Urban vs. Rural

What are the differences between urban vs. rural dental practices? I have practiced in both, but most of my professional life has been in a rural area.

May 1st, 2007

by Lanette Sikes, DDS

What are the differences between urban vs. rural dental practices? I have practiced in both, but most of my professional life has been in a rural area. I graduated in 1990 from Cleveland, Texas, in a class of 138. I said I was never coming back to this small town - or any small town, for that matter. Well, I got some good advice once: Never say ‘Never.’

Before we get too far into this, let’s clarify “rural” and “urban.” Merriam-Webster Dictionary defines urban as comprising a city or town, in U.S. census use, designating an incorporated or unincorporated place with at least 50,000 people. Rural is used when relating to the country, country people or life, or agriculture.

In discussing dental practices, I’ve found several major differences. Much of what I’m sharing with you is about life in a rural dental practice because that is with what I am most familiar. The first week I started working in Cleveland, I noticed something totally different from Houston, where I had been practicing: complex cases. I found that instead of doing as much preventative treatment, I was doing much more restorative work. Each week I saw patients with severe decay and full-mouth restorative treatment needs. Many patients in their 20s and 30s presented with decay in every tooth, sometimes to the point of being nonrestorable. It amazed me.

When I practiced in Houston, I rarely encountered this level of destruction. I saw it in Houston, but not often. In seeing all this decay and trying to pin the source of it, I found that many of my rural patients drank lots of soft drinks. Dr Pepper and Coke are very popular. Many patients didn’t realize that the carbonated drinks were contributing to their oral decay. This motivated me to measure 40 grams of sugar in a Ziploc bag to show patients how much sugar is in one can of Dr Pepper. I also measured out a six-pack and a 12-pack. Patients couldn’t believe there is that much sugar in soft drinks.

Another major difference is in patients’ attitudes in general. Many of my rural patients didn’t seem to be in a hurry to get out of the office; they seemed more appreciative of what we were doing for them. It was uncommon to see rural patients using their laptops in the waiting room. In the city atmosphere, I felt like I had to do more convincing for patients to accept treatment.

Now, patients are more trusting and accepting of my recommended treatment. I talked with some of my team members who also have practiced in both settings. Lisa, one of my hygienists, said, “There are more hugs and physical contact here.” She also pointed out that our patients bring food and treats much more often. This doesn’t mean that city patients are not as friendly; I think it has a lot to do with a fast-paced vs. slow-paced environment. We associate country life with “the simple life” and assume it’s a laid-back lifestyle. I’ve found it to be true when comparing dental-practice settings.

Insurance is another area that’s different. In Houston, just about everyone has some form of dental insurance. In Cleveland, it’s about 50/50. Industry and business are in the city, meaning jobs and insurance benefits. In many cases, my patients won’t have treatment done - even emergency treatment - until they have insurance.

Per capita income is another area where urban and rural areas differ. In Cleveland, the per capita income per family is $17,914. In the Houston suburb of Kingwood, the per capita income is $32,491. Being in an area where the per capita income is low greatly affects my practice. Many of my patients are uneducated and possess little knowledge of what it takes to have a healthy mouth. They listen to oral hygiene instruction, and I find that compliance is often better. Many of them can’t afford necessary treatment, so their only option is to have all their teeth removed for dentures. We find some creative ways to help patients afford to keep their teeth, including bartering.

Rural and urban dentists face different challenges, but we all love our patients and give them the best dentistry possible. That’s what it’s all about, isn’t it? That’s what makes dentistry fulfilling.


If you can answer ‘yes,’ your practice is rural.


Do you watch the annual Dairy Day Parade from your office windows?

Does a 7-year-old patient bring you a dozen eggs from her chickens?

Do you get blueberry coffee cake when Marcy comes for treatment?


If you can answer ‘yes,’ your practice is urban.


Do many of your patients wear dress clothes or bring laptops?

Do they try to talk on cell phoneswhile getting treatment?

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