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5 Reasons for the Oral Health Crisis in America

Although the oral health of Americans has improved greatly over the past 75 years, it is still far from ideal, especially for low-income families. For many, access to oral health care is out of reach, contributing to a vicious cycle of poverty and poorer overall health. Kids from low-income families are twice as likely to suffer from tooth decay and less likely to visit the dentist.

To be more specific, 13% of youth aged 2-19 years have untreated decay–that’s more than 9.6 million kids. Aside from the pain and anxiety that tooth decay can cause, these children are also likely to be malnourished (because it hurts to eat), and get bullied. Children with poor oral health are three times more likely to miss school because of dental pain, leading to 51 million hours of missed school each year. 

How does this happen in the wealthiest country in the world? The overarching reason seems to be a disregard for the importance of oral health, both as individuals and as a society.

  1. Oral Health is not a priority for many families. According to recent data, only slightly more than 52% of adults visit the dentist as recommended, and more than 1 in 5 reported they hadn’t been to the dentist in years. Parents say they’re doing better for their children than they do for themselves, reporting that nearly 65% of children had been to the dentist every six months, while more than 10% had not seen a dentist in more than a year. (However, Medicaid statistics tell a much different story, below.) Why don’t more parents take their child to the dentist at least once a year?

  2. Ignorance about the importance of oral health. We all have limited time and resources, but for many parents that means rationalizing skipping a trip to the dentist‒even for an urgent need‒rather than taking time off work or finding a way to pay for it. Many believe decay in a primary (baby) tooth is no big deal, or procrastinate because of how much they fear treatment will cost. (Read more here about why these are bad reasons to skip dental care.) Some caregivers believe that if the decay isn’t causing pain it doesn’t need to be treated. However, decay is an infection that can spread to other teeth, gums, and in severe cases even the brain, which can be deadly. It also can cause embarrassment or prevent the child from smiling or talking to others. This impacts the child’s ability to be social, make friends, and participate at school.

    Not only that, but not making oral health a priority can have consequences that last far beyond a toothache. Taking a child to the dentist for regular care instills healthy habits that will carry over into adulthood, which could be essential to their future success. In a recent survey, 20-28% of adults age 18-49 said the appearance of their mouth and teeth affected their ability to interview for a job. Furthermore, CNBC reported that most employers “make instant judgements based on appearance, including someone’s smile and teeth.”

  3. Low number of providers. In many areas there simply aren’t enough dentists to meet the needs of the community. These regions are classified as Dental Care Health Professional Shortage Areas (HPSAs). According to recent data, of the nearly 58 million people who live in these areas, on average only 29% are having their dental care needs met.

    HPSAs can exist in both rural and urban areas. One of our Dental Resource Program (DRP) member clinics, Healthy Smiles for Kids of Orange County, reported that “Orange County and California have some of the lowest Denti-Cal reimbursement rates in the country. Because of this, few dentists are able to afford serving a large number of Denti-Cal patients, making it difficult for children and families to find affordable and available dentists and dental homes. Data from Orange County shows that there is currently only one pediatric dentist per 4,900 Denti-Cal eligible children under the age of six accepting Denti-Cal patients, which creates significant barriers for parents searching for a qualifying dentist.”

    Which leads us to...

  4. Oral Health is not a priority for our government. Although the rate of children on public assistance who visit the dentist has improved in recent years, nationwide, only about half of the 39 million children on Medicaid or CHIP received dental care (compared to 67% of children with private dental insurance). This number varies drastically by state, largely due to the number of dentists who will accept the often low reimbursement rates offered by government programs. In many states, dentists simply can’t afford to keep their doors open if they accept patients on assistance.

    Nonprofit safety net clinics that accept government programs, like our DRP member clinics, must depend on monetary and product donations, and volunteers in order to meet the needs of the patients they serve. Wendy Dore from the University of Washington told us, “Funding is the most critical need to allow us to provide care to families in need. As the state's 'safety net' provider for children from the entire state‒ especially for children with special needs–this is a critical need.”

  5. Oral hygiene products are not on the list of SNAP approved items. For many low-income families that depend on food stamp programs, a trip to the grocery store means they must choose between buying food or buying toothbrushes and toothpaste. We consistently hear stories from our member clinics about children who are excited to receive a toothbrush at outreach and educational events. They often share one with their entire family or have no oral care products in their home at all.

As dire as this sounds, there are actions we can take to resolve these issues. Here are ways you can get involved to help improve the oral health of our nation:

  1. Change starts with you. Recognize the harmful habits you have that affect your oral health and change them. (Here are some helpful quizzes from the American Dental Association to help you.) Then, dispel myths that your family and friends believe that may have a negative impact on their oral health.

  2. Advocate for positive policy changes. Whether you’re a dental professional or simply a concerned citizen, connect with one of these organizations to help advocate for positive changes that actually do good, not just feel good:
    ADA (American Dental Association)
    AAPD (American Academy of Pediatric Dentists)
    CDHP (Children’s Dental Health Project)
    Families USA, The Voice for Health Care Consumers
    NNOHA (National Network for Oral Health Access)

  3. Help low-income families access basic oral hygiene products. We can provide everything you need to hold a Smile Drive! Just like a food drive collects pantry items for families in need, by joining our Smile Drive campaign, you can collect oral care items including toothbrushes, toothpaste, floss, and rinse to be distributed to families that can’t afford to buy them. Learn more here.

  4. Educate families about proper oral health. If you have the capacity to reach at least 250 children each year, apply for oral health education resources from America’s ToothFairy.

  5. Donate books about oral health to your local library or Title 1 school. Here’s a great list to get started.

  6. Sponsor Smile Guardian education kits for your community. If you are unable to teach kids yourself, consider sponsoring kits for those who can. Click here to learn more.

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Find out the state of oral health where you live here.

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