However, population growth has outpaced that work. About three years ago, the pipeline of new dentists began slowing relative to the influx of new residents. By 2007, the last year of available data, the state posted a 0.7 percent drop in the ratio of dentists to people.
Part of the problem is a lack of federal funding. Medicare, the federal insurance for older Americans, doesn't cover dental care. Medicaid, which covers poor children, reimburses at a rate that falls well below the expense of operating a clinic.
"I feel pretty frustrated about the dental situation," said Adam Searing, a health advocate with the N.C. Justice Center. "It's so important in overall health care, but it seems like the last thing people think about when they think about health reform."
A report by the Cecil G. Sheps Center at UNC-Chapel Hill shows that four of North Carolina's 100 counties have no dentists. Five more rural counties have dentists who have reached retirement age, and 39 mostly rural counties had a decrease in dentists between 1997 and 2007.
Dentists, like other health practitioners, move to urban areas because of cultural and economic opportunities. Many dentists get out of school owing more than $100,000 in college loans, making it difficult to set up shop in struggling, rural communities. Loan forgiveness programs have been established for dentists who practice in hardship areas, and some towns even band together and offer packages to entice a new dentist to open a clinic.
Still, more than half of North Carolina's counties have fewer than three dentists for every 10,000 people. The U.S. average is six dentists per 10,000.
In a faltering economy, many people who can find a dentist can no longer afford regular care. They put off minor fixes that erupt into major problems. As a result, hospital emergency departments are treating more patients with rotten teeth, abscesses and infections, while free dental clinics are jammed with people whose best hopes are to have their teeth pulled.
Dr. Alec Parker, executive director of the N.C. Dental Society, which lobbies for the state's dentists, said one of the society's goals is to improve preventive care.
"We are in a position, all of us in North Carolina, where we probably don't have enough money to throw at the problem in order to completely fix it," Parker said. "This is going to take a partnership between the private sector and the public sector."
