March 20, 2023
The Honorable Bernard Sanders
Chair
Health, Education, Labor, and Pensions Committee
United States Senate
Washington, DC 20510
The Honorable Bill Cassidy, M.D.
Ranking Member
Health, Education, Labor, and Pensions Committee
United States Senate
Washington, DC 20510
Dear Chairman Sanders and Ranking Member Cassidy:
On behalf of the members of the undersigned dental organizations, we are writing to you in
response to the Health, Education, Labor and Pensions (HELP) Committee’s request forinformation (RFI) on the health care workforce shortages. Thank you for your interest in thisimportant topic. Addressing these shortages is a top priority for our organizations, and wegreatly appreciate the Committee’s efforts.
To address the dental workforce shortages, we recommend that the HELP Committee focus onfour critical areas: the dental team, including dental hygienists and dental assistants; studentdebt; diversity; and underserved areas.
The Dental Team: Dental Hygienists and Assistants
Many dentists are small business owners and employers. And no dentist works alone. They are
the head of a clinical team that also includes dental assistants and dental hygienists. Every
member of this team plays an important role. Their work is essential to dental practice, and theyalso increase access to care by enabling dentists to see more patients.
Unfortunately, however, dentists throughout the country are reporting dental team workforce
shortages. For example, a January 2023 ADA HPI poll found that two out of three dentists
chose staffing as the top issue facing their dental practice. More than 93% of dentists said that itwas extremely or very challenging to recruit assistants, and more than 85% said that it wasextremely or very challenging to recruit hygienists. 1To help dentists find candidates to fill these positions, we ask Congress to support increases infunding for the Oral Health Workforce Development Program, which helps to build and train theoral health workforce, and improves access to quality oral health care for those most in need.
Student Debt
Recent surveys of dental graduates show that the average new dentist graduates with over
$300,000 in student debt. 2 This high debt burden restricts dentists’ ability to work in underserved
areas and with low-income patients.

ADA Health Policy Institute. “Economic Outlook and Emerging Issues in Dentistry: Insights from Datafrom January 2023.” Accessed March 11, 2023.
2
ADEA Trends in Dental Education, 2021-2022. Accessed March 11, 2023.
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In order to address the debt burden of dentists, we are asking the Committee to favorably report
the following legislation:• The Protecting Our Students by Terminating Graduate Rates that Add toDebt Act (POST GRAD Act), which would reinstate eligibility for graduate andprofessional students with financial need to receive Direct Subsidized Stafford Loans.
• The Resident Education Deferred Interest Act (REDI Act), which would
allow medical and dental residents to defer payments on their federal student loans—and delay the point at which interest begins to accrue—until after completing theirresidency.
• The Student Loan Refinancing Act, which would enable borrowers to refinance theirfederal student loans on multiple occasions to take advantage of lower interest rates.
• The Student Loan Refinancing and Recalculation Act, which would provide theopportunity for borrowers to refinance their federal student loans when interest rates arelower. It would also eliminate loan origination fees and allow medical and dental
residents to defer payments until after completing their residency programs. Additionally,
it would delay the accrual of interest for many low- and middle-income borrowers while
they are in school.
• The Student Loan Interest Deduction Act, which would double the student loan interest
deduction (from $2,500 to $5,000) and eliminate the income limits that prevent thosewith higher incomes from reaping the benefit.
• The Indian Health Service Health Professions Tax Fairness Act, which would allow
dentists participating in the Indian Health Service Loan Repayment Program to exclude
interest and principal payments from their federal income taxes, as well as certain
benefits received by those in the Indian Health Professions Scholarships Program.
• The Dental Loan Repayment Assistance Act, which would allow full-time faculty
members participating in the Dental Faculty Loan Repayment Program (DFLRP) toexclude the amount of the loan forgiveness from their federal income taxes.
• The HIV Epidemic Loan-Repayment Program Act (HELP Act), which would offer up to$250,000 in educational loan repayment to dentists, physicians, and other health care
professionals in exchange for up to five years of service at Ryan White-funded clinicalsites and in health profession shortage areas.
Diversity
The high levels of student loan debt are burdensome for any dentist, but according to the ADA
Health Policy Institute (HPI), black dentists graduate with far more student debt than othergroup. 3 The burden of student debt may contribute to the lack of an increase in the number ofblack dentists over time, despite the overall increased diversity of the dental workforce. Because
black dentists are the most likely group to participate as Medicaid providers and are far more
likely to treat vulnerable populations, 4 the disparity in student loan debt has implications foraccess to care.
Our groups recommend several ways to increase diversity in the dental profession, including:• Reducing the student loan burden of dentists.
• Providing additional support for dental schools at Historically Black Colleges andUniversities (HBCUs) or those seeking to expand their curriculum to include a dentaldegree.
ADA News. “HPI Publishes Findings into Racial Disparities in Oral Health.” April 19, 2021.
Nasseh K, Fosse C, Vujicic M. Dentists Who Participate in Medicaid: Who They Are, Where They
Locate, How They Practice. Medical Care Research and Review. 2022;0(0).
doi:10.1177/10775587221108751.
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Increasing funding for career and technical training programs at community colleges andtrade schools for dental hygienists and dental assistants.
Funding and supporting programs at elementary, middle, and high schools in
underserved and diverse communities that aim to attract people to the dental profession
at a young age.

Underserved Areas
Our associations ask Congress to help draw dentists to underserved areas through incentives
including:• Programs like the National Health Service Corps that forgive student debt in exchange
for service in underserved areas. These programs need to be well funded, easy tonavigate, and expanded to include shorter time commitments or fewer mandatory weekly
hours worked.
• Tax relief.
• Small business grants.
• Attractive loan terms for purchasing or building a new dental practice in communities ofneed.
We also urge the Committee to look at the way health professional shortage areas (HPSAs) aredefined. The current model of defining where the greatest needs lie in respect to number anddistribution of providers is sorely outdated and inflexible. When shortage areas are incorrectlydefined, human and capital resources are improperly disbursed, policy is improperly focused,and bad proposals move forward. Thus, those most in need are likely left behind in favor ofothers who may not need as much help. With an updated, technology-driven approach, we canbetter allocate resources to enact responsive policy that meets the unique needs of eachcommunity. We ask that the Committee consider using a revised HPSA algorithm, like that usedby the ADA HPI, that utilizes geomapping to locate beneficiaries, providers (with a particularfocus on those accepting new patients), travel options, and times to care.
***Thank you again for issuing a RFI on the health care workforce shortages. The dental
community looks forward to continuing to work with you. Should you have any questions, please
do not hesitate to contact Mr. Chris Tampio with the American Dental Association at
tampioc@ada.org.
Sincerely,
American Dental Association
Academy of General Dentistry
American Academy of Periodontology
American Association of Endodontists
American Association of Oral and Maxillofacial Surgeons
American Association of Orthodontists
American Dental Education Association
American Society of Dentist Anesthesiologists
American Student Dental Association
Association of Dental Support Organizations
Association of State and Territorial Dental Directors