Legislative calls for new methodologies to identify dentally underserved areas are an acknowledgement of the growing concern that the existing Dental Health Professional Shortage Area (DHPSA) designation criteria are outdated and ineffective. This report explores the history of DHPSAs, critiques the current designation criteria, and provides recommendations for the next steps in revising these criteria. DHPSA designation is currently a prerequisite for participation in a variety of state and federal programs designed to increase access to services, in particular the National Health Service Corps. These criteria should ideally be feasible for local administrators to implement and consistent with the public health goal to designate underserved populations based on unmet clinical need.