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Financial Disparities and Instabilities in Dental Care

Updated: Oct 31

Donna Jalai, Aimee Park, Trinity Low

Project Smile Global

23 October, 2024


It is no secret that, especially in the United States of America, proper healthcare is expensive; dentistry is no exception. Those who are more financially burdened often have less access to affordable healthcare, and as a result, have poorer oral health (Chavers et al. 140). Oral health care disparities can be defined as “unequal opportunities to be healthy, making disadvantaged groups even more disadvantaged with respect to their oral health” (Northridge et al. 513).  Accordingly, reducing such disparities provides disadvantaged populations with equal opportunities to be healthy (Northridge et al. 513). To address the issue of oral health disparities, there is a need to implement changes so that an all-around effective, accessible, and equitable system is available to all individuals (Northridge et al 535).

The definition above highlights the systemic nature of these disparities and how they are not merely about individual health issues but broader social and economic implications. Addressing health disparities requires a more comprehensive systemic change to ensure that each individual, regardless of socioeconomic status, has the resources to access equal oral health care (Northridge et al. 523). While it is easier defined than addressed, the primary reason for oral health care disparities arises from the lack of discussion around the issue (Northridge et al. 515). Disparities arise mostly among those of low socioeconomic status, members of a particular racial/ethnic group, immigrant populations, and individuals who live in rural areas; however, there is a significant lack of literature regarding oral health disparities (Northridge et al. 513). This lack of literature calls for attention to more investigation into the “allocation of resources for oral health care, the actual receipt (utilization) of oral health care services, the quality of health care services, the oral health care workforce, and the financing of oral health care, particularly concerning the burden of payment on the individuals and households” (Northridge et al. 515). Additionally, education surrounding dental care is a key factor in achieving equitable and affordable oral healthcare. One study found that the approach to dental care played a role in the quality of an individual’s oral health, with those who received dental care only if problems occurred—rather than being regular patients—experiencing more oral disadvantages (Chavers et al. 140). Similarly, the study highlights that the reasoning behind this reactive approach to dental care is often the high costs associated with regularly attending dentist visits, with low-income and minority individuals suffering most from the burden of these oral discrepancies (Chavers et al. 140). Furthermore, the lack of discussion around oral health disparities creates a significant gap in the research and hinders the ability to make the necessary changes to address these disparities. While many problems arising from oral health disparities are avoidable and preventable, comprehensive data is crucial for opening discussions and targeted policy interventions to provide equitable health care (Chavers et al. 140; Northridge et al. 515). Despite a discrepancy between socioeconomic class and receiving proper dental care, government-assisted healthcare has helped alleviate some of this stress on patients (Dumont et al. 10). In 2023, the Centers for Medicare and Medicaid Services (CMS) was instructed to further emphasize preventative, minimally invasive, and timely care in their Oral Health Initiative (OHI) (“Dental Care”). The organization also puts together seminars to improve the links between Medicaid and dental care, such as having a presentation roadmap outlining the steps needed for improvement projects (“Dental Care"). For example, one project is currently being worked on to use Medicaid policy tools to improve oral decay in early childhood (“Dental Care").

However, despite such efforts, disparities still exist between access to dental healthcare. The Affordable Care Act (ACA) was developed and implemented with the intent of improving overall healthcare quality, increasing public access to health insurance, and decreasing the cost of treatments. It is difficult to assess the true benefit of the ACA on dental care because the law is not written to be explicitly applied to dental insurance coverage (Dumont et al. 14). The ACA specifically provides improvements in decreasing cost barriers and increasing dental care for young adults and low-income children. However, the direct correlation between this positive impact and policymaking itself must be clearer, as it remains obscure (Song et al. 18). A study modeling how states can survey financial burdens through the ACA found that while this act has and continues to decrease financial burdens and alleviate barriers preventing access to affordable healthcare, there is a gap in dental care coverage, leaving many individuals without affordable dental care through the ACA (Dumont et al. 13).

Disparities in insurance coverage also significantly impact access to dental care. Compared to general medical insurance, employers less commonly provide dental insurance (Song et al. 2). This added burden disproportionately affects low-income and minority populations who are less likely to have profession-provided dental insurance or the financial means to be able to afford private insurance (Zivkovic et al. 2). Without proper coverage, patients are less likely to seek routine preventative dental care visits, resulting in untreated and poor oral hygiene (Zivkovic et al. 2). According to BMC Health Services Research, the accumulation of untreated oral issues leads to an increase in the number of emergency department visits, which are significantly more expensive (Zivkovic et al. 4). This report highlights the need for better insurance coverage for improved preventative care strategies (Zivkovic et al. 4). Furthermore, retired adults are less likely to have dental insurance from previous employers, which makes it challenging to receive expensive dental treatments, especially those that tend to be necessary with older age (Calvo et al. 85). As such, one-fifth of the older American population experiences untreated dental decay (Calvo et al. 85). This further highlights the need for proper education surrounding preventative dental care to prevent large emergency department bills in minority populations, low-income populations, and the elderly populations (Calvo et al. 85). The issues presented with the lack of dental insurance plans also give rise to discussions about how employers should administer dental care coverage plans at the same frequency that they administer medical health insurance plans to diminish the number of individuals and populations suffering from untreated dental care (Zivkovic et al., 124; Calvo et al., 85).

Given the financial barriers many face in accessing dental care, it is important to note that there are alternative solutions that can provide affordable treatments and improve overall oral health. For instance, dental schools are a great way to provide treatments at a significantly reduced cost as dental students gain clinical experience performing procedures on patients while being observed by licensed dentists (Bethesda, Sec. 3A). There are also community health centers available, with some providing basic dental care treatments for disadvantaged individuals. In the United States, veterans also receive dental care benefits (Bethesda, Sec. 3A). However, as highlighted in the studies listed throughout this paper, the best way to avoid high dental costs is to practice preventative care and implement measures in your daily routine to maintain a healthy smile. This illustrates that, while the need for affordable dental care is imperative to improving the health and quality of life for disadvantaged populations, a call for increasing dental education is equally crucial. This in turn allows people to be informed on how to best care for their teeth and gums to prevent disease if access to professional dental treatments is limited. With more programs implemented to provide affordable dental care and increased education about preventative care, financial disparities, and barriers can be alleviated to ensure that people from diverse backgrounds have healthy and happy smiles (Northridge et al., 515).



Works Cited


National Institutes of Health. Oral Health in America: Advances and Challenges. U.S. Department of Health and Human Services, 2021, pp. 3A-1–3A-96. www.ncbi.nlm.nih.gov/books/NBK578294/


Calvo, Jean, et al. “Financial Roadblocks to Oral Health for Older Adults.”  Journal of the American Society on Aging, vol. 40, no. 3, 2016, pp. 85–9.


Chavers, L. Scott, et al. “Racial and Socioeconomic Disparities in Oral Disadvantage, a Measure of Oral Health-Related Quality of Life: 24-Month Incidence.” Journal of Public Health Dentistry, vol. 62, no. 3, 2002, pp. 140–47, https://doi.org/10.1111/j.1752- 7325.2002.tb03435.x.


“Dental Care.” Medicaid, www.medicaid.gov/medicaid/benefits/dental- care/index.html. Accessed  July 1, 2024.


Dumont, Dora M., et al. “State-Level Surveillance of Underinsurance and Health Care- Related Financial Burden.” Journal of Public Health Management and Practice, vol. 23, no. 5, 2017, pp. 10–16, https://doi.org/10.1097/PHH.0000000000000481


Northridge, Mary E., et al. “Disparities in Access to Oral Health Care.” Annual Review of Public Health, vol. 41, no.1, 2020, pp. 513-35, https://doi:10.1146/annurev- publhealth-040119-094318.


Song, Jihee, et al. “The Impact of the Affordable Care Act on Dental Care: An Integrative Literature Review.” International Journal of Environmental Research and Public Health, vol. 18, no. 15, 2021, pp. 1-21,  https://doi.org/10.3390/ijerph18157865.


Zivkovic, Nevena, et al. “Providing dental insurance can positively impact oral health outcomes in Ontario.” BMC Health Services Research, vol. 20, no. 124, 2020, pp. 1-9, https://doi.org/10.1186/s12913-020-4967-3.

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