As lawmakers weigh a series of bills to address a shortage of dental care across New York, dentists are hopeful, but skeptical, about how legislative proposals will fix a statewide multidimensional problem.

Many rural and high-needs areas in the state have as few as one dental practitioner for every 4,000 people in many rural and high-needs areas, state health department data shows.

Saratoga County resident Sue Martin has tried to help her friend with disabilities find routine oral care for more than five years after his dentist suddenly closed.

He's one of thousands of patients on waitlists for care who's never reached the top of the list, or received a phone call to make an appointment outside emergency treatment. 

"I was looking for a denitst from Plattsburg to Albany to Schenectady — that whole area, we were willing to drive to and we were unable to find routine dental care," she said.

The Eastman Institute for Oral Health in Rochester has a waitlist of more than 19,000 patients alone.

A perfect storm of issues have created the state's oral health care crisis, including dentists retiring or closing, and new dentists leaving the state after they graduate – making it excessively difficult for low-income, elderly or disabled people to access needed dental care services.

The state has 37 accredited dental residency programs, but only seven north of Westchester County.

The state needs an additional 1,100 dentists to provide care to all New York residents, said Assemblywoman Carrie Woerner, who is leading legislative efforts to address the issue.

"This is not a small problem, and it is impacting rural and urban communities," said Woerner, a Democrat from Round Lake.

Woerner sponsors six bills within a legislative package aimed to improve New Yorkers' dental health, including requiring insurance plans to give dental providers a yearly schedule of reimbursement rates for services, create a workforce employment program for dental professionals and to exempt sales taxes on oral hygiene products.

Dentists like Arthur Bigsby, a maxillofacial prosthodontist in Syracuse, support several of the ideas. He said the sales tax exemption would help patients with a high-cavity index afford highly fluorinated products that could improve their oral hygiene, and overall health.

"Right now, it's like $22 a bottle or container, and no one can afford that every month," Bigsby said.

The Central New York dentist argues the federal policy should be removed that allows dentists to opt out of Medicaid and Medicare. 

Of the several bills related to improving dental care in the state, a few have fiscal implications that lawmakers are discussing to put in their one-house budgets expected to drop late Monday. Woerner said it's critical for the state to increase Medicaid reimbursement rates for dentists and oral care in the budget.

"I'm hopeful," the assemblywoman said. "I think people are starting to understand the importance, or the size and magnitude of the problem. It touches all parts of the state."

But Bigsby said lawmakers should focus most on reducing student loan debt within the industry. 

The number of national educational options for dental students has increased, but so has their debt upon graduation. Dental students graduate with an average of $300,000 of debt, according to the American Dental Education Association, or about $50,000 higher than the average medical student.

Lawmakers have proposed a bill to add dentists to the state-funded Doctors Across New York program to provide student loan repayment if they practice in underserved areas. Bigsby said such proposals typically do not pay dividends for graduates with debt, as the program limits a person's ability to work elsewhere and boost their income.

"So people have done the math and it doesn't make sense to do the loan forgiveness, mathematically," Bigsby said. "It's not going to not support them, it's just, is it actually going to do anything? Like is it changing the n number of patients that are being treated? And I don't think it would, realistically."

Dentists are also skeptical of a proposed law that would allow mid-level practitioners to perform basic dental procedures. Bigsby said he worries how that change would impact quality of care.

"There are great providers in those specialties, but the question is, you know, are enough of them as good as a dentist?" he said.

Woerner said lawmakers consulted dental health practitioners about the legislation, and she's heard similar concerns from them.

She argues some of the proposals would provide immediate relief to the oral care shortage while others would take several years to see an impact — and that both are needed.

"We have to try and come up with a multi-dimensional solution to fix this problem," Woerner said.