- The Washington Times - Monday, September 22, 2003

BERLIN, N.H. - Every few days, an agonized child or adult shows up at the emergency room of this mill town’s lone hospital, seeking relief from a pain that should have been treated elsewhere.

They have abscesses or toothaches, long-festering and suddenly unbearable. They turn to ER doctors, who can do little beyond supply antibiotics, because Berlin — like hundreds of communities nationwide — has too few dentists.

Home to 10,600 people — just two of them dentists — in far-northern New Hampshire, Berlin is one of 1,480 areas in the country designated by federal authorities as suffering from a dentist shortage, a twofold increase since 1990.

In some areas, even patients with private dental insurance have to wait months for an appointment, or travel long distances to a dentist with an open slot. Many low-income families have it worse: Their Medicaid coverage often isn’t enough to gain access to dentists, who are already busy.



Loretta Morrissette, who runs an oral-health program in Berlin’s public schools, sees the damage close-up in children whose parents can’t afford dental visits or can’t find a dentist who accepts new patients. She cited one mother who called 22 dental offices in one morning, many of them in distant towns, without any luck getting an appointment for her child.

“If the children had early intervention, they could be helped before they get to the point of pain,” said Miss Morrissette, a dental hygienist with Coos County Family Health Services. “They end up with an abscess two years down the road, and a four-surface filling instead of one little one. It’s traumatic.”

Dr. William Kassler, New Hampshire’s state medical director, said nearly 20 percent of the state’s 1.2 million residents live in communities with too few dentists. Many of those towns, Berlin among them, have unfluoridated water, contributing to higher cavity rates among local children.

As one of 16 states with no dental school, New Hampshire struggles to recruit newcomers to serve needy towns or replace the many dentists now nearing retirement. The dentists who do come — like their peers elsewhere — generally prefer relatively well-to-do communities, not the rural areas and poor urban neighborhoods with the most need.

Like many others states, New Hampshire is trying to ease the shortages by offering to repay the student loans of dentists willing to work in underserved areas. Under another new program, the state will pay the malpractice insurance and license fees of retired dentists who are willing to donate at least 100 hours a year to treat needy patients.

Nationwide, there are about 152,000 active dentists, more than a third of them over 55, according to the American Dental Association. It is estimated that dentists’ ranks will begin to decline in about 10 years as the number of dental-school graduates — now about 4,000 annually — falls below the number of dentists leaving the work force owing to retirement or other reasons.

To reverse the trend, dental schools would need to graduate more students. But many of the nation’s 56 dental schools are struggling just to maintain operations; there are more than 350 vacant faculty positions because of an exodus of teachers into better-paying private practice.

Dr. Eugene Kruysman, one of the two practicing dentists in Berlin, has hired a headhunter agency to recruit an associate to help him with his overbooked practice.

Dr. Kruysman, 49, has been practicing profitably in Berlin for 22 years. But he knows it won’t be easy to lure a partner to an economically struggling town several hours’ drive from the nearest big city.

“It’s tough to draw someone up here,” he said. “The problem only worsens the more remote the location.”

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