The Institute of Medicine's publication, Advancing Oral Health in America, states that while access to oral health care has modestly improved over time, many people still do not get the services they need. In 2007, only 5.5% of the population reported being unable to obtain, or had delays in receiving, needed dental care, but this was higher than the numbers that reported being unable to obtain, or had delays in receiving, needed medical care or prescription drugs. Accessing care is particularly difficult for certain populations, including people who live below the federal poverty line, African Americans, Hispanics, children insured by Medicaid and CHIP, residents of rural areas, people with disabilities, and migrant and seasonal farmworkers.
Furthermore, children, adults, and elders living in rural areas face special challenges when it comes to accessing quality oral care. Geographic isolation, lack of transportation, lack of fluoridated water, poverty stricken areas, low Medicaid reimbursement, and the fact that most rural dentists are older and therefore retiring, are all a factor.
From the surgeon general’s report, Oral Health in America, research has shown chronic oral infections can lead to heart and lung diseases, diabetes and stroke, premature births and low birth weights. Tooth decay and associated pain affect daily activities for four to five million children and adults a year.
Oral health is important to everyone’s general health and well-being as well as quality of life. Dental care involves educating people; raising awareness of oral health and oral health issues; involving local governments, day care providers, and corporate and community sponsors in the fight against tooth decay; finding solutions to access problems for older Americans; providing dental care to children; and developing, implementing, and facilitating educational and service programs designed to increase the visibility and public understanding of oral health.
For more information on oral health programs in your area, contact your state dental association to see what oral health programs are in your area.
There are more organizations related to Dental Health in the organizations section.
Frequently Asked Questions
- How do I start a dental service in my local community?
- What is the advanced dental hygiene practitioner program?
- What is the Children’s Health Insurance Program (CHIP): Dental Care for Kids?
- Does Medicaid cover oral health services?
- Where is there information on low-cost or free insurance for children that includes dental care?
- Are there any loan repayment programs for dental clinicians?
- Are there training programs for addressing American Indian and Alaska Native oral health/dental needs?
- What kinds of successful oral health programs do other states have?
- Are there any mobile oral health/dental programs?
- What oral health disparities are present in rural America?
- What proportion of rural community water supplies are fluoridated, and where can I find additional information about community water fluoridation?
How do I start a dental service in my local community?
There are several possibilities for funding to help get a clinic stocked, staffed and running.
One tool is the Safety Net Dental Clinic Manual. This guide discusses aspects such as start-up costs, picking a location, construction, square footage, rules and regulations, mobile dental unit, and required staffing.
What is the advanced dental hygiene practitioner program?
For the past few years, there has been a move by the American Dental Hygienists Association (ADHA) to pursue the concept of an Advanced Dental Hygiene Practitioner (ADHP). This would be a baccalaureate degreed dental hygienist who then completes an advanced educational curriculum, resulting in a Masters level dental hygienist who would be the dental equivalent to the Nurse Practitioner. This would prepare her/him to provide diagnostic, preventive, restorative and therapeutic services.
For further information, see:
What is the Children’s Health Insurance Program (CHIP): Dental Care for Kids?
The Balanced Budget Act of 1997 (P.L. 105-33) added a new Title XXI to the Social Security Act, creating the State Children's Health Insurance Program (SCHIP). The program was designed to help states cover more uninsured children with new federal money that must be matched with state dollars. This program is now known as the Children's Health Insurance Program (CHIP), reauthorized by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA or Public Law 111-3). It will preserve coverage for the millions of children who rely on CHIP today and provides the resources for states to reach millions of additional uninsured children.
The National Conference of State Legislatures has additional information on CHIP and Oral Health.
Does Medicaid cover oral health services?
Actual benefits vary by state.
The Kaiser Commission on Medicaid and the Uninsured has searchable state-by-state information on Medicaid dental benefits.
All children enrolled in Medicaid are entitled to comprehensive dental services. Medicaid's "Early and Periodic Screening, Diagnosis and Treatment (EPSDT)" program, the nation's primary source of well-child care for low-income youth through age 20, must provide dental examinations for all children. Despite the efforts of EPSDT programs across the country, many eligible children lack access to comprehensive dental care. Also see this information on dental care for Medicaid and CHIP.
Where is there information on low-cost or free insurance for children that includes dental care?
Insure Kids Now is a program through the U.S. Department of Health & Human Services. This is a national campaign to link uninsured children to free and low-cost health insurance, with some states providing dental care. Kids that do not currently have health insurance are likely to be eligible, even if you are working. The states have different eligibility rules, but in most states, uninsured children 18 years old and younger, whose families earn up to $34,100 a year (for a family of four) are eligible. See what Insure Kids Now offers in your state.
Are there any loan repayment programs for dental clinicians?
Yes. General practice dentists and registered clinical dental hygienists may qualify for the National Health Service Corps Scholarship & Loan Repayment Program.
The Indian Health Service also has a loan repayment program for those who qualify.
Are there training programs for addressing American Indian and Alaska Native oral health/dental needs?
Yes. The U.S. Department of Health & Human Services Indian Health Service has an Indian Health Dental Recruitment Program. This agency is responsible for addressing the health needs of over 1.6 million American Indians and Alaska Natives in over 230 hospitals and clinics in 35 states. Over 1800 dentists, hygienists, and dental assistants work in these programs to help prevent dental disease.
The Alaska Native Tribal Health Consortium (ANTHC) Community Health Aide (CHA) Program has a component called the Dental Health Aide Program, which is designed to address the oral health needs of Alaska Natives in rural settings.
What kinds of successful oral health programs do other states have?
There are numerous successful oral health programs throughout the United States. The Association of State and Territorial Dental Directors provides a list of state oral health programs. The CDC also has a listing of all oral health plans by state.
In addition, here are some specific, successful programs:
- Give Kids a Smile Day, Sponsored by the American Dental Association, is a nationwide, yearly event.
- Community-Based Oral Disease Prevention Project: Rural Native American Population works to reduce the incidence and prevalence of early childhood caries in the rural Native American population.
- America's Dentists Care Foundation Missions of Mercy (ADCF MOM) are gatherings of volunteer dental professionals and several hundred volunteer staff who hold free, two day dental clinics at locations around the country.
Colorado and New Jersey
BRIDGE (Campaign of Concern/Outreach Education) - A program in Colorado and New Jersey. People with developmental disabilities often cannot care for their oral health and have difficulties getting treatment. BRIDGE staff provides in-service training to nurses, teachers, case managers, residential staff, and parents of adult DD children to help improve oral hygiene and to follow up with routine dental care.
Kids in Need of Dentistry (KIND) - a non-profit children’s charity dedicated to providing low and no-cost dental care to children from low-income families throughout Colorado.
Connecticut Oral Health Initiative works through advocacy, coalition building, and education strives to create a public conscience that results in access to oral health care for all.
- Iowa I-Smile works to provide every recipient of medical assistance, who is a child twelve years of age or younger with a designated dental home, dental screenings and preventive care.
- Delta Dental of Iowa is a not-for-profit organization that focuses on providing better oral health for employees and their dependents for an affordable price, along with long-term cost savings through preventive and educational services.
- Kansas Mission of Mercy is a program held twice a year throughout Kansas which provides free dental care to patients who are seen on a first-come, first-served basis.
- Kansas Donated Dental Services provides free, comprehensive care for people who are permanently disabled, medically compromised or elderly and who are unable to afford dental care.
- Oral Health Kansas is a statewide oral health coalition dedicated to helping Kansas become a national leader in oral health education, prevention and treatment. The coalition's main areas of focus are advocacy, public awareness and education.
- Cavity Free Kids (CFK) is a program that provides a one-hour online educational program for pediatric providers on fluoride varnish application along with a free tool kit featuring 50 free fluoride varnish applications for children ages 0-3.
Varnish! Michigan A Fluoride Varnish Program offers fluoride varnishing services to Early Head Start and Head Start children throughout the state, servicing over 15,000 children.
St. Joseph's Community Dental Clinic is a Minnesota hospital-based clinic which works to reduce dental disease.
- Missouri Coalition for Oral Health is a statewide oral health coalition focusing on advocacy, coalition building, education and policy development.
- Oral Health Network of Missouri is a statewide oral health provider network which provides oral care to medically underserved, uninsured and insured populations at over 24 delivery sites within Missouri's rural and urban communities.
- Miles for Healthy Smiles program and Pilot Oral Health Collaborative are led by Community Health Centers to provide oral health services to those without access and stress the importance of prevention of caries and early interventions.
- Gallatin County Dental Alliance provides oral health screenings in the schools in Gallatin County.
Dental Day Program provides children in parts of Nebraska with free dental care for a day.
Red River Valley Dental Access Project is an oral health coalition committed to improving access to oral health care through advocacy, education, expanding and developing the workforce, assuring services and creating unified strategies to improve access.
Caring for Kids is a rural school-based dental program that provides care to children in South Texas.
- Tooth Tutor Program works to assure that every child has access to preventive, restorative and continuing care in a dental office.
- School-based Fluoride Mouthrinse Program provides free weekly fluoride mouthrinse to children in schools that do not have community water fluoridation.
- Baby Bottle Tooth Decay Initiative identifies children who are at risk and to assure that those children have access to early preventive care.
Regional Initiatives in Dental Education program, or RIDE is a strategic expansion of the University of Washington School of Dentistry in conjunction with Eastern Washington University, designed to help meet the oral health needs of rural and underserved communities in the Northwest.
- Wisconsin Seal-A-Smile Program works with Children's Health Alliance of Wisconsin to administer mini-grants for school-linked and school-based dental sealant programs.
- Donated Dental Services is directed at those people who are unable to afford needed dental care because of a limited income which is clearly linked to a permanent disability, chronic illness or advanced age (65 or over).
Are there any mobile oral health/dental programs?
Yes, several states have mobile units, such as:
- Ronald McDonald Care Mobile Program Forms relationships with local healthcare providers to bring cost effective, high-quality medical, dental and health education services directly to underserved children in both rural and urban areas around the world. There are many of these care mobiles throughout rural areas in the United States.
Travels throughout the United States to deliver quality comprehensive charitable dental care to children in need in the communities that host a PGA TOUR and Champions Tour tournament.
- Tooth Mobile Dental Care Program provides affordable and accessible mobile dental care.
- Denti-Cal Outreach Program provides a mobile trailer that travels to a different rural northern California county each month to provide dental treatment to children.
- Clinica Sierra Vista's Mobile Health Services which delivers dental services to homeless adults, as well as to children in schools.
Colorado, New Jersey and Illinois
Dental HouseCalls, enables people who cannot easily travel to dental offices because of disabilities or old age to receive comprehensive dental care. Portable dental equipment is taken into nursing homes, community mental health centers, special education centers, residences of the homebound, and facilities serving people with developmental disabilities.
Miles for Smiles Mobile Dental Clinic, sponsored by Kids in Need of Dentistry (KIND), provides comprehensive, quality dental care, including emergency care when necessary, to children in rural communities throughout Colorado.
Across the Smiles provides access to preventive and restorative dental care to many elementary and middle school children in the rural towns of Windham county in NE Connecticut.
Preventative Dental Hygiene programs are available to provide mobile oral health services.
SEAL! Michigan Dental Sealant Program is a school-based sealant program targeting second and sixth grade children. All services are provided within qualifying schools using portable dental equipment. See other mobile oral health services in Michigan through Smiles On Wheels.
Apple Tree Dental Mobile Services provides on-site services in nursing homes, group homes, Head Start centers, schools, and assisted living facilities in Minnesota.
- Elks Club provides funding for mobile dental clinic provides basic dental care for children with special health care needs and other special populations in Missouri.
- Miles for Smiles program travels to 12 counties in the Southwest Missouri area treating dental needs.
Nevada's Saint Mary's Foundation also utilizes the Ronald McDonald Care Mobile program for WIC nutrition services that includes dental care.
Southern Jersey offers the Mobile Medic offers mobile medicine, including dental care and emergency dental care, to residents of Burlington, Atlantic, and Salem counties.
- University of Rochester Eastman Dental Center's Collaborative School-Based Dental Program provides access to dental care via mobile dental services or by establishing onsite dental clinics linked with a school health clinic.
- University at Buffalo School of Dental Medicine has a mobile dental van that tends to rural Chautauqua County children.
- Access Dental Care provides dental care for older adults in long-term care settings and those with developmental disabilities in North Carolina.
- Carolinas Mobile Dentistry is a fully mobile dental office staffed by a geriatric dentist, dental hygienist, and dental assistants providing oral hygiene and dental care to nursing facilities, assisted living and retirement communities in Mecklenburg, Cabarrus, Union and Gaston Counties in North Carolina.
PennSmiles Program: Promoting Oral Health travels to area schools, Head Start programs, and other neighborhood sites in West Philadelphia.
Ronald McDonald Care Mobile travels around the state, bringing dental care to thousands of South Dakota children.
Magnolia Mobile Dental Services provides dental care to nursing home patients.
Yakima Valley Farm Workers Clinic offers a orchards, opening its doors to anyone who needs medical or dental care.
What oral health disparities are present in rural America?
Rural areas face a number of unique challenges that limit access to dental services for many residents. These include geographic and transportation barriers, fewer fluoridated community water supplies, and a lower rate of dental insurance.
Access to dental health care professionals is also a prominent barrier to dental care in rural communities relative to the rest of the country. Contributing factors to the shortage include limited slots in dental schools, an unwillingness of providers to work in rural areas, a large number of dentists retiring, and the growing trend of specialization in dental care. Many dentists do not accept Medicaid, due in part to low reimbursement rates, attributing to accessibility issues for low-income families. (Kaiser)
In 2004, U.S. health spending was about $963.9 billion, with dental care accounting for 7.5 percent. Although 47 million Americans lack health insurance, 108 million lack dental insurance.
For additional information on rural oral health disparities, including statistics and data, consult the following research articles:
- Brock-Martin A., "Analysis of State Dental Hygiene Practice Acts and Medicaid Policies for Children’s Dental Care: Services Covered and Practitioners Reimbursed South Carolina Rural Health Research Center. Research Project, August 2008 anticipated completion date.
- Fisher-Owens S., Barker J., Adams S., Chung L., Gansky S., Hyde S., Weintraub J., "Giving Policy Some Teeth: Routes To Reducing Disparities in Oral Health." Health Affairs. 2008; 27(2):404-412.
- Ramos-Gomez F., Cruz G., Watson M., Canto M., Boneta A., "Latino Oral Health: A Research Agenda Toward Eliminating Oral Health Disparities." Journal of American Dental Association (JADA). 2005; 136:1231-1240.
Older, but significant research articles on rural oral health disparities:
- Vargas C., Dye B., Hayes K., "Oral Health Care Utilization by US Rural Residents, National Health Interview Survey 1999." Journal of Public Health Dentistry. Summer 2003; 63(3):150-157.
- Vargas C., Dye B., Hayes K. "Oral Health Status of Rural Adults in the United States." JADA. December 2002; 133:1672-81.
- Vargas C., Ronzio C., Hayes K. "Oral Health Status of Children and Adolescents by Rural Residence, United States." The Journal of Rural Health. Summer 2003; 19(3):260-268.
- Vargas C., Yellowitz J., Hayes K. "Oral Health Status of Older Rural Adults in the United States." JADA. April 2003; 134:479-486.
What proportion of rural community water supplies are fluoridated, and where can I find additional information about community water fluoridation?
Community water fluoridation is consistently found to be one of the most effective means of preventing tooth decay. According to the Journal of Public Health Dentistry, every $1 spent on fluoridation saves $38 in treatment costs. Unfortunately, exact data on rural community water fluoridation are not available. However, it is proportionally much more expensive to fluoridate small community water supplies than large ones. The CDC reports that it is six times more costly per person to fluoridate water supplies with less than 5,000 people than those with greater than 20,000. In addition, most of the 12.6 percent of U.S. residents using private wells are located in rural areas. These wells are typically unfluoridated.
The Centers for Disease Control has information about water fluoridation, including maps, safety guidelines, and state statistics. The CDC also provides information on the fluoridation status of your community water supply.