Op-Ed: The Plague of Dental Inaccessibility in the United States
By Noor Chaudhry, JSTEP Global High School Fellow (Crofton High School ’24 — Davidsonville, Maryland)
The saying goes that one’s eyes serve as the window to their soul, yet missing in this expression is that the mouth and one’s smile are the windows to the rest of the body. Alongside the importance of oral health, dentistry is often overlooked and underestimated in comparison to other healthcare fields, yet it plays a crucial role in one’s overall well-being. Many of life’s most simple but enjoyable pleasures are dependent on our oral health: being able to speak and foster meaningful relationships with others alongside having the opportunity to gain insight into different cultures through eating various cuisines.
Beyond this, one’s oral health acts as a reflection of their overall health. The National Institute of Dental and Craniofacial Research concluded approximately 120 diseases related to the rest of the body can be discovered by oral health professionals. Something as seemingly innocent as swollen gums or dry mouth leads dental professionals to find indications of health conditions such as HIV/AIDS, diabetes, eating disorders, and cardiovascular diseases. Such discoveries, especially in the early stages can be the difference between life and death, and in a nation like the United States, which is renowned for being a global leader in healthcare with trailblazing research, avant-garde treatments, and state-of-the-art facilities, it is reasonable to anticipate that the majority of United States citizens have access to oral health care. However, that idea is a complete misrepresentation of the facts, demonstrated by the Centers for Disease Control and Prevention (CDC), which reported that in 2019, 34.5% of U.S. citizens (88 million individuals) aged 18–64 years old did not have access to a dentist, resulting in a loss of $45 billion in productivity as a result of untreated oral disease. Similar to many other social justice issues such as shelter instability and limited employment opportunities, the struggle for equal dental care is especially prevalent among low-income communities. This disparity is referred to as the dental care gap, a term coined by the author of Teeth: The Story of Beauty, Inequality, and Struggle for Oral Health in America, Mary Otto, who underscores dentistry’s associations with the concepts of class and privilege.
Many attribute the higher rates of oral disease among the lower classes to a lack of education — but this only brings more questions to the table: How can we expect low-income communities to pay attention to their oral health care if the U.S. government has painted dental care to be an exclusive privilege for the wealthy? How can we expect low-income communities to take care of their teeth when they are not provided the resources to do so? The striking divide between the rich and poor is exacerbated by the dental care gap: While the dental industry is worth over $100 billion, and provides the wealthy with cosmetic treatments like “gum contouring” and expensive whitening treatments to achieve a dazzling smile, those experiencing financial struggle suffer to the extent of dying of untreated, preventable tooth decay.
Dentistry, in many ways, has remained isolated from the rest of healthcare in terms of continuing to be a largely private industry that relies on self-pay rather than incorporating major aspects of “socialized medicine” such as Medicaid. Nearly one-quarter of the American population has no form of dental insurance at all, which is painful considering the standard dental cleaning costs upward of $200, and that is if the patient requires no restorations whatsoever, which is typically rare. Lacy Kyllonen, an adjunct dental assisting professor at Anne Arundel Community College and the director of the honors dental assisting program at the Center of Applied Technology-South in Eastern Maryland further elaborates on such limitations: “As a dental assistant, you act as the direct communicator between the patient and the dentist, and while partaking in that role, you become hyper-aware that having the ability to attend your biannual cleaning is not an opportunity everyone gets. We are so quick to judge someone’s personal hygiene but fail to recognize and hold the systems that cause barriers to the improvement of dental hygiene accountable…The number of patients who tell us that they cannot undergo certain dental procedures just because of the cost is mind-boggling and frankly heartbreaking. When working as a dental assistant, you come into contact with people with completely different experiences with dentistry. You’ll have some patients who never even learned how to brush their teeth and watch them face the health consequences of that, and others who were raised to give the utmost importance to their smile. Even after 6 years of teaching students and preparing them for the workforce, I have not found a way to describe the physical and mental agony many patients come into the dental practice with. It’s really unfortunate that it is so normalized,” Kyllonen says with a sigh. “The worst part for me is that these people who cannot afford dental work usually only come in when the pain is unbearable. At that point, the infection tends to be too far gone to restore, or requires such an extensive and costly treatment plan that the patient cannot get it done, regardless of how bad it hurts.”
The atrocities of dental inaccessibility have plagued the United States for years, but fortunately, national and state-wide programs alongside non-profits have been implemented, which strive to provide everyone with a healthy, functional mouth regardless of financial status. For example, the School Sealant Program was established by the Centers for Disease Control and Prevention (CDC) and continues to be funded by it since 2013. Implemented in 48 U.S. states, the School Sealant Program has provided children over 5 million sealants (a preventative measure for cavities) at no cost using portable dental equipment. This work is incredibly impactful considering that cavities continue to be one of the most frequent chronic diseases of childhood and that the program itself has reduced an estimated 3.4 million cavities within a 4-year timespan. Similarly, a non-profit called Mission for Mercy has operated mobile dental units in multiple sites in Arizona, Maryland, Pennsylvania, and Texas since 1994, where dentists and licensed dental assistants provide patients with free dental exams, fillings, extractions, dental hygiene education, and prescriptions, all at no cost beyond a phone call to set up an appointment.
Programs and organizations like the ones mentioned above instill hope — hope that with continued efforts from organizations and individuals alike, we can work toward a future in which the plague of dental inequality among people of lower socioeconomic status in the United States is overcome. It is vital that no one’s smile and the condition of their mouth remind them of their economic hardships but instead act as a continuous reminder that access to dental care should be a fundamental human right.
