HARRISBURG — Pennsylvania’s dental access in its remote communities is in crisis.

Senate Republicans heard testimony Wednesday from a variety of dental health professionals about the dire state of oral care in rural regions of the state.

A combination of insufficient dental coverage and the ongoing workforce shortage have converged to create a public health crisis that experts say goes far beyond having good teeth.

A patient arriving at a dentist’s office hoping to use his deceased neighbor’s dentures because he can’t afford his own; a young girl breaking down in tears because she may lose a front tooth due to wait times for care; a teenager needing total mouth replacements – these are all real scenarios detailed by the dental professionals who testified before the Senate committee.

Helen Hawkey, executive director for the PA Coalition for Oral Health, listed some of the downstream effects of oral health problems.

“Untreated cavities and gum disease don’t just cause pain and tooth loss, they’re associated with serious systemic conditions like diabetes, heart disease, strokes, and adverse pregnancy outcomes including preterm birth,” said Hawkey.

For children, dental issues can lead to missed school, poor self-esteem and speech problems. For older adults, access to nutritious food can be limited by what they are able to chew. Across the board, emergency room visits and hospitalization stemming from dental issues are a costly inevitability without access to care.

Sen. Dave Argall, R-Mahanoy, chairman of the Majority Policy Committee said that what he heard sounded “more like 1825 than 2025,” and said that the testimony provided was “eye-opening.”

Some of the solutions posed to improve oral health are straightforward. For instance, dentists have urged lawmakers to resist calls, like those coming from Secretary of Health and Human Services Robert F. Kennedy Jr., to remove protective fluoride from local water supplies. Making dental health education a priority in schools is another step in the right direction.

Changing the insurance culture to treat oral care as an integral part of health care and addressing the workforce shortage prove to be more complex problems. Advocates say that as a state, Pennsylvania’s reimbursement rates and average salaries make it an unappealing place for graduates with hundreds of thousands of dollars in student debt to settle. Rural regions pose an even greater challenge with students often preferring to stay in the urban areas where they completed their studies.

In a state with more than 13 million residents, The Center for Rural Pennsylvania says there are less than 7,500 practicing dentists. In rural areas, the ratio of dentists to residents is 3.7 per 10,000, compared to 6.3 per 10,000 in urban areas. Nearly a quarter of the state’s dentists are over the age of 65, and experts don’t anticipate the field recovering from the current shortage for at least fifteen years.

Dr. Michael Verber, CEO and chairman of the Verber Dental Group based in central Pennsylvania, says that numbers of graduating dentists are on the rise, but he contends that the bigger issue is creating interest in and providing opportunities for dental hygienists and dental assistants.

In his practice, Verber says expanded functions dental assistants, or EFDAs, perform much of the restorative care that was long considered the exclusive domain of dentists. This frees him up to perform more complex procedures. Meanwhile, hygienists continue to play the vital role of cleaning teeth and providing preventative care and education.

For students who are interested in pursuing careers in dental health, admissions are competitive. Dr. Joan Gluch, associate dean at University of Pennsylvania’s School of Dental Medicine, emphasized the importance of offering coursework in secondary education that prepares students for the challenges of a career in oral health.

Dr. Karen Rainey, director of the Dental Health Department at Luzerne County Community College, says that rural regions need more local pipelines toward work in the field. If students are educated about career options and have the chance to study where they live, they’re more likely to take on long-term positions in their home communities.

Temple University Kornberg School of Dentistry Dean Amid Ismail said that his school intends to do just that. Temple is working with locals in Tamaqua to launch a rural dentistry program. For Ismail, however, nothing is more important than system reforms. The complexity and low reimbursement rates of Medicaid deter dentists from participating, leaving the most vulnerable patients with few options for care.

“The solutions to the access to dental care in rural areas must be multi-pronged and start with redesigning the financial model to reduce the bureaucratic burden and increase the transfer of funds from taxpayers to the providers,” said Ismail.

The ability to make that kind of reform falls squarely on the shoulders of the legislators who heard Wednesday’s testimony.