Several articles in this issue address health care “at the margins.” One problem that affects almost all marginalized places and demographic groups is poor dental care, despite growing evidence that oral health problems can be symptoms of and even contributors to life-threatening illnesses like diabetes and heart disease.
The lack of access to dental care has two main causes. The first is that even employer-provided health insurance often does not cover dental care as generously as it does other health services. As for Medicaid, each state decides whether to cover dental care past childhood, and most states offer only emergency care. Also, the Medicare program does not cover routine dental services, and only about one-third of Medicare recipients choose to get supplemental coverage. Not surprisingly, only about half of Medicare recipients visit a dentist annually.
The second factor is that almost 63 million people, or more than one-fifth of the U.S. population, live in “dental deserts” with few or no places to obtain oral care, according to a 2018 report from the U.S. Department of Health and Human Services. Even though the number of dentists practicing in the United States has gone up, there are more and more shortage areas (5,866 communities as of 2017), mostly in rural communities and low-income urban neighborhoods.
These two factors contribute to huge disparities in oral health among demographic groups. The Centers for Disease Control reports that 47 percent of the U.S. population has periodontal disease, but there are much higher rates among blacks and those of Mexican descent and among those with less than a high school education. The same pattern holds true for tooth decay.
Any further decline in oral health would constitute a public health crisis, one that can easily be avoided. Health care remains a top priority for voters, and policy makers should consider new requirements for health insurance to cover dental care, as well as incentives (perhaps loan forgiveness) for dentists to practice in underserved areas. Dental care is inseparable from overall health care, and it should be a priority in any plan to reduce inequities and improve the well-being of all citizens.