Florida ranks among the lowest states for dental care access, with 65 of its 67 counties facing shortages of dental professionals.
Nearly 6 million residents live in federally designated dental health professional shortage areas (HPSAs). In Alachua County, residents have access to only about 11% of the dental providers who are available for residents in Miami-Dade. Alachua County has 206 providers, while surrounding rural counties report far fewer: Levy has 10, Bradford has seven and Gilchrist four.
"We clearly have the data that says this is a huge problem in Florida," said Dr. Frank Catalanotto, professor emeritus at the Department of Community Dentistry and Behavioral Science at the University of Florida College of Dentistry. "The worst in the country, by any of the measures you can look at."
Catalanotto is leading a push to bring dental therapy to the state, citing what he calls Florida's "oral health crisis." He founded Floridians for Dental Access, a bipartisan coalition of organizations and individuals advocating for expanded dental care.
The group is advocating for the introduction of dental therapists, who are midlevel oral health providers. Similar to a physician's assistant, dental therapists are hired and supervised by a licensed dentist.
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"So, 20 years ago to 22 years ago, a native tribe in Alaska got tired of the lack of care provided by the Indian Health Service, so they looked around for another model," Catalanotto said, "and they found these dental therapists in literature."
Catalanotto was invited to spend a week with the program at the end of its first year in Anchorage. During a 10-year period starting in 2006, dental health aide therapists (DHAT) started providing care to the population under general supervision in the Yukon-Kuskokwim Delta.
Findings suggested that increased DHAT treatment days were positively associated with preventive care utilization and negatively associated with extractions. Now, 14 states have adopted this program. However, implementing dental therapists can be quite the challenge.
"Obviously, dentists as a group are conservative, fearful of change," Catalanotto said. "They have a monopoly on dental care."
Dentists: Real problem is financial, not workforce
A bill (HB 21) was introduced in Legislature this year to introduce dental therapy to the state. It passed in the House, but died in committee in the Senate.
Catalanotto argues the Florida Dental Association is an impediment.
"There really isn't a shortage of dentists," said Bertram Hughes, an FDA board member and general dentist who has worked under Florida's Medicaid system for 35 years. "We have about 14,000 to 15,000 dentists in the state of Florida."
But Catalanotto thinks the issue is distribution.
"Dentists go to the larger metropolitan areas — Tampa, Miami, Jacksonville, Orlando — and they don't really go to the rural areas as much," Catalanotto said, "and that's partly due to the reimbursement levels being offered."
Florida ranks last in the nation for Medicaid reimbursement rates for children's dental services, Hughes said. Although the state publishes a fee schedule outlining how much dentists should be paid for procedures, Managed Care Organizations that provide dental benefits often reimburse providers at rates below those benchmarks.
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"They took the money and then never appropriated it for the dentist," Hughes said. "They just put it in their pockets."
For new dentists graduating with student debt in the range of $300,000 to $400,000, these low reimbursement rates make rural practice financially impossible.
"If you look at the fees being offered, they're about 20 to 22 percent of what usual and customary rates are," Hughes said. "You can't pay another layer of care when the numbers don't work."
Supporters say dental therapists help cut costs, ER visits
Scott Darius, executive director at Florida Voices for Health, a health advocacy organization focused on improving access to care, begs to differ. Those in favor of dental therapy say the cost of dental therapists isn't as great as it may seem.
In counties with limited dental care access, residents are often left with no option outside of an emergency room. Untreated oral health problems escalate into severe conditions, driving patients to hospitals and costing Florida hundreds of millions of dollars each year.
According to Floridians for Dental Access, there were a total of 4,012 hospitalizations for nontraumatic dental conditions in 2024, with hospitals charging $281,660,948. The burden of covering these costs may ultimately fall on taxpayers, leading to higher taxes and insurance premiums.
"We spend half a billion dollars for dental care that was completely preventable in ER settings," Darius said. "That's just money we're flushing down the drain because we're not getting people access to care."
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The introduction of dental therapists in the state could lower the cost of emergency room visits for dental issues, allocating the money spent on ER trips to more affordable caretakers. Dental therapists can perform care such as filling cavities, placing temporary crowns or extracting teeth, which most hospitals are unequipped for.
Floridians for Dental Access plans to get legislation passed by the 2026 legislative cycle. Catalanotto said he knows eight Florida universities willing to host dental therapy programs, which condenses six semesters into two full-time years of study.
"Dental therapy is not a radical idea," Catalanotto said. "It's a proven model that's been working for decades in other states and countries. It's about giving people access to basic care."
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