Understanding Dental Cleanings: A Public Health Perspective on Access, Prevention, and Equity

Wenjing Hu, Alana Odinocki, Archi Parikh

Project Smile Global

15 May, 2025

Oral health is crucial to overall health and well-being, as dental plaque accumulation plays a central role in creating dental caries and periodontal diseases (Petersen & Ogawa, 15). Professional dental cleanings are important because they effectively remove biofilm and calculus that cannot be eliminated through routine oral hygiene practices (Weik et al.,1). Regular oral hygiene practices, such as brushing with sodium monofluorophosphate solutions, has shown to reduce gingival inflammation and slow the progression of periodontal disease (Axelsson & Lindhe, 1). This article will focus on the dental cleaning process, its preventive benefits, and the efforts being made to bridge disparities in dental care linked to income and race. 

The process of a professional dental cleaning begins with an oral examination, during which a hygienist assesses teeth and gums using a small mirror to detect inflammation or plaque buildup (New England Dental Health Services). Next is scaling, where manual scalers or ultrasonic instruments remove plaque and calculus. The hygienist then polishes the teeth thoroughly using prophylactic toothpaste, whose grainy texture effectively polishes the enamel.. Once the teeth have been polished, the hygienist will floss between the teeth and also assess the condition of the gums, checking for issues like bleeding or sensitivity, which may signal the need for further attention (New England Dental Health Services). Finally, after rinsing the mouth, a fluoride treatment is done. This treatment helps to strengthen teeth and prevent cavities from forming until the next check-up (New England Dental Health Services). 

Although preventive dental care is important to all, preventive dental care is especially important to a child's well-being, as dental caries remains the most common chronic childhood disease, affecting nearly 1 in 5 children ages 6–11 in the U.S. (Luo et al. 161). If left untreated, caries can lead to severe infections and difficulties in eating, speaking, and learning (Wei et al. 53).

Fluoride treatments and dental sealants are two highly effective methods of preventing caries and are especially impactful in high-risk populations (Wei et al. 54). The U.S. Preventive Services Task Force recommends applying fluoride varnish as early as the first tooth eruption, ideally two to four times per year until age five (Luo et al. 161).

Despite their benefits, these services are underused by minority and low-income populations. For instance, Asian American children are 31% more likely to experience dental caries compared to non-Hispanic white children (Luo et al. 165). Additionally, from 2016 to 2020, they were over 20 percentage points less likely to have received fluoride treatment in any given year (Luo et al. 164). When children receive only basic dental cleaning services with no proven effectiveness in caries prevention, they miss opportunities for essential care (Wei et al. e57). This underutilization contributes directly to long-term oral health inequities.

Data reveal persistent gaps in who receives effective dental care. From 2016 to 2020, non-Hispanic white children consistently exhibited the highest rates of both fluoride treatment and dental sealant application, compared to their Black, Hispanic, and Asian peers (Luo et al. 164). For example, the rate of sealant use among Asian children declined significantly, from 16.6% in 2016 to 11.6% in 2020 (Luo et al. 164).

Income disparities further exacerbate the issue. Children from low-income families were 11% more likely to experience dental caries than their higher-income peers (Luo et al. 165). Additionally, these children were less likely to receive sealants (AOR = 0.89) or fluoride treatment over time (Luo et al. 165). Wei et al. reinforce this, noting that children from low-income families were twice as likely to receive dental cleanings rather than evidence-based treatments like sealants or fluoride (Wei et al. 58). This leads to overstated success in public health metrics—services may be counted, but children are not protected from decay (Wei et al. 59).

Racial disparities also influence how care is delivered. By 2013–2014, disparities in overall preventive visits between Black, Hispanic, Asian, and white children had narrowed (Wei et al. 56). However,  when focusing only on evidence-based care, non-Hispanic Black children remained 6.5 percentage points behind their white peers (Wei et al. 56). This suggests that systemic issues persist not just in access to care, but also in the quality and type of services provided during those visits.

While disparities in dental care access and quality remain a pressing concern, a variety of strategies can be employed to bridge this gap. These include policy-level reforms, community-driven interventions, and steps that individuals and families can take to protect their oral health.

At the systemic level, expanding dental coverage under public insurance programs like Medicaid and the Children’s Health Insurance Program (CHIP) is crucial. These programs should cover basic cleanings and prioritize reimbursement for evidence-based preventive treatments such as fluoride varnishes and sealants. Increased enrollment in Medicaid and CHIP since 2009 has contributed to a significant rise in dental coverage, with 87.8% of U.S. children having dental insurance by 2013—a 9.5 percentage point increase since 2000. Increasing these services' availability and affordability would improve outcomes for low-income children, who are often left out of such care (Duffy et al. 2).

In addition, offering incentives for dentists to practice in underserved areas—through loan repayment programs, grants, or tax benefits—can help address geographic disparities in dental care access. Recruiting more culturally competent providers from diverse backgrounds can also enhance trust and communication with minority patients (Bethesda).

Furthermore, community-based approaches are important for reaching populations that face barriers to traditional dental care. Mobile dental clinics are fully equipped dental offices on wheels, such as vans or trailers, that travel directly to underserved communities to provide on-site services like cleanings, fluoride treatments, sealants, and oral health education (Bala et al.1384). By reducing barriers such as transportation, cost, and time off work or school, these clinics make preventive care more accessible. Similarly, school-based oral health programs offer a practical and effective way to provide screenings, sealants, and fluoride applications to children, especially in schools with high percentages of students from low-income backgrounds (Gargano et al. 3-5).

Local health campaigns, particularly those conducted in multiple languages or led by community health workers, can raise awareness about preventive practices and available services (Glenton et al.). These campaigns should focus on promoting dental visits, not just for cleanings but for preventive treatments that reduce the risk of disease.

Even with broader reforms, individuals and families have an important role in promoting oral health. Practicing consistent oral hygiene at home—brushing with fluoride toothpaste twice daily, flossing once a day, and reducing sugar intake—remains foundational in preventing both caries and gum disease (National Institute of Dental and Craniofacial Research). It is also important to know how often to visit the dentist—ideally every six months—and to understand what to ask during those visits (NHS). Patients and parents should feel empowered to request fluoride treatments or sealants if they are not offered and to inquire about any signs of early decay or gum issues. This proactive engagement helps ensure that visits go beyond cosmetic cleanings and address the patient’s full preventive care needs.

Dental cleanings are more than a routine procedure, they are a gateway to broader preventive care that can significantly impact oral and overall health. From the initial examination to the final fluoride treatment, each step in a dental cleaning plays a role in maintaining a healthy smile. However, as the evidence shows, cleanings alone are not enough. Preventive measures like fluoride varnish and sealants are critical tools in the fight against dental caries, especially for children. Unfortunately, these services are often underutilized by those who need them most, due to systemic, racial, and economic disparities.

The urgency of improving access to effective dental care is clear. Without intervention, children from minority and low-income families will continue to face avoidable pain, infections, and long-term health consequences. Bridging this gap requires coordinated efforts. Policymakers must expand and prioritize coverage for evidence-based preventive care. Communities must invest in outreach, school-based programs, and mobile clinics to bring services directly to those who need them. And individuals and families must be equipped with the knowledge and confidence to advocate for their oral health.

Dental disease is largely preventable. With the right resources, education, and commitment, we can ensure that every child, regardless of background, has access to the comprehensive care they deserve.

Works Cited

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