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unbearable. It is at that point when many people go to the emergency room for relief because they have no other option. To make matters worse, often people are faced with the difficult decision to remove their teeth because extractions are considerably cheaper than the cost of treatments to save them, regardless of the negative health and social impacts of missing teeth. Heather Getty, East Fairfield, Vermont: “My husband and I and our four kids are the working poor. We have to think about rent and electricity before we think about dental care. My wisdom teeth have been a problem for over a decade now. I take ibuprofen and just keep on going. My husband has not seen a dentist since he was a teenager. He’s afraid of the costs if they find something. So it’s been 20 years. Because of Vermont’s Dr. Dynasaur program, at least my children have been lucky enough to have regular cleanings, but I have to comb through the Yellow Pages to find an office who will accept their coverage. One time I missed an appointment because my car broke down, and when I called to reschedule, they told me that we had been blacklisted and that no one from my family could be seen by that office again. We’ve learned over the years how important dental care is. If you get preventive care early, you are less likely to have problems later on.” 3 A Shortage of Providers Willing to Serve Those with the Greatest Needs There are about 190,000 dentists currently practicing in the United States.17 Not only is this number too low to meet the current need, but an uneven distribution of dentists across the country makes the problem even worse. Dentists have a disproportionate presence in suburbs whereas those who are most in need of care are concentrated in inner cities and rural communities.18 In fact, more than 47 million people live in over 4,400 “dental health shortage areas” around the U.S. The Health Resources and Services Administration (HRSA) estimates it would take a net increase of nearly 9,500 providers to address the unmet need today.19 Although we know that additional dental providers are necessary to meet the current and growing need, dental schools are graduating fewer dentists than the number required to replace those who retire each year.20 While these aggregated numbers indicate the scale of the problem, the real crisis is that too few dentists are willing to provide care to low-income populations, older adults, and people with disabilities. Only about 20 percent of the nation’s practicing dentists provide care to people with Medicaid, and, of those who do, only a small percentage devote a substantial part of their practice to serving those who are poor, chronically ill, or living in rural communities.21 The Government Accountability Office (GAO) found that less than half of dentists in 25 states treat any people with Medicaid at all.22 More than One Third of Americans Do Not Have Dental Coverage As many as 130 million Americans do not have dental insurance coverage.23 Private health insurance plans often exclude dental coverage, and even those that include a dental benefit often require high levels of cost-sharing, making care unaffordable for many low- and middle-income families. Traditional Medicare does not offer dental benefits, and many veterans do not qualify for benefits through the Veteran’s Administration. About half of all dental services are paid for out of pocket because so many people do not have dental insurance, and it is very common even for people with insurance to have to pay for a significant portion of their care.24 Dental services are an optional benefit for adults who have Medicaid. This means that states may place limits on the types or amount of services they will cover or may elect not to provide dental services at all as part of the Medicaid program.25 While most states provide at least emergency dental services for adults with Medicaid, less than half of states provide coverage for other types of dental care. The little bit of good news is that Medicaid and the Children’s Health Insurance Program (CHIP) provide