Barriers to Care Are Driving Oral Health Disparities. These Four Solutions Can Help.

Without regular, preventive dental care, early tooth decay or gum disease can worsen, hurting our overall health and increasing treatment costs. But many people can’t access the preventive services they need. Policy and structural barriers — from inadequate dental coverage to a lack of providers in their community — stand in their way, creating broad oral health disparities.

Those barriers present real and daily challenges, but they are not insurmountable.

Changing where and how dental services are delivered, increasing the use of technology, strengthening dental coverage, and continuing community-based advocacy efforts can help more people regularly access critical preventive care.

Why the Emergency Department Isn’t Part of the Solution

When dental problems fester, they can quickly and unexpectedly turn unbearably painful. The only option for many people, especially those without access to regular dental services, is to seek treatment at a local hospital’s emergency department (ED).

But EDs are ineffective at resolving dental health crises, as they’re ill-equipped to treat the root cause of oral disease. Recent research by CareQuest Institute for Oral Health shows that, after visiting an ED for dental concerns in 2021, 57% of adults were referred to an oral health provider because the department could only offer temporary relief. And more than 6 in 10 adults were prescribed painkillers during or after being seen at the ED.

Related research finds that people more likely to use the ED for dental concerns share many characteristics, including the following:

• They live in a rural area.
• They tend to have lower incomes.
• They are often uninsured or enrolled in Medicaid coverage.

The lack of adequate insurance is a particularly big hurdle — and a common reason for an ED visit for a non-traumatic dental condition. In 2019, among those under age 44 who went to the ED for dental problems, 7 in 10 were enrolled in Medicaid or not insured.

In addition to not resolving patients’ underlying dental needs, ED visits for dental concerns are more expensive than other care options. In 2019, they cost the health system $3.4 billion to treat.

Oral Health Disparities Continue to Hurt the System

Uneven access to care means some communities face a greater risk of dental disease and struggle with related financial consequences. People with low incomes are among those hit hardest, while racism compounds the harm.

Examples of economic and racial disparities from recent CareQuest Institute research include the following:

• Adults earning $100,000 or more a year were much more likely to rate their oral health as excellent, very good, or good (87%), compared with 60% of those making less than $30,000 per year.
• Homeownership was linked to higher rates of having a dental home, better self-rated oral health, and more regular dental visits, compared with renting or occupying a home without payment.
• Children and adults of color have greater rates of untreated tooth decay than white children and adults.
• Black adults are two and a half times more likely to visit an ED for dental pain than their Asian, Hispanic, or white peers.

Other structural barriers include geographic isolation and poor dental coverage.

Veterans, for example, feel the impact of both hurdles. Nearly one in four veterans live in rural areas, where routine dental care is harder to obtain. They face higher rates of tooth decay and gum disease and need more restorative dental care than civilians. And dental insurance options for veterans are also narrow. Accessing care often depends on being able to pay out of pocket.

Medicare and Medicaid are similarly limited. Neither program guarantees adult dental benefits in federal policy. For the nearly 60 million individuals enrolled in Medicare, the absence of coverage takes a huge toll:

• Adults enrolled in traditional Medicare plans are stuck paying for 79% of their dental care out of pocket.
• Many seniors say that cost is a primary reason for delaying needed care.

Four Solutions That Can Help

Fortunately, there are some systemic solutions that can boost access to dental care and reduce oral health disparities. Here are four top strategies that policymakers, oral health advocates, and other industry and community leaders can use to make progress:

1. Using school-based dental services (SBDS). Many students see dental providers at school for dental cleanings, diagnostic services, and preventive care, including fluoride treatment and dental sealants. Studies show that sealants offered through SBDS reduces tooth decay among otherwise underserved students. In a recent CareQuest Institute webinar, experts noted that sealant programs were scaled back during the COVID-19 pandemic, likely harming children’s health and school success. It is important to reinvigorate such programs today, as they position more children for a healthier future.
    
2. Expanding teledentistry. Harnessing telehealth is already expanding access to care for adults and children, and it has the potential to do much more. It can be particularly valuable in helping to overcome geographic isolation and may be part of SBDS. For instance, in North Carolina, a Federally Qualified Health Center utilized a mobile clinic to partner with a rural school to expand care. There, dental hygienists provided care to 1,200 students in just one year. CareQuest Institute’s Community Oral Health Transformation (COrHT) Initiative is helping oral health teams learn about and use teledentistry, among other solutions, to bring dental care to people experiencing access barriers.
    
3. Strengthening Medicaid adult dental coverage. Today, most states don’t offer the extensive benefits adults need to experience excellent oral health. In states where Medicaid covers adult dental care, policymakers frequently cut benefits when facing budget shortfalls. Bolstering Medicaid dental coverage is proven to significantly strengthen adults’ access to and use of dental care. It also reduces out-of-pocket costs for patients and ED visits, conserving health system resources.
    
4. Continuing community-based advocacy efforts. Working to lift barriers to access is challenging but crucial work — and oral health advocates do much of it. In 2022, CareQuest Institute invested more than $14 million in 86 grantee organizations, 33% of which are BIPOC-led. That work has continued in 2023 with $2.7 million in awards in the first quarter of the year. Organizations across the country work in their communities to reduce racial and economic disparities, working to ensure that benefits and care reach everyone in need.