America’s Silent Epidemic: Oral Healthcare Access Among Uninsured and Underinsured Adults

Policymakers view dental care as a supplemental luxury rather than an essential health need. Medicare specifically excludes dental care coverage and most state Medicaid plans and many private insurance plans provide limited to no dental benefits to enrollees. In the early 2000s several states made cuts to Medicaid dental benefits, and few of these policies have been reversed. The result: 58 percent of low-income9 adults have no way to access affordable, quality oral health care. Given the prohibitive out-of-pocket costs for dental care, uninsured and underinsured Americans exhibit higher incidence of oral disease when compared to adults with dental insurance. The current system fails to provide care to low-income Americans. Community health organizations like the American Dental Association Foundation face the task
of creating innovative solutions to address the following problems that stem from the lack of affordable dental care for low-income adults.

Uninsured adults turn to the Emergency Department for untreated oral health issues

Poor oral health causes pain, difficulty eating, and diminished quality of life. The oral cavity is a key entry point for bacteria into the body. Untreated dental decay can escalate into serious health
problems such as abscesses and even heart disease. In 2010, over two million adults visited the emergency department for complications sparked by inadequate oral health care. These patients receive antibiotics and painkillers, but ED physicians lack the training to treat dental issues.

Low-income adults are a forgotten demographic in oral health interventions

Nationally, Affordable Care Act Medicaid expansion does little to increase dental benefits for
adults. Congress does, however, list oral health as an essential health benefit for children14.
Initiatives to expand oral health access often focus on providing care for children. Mobile dental
vans set up free clinics outside of schools, and public health departments offer preventative
treatments such as fluoride varnish to students during school days. Low-income adults face more
severe dental issues as a result of years without preventative care. These issues warrant the
attention of a dentist, but there have been few sustainable interventions to provide free or low
cost dental treatments for adults.

Safety net clinics cannot meet the demand for dental care among low-income adults

The dental safety net is supposed to provide services to low-income adults who lack dental
coverage through Medicaid but cannot afford private insurance. The system of care currently
includes dental clinics at Federally Qualified Health Centers, public health departments, private
charities, and dental schools. But the fragmented and limited supply of low cost dental care does
not meet patient demand. Most clinics lack financial sustainability since patients cannot afford to
cover the full cost of care. Free and low cost clinics struggle to employ sufficient numbers of
dentists to regularly deliver care to millions of adults in need. Free clinics must place caps on the number of patients they treat, and patients must wait hours just for the chance to see a dentist.

As a philanthropic organization uniquely dedicated to the field of dentistry, the American Dental Association Foundation is well suited to take steps to address the issue of lack of oral healthcare for low-income adults. The central pillars of the American Dental Association Foundation– research, access to care, and education–are each specifically suited to address these problems.