expanding access to oral health services, particularly in underserved and rural communities. Initially introduced in Alaska, where dental health aide therapists served tribal communities, the dental therapy model has extended to states such as Washington and Oregon, with the most widespread implementation in Minnesota. Dental therapists can pursue 2 major educational pathwaysâeither the direct pathway or dental hygiene-based modelsâleading to an associate degree, a dual degree in dental hygiene and therapy, or a masterâs degree in advanced dental therapy, depending on the program. Dental therapists, operating under the supervision of a dentist, deliver routine preventive and basic restorative care, including simple extractions of primary teeth.
Currently authorized in 14 states, including tribal territories, dental therapists help reduce oral health disparities by serving populations with limited access to care. Their scope of practice varies based on education and state regulations. Successful legislative approvals in multiple states highlight the growing acceptance of this model. Proposals for expansion are under consideration in additional states, showcasing the potential for dental therapists to bridge gaps in oral health care. By working in collaboration with dentists, dental therapists contribute significantly to improving access and affordability of dental services, particularly in regions facing challenges in obtaining adequate oral health care.
Dental laboratory technicians collaborate closely with dentists to craft various dental prosthetics, including dentures, bridges, crowns, veneers, and orthodontic appliances. Unlike direct patient interaction, their role is primarily focused on executing dentistsâ instructions.
Education for dental laboratory technicians commonly involves a 2-year program, leading to graduates earning either an associate degree or a certificate. Some programs even offer a 4-year baccalaureate program in dental technology, providing a comprehensive foundation for those pursuing a career in this specialized field. Those trained on the job or through non-accredited programs can pursue dental laboratory technician certification after accumulating 5 years of work experience.
Private Dental Practices
In the United States, over 90% of active dentists practice in privately owned, non-government settings. These private practices, which can be individually owned or part of a group, primarily serve patients with dental insuranceâeither purchased individually or through employersâor those who pay out-of-pocket. The remaining active dentists are employed in federal services, academic institutions, the armed forces, state or local government, and other health care organizations. According to the Health Policy Institute of the American Dental Association, about 50% of dentists work in solo practices, a decline from nearly 66% in the early 2000s.
In 2022, about 13% of dentists were affiliated with large, multigroup dental support or service organizations (DSOs). These organizations provide practice management services such as employment and human resources, billing, accounting, regulatory compliance, lease arrangements, purchasing services, and information infrastructure and technical tools for clinical decision-making. The configurations of DSOs vary widely, with some consisting only of DSO-employed dentists and others comprising small private practices that retain individual ownership and contract with a DSO for nonclinical administrative services.
Safety-Net Dental Practices
Publicly owned dental practices, including Federally Qualified Health Centers (FQHCs), community clinics, and dental school clinics, serve as safety nets for underserved populations such as the uninsured, Medicaid recipients, and other vulnerable groups. These clinics offer essential oral health care to underserved children and adults who might otherwise lack access due to socioeconomic status, geographic location, or health literacy. In 2023, FQHCs served about 6.4 million dental patients. Specialized government clinics also provide care for military personnel, veterans, American Indians/Alaska Natives, and incarcerated individuals. Additionally, dental schools and education centers, which train dentists, dental assistants, hygienists, and therapists, serve as dental care sites for those with Medicaid, the Childrenâs Health Insurance Program (CHIP), or no insurance.
Nontraditional Settings
To reach patients who cannot access traditional dental settings, some organizations provide services in nontraditional locations like day care centers, schools, assisted living facilities, and rural community centers. These settings often use mobile dental equipment and expanded-function providers, such as dental hygienists and therapists, to deliver preventive and routine care.
Other nontraditional practices may include the use of teledentistry to facilitate place-based care via telecommunication, with a remote supervising dentist as needed. Patients in such settings who have more complex dental needs may be referred to a traditional dental clinic. Integrated managed-care organizations also promote interprofessional practice, with pediatric clinics offering oral health exams and dentists addressing broader health concerns.
Dental insurance in the United States serves as a crucial financial mechanism to help individuals manage the costs of oral health care. Typically, dental insurance plans operate separately from medical insurance, covering a spectrum of dental services, including preventive care, basic restorative procedures, and, in some cases, major dental work.
Employer-sponsored dental insurance is a prevalent source of coverage, included in many comprehensive employee benefits packages. Alternatively, individuals can purchase dental insurance plans independently. Public dental insurance in the United States is primarily through Medicaid and the Childrenâs Health Insurance Program (CHIP), and helps expand access to oral health care for low-income individuals and children.
Medicaid and the Children’s Health Insurance Program (CHIP)
Medicaid and the Childrenâs Health Insurance Program (CHIP) play critical roles in ensuring access to dental care for vulnerable populations in the United States. These programs, jointly funded by federal and state governments, provide dental benefits to eligible low-income children and adults. Medicaidâadministered by states within federal guidelinesâcovers a range of dental services, including preventive, diagnostic, and restorative services for eligible adults. CHIP specifically targets children in families with low incomes who do not qualify for Medicaid.
While dental coverage under Medicaid is mandatory for children, states have flexibility in offering it to adults. States also determine the extent of coverage, which can vary, impacting the accessibility of comprehensive dental services. The effectiveness of Medicaid and CHIP dental benefits lies in their commitment to improving oral health outcomes for disadvantaged individuals, ensuring essential dental care for those who might otherwise face barriers to oral health services.
In 2000, a report by the United States Surgeon General described poor oral health as a silent epidemic. Since then, as a follow-up to the Surgeon General’s report, a new report has been published which explores the nation’s oral health over the last 20 years. Oral Health in America: Advances and Challenges is a culmination of 2 years of research and writing by over 400 contributors. It illustrates mounting evidence on uneven access to oral health services. Furthermore, those with the most limited access include children, older adults, racial/ethnic minorities, and low-income populations.
Oral health providers are now using a variety of innovative strategies to expand access to oral health services in community-based settings, including federally qualified health centers (FQHCs), schools, and nursing homes, among others.
Click on each of the tabs to the left to learn more about these specific models of care.
While the value of integrated health services delivery is widely acknowledged, efforts to sustainably integrate primary care and oral health have faced barriers. The separation of dentistry and medicine within the larger health care delivery system is often cited as a contributing factor to oral health disparities. Federally qualified health centers (FQHCs) are structurally integrated organizations that deliver primary care, behavioral health, oral health, and ancillary services, including pharmacy, for their patients. FQHCs are well positioned to provide dental care for patients who lack access to oral health services. To integrate oral health and primary care, FQHCs often:
- Use team-based approaches to provide comprehensive oral health services
- Implement policies that support oral health assessments and routine referrals within primary care clinics
- Leverage technology such as integrated electronic health records (EHRs) and teledentistry
- Employ innovative workforce models like community dental health coordinators to expand access to oral health services
Related Reports:
Determinants of Oral Health Assessment and Screening in Physician Assistant Clinical Practice
Teledentistry has become a valuable tool for virtual diagnosis, treatment planning, and oral health education. It enhances the health care system’s capacity by enabling remote consultations and efficiently addressing patient needs. The COVID-19 pandemic accelerated the adoption of teledentistry, demonstrating its effectiveness in maintaining patient-provider interactions and meeting sudden demands during public health emergencies. As a subset of telehealth, teledentistry uses technology for remote health services, education, and administrative activities. It encompasses a range of oral health services delivered live or via a “store and forward” method, facilitating consultations such as oral surgery assessments without requiring extensive patient travel. Integrating teledentistry into health records streamlines patient care, reduces redundancies in tests and treatments, and ultimately improves access to specialized care while minimizing costs and time.
To learn about regulatory guidance for teledentistry by state, view our infographic.
Related Reports:
Teledentistry Adoption and Use During the COVID-19 Pandemic
Teledentistry Trends in the United States During the COVID-19 Pandemic
The prevalence of mobile and portable oral health initiatives has increased in recent years, expanding the range of oral health services offered to diverse populations. Annually, more than a million children receive essential preventive dental services through mobile and portable school-based programs. Simply put, these programs bring dental services directly to the patientâs location (ie, via a âdental vanâ). These initiatives are crucial in high-need communities, rural areas, and low-income regions, enhancing access to dental care. Additionally, mobile and portable dental programs effectively serve individuals in nursing homes, those with developmental disabilities, the elderly, homeless individuals and families, and various residential and community settings. The growth of these programs is partly due to the expanded scope of practice for dental hygienists in public health settings.
Related Reports:
An Assessment of Mobile and Portable Dentistry Programs to Improve Population Oral Health
Dental therapists are primary care dental providers practicing in over 50 countries, offering preventive, restorative, and extraction services. Their global use has proven safe and effective, promoting community-based services and enhancing oral health equity. Dental therapy began in the United States with the Alaska Native Tribal Health Consortium in 2005. Minnesota was the first state to legislate dental therapists (DTs) and advanced dental therapists (ADTs) in 2009. Since the Commission on Dental Accreditation (CODA) approved education standards in 2015, dental therapy has grown, with 14 states now authorizing DTs to varying degrees. This expansion reflects a growing recognition of the role DTs can play in improving access to dental care particularly for underserved populations.
To learn about the authorization status of dental therapists by state, view our infographic.
Related Reports:
Provider and Patient Satisfaction With the Dental Therapy Workforce at Apple Tree Dental
Concerns about the scope of practice for health professions impact access, quality, and cost of services. Since regulation falls under state jurisdiction, each state defines the legal scope of practice in specific practice acts. These acts outline the services professionals can provide, the conditions under which they can be provided, and the requirements for education, certification, licensure, and supervision. Restrictive scopes of practice that limit providers’ abilities often hinder effective and efficient health service delivery. For years, the scope of practice for dental hygienists has been a contentious issue. Many tasks that dental hygienists are trained to perform require dentist supervision. Research shows that a broader scope of practice for dental hygienists is significantly associated with improved oral health outcomes in state populations.
To learn about variation in dental hygiene scope of practice by state, view our infographic.
Related Reports:
Development of a New Dental Hygiene Professional Practice Index by State, 2016
Dental Hygiene Professional Practice Index by State, 2014
Related Journal Articles:
Innovations in Scope of Practice
Dental service or support organizations (DSOs) provide a range of practice management services, including human resources, billing, accounting, regulatory compliance, lease arrangements, purchasing, and technical tools for clinical decision-making. DSOs vary widely, from employing dentists directly to contracting with small private practices for nonclinical administrative services. The number of DSOs has grown substantially across the United States, partly due to the Affordable Care Act, which increased Medicaid enrollment, especially among adults. By leveraging their size and market penetration, DSOs make dental services more affordable and accessible. This allows them to broaden their patient base to include publicly insured patients and operate in underserved areas more effectively than small practices.
Related Report:
Developing diverse educational pathways is essential to ensuring a sufficient dental workforce. While diversity, equity, and inclusion (DEI) initiatives have advanced, recruitment of underrepresented students remains well below population parity, and many programs are in early stages of supporting LGBTQ+ students and patients. Many dental schools have adopted or expanded community-based education programs, enriching studentsâ experiences while increasing access to care for underserved populations. However, significant gaps remain in preparing students to care for underserved communities, special needs patients, medically complex individuals, and those in assisted living or long-term care settings. Interprofessional education has become a standard in many academic health center-based programs but integrating dental and dental hygiene students into medical education systems often remains limited to training, with little continuation into professional practice due to ongoing silos in the health care system.
Related Report:
The Changing Role of Post-Baccalaureate Programs in Dental Education
Related Journal Articles:
Practice Patterns of Postgraduate Trained Dentists in the United States
