Maine Trains Physicians to do Dentistry

Dentists are in such short supply in Maine that primary care doctors who do their medical residency in the state are learning to lance abscesses, pull teeth and perform other basic dental skills through a program that began in 2005. 

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Maine has one dentist for every 2,300 people, compared with one doctor for every 640, and the gap is expected to widen as both dentists and doctors retire over the next decade.

Nationally there is one dentist for every 1,600 people.
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Maine has trouble recruiting dentists because many young graduates do not want to work in rural areas. The shortage is much less acute in Portland, the state’s largest city. Maine also does not have a dental school — the closest are in Boston, about 50 miles from the state’s southernmost town.

Last year the American Dental Association and the American Academy of Pediatrics announced a program to train pediatricians to apply fluoride and look for signs of tooth decay, a step already taken by some other states, including Illinois, Iowa, North Carolina and Washington.

In Maine, training physicians in dentistry provides a dental safety net for the rural poor who have never had one, doctors and dentists said. About two-thirds of the residents who have trained at the dental clinic now practice in the state, many in rural areas. 

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Natalie Karishev, a third-year medical resident, pulled the tooth with a dentist's supervision.  Dr. Karishev injected a novocaine in Mr. Smart’s gums and cheek, loosened the tooth and started to pull. Mr. Smart yelled; it wasn't numb enough.

After injecting three more syringes of local ansthetic and applying a nerve block, Dr. Karishev was able to extract the tooth comfortably. 

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While the Maine Dental Association supports the program, its executive director, Frances Miliano, said the better solution would be to recruit more dentists to the Maine.

“Medical residents are only going to be doing this in really dire circumstances,” Ms. Miliano said. “They’re not going to be the alternatives to dentists in rural areas. It’s not a total solution by any means.”

Other places are trying similar approaches. The University of New Mexico School of Medicine runs a yearlong residency program for dentists, and medical residents are allowed to participate to learn basic dentistry.