Introduction
America is getting older, fast. By 2050, the U.S. population aged 65 and up is projected to grow from 17% to 23% of all Americans. Older adults are keeping more of their natural teeth than any generation before them, a fact that sounds like good news until you weigh the trade-offs: more root surfaces exposed to decay, more complex restorative histories, polypharmacy-driven dry mouth, and growing numbers of patients managing dental care alongside diabetes, cardiovascular disease, dementia, and frailty.
The workforce meant to meet this demand is not keeping pace. Nearly 77 million Americans live in designated dental Health Professional Shortage Areas, and HRSA estimates the country needs 12,760 additional dentists just to close existing shortage-area gaps, before even considering aging-specific needs. Geriatric-focused training remains inconsistent across dental schools and residency programs, reimbursement structures discourage treatment of medically complex elderly patients, and more than a third of the existing dentist workforce is now over 55 and approaching retirement.
This blog reviews where the geriatric dental workforce stands today, the barriers holding it back, and the educational, team-based, and policy strategies being used to close the gap.
The Current State of the Geriatric Dental Workforce
The numbers paint a difficult picture. The U.S. had just over 202,000 professionally active dentists in 2024, and 34.2% of them are 55 or older and approaching retirement, a wave of departures that will hit right as demand from aging Boomers peaks. Dentists are also retiring later on average (68.7 in 2024, up from 64.7 in 2001), which has partially offset the shortage but hasn’t fixed distribution problems in nonmetro areas or long-term care settings, where residents often face transportation gaps and a lack of on-site dental staff. Meanwhile, formal postdoctoral training in geriatric dentistry remains a small, underfunded niche rather than a standard, self-sustaining track.
Barriers to Building a Robust Geriatric Dental Workforce
Several structural barriers compound to keep the geriatric workforce thin:
Inconsistent Curriculum
The Commission on Dental Accreditation (CODA) requires graduates to be competent in assessing and managing patients with special needs, a category that includes the vulnerable elderly, but with few specifics on the unique demands of gerontology and geriatric care. Geriatric dentistry is a required subject in most U.S. dental schools, but experiential (hands-on) training is only mandatory in a little over half of those programs.
Reimbursement Disincentives
Geriatric patients are often the most time-intensive to treat, with mobility limitations, medical complexity, and communication barriers layered on top of routine care. Yet Original Medicare has excluded routine dental care with only narrow exceptions since the program’s creation in 1965, under Section 1862(a)(12) of the Social Security Act. The first meaningful change in Medicare coverage regarding oral health came in 2023 when CMS added coverage for dental services that are “inextricably linked to, and substantially related and integral to the clinical success of a certain covered medical service,” for example, treating a patient before a covered organ transplant procedure is done. On top of that, Medicaid dental reimbursement for adults remains low or nonexistent in many states, and these mismatches between cost and reimbursement push providers toward healthier, better-insured patients and away from the population that needs care most.
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Logistical and Access Complexity
Treating homebound or nursing-facility residents often requires portable equipment, facility coordination, and transportation solutions that don’t exist in a typical private practice model. Community health center and long-term care staff involved in mobile dental programs consistently point to transportation as one of the biggest barriers a resident faces in reaching care.
Limited Interprofessional Training
Oral health is deeply intertwined with systemic health in older adults (e.g. aspiration pneumonia risk, diabetes management, cardiovascular disease, and more), but dental and medical, nursing, and social work education still happen largely in separate silos, leaving new graduates underprepared to collaborate with a patient’s broader care team.
Educational Pathways and Training Initiatives
Momentum is building on the education side, even if unevenly distributed.
Predoctoral Innovation
Some schools have developed innovative geriatric dentistry programs, such as the Ostrow School of Dentistry of USC’s multi-modality model, which pairs a hospital outpatient Geriatric Medicine Clinic rotation with treatment of older adults in a school-based Special Patients Clinic and a mobile dental van visiting a lifecare campus, plus computer-based case assessments and OSCEs (Objective Structured Clinical Examinations).
Continuing Education for the Existing Workforce
Because most currently practicing dentists graduated before geriatric-specific training was standardized, continuing education is the primary lever for upskilling today’s workforce, covering topics like polypharmacy-related dry mouth, dementia-friendly communication, and modifying treatment plans for frailty.
Fellowship and Advanced Training
Formal Geriatric Dentistry fellowships remain few and far between compared to demand, and most rely on federal funding streams, chief among them the Geriatrics Workforce Enhancement Program (GWEP), whose future is currently uncertain (see Federal workforce program funding, below).
Interprofessional Education (IPE)
Expanding the Care Team: Beyond the Dentist
Given the dentist shortage, much of the innovation in geriatric oral health workforce development isn’t about training more dentists, but about better utilizing the broader dental team.
Dental Hygienists with Expanded Authority
A growing number of states now grant hygienists “full practice authority” or “direct access,” letting them evaluate, treat, and manage certain care without a dentist on-site, a model well suited to nursing facilities and community settings where the lack of a dentist’s physical presence is often the bottleneck to care. As of 2026, the American Dental Hygienists’ Association has formally adopted policy supporting full practice authority in all states, alongside a push toward various doctoral degrees by 2032 meant to support expanding the hygienist’s scope and bringing the profession toward parity with fields like nursing and physical therapy.
Dental Therapists (mid-level Providers)
These mid-level providers, trained in a subset of restorative and preventive procedures, are now authorized to practice in at least 13–14 states, including Alaska, Minnesota, Vermont, and Washington, with several more considering legislation. Much of the dental therapy movement has focused on pediatric and rural access, but the underlying model, extending basic restorative and preventive capacity beyond dentists alone, is directly relevant to closing geriatric care gaps in underserved and long-term care settings.
Caregiver and Nursing Staff Training
Because daily oral hygiene for many frail or cognitively impaired older adults depends on facility staff or family caregivers rather than the patients themselves, training programs for nursing assistants and caregivers are an underappreciated but critical effort, one that expands the “oral health workforce” to people who never set foot in a dental operatory.
Teledentistry as a Force Multiplier
Asynchronous teledentistry, in which hygienists or aides use mobile equipment and intraoral cameras on-site while a remote dentist reviews images and directs treatment, has shown strong diagnostic accuracy, cost effectiveness, and patient acceptance among residents of care facilities.
Policy and Systemic Solutions
Workforce development doesn’t happen in a vacuum; it’s shaped heavily by policy and reimbursement.
Medicare Dental Coverage
As of 2026, no broad legislative expansion of Medicare dental coverage has passed. Advocacy groups argue that expanding Medicare to include dental benefits, paired with adequate reimbursement rates, would be one of the most effective ways to make treating older adults financially viable for providers, drawing more of the workforce toward geriatric care. The ADA has taken the position that any expansion must include reimbursement high enough that at least half of dentists in a given area receive their full fee, to avoid the access problems Medicaid dental programs have struggled with for decades.
Loan Forgiveness and Incentive Programs
Federal and state programs that forgive dental school debt in exchange for service in shortage areas or underserved facility-based settings remain a proven tool for redirecting new graduates toward geriatric patients and other underserved populations.
Federal Workforce Program Funding
GWEP and its companion Geriatric Academic Career Award (GACA) program, the only federal programs specifically designed to train the geriatrics workforce, expired at the end of federal fiscal year 2025. Bipartisan legislation to reauthorize them was introduced in the Senate shortly after, but as of mid-2026 remains in committee, with its last action being an initial review in March 2026. Advocates are requesting stable, multi-year funding to prevent further disruption to training pipelines.
The Future of the Geriatric Dental Workforce
What isn’t in question is the demographic trajectory: the population of adults 65 and older will keep growing for decades. What remains uncertain is whether workforce development can catch up and then keep pace. The components most likely to define the next decade include continued expansion of hygienist and dental therapist scope of practice, wider institutionalization of teledentistry and mobile care models as permanent rather than short-term fixes, federal action on Medicare dental coverage, and dental schools moving geriatric competency from a checkbox requirement to genuine clinical fluency.
Conclusion
Oral health workforce development for older adults sits at the intersection of demographics, education policy, reimbursement structures, and scope-of-practice law, none of which moves on its own, which is exactly why progress has been slow and uneven. But the tools to close the gap already exist: better predoctoral training, expanded roles for hygienists and dental therapists, teledentistry models that extend a limited specialist pool, and policy reform that makes treating complex older patients financially sustainable. The question for dental schools, policymakers, and practicing clinicians alike isn’t whether these solutions work, pilot data increasingly says they do, but whether they’ll be scaled fast enough to meet the population that needs them.
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References
American Dental Association. “Expanding Medicare: What Every Dentist Needs to Know.” https://pages.ada.org/expanding-medicare-what-every-dentist-needs-to-know
American Dental Association, Health Policy Institute. “Dentist Workforce.” https://www.ada.org/resources/research/health-policy-institute/dentist-workforce
American Dental Hygienists’ Association. “ADHA Adopts Ten Policies Affecting Scope of Practice, Education and Licensure.” 2026. https://www.adha.org/newsroom/adha-adopts-ten-policies-fy26/
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Centers for Medicare & Medicaid Services (CMS). “Medicare Dental Coverage.” https://www.cms.gov/medicare/coverage/dental
Commission on Dental Accreditation (CODA). “Accreditation Standards for Dental Education Programs,” Standard 2-25. https://coda.ada.org/-/media/project/ada-organization/ada/coda/files/2022_predoc_standards
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Health Resources and Services Administration (HRSA). “Designated Health Professional Shortage Areas Statistics,” as of June 30, 2026. https://data.hrsa.gov/default/generatehpsaquarterlyreport
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