By Rick Valachovic, DMD, MPH, Clinical Professor and Director of the NYU Dentistry Center for Oral Health Policy and Management

It’s remarkable. Despite the cost and other challenges of opening a new dental school, the numbers have risen steadily — from 53 CODA-accredited U.S. dental schools in 1996 to 70 such schools today. That’s more than one new dental school opening every two years. Another four are currently seeking CODA accreditation and at least eight more schools are in the planning stage, with for-profit entrants in the mix. Given these developments, some people wonder, “Are we at risk of having more dental schools than we need?”

Dental educators who remember the 1980s have reason for concern. In that decade, the applicant pool shrunk. With only 1.3 applicants for every first-year dental school slot, seven dental schools closed their doors, all in private universities. Many other schools reduced their class sizes dramatically. The impact was felt almost immediately. By 1990, we graduated only 4,000 dentists per year — 2,000 fewer than in 1980.

Fortunately, today’s dental school applicant pool is more robust, with 1.86 applicants per first-time, first-year enrollee in 2021, and the number of graduates has rebounded since 1990. Yet rebounding could feel like a very low bar given the opening of so many new schools. We currently graduate just a few more dentists that we did four decades ago — 6,300 graduates in 2020, up from 6,030 graduates in 1980. Meanwhile, the U.S. population has grown by 45%, from 245 to 320 million. Those numbers suggest there is continued room for growth in dental education, and they have made me far more sanguine about opening new dental schools than I was in the early 2000s.

I currently sit on the board of trustees of Kansas City University (KCU), a private, not-for-profit health sciences university, which is preparing to open a dental school in Joplin, Missouri next summer. In May 2011, an almost mile-wide tornado devastated the city and rendered its hospital unsafe. The Federal Emergency Management Agency (FEMA) erected a temporary hospital, and once a permanent replacement was complete, community leaders offered the site to medical schools as a satellite campus. KCU accepted the offer and decided to start a dental school as well to help meet the substantial need for care in Joplin and the surrounding rural communities. In Joplin proper, I’m told only one dentist accepts Medicaid insurance. According to data from the Health Resources and Services Administration (HRSA), Missouri has more HRSA designated dental shortage areas than all but one other state.

The university has already raised $40 million in philanthropic contributions and invested $10 million of its own to construct a 92-chair clinical facility and an 84-chair simulation lab at the new College of Dental Medicine. Founding Dean Linda Niessen, DMD, MPH, MPP, and her academic team are also putting together a competency-based curriculum with a strong public and community health orientation.

“We are looking for students who can become excellent clinicians, but we also want them to become leaders in their communities,” Linda told me. “We’re going to have the students engage with the community through various outreach programs early in their education. This will help them understand the important role oral health plays in children’s learning and adults’ employment. Students may provide oral health education and conduct screenings in school settings and/or health fairs to learn about the community’s oral health needs and understand their responsibilities as a dentist.”

These experiences are essential, because as critics of new schools have noted, just producing more dentists won’t solve the problem of their maldistribution — the tendency of dentists to cluster in urban areas with a high density of patients who can afford dental care rather than to practice throughout less affluent, rural regions.

Two of the dental schools that opened in this century provide models for educating dentists who are prepared to work in rural settings. A high proportion of the dentists who graduated from the Arizona School of Dentistry and Oral Health and East Carolina University have chosen to serve populations in need. Their success reflects the schools’ cultures, but also their locations and the students they recruit. KCU hopes to achieve similar success by recruiting students from its rural environs, including members of Oklahoma’s Eastern Shawnee tribe, and giving students outreach opportunities in community health centers, among them those affiliated with the Indian Health Service. Overall, about half of the new schools are in rural areas or have a commitment to caring for rural populations.

Critics of new schools also worry about their potential impact on the dental faculty shortage. Their concerns are understandable, but faculty now play considerably different roles than they did in the past. Much of the course content once delivered through in-person lectures now reaches students digitally, and some of it comes from faculty at collaborating institutions. In preclinical classes, haptics, artificial intelligence, and other digital technologies are giving students more precise feedback on their hand skills than any human observer could provide. And in dental school clinics, the faculty ranks are increasingly supplemented by late career private practitioners who serve in clinical faculty roles.

The late Art Dugoni, DDS, a legend in dental education, once fought the opening of new dental schools. Many were being planned in the early 2000s, and he was understandably concerned about competition for applicants at that time. Yet once the decision to open new schools was made, Art was among the first to say our community should do everything it could to support their development. His priority shifted to ensuring that the newest schools graduated qualified dentists.

I admire Art’s decision to rise above his own institution’s interests and to focus on the greater good. This should be the attitude of all dental educators, whether they support or oppose the opening of more schools. Linda Niessen, for instance, while firmly committed to the launch of her own institution, appreciates, and even shares, some of the concerns raised by new school critics.

“You can’t start a dental school without sufficient resources,” she told me. “You need more than just financial resources, you need physical facilities, educational resources, research experiences, and interprofessional opportunities. There are schools opening now that don’t have a medical or a nursing school associated with them, and that’s a concern. Where will these new schools find what they need to develop a quality program and meet CODA standards?”

While I don’t think we need to worry about having too many dental schools right now, I want to be sure each and every dental school is prepared to produce graduates with the skills, knowledge, and attitudes that will allow them to meet high standards for care. If they also enter our profession ready to care for the underserved, engage in their communities, and contribute to the creation of new knowledge that makes dentistry a learned profession, so much the better.