Public Dental Workforce Capacity and Inequality in Spain

Spain combines one of Europe's highest dentist densities with limited public oral health coverage and marked regional variation in publicly funded provision. This study quantified total, salaried public and privately accredited dental workforce capacity across Spain and assessed implications for public oral health system planning and equity.

A cross-sectional national workforce analysis was conducted across the 17 Autonomous Communities and the Autonomous Cities of Ceuta and Melilla. Data were obtained through formal transparency requests to all administrations, supplemented by official professional registration data, population statistics and Ministry of Health records. Indicators included total and salaried public dentists per 100,000 inhabitants, population load per public dentist, the public/total ratio and a Structural Dependence Index (SDI) quantifying reliance on accredited private providers.

In 2024-2025, Spain registered 42,860 active dentists (84.68/100,000) but only 1685 salaried public dentists (mean territorial density: 3.36/100,000; mean territorial load: 31,590 inhabitants per public dentist). The public/total ratio ranged from 2.0% in Madrid to 7.6% in Castilla-La Mancha. A further 6810 privately accredited providers participated in publicly funded programmes across 11 mixed-model regions, yielding an effective public-system workforce of 8495 professionals (17.21/100,000). Among territories with reported individual accredited-provider counts, SDI ranged from 0% in direct public-provision regions to 95.4% in País Vasco; ten of eleven mixed-model regions recorded SDI values above 80%.

Spain does not face a shortage of dentists, but a structural imbalance between abundant private professional supply and limited, unevenly distributed public-system capacity.

High aggregate dentist density is a poor proxy for public oral health system capacity. Workforce planning standards and stronger monitoring systems are needed to translate expanded publicly funded oral health coverage into effective and equitable access.