In the U.S., a lack of access to regular dental care is a significant factor leading to the economic consequences of poor oral health. The barrier to dental health access is not just felt by underserved communities; it impacts Americans across socioeconomic statuses, as coverage for all dental services is not guaranteed through Medicaid or private insurance plans.
These care gaps leave us wondering how the U.S. healthcare system, specifically dental health, got here.
The data tells us that approximately 67 million Americans are living without dental insurance, according to the National Institutes of Health, Oral Health in America. Since February 1, 2024, more than 16 million Medicaid beneficiaries were disenrolled due to the unwinding of public health emergency funds based on current data cited by the Kaiser Family Foundation. Although data are limited, children accounted for roughly four in 10 (38%) Medicaid disenrollments in the 21 states reporting age breakouts.
The negative impact that absent oral health can have on an individual’s financial well-being is staggering. With dental costs 30% higher per person than they were 20 years ago according to the National Institutes of Health (NIH) report, it’s less surprising that dental care is out of reach for many Americans.
To ward off the worsening economic impact and escalating costs associated with neglected oral health in the U.S., we must work with policymakers and state governments to expand access to routine dental healthcare and improve dental insurance availability and service coverage for all.
The dental divide
As the CEO of a dental healthcare and orthodontics organization committed to providing quality care to over 100 underserved communities, I have seen the difficulties of medical care and dental care functioning in silos firsthand. This dental divide is central to many financial challenges for patients and institutions in healthcare. As many as 58% of consumers view dental insurance as unaffordable, and 75% of uninsured patients feel it’s too expensive, according to a study from Synchrony. The divide also leads to the nation’s healthcare system bearing much of the costs of poor oral health in communities nationwide.
With high prices discouraging many families from seeking routine dental care, 92% of adults said they have considered delaying dental care due to costs. Research also found that 27% of adults put off dental care because they could not afford it. Even worse, the National Institute on Minority Health and Health Disparities revealed that the financial strain of health disparities in the U.S. is rising. Carrying an enormous cost of $451 billion in 2018, up 41% from $320 billion in 2014, racial and ethnic health disparities not only impact health outcomes but they have hit the economy hard. The same research also shows barriers to education have come at a significant price. For people without a college degree, the related health cost burden to the U.S., beyond dental, was $978 billion in 2018—double the percentage of the U.S. economy’s annual growth rate that year.
High costs ultimately lead to delayed treatment, which leaves those suffering from severe dental pain to turn to emergency departments, placing the burden of care on our hospitals and health systems. For reference, there were 2.1 million emergency department (ED) visits for dental conditions at a cost of $2.7 billion in 2017. Adult and child Medicaid beneficiaries made up a majority of these ED visits at 40% and 69%, respectively. The disconnect between healthcare and dental health makes incentivizing change in healthcare or dental care difficult.
Dental health impacts whole person care
Many must realize that oral health plays a significant role in overall health. Left untreated, dental issues can create substantial healthcare costs and indirect costs that negatively impact other areas of people’s lives.
There are many diseases and health complications linked to oral health, including heart disease, diabetes, cancer, osteoporosis, dementia, Alzheimer’s, and more, which result in costly treatments and devastating effects in the long term. Poor oral health also hurts economic productivity by limiting workforce participation. In 2015, productivity losses associated with oral disease in the U.S. totaled approximately $45.9 billion. According to the National Institutes of Health, that’s higher than the work loss dollars of 195 other countries.
In addition to the significant financial costs associated with delayed dental care, there are hidden costs that are harder to quantify. From the pain of a toothache to the anguish of a missing tooth, each experience has an emotional toll on a child’s ability to learn, communicate, and thrive socially. School absences due to dental problems account for an estimated 34 million hours of school absences among children. One study revealed that children with oral health neglect are three times more likely to miss school than their peers, and their dental pain is also tied to poorer school performance.
A resolution: Establish dental homes
What can healthcare providers and dentists collectively do to bridge the dental divide and help patients?
Primary care providers (PCPs) and clinicians across the care continuum should join forces to help families establish dental homes—the ongoing relationship a child or family establishes with a dental provider, much like the one they have with their primary care doctor. For patients with or without insurance, PCPs, ED physicians, or urgent care clinicians should recommend that patients secure a local dental home by age one to keep their mouth and teeth healthy through regular dental visits. Giving patients a resource for dental care outreach is the first step in arming them with the knowledge to connect with a dental provider before treatment needs escalate into an emergent care visit.
Patients will benefit by forming a relationship with a hygienist who can perform dental cleanings and educate them on how to maintain a healthy smile. Routine cleanings are a preventive service that also offers tips on the use of fluoride or sealants and focuses on nutritional counseling, which costs much less than restorative procedures.
For patients without dental insurance who need to pay out-of-pocket , the cost of routine cleanings depends on the dental provider; however, the average price is $104 in the U.S., according to the American Dental Association Health Policy Institute. Lower-income families may be choosing to buy groceries for their family over a dental cleaning given the high cost of a visit.
Resources are available for healthcare providers with Medicaid or Children’s Health Insurance Program (CHIP) patients to confirm if their state plans provide dental coverage by clicking here.
Through their collaboration, healthcare providers and dentists can improve health outcomes and the related costs for children and adults by preventing the early onset of dental disease.
