Geographic and rural health care resource gaps in orofacial pain provider distribution across the United States

J Am Dent Assoc. 2026 Mar 1:S0002-8177(26)00040-1. doi: 10.1016/j.adaj.2025.12.021. Online ahead of print.

ABSTRACT

BACKGROUND: One factor contributing to suboptimal management of orofacial pain (OFP) is the scarcity of OFP specialists nationwide. The authors assessed the distribution of OFP providers across the United States according to state and rurality relative to the underlying population.

METHODS: The number of OFP providers and address ZIP Codes were extracted from specialty-specific websites (ie, American Academy of Orofacial Pain and American Board of Orofacial Pain). State and rural-urban population estimates were extracted from the 2023 American Community Survey. Rural-Urban Commuting Area codes were used to classify the ZIP Codes of OFP provider employment (ie, urban, large rural, small rural, and isolated) and were compared with population estimates from the 2023 US Economic Research Service. Prevalence ratio (PR), 95% CI, and provider to population ratio per 10,000 residents were calculated. As examples for context, the authors compared the findings with the distributions of orthodontists and prosthodontists.

RESULTS: There were 531 OFP providers in the United States (1 OFP provider/≈ 627,000 people). OFP providers were overrepresented in Minnesota, Arizona, Kentucky, California, and Massachusetts (PR, 1.7-2.9; provider to population ratio range, 0.027-0.045). Seven states (ie, Alaska, Hawaii, Idaho, Nebraska, New Hampshire, North Dakota, and Wyoming) had no OFP providers. Approximately 3.4% of OFP providers were in rural areas (PR, 0.3; 95% CI, 0.2 to 0.4; provider to population ratio, 0.004); specifically, 2.3% were in larger rural areas, 0.9% were in small rural areas, and 0.2% were in isolated areas. The national provider to population ratio for OFP providers was 0.016 per 10,000 residents, substantially lower than that for orthodontists (0.336) or prosthodontists (0.065).

CONCLUSIONS: There is a shortage of OFP providers in the United States.

PRACTICAL IMPLICATIONS: The shortage of OFP providers is likely affecting access to OFP care, especially in rural areas.

PMID:41653175 | DOI:10.1016/j.adaj.2025.12.021