Many Americans going without dental care

Marcus Pickett

Millions of Americans aren't getting the dental care they need, according to a report from the Institute of Medicine (IOM). Although oral health is vital to overall physical health (gum disease can lead to heart disease), many are encountering "persistent and systematic barriers" to finding care -- and affording it -- according to the report.

Dental care challenges

Thanks to improvements in medical technology, oral health in the United States has been improving overall. But not for everyone. According to the IOM report, racial minorities, low-income families, seniors receiving Medicare benefits and rural residents are underserved when it comes to dental care. Some of the obstacles they face, according to the report, include:

  • Affordability and coverage: The average annual cost of dental care for people who visited the dentist was more than $600 in 2007, according to the IOM. Dental insurance can alleviate some of that expense -- but even those with coverage end up paying an average of about 30 percent of their dental costs out of pocket.

Despite the out-of-pocket expenses, having dental coverage makes people more likely to see the dentist. In fact, according to the report, those who do not have dental insurance are about two-thirds less likely to have visited a dentist within the past year, compared with those who have private coverage. Unfortunately, about 130 million Americans lack private dental coverage. That includes 22 percent of children between ages 1 and 17, 40 percent of adults between 21 and 64 and 70 percent of seniors age 65 and older.

When families can't afford dental care, they skip it. In 2008, for example, 4.6 million children in the United States did not obtain necessary dental care because their families couldn't afford it, according to the IOM. Government programs help. But according to the Health Resources and Services Administration (HRSA), about 80 percent of the country's practicing dentists do not accept Medicaid, and even fewer devote a substantial part of their practice to serving the poor and other at-risk groups.

  • Shortage of dentists: Even those who can afford dental care may not be able to get it in a timely manner. According to the IOM report, more than 33 million people live in areas that don't have enough dental health professionals.

The problem is expected to grow, according to HRSA, because demand is growing. The U.S. population is aging, meaning many dentists are poised to retire -- without enough to replace them. HRSA estimates that in 2010, the United States had a shortage of about 4,000 dentists, compared with a shortage of about 800 in 1993. Unfortunately, the amount of student loan debt that many dental students rack up makes becoming a dentist a tough sell.

Possible solutions

The solutions to these problems are complicated, but necessary, according to the IOM. Some ways to tackle affordability and accessibility problems could include:

  • Involving primary care physicians. If low-income people are skipping dental care, it may be necessary to reach them through their primary care doctors. Training primary care doctors to better recognize oral health problems could make them more likely to refer their patients to a dentist.
  • Increasing flexibility. Some states require that only dentists (rather than dental hygienists) perform certain procedures. But such regulations can do more harm than good in areas where there aren't enough dentists. Training dental hygienists to perform more procedures (and allowing them to do so) could help expand needed care.
  • Breaking down barriers. Children from low-income families often are at the mercy of their parents when it comes to dental care. If their parents can't afford it don't value it, children will go without it. While Medicaid dental coverage for children is mandatory in all states, it's not mandatory for adults. Therefore, the IOM recommends expanding dental coverage to adults, in hopes that they will make it a regular part of their own care -- and their children's care.