Accessing safe, quality, and affordable dental care remains challenging for many.
Dr. Rena D’Souza
Director, National Institute of Dental and Craniofacial Research (NIDCR)
“Improving access to integrated, holistic care that includes dental care is paramount to ensuring better overall health for all of us.”
In December 2021, the National Institute of Dental and Craniofacial Research (NIDCR) published a detailed report on the state of oral health in America. One of the key findings of the report was the vast disparities in oral health across the country.
“In this nation, oral healthcare is experienced differently by different groups of people,” said Dr. Rena D’Souza, director of NIDCR. “Somehow, the scientific advances we’ve made have not been fully translated over to communities in need.”
The report, the culmination of two years of research and writing by more than 400 contributors, found that despite great scientific advances and improvements in the nation’s overall oral health in the last two decades, stark differences in access to care left many Americans unable to reap the benefits. Most of these disparities stem from underlying economic, demographic, and societal inequities.
Dr. D’Souza recounted one among several tragic examples, in which a 12-year-old child died because he was unable to access dental care. “His mother took him to three dental offices, and they wouldn’t see him because he didn’t have insurance,” Dr. D’Souza said, “and then he actually died because the abscess went to his brain.”
Several factors are causing this disparity in access, including high out-of-pocket costs and limited insurance coverage. “Oral health is essential to overall health, but dental coverage is often regarded as an add-on to health insurance, rather than a crucial part of it,” Dr. D’Souza said.
Fortunately, over the past 20 years, some progress has been made to integrate oral healthcare into primary healthcare, she said. For example, providing preventive dental care in a pediatrician’s office has improved oral healthcare access for children. The same approach — offering oral health assessments and preventive care in a primary healthcare setting, rather than exclusively in a dental office — could benefit adults as well.
Another innovation that is improving access to dental care is the move to provide it in nontraditional settings, such as schools, community health centers, and long-term care facilities.
The shortage of dentists in certain regions is another barrier to care. “In rural areas, we simply don’t have enough dental offices. Some people need to travel 200 miles to reach one,” Dr. D’Souza said. “This access-to-care issue could be countered through teledentistry and mobile dentistry, where dental personnel travel to rural areas in specially equipped vehicles to provide services.”
Also helping to fill the gap are increasing numbers of non-dentist service providers like dental hygienists and dental therapists, who can carry out basic procedures like cleanings and fillings.
While these efforts are cause for hope, Dr. D’Souza says, much work remains. NIDCR is poised to accelerate the translation of science into strategies that break down the structural and institutional barriers to equitable oral health care. The goal is to improve the health of all members of the American public.
“Improving access to integrated, holistic care that includes dental care is paramount to ensuring better overall health for all of us,” Dr. D’Souza said.