In the United States, lack of access to regular dental care is a major contributing factor to the economic consequences of poor oral health. The barrier to access to dental health is not just felt by underserved communities; It impacts Americans of all socioeconomic statuses because coverage for all dental services is not guaranteed by Medicaid or private insurance plans.
These gaps in care make us wonder how the U.S. health care system, particularly dental health, got here.
According to the data, about 67 million Americans live without dental insurance, according to the National Institutes of Health, Oral Health in America. Since February 1, 2024, more than 16 million Medicaid beneficiaries have been disenrolled due to the liquidation of public health emergency funds, according to recent data from the Kaiser Family Foundation. Although data are limited, in the 21 states that reported age exceedances, children accounted for approximately four in 10 (38%) Medicaid disenrollments.
The negative impact that poor oral health can have on a person’s financial well-being is frightening. With dental costs per person 30% higher than they were 20 years ago, according to the National Institutes of Health (NIH) report, it is less surprising that dental care is out of reach for many Americans.
To stave off the worsening economic impacts and rising costs associated with neglected oral health in the United States, we must work with policymakers and state governments to expand access to routine dental health care and improve dental insurance availability and coverage for all.
The tooth pitch
As the CEO of a dental health and orthodontic organization committed to providing quality care to over 100 underserved communities, I have seen firsthand the difficulties of providing medical and dental care in silos. This dental divide is central to many financial challenges for patients and healthcare institutions. According to a study by Synchrony, up to 58% of consumers believe dental insurance is unaffordable, and 75% of uninsured patients believe it is too expensive. The gap also leaves the nation’s health care system bearing much of the cost of poor oral health in communities across the country.
With high prices preventing many families from seeking routine dental care, 92% of adults said they have considered postponing dental care because of cost. Research also found that 27% of adults put off dental treatment because they cannot afford it. Worse, the National Institute on Minority Health and Health Disparities has revealed that the financial burden of health disparities in the United States is increasing. With a staggering cost of $451 billion in 2018, a 41% increase from $320 billion in 2014, racial and ethnic health disparities not only impact health outcomes but have also hit the economy hard. The same research also shows that barriers to education come at a significant cost. For people without a college degree, the associated healthcare cost burden in the U.S. beyond dentistry was $978 billion in 2018 – twice the percentage of the U.S. economy’s annual growth rate that year.
High costs ultimately lead to delayed treatment, resulting in patients having to go to the emergency room with severe tooth pain, placing a burden on our hospitals and healthcare systems to provide care. To illustrate, in 2017 there were 2.1 million emergency room visits for dental conditions, costing $2.7 billion. Adult and child Medicaid recipients accounted for the majority of these emergency department visits, at 40% and 69%, respectively. The disconnect between healthcare and dental health makes it difficult to incentivize changes in healthcare or dental care.
Dental health impacts the care of the entire person
Many people need to understand that oral health plays an important role in overall health. If left untreated, dental problems can cause significant healthcare and indirect costs that negatively impact other areas of people’s lives.
There are many diseases and health complications related to oral health, including heart disease, diabetes, cancer, osteoporosis, dementia, Alzheimer’s disease and more, which result in costly treatments and devastating effects in the long term. Poor oral health also harms economic productivity by limiting labor force participation. In 2015, productivity losses associated with oral disease in the United States amounted to approximately $45.9 billion. That’s more than the job loss dollars of 195 other countries, according to the National Institutes of Health.
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 agony of a missing tooth, every 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 absence among children. A study found that children with neglected oral health are three times more likely to miss school than their peers, and their toothache is also linked to poorer academic performance.
A resolution: establish dental clinics
What can healthcare providers and dentists do together to close the tooth gap and help patients?
Primary care providers (PCPs) and physicians across the continuum of care should join forces to help families build dental homes – the lasting relationship a child or family develops with a dentist, similar to the relationship they have with have your family doctor. For patients with or without insurance, primary care physicians, emergency room physicians, or urgent care physicians should recommend that patients engage with a local dental practice through the age of one year to keep their mouths and teeth healthy through regular dental visits. Providing patients with a dental care resource is the first step in equipping them with the knowledge to engage with a dentist before the need for treatment leads to an emergency visit.
Patients will benefit from developing a relationship with a dental hygienist who can provide dental cleanings and teach them how to maintain a healthy smile. Routine cleaning is a preventive service that also offers tips on using fluoride or sealants and focuses on nutritional advice, which is significantly less expensive than restorative procedures.
For patients without dental insurance who must pay out-of-pocket, the cost of routine teeth cleaning depends on the dentist; However, according to the American Dental Association Health Policy Institute, the average price in the United States is $104. Lower-income families may choose to buy groceries for their family instead of getting a dental cleaning given the high costs.
Resources are available for healthcare providers with Medicaid or Children’s Health Insurance Program (CHIP) patients to confirm whether their state plans provide dental coverage by clicking here.
By working together, healthcare providers and dentists can improve health outcomes and associated costs for children and adults by preventing the early onset of dental disease.