Northern Exposure

Long before he decided to become a dentist, Darren Smith, D17, knew that people in rural Maine needed better access to dental care. His family originated in Rumford, a mill town 80 miles northwest of Portland with about 4,300 residents and a median income of just over $25,000. Though Smith was born in Burlington, Vermont, his extended family remains in Rumford. "My grandfather has type 2 diabetes and gum disease. Many of his teeth are missing or decayed," he says. "A patient with issues like his should be seeing a dentist regularly."

Before an affordable community dental clinic opened in Rumford in 2008, Smith's grandfather, who has no dental insurance, sometimes went without care or traveled 45 minutes to see a specialist.

Smith could help turn that around. He is one of five Tufts dental students selected to receive the first scholarships established by the insurance company Northeast Delta Dental to encourage young dentists to settle in northern New England communities where the need for care greatly outpaces the number of dentists available to provide it.

The U.S. Department of Health and Human Services has designated most of Maine, New Hampshire, and Vermont as Dental Health Professional Shortage Areas, meaning the region has less than one provider for every 4,000 to 5,000 residents.

Created with a donation of $600,000 from the dental insurer and $400,000 in matching funds from Tufts University's Financial Aid Initiative, the $1 million Northeast Delta Dental Endowed Scholarship will enable the School of Dental Medicine to offer up to five scholarships every year, averaging $7,500 each, to students from Maine, New Hampshire, and Vermont. Recipients are selected based on their ties to northern New England and their commitment to practice there after graduation.

"We want to ensure there are practitioners in the area who can help more people get routine, preventive dental care," says Mark Gonthier, the dental school’s executive associate dean. "It became almost a personal journey for us," adds Northeast Delta Dental President and CEO Tom Raffio, referring to the many discussions he and Gonthier had about the acute need for dentists in northern New England. "We both wanted to use our positions to do something with a lasting impact."

An Aging Workforce

The region's dentist shortage has a long and complex history. Many local economies never recovered after textile and paper mills started moving out in the early 20th century. Many families still struggle to pay for basic needs like food and housing. For many, routine health care—let alone regular dental visits—is a luxury.

Compounding the financial issues, the region's dentists are among the oldest in the country—almost half are over age 55, and some continue to practice well into their 70s and 80s rather than leave their town without a dentist. For residents who need complex care or subsidized care, the closest option is often a drive of 50 miles or more, and the wait for an appointment can be months.

Scholarship recipient Jennifer Barton, D16, DG17, came away from her five-week externship at a community clinic in Somersworth, New Hampshire, a former mill town of less than 12,000 residents, with a heightened understanding of how financial hardship exacerbates oral health problems.

"A lot of patients simply didn't have the money to take care of their teeth," says Barton, who is doing a general practice residency in three rural communities in Maine this year. "It's so different from Boston, where MassHealth [the state's safety net for its neediest residents] covers preventive care. Here, people have to choose between putting food on the table and seeing a dentist. You see a lot more emergent cases—root canals, tooth extractions, people in serious pain."

The numbers of dentists on the verge of retirement, coupled with an ample patient population, provides opportunities for young dentists to establish a thriving practice in a region that is underserved.

A Common-Sense Alliance

When looking for a partner to address the dentist shortage, Northeast Delta Dental quickly identified Tufts School of Dental Medicine as the ideal choice. "A large percentage of our participating dentists are Tufts graduates," says Raffio. "It just made sense to support and work with Tufts."

In fact, half the practicing dentists in northern New England graduated from Tufts, says Gonthier, who sees the endowed scholarships as the first step in establishing a strong network of care in the region. "Northern New England has very few dental residency programs compared to southern New England," he says. "I hope to see an expansion of dental training and residencies in the region over the next 10 years."

For Darren Smith, the scholarship's benefits go beyond financial support. "Northeast Delta Dental's commitment to helping people in northern New England reassures me that I won't be on my own. I'll be able to work with others to take on this problem that has been around for a long time."