Despite Progress, Millions Still Face Barriers to Adequate Oral Health Care

Discrimination. Cost. Education. Employment. 

Together, they are four powerful socioeconomic factors that act as barriers to adequate oral health for millions of adults in the United States. The newest CareQuest Institute report, Does Our Oral Health Care System Welcome Everyone? dives into those factors in great — and concerning — detail. 

The report features findings from CareQuest Institute’s annual State of Oral Health Equity in America 2024 (SOHEA) survey, which examined the oral health attitudes, experiences, and behaviors of more than 9,000 adults. 

“In this year’s report, we had more than 9,000 people complete the survey, compared to a little more than 5,000 people in previous years,” said Lisa Heaton, PhD, science writer at CareQuest Institute. “This larger sample size allows us to dive deeper into more areas of interest and draw more conclusions than we could with data from a smaller group of respondents.” 

Heaton, one of the authors of the report, explains more about the findings and what actions organizations and people can take to break down those barriers. 

1. What would you say are the biggest takeaways from the report? 
   
   While the oral health care system works well for some to achieve and maintain good oral health, many adults are still unable to receive adequate oral health care. For example, just under one third of adults surveyed say they haven’t visited a dentist in the last year, and more than 1 in 10 say they do not plan to see a dentist in the coming year. As poor oral health is linked to myriad chronic health conditions — such as heart disease, diabetes, and dementia — adults who are not able to access oral health care are at increased risk of other health conditions. 
   
   We also learned that within the prior year, approximately 10 million people lost dental insurance. It is important to keep track of these numbers so we can better understand how people’s oral health can change as their dental insurance coverage also changes. 
    
2. Do any findings show a significant change in adult oral health status in the last year? 
   
   On a positive note, the percentage of adults who report having ever experienced discrimination in an oral health care setting decreased from 7% in 2023 to 4% in 2024. However, while this overall number is relatively low, the percentage of those who said they both experienced and had been denied oral health care due to discrimination increased slightly from 22% in 2023 to 27% in 2024. This finding shows that there is still work to do for oral health care to be more inclusive and welcoming of all individuals. 
    
3. Did your research focus on anything new this year? 
   
   For the first time in 2024, we asked adults how important they feel it is for the dental setting to be a diverse and inclusive place. For example, nearly half of adults in the sample overall (47%) say it is important to them that their dentist embraces their cultural preferences. This suggests that many adults prefer to seek care in dental settings that represent diversity and inclusivity. 
    
4. Did anything surprise you in the report?
   
   Something we found surprising is that almost half of adults continue to have experienced at least one oral health problem in the previous year (48%), such as toothache (18%), cracked or broken teeth (17%), frequent dry mouth (15%), and swollen or bleeding gums (15%). The consistency of this finding year after year (51% in 2023) highlights how important preventive oral health care is to prevent larger problems.
    
5. What actions do you hope readers — providers, oral health advocates, policymakers — take after reading the report? 
   
   We hope these findings emphasize that when the dental team gets to know and respect their patients as individuals, they’re providing care that their patients really appreciate and value. With regard to advocacy and policymaking, while the oral health care system is working for many people, there are still many adults who are being left out of the opportunity to achieve and maintain optimal oral health. Several US states have enhanced adult dental benefits in their Medicaid programs. That said, with 69 million adults still without dental insurance in 2024, there is still a lot of work to do to create an oral health care system that is accessible, equitable, and integrated for everyone. 
    
6. What direction do you see the survey taking in the future? Which areas do you feel need more research or attention? 
   
   Starting in 2025, we plan to offer the survey in both Spanish and English. About one third of adults surveyed in 2024 said it was very important or important to them that their dentist offer translation services. However, we couldn’t draw any conclusions about adults’ preferences for translation services who aren’t able to participate in an English-language survey. We also added a question for 2025 about the importance of dentists speaking the same language as their patients, which will help us to better understand language-related oral health care barriers.
   
   We’re also adding about 20 new questions to the 2025 survey, including about dental tourism, underground dentistry, and whether adults have ever had to delay medical care — such as cancer treatment — due to untreated dental problems. 

Editor’s note: For more information on CareQuest Institute publications and reports, go to our Resource Library.