Amid a growing shortage of dentists in Maine, pediatricians and other primary care providers are increasingly stepping up to treat children’s early tooth decay using innovative treatments such as silver diamine fluoride (SDF). This shift comes as access to regular dental care remains elusive for many Maine children—even those with dental insurance.
A recent study found that only about one-third of Maine children with any type of dental insurance receive the recommended annual dental checkup and cleaning. The shortage of dentists in the state is worsening, with the number of practicing dentists declining from 590 in 2019 to 530 in 2023. This shortage exacerbates the barriers to dental care, particularly for lower-income and rural families.
Traditionally, solutions have focused on training more dentists and increasing reimbursement rates through MaineCare (the state’s Medicaid program) to incentivize dentists to accept more publicly insured patients. However, experts highlight that these measures alone are insufficient, given the scale of the problem.
As a result, Maine’s Children’s Oral Health Network is advocating for expanded treatment options outside the traditional dental office. One such treatment gaining traction is silver diamine fluoride, a painless topical solution that stops tooth decay from progressing. The World Health Organization included SDF in its Model List of Essential Medicines in 2021, and the American Academy of Pediatrics now recommends its use in pediatric medical settings.
Pediatricians are uniquely positioned to provide early oral health interventions since they regularly see children for well visits. Dr. Brian Youth, a pediatrician and president of the Maine Chapter of the American Academy of Pediatrics, was an early adopter of SDF treatment in Maine. By applying this fluoride-silver solution during primary care visits, Dr. Youth can halt cavities early, preventing pain, infection, and school absences associated with untreated decay.
The application process is simple: the tooth is dried, and the SDF solution applied with a small applicator for under a minute. Follow-up visits evaluate treatment effectiveness and refer children to dentists when more advanced care is needed. Since adopting SDF treatment last year, Dr. Youth and colleagues have treated over 70 children and have trained pediatric residents in its use.
While highly beneficial, SDF can cause a cosmetic side effect—brown or black staining at the site of decay—and is not suitable for all cases, such as advanced cavities or children allergic to silver. Despite these limitations, it offers a critical tool for early intervention when dental care access is limited.
In addition to pediatricians, Maine has trained school nurses and school-based health centers to identify early tooth decay and apply SDF, aiming to reach children in underserved communities. Training programs like From The First Tooth have expanded education about SDF across the state.
Nationally, the dental workforce shortage and access challenges mirror Maine’s situation. The American Dental Association reports dentist availability varies widely across the U.S., with rural areas disproportionately affected. Dental insurance coverage also does not guarantee care accessibility, as many dentists do not accept Medicaid or have long wait times.
Efforts to address this gap increasingly include integrating oral health into primary care, expanding the use of preventive treatments like SDF, and enhancing school-based dental programs. Continued policy focus on improving reimbursement, workforce expansion, and innovative care delivery models remains essential to improving children’s oral health nationwide.
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