Cindy Merrithew was nervous about having her teeth pulled, mainly because a doctor would be doing the work.
"I was skeptical," said Ms. Merrithew, 47, a nurse's assistant whose mouth is filled with damaged, brittle teeth. "I didn't know if they knew much about the dentistry field."
Dentists are in such short supply in Maine that primary care doctors who do their medical residency in the state are learning to lance abscesses, pull teeth and perform other basic dental skills through a program that began in 2005.
"Doctors typically approach the mouth from a distance," said Dr. William Alto, a physician at the Maine Dartmouth Family Practice Residency here in rural Fairfield, which conducts one of two dental clinics for medical residents (the other is at Maine General Hospital in Augusta).
"They say 'say aah,' take a look at the back of the throat and are done," Dr. Alto said. "Many physicians, even family physicians, have given up that part of the body because they don't have the skills."
Maine has one dentist for every 2,300 people, compared with one doctor for every 640, and the gap is expected to widen as both dentists and doctors retire over the next decade.
Nationally there is one dentist for every 1,600 people.
Maine has trouble recruiting dentists because many young graduates do not want to work in rural areas. The shortage is much less acute in Portland, the state's largest city. Maine also does not have a dental school — the closest are in Boston, about 50 miles from the state's southernmost town.
Last year the American Dental Association and the American Academy of Pediatrics announced a program to train pediatricians to apply fluoride and look for signs of tooth decay, a step already taken by some other states, including Illinois, Iowa, North Carolina and Washington.
In Maine, training physicians in dentistry provides a dental safety net for the rural poor who have never had one, doctors and dentists said. About two-thirds of the residents who have trained at the dental clinic now practice in the state, many in rural areas.