Grants to States to Support Oral Health Workforce Activities - Texas faces one of the nation's largest oral health workforce challenges: as of July 2026, the state contained 361 federally designated Dental Health Professional Shortage Areas (Dental HPSAs) affecting approximately 2.5 million residents, with only 28 percent of identified need met, and an estimated 459 additional dentists needed to remove these designations. These shortages reflect the geographic maldistribution of providers rather than an insufficient number of graduates. Limited provider availability contributes to delayed preventive care, greater emergency department use, and persistent gaps in access for Medicaid beneficiaries, pregnant women, young children, and older adults. State projections indicate many shortages will persist through at least 2030 without intervention, and Texas lacks a statewide system to continuously assess workforce capacity and align investments with need. To address these gaps, the UTHealth Houston School of Dentistry proposes LEAD Texas, a coordinated statewide initiative developed in partnership with the Texas Department of State Health Services and Texas A&M University College of Dentistry and endorsed by the Texas State Dental Director, to strengthen the oral health workforce through community-based education, prevention, leadership development, and workforce planning. LEAD Texas is organized under a single program goal and three objectives: encouraging state innovation to increase oral health services in Dental HPSAs, strategically using evaluation to improve performance and assess impact, and developing ways to sustain effective programs. Five integrated programs implement them. Under Objective 1: (1) the Texas Oral Health Workforce Leadership (TOHL) Fellowship competitively selects and prepares oral health professionals to lead and practice in medically vulnerable communities through community-based experiential learning with the City of Houston Health Department WIC Program, Harris Health, and HOPE Clinic, then connects graduating LEAD trainees to practice in Dental HPSAs and tracks placement for one year after graduation; (2) a maternal and early childhood oral health prevention model delivers preventive dental services and caries-preventive counseling to pregnant women and young children; and (3) the Albert Schweitzer Fellowship Houston Galveston Oral Health Career Initiative develops an oral health career pathway for youth in medically vulnerable communities. Under Objective 2: (4) a statewide oral health workforce assessment and planning initiative convenes a statewide advisory council and builds a lasting data infrastructure to guide workforce decisions. Under Objective 3: (5) statewide leadership and dissemination activities move those findings and models into practice: LEAD trainees present community workforce improvement projects at the annual Texas Oral Health Coalition meeting, the Coalition promotes LEAD Texas resources statewide, and the Advisory Council carries assessment findings and workforce recommendations to state agencies, dental schools, and policymakers. The innovation of LEAD Texas is an integrated statewide model that strengthens educational preparation, community-based prevention, and workforce intelligence. Evaluation is central: the statewide workforce assessment and a continuous quality improvement framework assess each program's effectiveness and impact. Over five years, LEAD Texas will prepare successive cohorts of LEAD trainees and establish a sustainable workforce data system. LEAD Texas serves residents of Texas Dental HPSAs: pregnant women, young children, older adults, and youth. Effective components will be institutionalized within participating institutions and community partners to sustain access beyond the award.
