Dental Health Frequently Asked Questions
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
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
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
The Children’s Health Insurance Program (CHIP) may
provide a dental benefit to low-income children as well.
Explore programs in your
state. Review information about this optional
dental care benefit.
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
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?
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
Further information on loan repayment programs are
available in the topic guide titled Health
Education Financial Aid, specifically in the
frequently asked questions section on loan
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.
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
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
health plans by state.
In addition, here are some specific, successful programs:
Colorado and New Jersey
(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
Health Initiative works through advocacy, coalition
building, and education strives to create a public
conscience that results in access to oral health care
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.
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.
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,
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.
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
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
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
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
Program provides children in parts of Nebraska with
free dental care for a day.
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.
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:
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.
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.
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
Preventative Dental Hygiene programs are available
to provide mobile oral health services.
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
Apple Tree Dental Mobile Services provides on-site
services in nursing homes, group homes, Head Start
centers, schools, and assisted living facilities in
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
Dental Care provides dental care for older
adults in long-term care settings and those with
developmental disabilities in North Carolina.
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
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
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
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
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
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
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
- 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
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.