With dentists aging, nearly frozen insurance reimbursement rates not keeping pace with increasing costs and fewer people choosing to go into the profession, “we’re sort of at a tipping point,” says Rhode Island Dental Association president, Dr. Frederick Hartman, DMD Oral Surgery Service.

Hartman sees what’s happening first hand. He’s one of 22 oral surgeons in the state. As recently as a decade ago there were more than twice that number.

The demand is unrelenting, yet the number of providers is dwindling. Hartman said in his practice the earliest he can book a procedure is in April.

Hartman and the association are looking for some help from legislators. They held a fundraiser Tuesday at Chelo’s on Post Road, Warwick for Speaker K. Joseph Shekarchi.

The goal of the event, Hartman said in an interview Saturday, “is to get the speaker’s attention.” Hartman has meet Shekarchi and finds him approachable and based on his performance, a consensus builder. That’s what Hartman believes is necessary to stem what is basically a small business from crumbling to the detriment of Rhode Islanders. Defining conditions, Hartman said the state has one of the oldest populations of dentists in the country with 47 percent of them 55 years old or older.  The average age is 62. The state has approximately 500 dentists, with about 60 percent of them association members.

“They slow down,” Hartman said of aging dentists. ”They’re trying to keep up with the demand…but they’re getting burnt out and retiring.” He said the situation is a “public health issue” and that the RI Department of Health has commissioned a study addressing the root causes of the problem.

Aaron Guckian, after his unsuccessful bid as a Republican candidate for Lieutenant Governor in 2022, became the association’s executive director.

“It’s a crisis here in Rhode Island,” he said in an interview on Nov. 24. As Hartman described, Guckian said the volume of patients is too great for the number of providers. He points out the state does not have a dental school and while CCRI has a strong dental hygienist program, many graduates choose to go to Massachusetts where they can make more money. For the same reason – money – compounded by insurer reimbursement rates, dentists are not choosing to practice in the ocean state.

Delta Dental Rhode Island is Rhode Island’s major insurer with more than 600,000 members or about 85 percent of the market.

Guckian said conditions are most acute for children and patients with special needs. Setting up an appointment for pediatric extractions requiring a dental surgeon are six to nine months out.

“More and more kids are needing this and we just don’t have enough doctors,” he said. In addition, he notes, “We don’t have the surgical centers to do this.”

The answer, he says, is to make the state “more competitive” as a location to establish a practice.

“We need to get more support from the community to keep them (dentists and dental surgeons) here,” he said.

Hartman said Delta Dental does a lot of philanthropic work in the community, is politically well connected and “making a lot of money.” But he adds the company has only minimally adjusted reimbursement making a comparison to “a gift card with a lot of strings attached.” He said the company “has a strangle hold” on dentists.

In the last legislative session, the association backed legislation similar to the medical loss ratio setting a percentage of insurance premiums to go to patient care which 72 percent of Massachusetts voters approved in a referendum. That law that takes effect in 2024 sets the MLR for dental plans at 83 percent.

The Rhode Island bill did not gain approval last year. Hartman said the association is considering similar legislation for the upcoming session.