In a recent alarming case, Dr. Susanna Fournier, a dentist at an urban hospital in Louisiana, treated a 16-year-old patient whose swollen face and difficulty breathing had escalated to a critical state. The teen required the extraction of six teeth, and due to airway obstruction, was intubated and admitted to intensive care.
Though the patient survived, Fournier fears that many other children across the country face similar life-threatening consequences due to poor oral health and lack of timely treatment. “I am genuinely worried that people could die from infections stemming from untreated dental abscesses,” she said.
Dental Care Access Remains Out of Reach for Millions
According to the latest State of Oral Health Equity in America report by the nonprofit CareQuest Institute for Oral Health, approximately 72 million U.S. adults lack dental insurance, compared to 9.5% without medical insurance. While many children have dental coverage through Medicaid or the Children’s Health Insurance Program (CHIP), low reimbursement rates discourage many dentists from accepting these plans, creating widespread “dental deserts.” Analysis from the Kaiser Family Foundation shows only about half of children on Medicaid accessed dental care within a year.
Dental professionals warn that proposed cuts to Medicaid could worsen oral health nationwide. Federal budget trimming threatens programs including the CDC’s oral health prevention initiatives. Meanwhile, several states including Florida and Utah have passed laws banning fluoride in drinking water, with others considering similar measures — a move dentists warn will negatively impact oral health for both children and adults.
Melissa Burles, CareQuest’s Public Policy Director, said, “We are already in the midst of an oral health crisis. Medicaid cuts and reductions in water fluoridation are two major factors accelerating this issue.”
Dental Care: An Overlooked Component of Healthcare
Oral health in the U.S. has long been treated separately from general healthcare. Medicare, the federal health insurance for seniors, typically excludes dental coverage. Medicaid dental benefits vary widely by state, with no federal mandate for adult dental coverage, though coverage for children is required. Individuals purchasing insurance through the Affordable Care Act marketplaces cannot buy standalone dental plans without a medical plan, and subsidies do not apply to dental coverage.
Even those with dental insurance often find their plans cover only routine cleanings and exams, leaving costly treatments out-of-pocket. A recent survey by the health advocacy group PAN Foundation found that about 40% of insured adults do not regularly see a dentist.
Health Consequences of Poor Oral Care
Neglected oral health can exacerbate chronic illnesses such as heart disease, low birth weight in infants, and respiratory conditions. Adults seeking emergency care for dental pain are often prescribed opioids, raising addiction risks. For children, tooth pain can impair eating and sleep, potentially causing malnutrition. The CDC estimates that dental issues cause a loss of 34 million school hours annually.
“Poor dental health has been linked to pneumonia, diabetes, and heart disease,” said Dr. Lisa Simon, an internist with a dental background practicing in Massachusetts, a state with one of the nation’s most comprehensive dental coverage systems. Despite this, she still treats patients whose dental infections have led to life-threatening sepsis or delayed critical treatments like chemotherapy. Many patients avoid dental exams due to shame or financial constraints.
The Impact of Fluoride Bans
Dr. Fournier recently testified before the Louisiana House opposing a bill that would restrict local governments’ ability to fluoridate public water supplies — only 38% of Louisiana residents currently have access to fluoridated water. Although the bill failed, similar legislation has been introduced or passed in states like North Carolina, Massachusetts, Ohio, Nebraska, Utah, and Florida. Local counties are also voting on fluoride bans scheduled for 2025.
Dentists attribute this trend partly to campaigns led by U.S. Health Secretary Robert F. Kennedy Jr., who calls fluoride a “dangerous neurotoxin” and has urged the CDC to stop recommending it. The FDA recently sought to remove ingestible fluoride tablets from the market.
Research published in JAMA Health Forum warns that removing fluoride from public water will raise cavities by 7.5%, costing nearly $9.8 billion over five years. Cities that ended fluoridation, such as Calgary in Canada, have since reinstated it due to increased dental decay.
Florida dentist Dr. Jeff Ottley notes a clear rise in both the frequency and severity of cavities among children since the 2014 cessation of fluoridation in his area. With Florida Medicaid offering minimal adult dental coverage, he predicts more severe cases requiring hospitalization.
Seeking Solutions Amid Budget Constraints
Advocates point to some recent progress, such as a Senate bill proposing to add dental, vision, and hearing coverage to Medicare and several states expanding Medicaid dental benefits for adults. Data from Colorado shows a 22% drop in extractions at safety-net clinics following Medicaid dental expansions.
However, many fear these gains could be reversed amid tightening budgets. “We are at a tipping point,” Dr. Simon said. “If progress continues, millions could access dental care. But historically, dental services are the first to be cut when funds are scarce.”
Preventive care like fluoride treatments and water fluoridation save states money in the long run. CareQuest estimates fluoride treatment saves Medicaid programs $88 to $156 per child annually, while the CDC reports community water fluoridation saves $6.5 billion yearly in dental costs and reduces cavities by 25%.
Still, PAN Foundation’s Chief Mission Officer Amy Niles cautions, “The U.S. often underestimates the value of prevention for long-term health.”
Dr. Fournier takes some solace in the fact her testimony helped stop the Louisiana fluoride bill, but remains frustrated by systemic barriers to preventive oral health care. “Our goal aligns with Robert Kennedy’s vision of a healthier America,” she said. “But it feels like we are not ready to wage the war against the nation’s number one chronic childhood disease — tooth decay.”
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