title: The challenge to delivering oral health services in rural America.
abstract: OBJECTIVE
  This review identifies the challenges to oral health in rural America and describes areas of innovation in prevention, delivery of dental services, and workforce development that may improve oral health for rural populations.
  
  
  METHODS
  This descriptive article is based on literature reviews and personal communications.
  
  
  RESULTS
  Rural populations have lower dental care utilization, higher rates of dental caries, lower rates of insurance, higher rates of poverty, less water fluoridation, fewer dentists per population, and greater distances to travel to access care than urban populations. Improving the oral health of rural populations requires practical and flexible approaches to expand and better distribute the rural oral health workforce, including approaches tailored to remote areas. Solutions that involve mass prevention/public health interventions include increasing water fluoridation, providing timely oral health education, caries risk assessment and referral, preventive services, and offering behavioral interventions such as smoking and tobacco cessation programs. Solutions that train more providers prepared to work in rural areas include recruiting students from rural areas, training students in rural locations, and providing loan repayment and scholarships. Increasing the flexibility and capacity of the oral health workforce for rural areas could be achieved by creating new roles for and new types of providers. Solutions that overcome distance barriers include mobile clinics and telehealth technology.
  
  
  CONCLUSIONS
  Rural areas need flexibility and resources to develop innovative solutions that meet their specific needs. Prevention needs to be at the front line of rural oral health care, with systematic approaches that cross health professions and health sectors.
authors.affiliation: University of Washington, Rural Health Research Center, USA. skillman@u.washington.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Skillman
authors.forename: Mark P
authors.initials: MP
authors.lastname: Doescher
authors.forename: Wendy E
authors.initials: WE
authors.lastname: Mouradian
authors.forename: Diane K
authors.initials: DK
authors.lastname: Brunson
mesh_terms: D003159:Community-Institutional Relations; D003727:Dental Auxiliaries / Q000706:statistics & numerical data*; D003752:Dental Health Services; D004497:Education, Dental / Q000191:economics; D005457:Fluoridation; D006267:Health Education, Dental; D006297:Health Services Accessibility; D006801:Humans; D008952:Mobile Health Units; D019035:Rural Health Services; D017216:Telemedicine; D014481:United States; D000078329:Workforce