Vermont’s Oral Health Landscape Report Reveals Severe Workforce Shortages, Access Barriers, and Systemic Inequities

[Montpelier, VT] — Vermonters are facing significant obstacles in accessing affordable, quality dental care, according to an Oral Health Landscape report released by Voices for Vermont’s Children on behalf of the Vermont Oral Health Equity Project. The report and executive summary reveal critical, far-reaching issues, including severe workforce shortages, disparities in access, and systemic inequities, that prevent communities—particularly low-income, rural, and marginalized populations—from receiving essential oral health services. Centering the experiences of the communities most impacted by barriers to access, the report identifies a roadmap for change for every Vermont family, emphasizing data-driven solutions such as Minimally Invasive Care (MIC). 

“Oral health is foundational to health and well-being,” says Voices’ Executive Director Michelle Fay. “But our current approach is failing Vermonters. Far too many of us, especially those living in economically disadvantaged counties, are lacking access to even basic care. We need to respond to this crisis with the urgency and leadership it demands.”

The report reflects input from a diverse array of stakeholders and community members representing Vermonters across the lifespan and in every corner of the state. Project advisors were clear in describing the immediacy of the crisis. Grace Winslow, RN, BSN, health manager for Bennington County Head Start/Early Head Start, warns: “We're one retirement away from having no dentists that accept children with Medicaid in Bennington County." 

Focus groups and interviews with young adults, parents of children with complex health needs, free clinic directors, and others contributed essential insights into the range of barriers impeding equitable access to oral health care and shaped the creation of the report’s recommendations. “By taking the concrete actions we’ve outlined,” says Fay, “the state can establish its commitment to a future where every Vermonter has equitable access to the essential services they deserve.”

Key Barriers and Challenges Identified in the Report

1. Workforce Shortages: Vermont experienced one of the largest declines in dentists per capita in the nation since 2001 (-6.5%) and the most precipitous pandemic-related decline, down 14.4% between 2019 and 2022. The dental hygienist workforce also shrank, limiting the availability of dental care and leaving residents without local providers, regardless of insurance status.

2. Availability & Access: In Vermont’s least populous counties, residents experience a “double bind”—fewer dentists per capita and a higher concentration of Medicaid enrollees. In Orleans County, for instance, 31% of residents under 65 are enrolled in Medicaid, yet the area has one of the lowest rates of primary care dentists. Furthermore, only 44% of dental practices report accepting five or more Medicaid-enrolled patients per month, underscoring the urgent need for expanded access.

3. Lack of Culturally Responsive Care: People of the Global Majority (Black, Brown, and Indigenous) and 2SLGBTQIA+ individuals participating in this project overwhelmingly reported a need for greater cultural humility, safety, and respect in dental care. Additionally, immigrants without legal status in Vermont face extreme barriers to care, including lack of insurance, transportation challenges, language barriers, and job schedules that conflict with clinic hours, exacerbating their inaccessibility to care.

4. Accessibility for People with Disabilities: The report also highlights a lack of dental practices equipped to meet the unique needs of people with disabilities and their families. Parents of children with disabilities shared that dental care is one of the most challenging forms of health care to access due to insufficient inclusion capacity within many practices.

5. Disinvestment in Public Health: Prior to the pandemic, Vermont employed five public health dental hygienists to provide care coordination and referrals across WIC clinics statewide. Today, only one remains in practice. Additionally, funding for the 802 Smiles program and an oral health program epidemiologist relied upon discretionary federal funds that were withdrawn in 2024, and the state has so far only committed to partial funding.

6. Slow Adoption of Evidence-Based Care: Despite the proven effectiveness of minimally invasive care (MIC) strategies such as silver diamine fluoride (SDF), private dental practices have been slow to adopt new treatments that can alleviate the crisis.  Fewer than half (46%) of dentists who made Medicaid claims in 2023 billed for it, according to data analysis provided by the Vermont Department of Health. Meanwhile, every year, about 400 children under age six undergo general anesthesia for dental decay, which could often be managed with MIC. Practices that have embraced MIC report dramatic reductions in sedation dentistry, with some seeing decreases of up to 90%.

Data-Driven Solutions and Recommendations

In response to these challenges, Voices for Vermont’s Children identifies the following strategic recommendations for change:

• Rethink the Oral Health Workforce and Incentivize Minimally Invasive Care(MIC):        Implement policies, incentives, and education strategies to expand the use of minimally invasive care. While some dentists object to the application of SDF by dental hygienists and medical providers in alternate settings, this crisis demands rapid response from whichever healthcare providers are willing to meet the need. “MIC can offer patients greater choice in the type of treatment they receive, address the pain and trauma that often comes along with more invasive dental care, and can easily be provided in clinical and community settings by many different health and allied care professionals, thereby expanding access to care.”- Community Catalyst Dental Access Project

• Enhance Medical-Dental Integration: Bridging the gap between medical and dental care is essential. By making MIC services available in community settings, patients in Vermont can receive the care they need in fewer visits, reducing the burden of travel and time off work for appointments.

• Prioritize Immediate Access for Medicaid and Uninsured Patients: Mobile clinics and community-based acute care should be implemented now to serve rural and underserved areas, using MIC to meet urgent needs quickly and cost-effectively.

• Launch an Oral Health Education Campaign: Working with the Vermont Department of Health, public health advocates should develop culturally sensitive educational campaigns to raise awareness of minimally invasive care options. This campaign would empower communities and improve providers' knowledge of inclusive care practices.

• Strengthen Pediatric Oral Health Programs: Fully funding 802 Smiles and reinstating regional public health dental hygienists will help ensure that all Vermont children have access to the preventive and restorative care they need.