Dental care is vital to individuals’ well-being. Dental care can help prevent future diseases such as bacteria from the mouth spreading onto other parts of the body, causing further infection and chronic disease (Penn Dental Medicine, 2022). From common cavities to abscess or periodontal disease that require teeth removal, individuals are likely to face oral health issues. Caries affects about 90% of adults aged from 20 to 64 years and gum disease affects almost 50% of adults from 45 to 64 years, being two of the most prevalent diseases (Feine, 2022). As essential as this is, Puerto Rico face barriers to receiving adequate dental care, specifically in dentist accessibility. In 2023, there was a 33% decrease in dentists that translates into a loss of 400 licensed dentists practicing on the island; those still practicing were on average 58 years old and therefore likely to retire within a decade or two (Puerto Rico Dental Association). With this decrease, oral health disparities persist among children and adults in Puerto Rico. Increase accessibility to dental is needed as three in five adults in Puerto Rico have at least one extracted tooth, revealing the chances of unprevented treatment (ASTDD, 2021).
A decrease in dental professionals practicing in Puerto Rico can stem primarily from relocating to the continental United States. Puerto Rico is a U.S. territory that follows the same laws and regulations inclusive of dentists trained under the American Dental Association. Trained dentists have the option to move to the continental United States to practice after completing certain requirements. Depending on the state, the most common requirements for prospective dentists must be to take their licensure exam, continuing education courses, and the jurisprudence law and ethics exam (Florida Board of Dentistry).
A study analyzing pediatric dentists in Puerto Rico found that of the 77% of pediatric dentists in Puerto Rico (60 participants), 57% revealed dissatisfaction with practicing on the island. Furthermore, the study found that the three top factors with their dissatisfaction stem from: safety concerns (88%), quality of life (85%), and lack of more professional opportunities (76%) (Arévalo et al., 2015). Concerning the safety and quality of life, the environment and the state of the economy played a similar role in driving residents off the island after life threatening events. For instance, after events such as COVID-19 and Hurricane Maria, 97,000 people migrated to the continental United States while only 20,000 returned to live in Puerto Rico (Lafarga Previdi & Vélez Vega, 2020). For dentists practicing in Puerto Rico that live in a more stable area, safety and income-based outcomes are less of a concern (Arévalo et al., 2015).
In relation to access to professional opportunities, various states within the continental United States such as New York, Texas, and Florida, attract more interest for dental professionals with more practicing options. These states have more attraction due to the income being a central aspect in work satisfaction (Arévalo et al., 2015). In states like Florida, there is a demand for dental professionals, that allows for greater recognition, achievement, and greater benefits within the profession due to the state’s healthy economy (Falkner, 2022). As more residents have more disposable income, it puts them in a better position to continuously visit the dentist.
After Hurricane Maria, various weaknesses in the Puerto Rico healthcare system were exposed, including poor patient coordination, interruption of medical care, and limited transportation to the clinic (ASTDD, 2021). There were also the transitions of dentists moving to another state, which limited patients from being seen in the process, leading to more consequences for both standpoints.
There continues to be a strong need for dental professionals as dental issues such as cavities, periodontal disease and other common conditions continue to persist. Only around 55% of adults aged 18 and up in Puerto Rico reported visiting the dentist or a dental clinic within the past year, raising more concern on prevention (CDC, 2020). Eliminating barriers to dental care can increase prevention and access to oral health literacy for residents to follow better habits.
For Puerto Rico, it is essential to reassess its standards and regulations to lessen the flaws within the dental care system including addressing push factors for dentist. These included safety, quality of life, and increased professional opportunities. As such, states like Florida continue to offer pull factors for dentists that increase their economic benefits and opportunities. Potentially, Puerto Rico could work to implement more benefits that align with those in Florida to decrease the relocation of dentists from the island. Along with increasing dental professionals, residents of Puerto Rico should continue to receive dental education and resources for personal prevention. This can include classroom material for maintaining proper oral health. Further government implementation, concentrating on patient coordination and outreach, can also help to alleviate the strain of patients that struggle with access to dental care.
References
Arévalo, O., Saman, D. M., Tabares, M., Hernández, A., & Sanders-Ward, R. (2015). Job Satisfaction and Relocation Desire among Pediatric Dentists in Puerto Rico. Puerto Rico Health Sciences Journal, 34(4), 201–207. https://pubmed.ncbi.nlm.nih.gov/26602579/
Association of State and Territorial Dental Directors (ASTDD). (2021). Current Status and Strategies to Improve Oral Health Program Infrastructure and Capacity in Puerto Rico: A Needs Assessment Project Report produced by the Association of State and Territorial Dental Directors (ASTDD) in collaboration with the Puerto Rico Strategy 3 Workgroup Supported by the Centers for Disease Control and Prevention (CDC) Cooperative Agreement NU58DP006573 with ASTDD. https://www.astdd.org/docs/puerto-rico-oral-health-needs-assessment-full-report.pdf
Center for Disease Control and Prevention (CDC). (2020). Oral Health Data: Puerto Rico. Explore Oral Health Data by Location. https://nccd.cdc.gov/oralhealthdata/rdPage.aspx?rdReport=DOH_DATA.ExploreByLocation&rdProcessAction=&SaveFileGenerated=1&irbLocationType=State&islLocation=72&rdICL-iclTopic=ADT&iclTopic_rdExpandedCollapsedHistory=&iclTopic=ADT&islYear=2016&hidLocationType=&hidLocation=72&hidTopic=ADT&hidTopicName=&hidYear=2016&irbShowFootnotes=Show&iclIndicators_rdExpandedCollapsedHistory=&iclIndicators=ADT1_1%2cADT1_3%2cADT1_4&hidPreviouslySelectedIndicators=&DashboardColumnCount=1&rdShowElementHistory=&rdScrollX=0&rdScrollY=0&rdRnd=51655
Florida Board of Dentistry. (n.d.). Florida Board of Dentistry» Dentist- Licensing, Renewals & Information. Florida Board of Dentistry. https://floridasdentistry.gov/licensing/dentist/
Falkner, J. (2022, November 9). 5 Reasons Why Dentists Choose to Practice in Florida. Florida Physician Network; Physician Jobs Florida | Doctor Jobs Florida | Florida Physician Network. https://www.floridaphysiciannetwork.com/employment/5-reasons-why-dentists-choose-to-practice-in-florida-article-93.aspx
Feine, J. (2022, April). Oral Health in America – April 2022 Bulletin. Www.nidcr.nih.gov. https://www.nidcr.nih.gov/research/oralhealthinamerica/section-3a-summary
Ismail, A. I., & Szpunar, S. M. (1990). The prevalence of total tooth loss, dental caries, and periodontal disease among Mexican Americans, Cuban Americans, and Puerto Ricans: findings from HHANES 1982-1984. American Journal of Public Health, 80(Suppl), 66–70. https://doi.org/10.2105/ajph.80.suppl.66
Lafarga Previdi, I., & Vélez Vega, C. M. (2020). Health Disparities Research Framework Adaptation to Reflect Puerto Rico’s Socio-Cultural Context. International Journal of Environmental Research and Public Health, 17(22), 8544. https://doi.org/10.3390/ijerph17228544
Penn Dental Medicine. (2022, March 25). Why is Oral Health Important? Here are 4 Reasons. Penn Dental Medicine. https://penndentalmedicine.org/blog/how-dental-health-affects-overall-health/
Puerto Rico Dental Association. (2023). Addressing the Oral Health Care Crisis in Puerto Rico: Universidad Ana G. Méndez’s Response. Adea.org. https://www.adea.org/ADEA/Blogs/Bulletin_of_Dental_Education/Addressing_the_Oral_Health_Care_Crisis_in_Puerto_Rico__Universidad_Ana_G__M%C3%A9ndez_s_Response.html