Reversing a trend Five new dental schools under consideration

A combination of forces has led to serious discussions about creating five new dental schools in the United States, an unprecedented number of new institutions for a profession that saw seven dental schools close from 1986-2001.

Included among those factors are a maldistribution of dentists that has led to a lack of access to care in many regions, projected workforce shortages with more practicing dentists reaching retirement age, a limited capacity for enrollment at current dental schools, and a robust applicant pool that indicates the dental profession continues to hold great appeal for young people.

New dental schools are in the early planning stages at Midwestern University in Downers Grove, Ill.; Texas Tech University Health Sciences Center in El Paso, Texas; the University of Arkansas in Little Rock, Ark.; the University of New England in Portland, Maine; and the University of Southern Nevada in South Jordan, Utah.

Though they have yet to open, two dental schools are already in the works for East Carolina University in Greenville, N.C., and Western University of Health Sciences in Pomona, Calif. The Commission on Dental Accreditation granted initial accreditation to the Western University of Health Sciences at its January meeting. (See story, page five.) Four dental schools have been accredited and opened since 1997.

All the new programs under development say that providing access needs for underserved patients is their No. 1 objective, said Dr. Richard W. Valachovic, executive director of the American Dental Education Association.

“The motivating factor in most cases is a desire for these institutions to respond to access problems by adding new dental schools,” said Dr. Valachovic.

While additional schools could provide access for underserved areas and the opportunity for more students to pursue careers in dentistry, others question whether having more dentists will have a long-term affect on access to care.

“There is an idea that because there will be more dentists, they will go to where the care is needed,” said Dr. Denis E. Simon III, chair of the ADA Council on Dental Education and Licensure. “Dentists are still independent practitioners who have to go out and make a living. Even in my own state of Louisiana, new graduates tend to stay and practice in Baton Rouge, New Orleans or other more metropolitan areas rather than go to some of the areas of the state where there are fewer dentists.”

Whether the economic downturn will have an impact on new programs remains to be seen. ECU, Texas Tech and the University of Arkansas are public universities, while WesternU, Midwestern, the University of New England and the University of Southern Nevada are private institutions, said Dr. Valachovic.

“Although the current economic crisis is affecting the fortunes of both private and public institutions, I do not believe that it will significantly impact the development of any of the new dental schools that are under consideration,” he said.

Some universities can point to the rising applicant pool to show that dentistry is a good business decision.

“Dentistry as a profession currently has great appeal,” said Dr. William K. Lobb, vice chair of CDEL and dean of the Marquette University School of Dentistry. “With a robust applicant pool willing to invest in dental education, I am sure these institutions see a good return on their investment. I believe some of these decisions are being made for business reasons.”

Dental school enrollment has grown slowly since the mid-1990s while the applicant pool has increased to a point where there are now nearly three applicants for every available position, said Anne Wells, Ed.D., associate executive director of ADEA and director of Educational Pathways.

According to ADEA’s 2007 Entering Class Applicant Analysis (the most recent for which statistics are available) and the ADA Survey Center’s 2007-08 Survey of Dental Education鈥擜cademic Programs, Enrollment, and Graduates (Volume I), about 13,742 students applied to U.S. dental schools in 2007, while just 4,770 students were enrolled for their first year.

The country had its highest enrollment in 1978 with 6,301 first-year dental students鈥攗p from 3,573 in 1960. “After that, enrollment declined very substantially,” said Dr. Wells.

“There was a perception there were too many dentists,” she said. “Whether real or not, many dental schools closed and some retracted their enrollment. Dental school enrollments dropped dramatically, as did applicants. Since then we’ve seen a growing number of applicants and enrollees, though with enrollees it’s a slower growth. We are still enrolling significantly fewer students in dental school.”

Adding more slots in current dental schools isn’t necessarily a solution, said Dr. Wells. “Dental schools are limited in their capacity to raise enrollment by the physical size of the school, faculty shortages and limited resources,” she said. “If they raise enrollment, they usually can do so only incrementally. It’s not the same type of impact of an entirely new school.”

The following is an update on new dental schools that are being developed:

Midwestern University

Midwestern University opened its first dental school on its Glendale, Ariz., campus. The first class of 110 students began predoctoral studies there in the fall of 2008. Plans are now in the works for a school on Midwestern’s Downers Grove, Ill., campus, located in Chicago’s western suburbs.

Midwestern conducted a needs-assessment study which indicated that while the number of dentists in the state has remained relatively constant, many are nearing retirement age. The assessment showed a need for patients in underserved and rural communities in Illinois and the surrounding states.

According to the Illinois State Dental Society, about 678 students applied for 50 seats at the Southern Illinois University College of Dental Medicine last year; 1,600 applied for 64 seats at the University of Illinois at Chicago College of Dentistry.

“Since we had already gone through the process of starting a dental school in Arizona, we felt that we had the expertise to start one here,” said Dennis Paulson, Ph.D., vice president for dental and medical education at Midwestern University.

Construction on a facility is set to begin this spring. Once the new dean is on board鈥擠r. Paulson plans to announce the dean in the next two weeks鈥擬idwestern will begin preparing for the accreditation process.

“If everything goes smoothly, we hope to matriculate the first class in the fall of 2011,” said Dr. Paulson.

Texas Tech University Health Sciences Center

With a new medical school set to open this fall, the Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center in El Paso, Texas, is conducting a feasibility study to determine the need for a dental school in the border region of western Texas.

“The concept is in its infancy stage right now,” said Mary Croyle, director of communications for Texas Tech University Health Sciences Center.

Dentistry is one of several health programs being discussed for the campus鈥攖he others are pharmacy and nursing. There are three dental schools in Texas (in Dallas, San Antonio and Houston). Statewide, there is one dentist for every 2,748 people but one dentist for every 5,479 residents on the border, according to a 2001 report by the Texas Higher Education Coordinating Board.

University of Arkansas

Dr. Lynn Douglas Mouden, director of the office of oral health, Arkansas Department of Health, was one of several dentists asked by the state legislature in 2008 to develop an interim report in response to a growing concern over a future shortage of dentists in the state. Presented to the legislature in October 2008, the report requests $1 million to create the Center for Dental Education at the University of Arkansas for Medical Sciences in Little Rock, Ark.

“For now, we see the Center for Dental Education as a short step to getting a dental school in Arkansas,” said Dr. Mouden. The center will initially provide a location for continuing education programs and in the long-term work toward creating residencies in pediatric dentistry and oral surgery.

Perhaps most importantly, “The center will be charged with conducting a study to determine whether it’s feasible to have a dental school in Arkansas,” he said.

Through agreements with eight dental schools, Arkansas currently provides for 30 students to attend dental school out of state and return to practice in Arkansas. However, the number of new dentists is not keeping pace with those retiring. Four counties in the state have no dentist; 32 have five dentists or fewer. Arkansas ranks 50th in the country for dental access.

“We’re looking at doing something about this now before it reaches crisis proportions,” said Dr. Mouden.

University of New England

The University of New England in Portland, Maine, is a private university with graduate health professions programs in medicine, physical therapy, nursing, physician assistant, occupational therapy, dental hygiene, pharmacy and social work.

“We’re looking into starting a dental school here,” said Ellen G. Beaulieu, Ed.D., associate provost and professor. “It’s not definite, but we are interested in the potential to address access to care issues in the northern New England region, and dentistry is certainly a good fit for the university as far as the types of education we offer.”

The entire state of Maine is designated as a dental health professions shortage area, said Dr. Beaulieu. “The number of dentists projected to leave the profession for retirement or cut back hours in the coming years also factored into the need for a dental school,” she said. “We’re conducting a feasibility study to determine whether there is a need and if we can raise the funds to start a program here.”

Getting students to stay and practice in northern New England would be a goal, said Dr. Beaulieu.

“We have some evidence with our other programs that about two-thirds of our students do stay in the region,” said Dr. Beaulieu. “We know we are a net importer of health professionals, and we hope to use our experience and skills with clinical placement to encourage students to see this as a viable option.”

University of Southern Nevada

The University of Southern Nevada College of Dental Medicine has campuses in Henderson, Nev., and South Jordan, Utah, a suburb of Salt Lake City.

“We are in the planning stages for additional predoctoral and postdoctoral dental education programs at the University of Southern Nevada,” said Dr. C. Lynn Hurst, dean of the College of Dental Medicine.

In January, the Commission on Dental Accreditation granted initial accreditation to USN’s advanced education in orthodontics and dentofacial orthopedics residency program on the Henderson campus. The program combines specialty training with a master’s of business administration degree. Dr. Hurst said plans are also under way for a predoctoral dental education program on the Utah campus.

“We are looking forward to the possibility of a predoctoral program at South Jordan in 2010,” said Dr. Hurst.

University leadership is now considering the results of the feasibility study conducted for the new dental school. If approved, the plan goes before the USN board of trustees. “Our 2010 budget provides for year zero of the predoctoral program, so we’ll be able to put our administrative team in place and prepare for accreditation,” said Dr. Hurst.

Growing retirements under scrutiny
The ADA Survey Center’s 2006 Survey of Dental Practice shows that for dentists in private practice who are owners of the practice, 39.2 percent were age 55 or older.

The Survey Center’s 2006 Distribution of Dentists indicates that 33.9 percent of all professionally active dentists are 55 or older.

In the 2003 Survey of Dental Practice, owner dentists in private practice said they intended to retire at an average age of 63.9. In 2007, a survey of practicing dentists age 55-65 revealed their average intended retirement age to be 66.3.