While it’s not likely that you — or anyone you know — actually enjoys going to the dentist, oral health is an important aspect of one’s overall health picture.

That’s why a recent report produced by the Pennsylvania Coalition for Oral Health has many in the dentistry profession concerned — particularly for those who live in rural communities such as those that populate Butler County.

According to Part II of the report, released earlier this year, the state’s rural counties have seen steady attrition in the dental ranks, and it’s expected that more is on the way. Specifically, the report anticipates rural areas seeing the largest percentage of workforce retirements within the next six years.

The report also characterizes the pipeline to replace those retiring practitioners as “insignificant.” And it notes that those who continue to practice in rural areas have the highest levels of dissatisfaction with their situations.

The problems aren’t limited to the state’s rural areas. The report notes that Pennsylvania as a whole has lost a “significant portion” of its dental care workforce since 2015, with those workers citing retirement, physical demands, burnout and a desire to change careers as the biggest reasons for their departure from the profession.

Rural areas and Medicaid provider networks saw the most significant attrition, according to the report.

The data tells part of the story; the coalition report notes that the number of clinically active dentists in the state dropped from 61.4 per 100,000 people in 2019 to 52.6 in 2021. Rural counties showed a ratio of just 40.8 compared to 56.7 in urban counties.

Overall, Butler County fared well at 66.5 per 100,000 people, but the surrounding counties did not; Armstrong is at 24.7, Clarion 31.2, Venango 19.7; and Lawrence and Beaver are under 40.

Those with a vested interest in the situation aren’t taking the report lightly. Helen Hawkey, executive director of the Coalition for Oral Health, acknowledged that the picture is far from rosy.

“We lost 10% of our dental workforce from 2015 to 2021,” she said. “When the population is growing and the number of providers is going down, that doesn’t make for a great situation.”

Hawkey admitted there’s no magic wand that can be waved to remedy the situation. She also said the decline in the number of dentists, while perhaps precipitated by

COVID-19 and all of its ancillary problems, was a problem “40 years in the making.”

Hawkey said back in the 1970s and early ’80s, a big push was made to encourage young people to go into dentistry. Then, when the market became saturated, the number of dental school applicants declined for some time.

“We lost people coming into dentistry for a good decade or so, then it picked back up,” Hawkey said. “Now those who graduated in the late ’70s or early ’80s are retiring, and we’re left with a dip (in the workforce).”

Several dentists in the Butler area fit the profile of baby boomer practitioners who are nearing retirement age, including Dr. Robert Todd, who graduated from dental school in 1980 but has no intention of leaving the profession anytime soon.

“I still very much enjoy what I do,” said Todd, who turns 69 in April. “And I still feel like I do it well.”

Todd said when the pandemic struck, he wanted to find a young associate to join his practice and “try to create a transition plan. But that’s still on the agenda. I have done some searching, but I’ve yet to find someone who’s interested in coming to Butler, Pa. But that doesn’t mean I won’t.”

Todd said he knows of at least one dentist who was persuaded to pull up stakes in the wake of the pandemic. “We were all shut down for about three months where we weren’t supposed to be seeing anything but emergency patients,” Todd recalled. “One dentist chose to sell his practice and went back to the military to work as a dentist. I’m also aware of a couple of people in Western Pennsylvania who were of an age where they were considering retiring or closing up anyway, and the pandemic was the final straw. They just locked their doors and went out of business.”

Another longtime area dentist who has yet to completely put away his instruments is Dr. John Pawlowicz Jr., who has been practicing since 1964. Pawlowicz, 87, who has three sons who are dentists, certainly has seen some changes in the industry during his seven decades in the profession. One of them is the growth of so-called corporate dentistry, or dental service organizations.

“You couldn’t start a clinic years ago unless you were a dentist,” Pawlowicz said. “Now you have Aspen and different companies, and they’re not run by a dentist — they’re run by someone who’s got a few coins.”

Hawkey said working in the corporate dentistry arena is an attractive option for some.

“It used to be that dentists practiced independently and had their own business or worked with one partner,” she said. “Now you’re seeing a bigger push to corporate dental offices. They can be employees — they don’t have to do employee reviews or buy supplies. They can just be a dentist and go home at the end of the day. So that’s very appealing to some.”

To make matters worse, large corporate dentistry models don’t exist in rural Pennsylvania for the most part because “the numbers aren’t there to support it,” Hawkey said. “So we’re seeing an even bigger divide due to the increase in corporate dentistry.”

The Oral Health Workforce report notes that, according to the American Dental Association, practice ownership from a dentist declined from 84.7% in 2005 to 73% in 2021. And according to the ADA Health Policy Institute, the “percentage of private practice dentists in solo practice (also) continues to decline at 46.2%, down from 66.5% in 2001.”

In Pennsylvania, the percentage of dentists in solo private practice as a full or part owner was pegged at 52.4% in 2021 — a decrease from 70% just six years earlier. And the number of dentists in the state reporting as an employee of another dentist or facility jumped from 26% in 2015 to 42.2% in 2021.

One area dentist who continues to buck that trend is Dr. Paul Keelan of Keelan Dentistry. While he also is nearing retirement age — he’s 60 — Keelan has no plans to step away in the near future.

“I love what I do,” he said. “I’m at the top of my game. I’ve been doing it long enough that I really enjoy it. I think I’m very good at it and it’s fun.”

One of the aspects of the business he enjoys most is mentoring younger dentists and helping his staff grow and acquire new skills. He also never passes up an opportunity to bring high school and college students into his office to get a feel for the business.

“That’s even more fun than doing dentistry,” he said.

Trying to reach younger people is one of the goals that Hawkey and others have as a means to rebuild the workforce so that Pennsylvania residents can have ample access to dental care.

Hawkey said it’s important to plant the seed of dentistry as a potential profession early — even as early as elementary school. She said the state Department of Education requires career discussion in the fifth grade, so why not start talking about the field of dentistry then — and continue to talk about it throughout high school and into college?

Hawkey said that for whatever reason, when young people consider a career in the health care field, dentistry isn’t always the first avenue of choice. She said that if those with a vested interest in the dentistry field can put the idea of becoming a dentist in young people’s minds early, that might make a difference.

“It’s a hard sell to a recent graduate with more than $300,000 in debt when the average salary is about $160,000 for a general dentist,” Hawkey said.

Still, talking about it early and often could help build the number of rural Pennsylvania residents who apply to the state’s three dental schools — the University of Pittsburgh, Temple University and the University of Pennsylvania. Hawkey said the latest figures show that just 9% of all applicants to those three schools are from the Keystone State, and of the roughly 300 graduating dentists each year, only about 7.5 end up practicing in rural areas.

Convincing young dentists to set up shop in rural areas isn’t easy, in part due to what Hawkey calls a “lifestyle piece.” In other words, some dentists want access to amenities that aren’t available in less-populated areas of the state.

Todd said part of it has to do with the demographics of today’s dental school students, as there are more women and international students than in the past. Todd said some women aren’t necessarily interested in working full time, and international students might find an urban setting more appealing than a rural setting.

However, the prospect of setting up a practice in a rural area can be attractive to some young dentists — particularly those who enjoy the outdoors.

“It takes the right kind of person to want to come to Butler,” Keelan acknowledged. “I’ve interviewed lots of people who want to live in Shadyside and be near cool, fun stuff. But then you have someone who wants to raise a family, who likes hunting and fishing. One of my associates’ husband is from Butler, and he likes to hunt and fish, so it was a good match for them.”

Other incentives to entice young dentists to locate in rural areas include increasing the number of dentists chosen for loan repayment programs and improving the distribution of those dentists in rural counties, according to the Oral Health Workforce report’s recommendations list.

Certain portions of Butler County might have an advantage over others when it comes to attracting young dentists. Keelan said he likes to point out that Butler itself isn’t all that far from Pittsburgh, and you still have a slower pace of life — and the outdoors factor. In addition, in his situation, there’s plenty of support and mentoring for a young dentist.

The support aspect is important, Keelan said. “It’s scary — one day you’re in dental school, and the next day you have your license and you’re on your own,” he said. “With four dentists in my group, if you need a second opinion, it’s sitting there right next to you.”

Dr. Nyla Balakrishnan, a public health dentist and an assistant professor at the University of Pittsburgh School of Dental Medicine, directs the Student Community Outreach Program and Education (SCOPE) — in which dental students are sent into the community to treat patients. The program has affiliations with several clinics, including the Jean B. Purvis Community Health Center in Butler, and some students experience working in a rural environment.

Balakrishnan said there’s no denying that most young graduating dental students are drawn to urban areas rather than rural areas. “The salaries are a little higher, they like being close to a city — it’s lifestyle choices,” she said. “We do have some students whose hometowns are in rural areas, or they have ties to a rural area. And they’re more likely to go back to a rural area. But the vast majority of graduates tend to work in urban areas.”

However, Balakrishnan acknowledged that some students who get experience in rural areas through the SCOPE program do find their way back to a rural setting after graduation.

“Once they go out and work in a rural area where there are not many dental practitioners, they get a lot more clinical experience and work on complex cases,” she said. “When students go out there and get these experiences, they get excited. They are serving a community where people truly need care.”