Many Vermonters have insufficient or nonexistent access to dental care, and the state is losing dental providers, according to a new report released Thursday. 

The Vermont Oral Health Equity Landscape Report, published by the nonprofit Voices for Vermont’s Children, found that, over roughly the past half-decade, Vermont has lost dentists at a faster rate than almost every other state and seen a decline in its children’s dental health.

The state has also been slow to roll out new dental procedures — non-invasive methods that could easily and cheaply improve oral health for many Vermonters, according to the report. 

“It’s very clear that oral health is a key component of overall systemic well being,” Michelle Fay, the executive director of Voices for Vermont’s Children, said in an interview. “And the system that we have set up isn’t working.”

According to national data from the American Dental Association cited in the report, Vermont had nearly 60 dentists per 100,000 residents in 2019, roughly the national rate.

The state reached that figure “after many years of robust recruitment and policy incentives meant to bolster the dental workforce,” the report reads. But the Covid-19 pandemic erased those gains: As of 2023, Vermont had only 53 dentists per 100,000 residents, the second-steepest decline in the country, per the report. 

From 2015 to 2021, the number of dental hygienists practicing in the state also declined by about 4%, according to data cited by the report. The number of public health dental hygienists — hygienists employed by the Vermont Department of Health — dropped from five prior to Covid-19 to one currently, the report reads. 

The state has also struggled to add dental therapists, professionals who perform routine dental care, to the ranks of practitioners. Last year, the Vermont state auditor found that Vermont State University had failed to stand up a dental therapy program, even after seven years and a $2.6 million investment of public funds. 

One bright spot noted in the report is Vermont Medicaid’s coverage of dental care. As a whole, Vermont dentists see more Medicaid patients than any other state, although its Medicaid reimbursement rates for dental care were mixed: adult reimbursement rates were relatively high, while rates for children’s dental care were in the middle of the pack nationally. 

Still, Fay said, accessing dental care as a Medicaid patient is not easy. Some dentists may think, “in theory, I’ll take a Medicaid patient,” Fay said, “but only if I haven’t filled all my slots with either private pay or insurance with a higher reimbursement.”

The report also notes that Vermont providers have been slow to adopt new, inexpensive and minimally invasive dental procedures. The report names two specifically: silver diamine fluoride and silver modified atraumatic restorative technique, methods in which protective materials are applied to the outside of teeth. 

Those procedures could have a significant impact on Vermonters’ dental health at low cost, the report says. 

Voices for Vermont’s Children recommends that the state invest in low-cost dental facilities and procedures across the state, including the integration of dental facilities with primary care facilities. The state’s health department should also consider a public education campaign focused on oral health, the report says. 

“The top line is really just the need to think differently about integrating oral health into overall health,” Fay said, “and using all available treatment models to meet the needs of these communities.”