Access to dental care: a historical review of medicaid eligibility growth and dental productivity decline.

The present dilemma in providing dental services to the indigent and Medicaid recipients throughout this nation has generated considerable controversy as to the evolution of the problem. Most states recognize that there are deficiencies in the provision of dental services to these populations and are seeking resolutions. While state licensing board practices and dental professional society politics have been the object of criticism as contributing to if not causing of this problem, other rational and statistically valid explanations for the current difficulty exist. As an explanation for access to care issues, this paper explores the decline in the national numbers of dental practitioners and concomitant dental productivity. Furthermore, it relates those parameters to the dramatic rise in the utilization and demand for dental services resulting from a robust economy, population growth trends, and changes in state and federal Medicaid legislation that increase numbers of Medicaid-eligible recipients. While these general trends are national in scope and application, the state of North Carolina and its experience will be used to fully explore the impact of these trends at the state and local level.