2 dentist looking at x-ray with patient
By IHPL - February 7, 2018

“…if we don’t take care of our oral health, it affects so many different aspects of our lives. If your smile and mouth is not together, it affects your relationship, your self-esteem, your health.”
Sherri Shepherd

Oral Health Landscape in America

By Priya Vedula

A few years ago, my friend, a diligent student who never missed a single class during her four years of college, missed her final exams because she had an intense toothache. Treating it like a cold, she initially decided to ride it out, hoping it would eventually dissipate. By the third night, she was writhing in pain. There were no 24/7 dental emergency clinics and exam season was upon us. With a defeated sigh, she purchased her dental insurance online, booked her appointment for the next day, and signed up for a job at the University café in order to be able to pay it off.  

The Centers for Disease Control and Prevention estimates that between 2013-2014, 32 percent of adults aged 20+ suffered from untreated dental caries.1 Dental caries, commonly known as cavities, are caused by bacterial infections in our teeth that eventually lead to tooth decay. Surpassing asthma, tooth decay is the number one chronic disease in children even though it is preventable. Poor oral health can also be associated with heart and lung diseases, oral and pharyngeal cancers, and pre-and-post-term pregnancy complications. In 2000, the Surgeon General Dr. David Satchel released a report highlighting the importance of oral health to the general well-being.2 Poor oral health can also lead to missed days of work, problems with eating, difficulty acquiring a job, and low self-esteem. The Department of Health and Human Services defined national health promotion and disease prevention goals for oral health in Healthy People 20203.  

Covering Oral Care in America

Studies show that preventive services provided during a dental checkup, such as dental sealants, improve oral health outcomes and can save money in the long run.4 In 2012, the cost of emergency department (ED) visits for dental problems alone was $1.6 billion.5

The National Association of Dental Plans reports that an estimated 77 percent of the population now has dental benefits.6 And while dental benefits are provided for many low-income adults, the coverage may not be comprehensive. For those who have to get private insurance, cost-sharing can be high and waiting periods long. For example, the dentist told my friend she needed a root canal treatment. Despite having insurance, she still paid 50 percent of the cost of the surgery. She also learned that she would need to wait for six months before insurance would pay for a crown.

Price, however, may not be the only reason for unmanaged oral health. Take California, for instance, where low-income children on Medi-Cal receive comprehensive dental benefits through Denti-Cal. Although the plan even covers braces depending on the severity and need, only half the children had access to basic dental care in 2013.

According to the Centers for Medicaid and Medicare Services, here are some reasons why:

  • Insufficient enrollment of oral health providers in the Medicaid program;
  • Lack of available oral health providers within neighborhoods;
  • Lack of transportation to oral health providers;
  • Language barriers; and
  • Lack of awareness of oral health benefits.7  

Data shows that only 29 percent of California dentists participate in the program compared to the national average of 42 percent, as of 2014. This could be because Medi-Cal’s fee for service reimbursement rates for dental services are 29 percent of what private dental benefit plans pay.8 In fact, a California bill (AB-15) aiming to double reimbursement rates for the 15 most common oral health services, recently failed in appropriations.9

Thus, coverage doesn’t equate to access. It certainly is, however, an important first step since without coverage, having dentists in your backyard is not necessarily helpful. 

What’s Next?

California has begun a new telehealth strategy known as “Virtual Dental Home” to combat the problem. With portable x-ray machines and other tools, dental assistants can come to schools in underserved neighborhoods and send live images to a dentist; the dentist can then determine if somebody may require a scheduled dental visit to get treatment.10 This strategy is also seen in school-based health centers throughout the country.11

It is evident that poor oral health outcomes are still a major issue for Americans. Programs such as “Virtual Dental Homes” bring us one step closer to reaching the goals set forth by Healthy People 2020. Yet, there is still more to be done. For one thing, research seems to be lacking. The last consensus on national dental caries burden was in 2013. Moreover, oral health is simply not a priority for many lawmakers.12 The idea of dental treatment seems more of a luxury good than a medical necessity that should be covered. Through research, advertising, and advocacy, we need to spread a new awareness and an acceptance that oralx health is essential to our well-being.


  1. National Center for Health Statistics. (2017, May 03). Retrieved January 26, 2018, from https://www.cdc.gov/nchs/fastats/dental.htm
  2. U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health. 2000. Retrieved January 26, 2018 from https://profiles.nlm.nih.gov/ps/access/nnbbjv.pdf
  3. Office of Disease Prevention and Health Promotion. Retrieved January 26, 2018 from https://www.healthypeople.gov/2020/topics-objectives/topic/oral-health.
  4. http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12811/full
  5. http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0415_2.ashx
  6. http://www.nadp.org/Dental_Benefits_Basics/Dental_BB_1.aspx
  7. http://www.medicaidinnovation.org/_images/content/Oral_Health_Benefits_in_Medicaid_final.pdf
  8. https://www.ada.org/en/science-research/health-policy-institute/oral-health-care-system/California-facts
  9. http://www.chcf.org/media/press-releases/2010/virtual-dental-home-to-provide-care-to-underserved-communities-in-california
  10. https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201720180AB15
  11. https://www.schoolhealthcenters.org/healthlearning/oralhealth/
  12. https://kristof.blogs.nytimes.com/2017/05/23/our-teeth-are-making-us-sick/


Author Bio:
Priya Vedula is a health policy analyst at the Institute for Health Policy and Research. Her work involves examining health policies and regulations with a focus on oral health, mental/behavioral health, and hunger. She received her Master of Public Health degree from Columbia University.