Healthy Smiles, Full Hearts Tackling Tennessee’s Dental Care Shortage

Recent College of Dentistry alumnus Dillon Cutshaw, DDS, knows a trip to the dentist may sometimes be benched in favor of life's necessities.

"We can go to the dentist every six months," he says. "It's not you having to decide between this tooth hurting versus not buying food the next day. For a lot of people, they're kind of having to make that decision."

Dr. Cutshaw is an example of the Healthy Smiles Initiative, a program growing dental care access across the state, in part through the University of Tennessee Health Science Center College of Dentistry and focusing on rural areas with high need.

Three years ago, the College of Dentistry, collaborating with the Tennessee Department of Health, set out to tackle the state's dentist shortage and improve oral health. The goal is to have dental care available within a one-hour drive to all Tennesseans. State-funded and called the Healthy Smiles Initiative, the project is multi-pronged. The state committed $94 million over five years for its Healthy Smiles effort. The UT Health Science Center College of Dentistry's effort accounts for $53 million of that.

Funding allowed for an increase in class sizes and brought students to particularly underserved areas to practice and potentially return. Six rotation sites are operated outside of Memphis, including Bristol, Chattanooga, Crossville, Kingsport, Knoxville, and Union City, as well as planned sites in other rural Tennessee communities. Every two weeks, students from the college are sent to receive supervised hands-on training, treating patients at the rotation sites. A key part of the Healthy Smiles Initiative funds loan repayment programs to dentists, dental hygienists, and dental assistants working in underserved communities.

The Healthy Smiles Initiative aims to bring dental care within a one-hour drive to all Tennesseans.

In his last year of dental school, Dr. Cutshaw did a clinical rotation at Healing Hands Health in Bristol and is now working at the facility as a dental provider. The clinic provides primary and dental care to the uninsured and underinsured.

"Most students say it's their favorite place," Dr. Cutshaw says of the community-supported clinic he returned to upon graduating.

Focusing on the Underserved

Site Preceptor Mark Schlothauer, DDS, is an associate professor in the College of Dentistry and staff dentist at Healing Hands. The clinic and university drew him in because of their dedication to making the rotation site exceptional for students.

"When students travel across the state from Memphis to Bristol to serve here, they're met with a clinic that's modern, welcoming, and deeply committed to community care. That experience, especially treating veterans and underserved patients, makes their journey worthwhile. This partnership shows that oral health care matters in every corner of Tennessee, and that our students are part of something bigger than themselves."

During his Healing Hands rotation, Dr. Cutshaw learned the clinic's mission and that the team wanted to hire another dentist. He knew it was something he wanted to be part of, he says.

Also, he met his wife while they were undergraduates at East Tennessee State University, and they both had fallen in love with the Tri-Cities area, had family nearby, and were excited for the opportunity to move back and stay in East Tennessee. Additionally, a three-year contract with Healing Hands through Healthy Smiles would qualify for student loan repayment.

Finding the Right Teammate

"I think you have to have a heart for this job, when you're working in charitable care," says Healing Hands Director of Clinic Operations Corey Smith. "It's challenging and tough. A lot of our patients have never been to a dentist. It can be kind of scary and nerve-wracking for the patients. You really want a person who's calm and has empathy and understanding."

Smith says Dr. Cutshaw is the type to provide superb care, as well as ease a patient's mind, the type to take time to build rapport and show pictures of his three-legged dog, Sam Elliot, he adopted while in dental school.

"He fit that mold," she says of Dr. Cutshaw. "We were very relieved and excited that he would be stepping in. Every dentist we've had has been like that."

The team has been able to recruit providers who are also great recruiters and mentors, she says, filling needs to give back but also grow professionally.

Dr. Cutshaw says after he interviewed for the position and explored more about what the opportunity would entail, including loan repayment for his service, he texted his wife: "Well, I think we're moving back to Bristol."

Putting the Win-Win in Perspective

"It's getting loan repayment and then seeing the people I see," he says. "There's so much need for dental care here.

"They've been dealing with this tooth pain sometimes for years. I see people who haven't been to the dentist maybe their whole life and they're in their 40s. It's because they're having to make other decisions for their children or themselves, for food, shelter, very basic things that I think we take for granted.

"Healthy Smiles incentivizes someone like me to work somewhere like Healing Hands. I'm not going to be making quite as much money as maybe some of my peers, but having this loan repayment incentive pretty much cancels that out. That gives me the freedom to not worry and to work somewhere like this to provide for people who desperately need it."

Growing a Future Dentist

Dr. Cutshaw grew up on a farm near Maryville, Tennessee, and no one else in his family had gone to college.

"I think when I was a kid, I probably heard dentists only had to work four days a week, and I thought that was awesome. But as I got older and I went to the dentist, and started asking them questions about what they do, then learned more about it, and eventually started shadowing - I liked working with my hands."

At ETSU, he earned his undergraduate degree in biology with a minor in anthropology. He was accepted to another graduate school but knew UT Health Science Center would be more affordable and knew others who had attended.

"Some dental schools are more clinic-based, and some are more research- or science-based. I knew I wanted to go somewhere that was going to focus on clinical training. I wanted to be out working."

Dr. Cutshaw with his wife, Brianna, and their three-legged rescue dog, Sam Elliot, who they adopted while Dr. Cutshaw was in dental school.

Developing a Successful Initiative

The university has been partnering with Healing Hands for over 10 years, serving Northeast Tennessee and Southwest Virginia.

Recently, the Kingsport Dental Clinic of the Appalachian Highlands extends access in another area with high demand for more accessible care. Its first year, the clinic saw 1,085 patient seatings and is continuing to recruit and develop a variety of services.

"The really great thing about the Healthy Smiles Initiative is it's meeting both long- and short-term needs," says Allen Stanton, director of strategic initiatives for the UT Health Science Center College of Dentistry. "It's addressing the long-term need for an increase in the dental workforce, and it's addressing the immediate need for dental care access. After students graduate, they have clinics they can return to, to practice, but students are also providing services during training because care is needed now."

By the 2030-31 academic year, the projected Healthy Smiles state impact will add more than 640 dentists and 250 dental hygienists, more than 37,000 procedures per year, and more than $7 million in annual care, as well as $25 million invested through public-private partnerships. As Tennessee's only statewide academic health science institution, the university is well-positioned to continue to improve underserved and rural health.