Dental Disparities: How Income and Race Affect Access to Care

Dental health in America is not distributed equally. Where you live, how much you earn, and your racial or ethnic background all significantly affect your access to dental care and your oral health outcomes. These disparities are not minor variations. They are stark gaps that translate into real differences in tooth decay, tooth loss, gum disease, and quality of life.

According to NIH data, poverty nearly triples the rate of untreated tooth decay: 34 percent among adults living in poverty compared to 11 percent among higher-income adults. Periodontitis, the severe form of gum disease, affects about 60 percent of low-income adults compared to 30 percent of higher-income adults. Among older adults, 54 percent of those aged 75 and older living in poverty have fewer than 21 natural teeth, according to NIH statistics. The CDC estimates that 34 million school hours are lost each year to dental disease, disproportionately affecting children from low-income families.

Income-Based Disparities in Dental Health

Income is one of the most powerful predictors of dental health in the United States. Low-income adults are less likely to have dental insurance, less likely to visit a dentist, and more likely to have untreated dental problems. The relationship between income and dental health operates through multiple pathways.

Cost is the most direct barrier. Without dental insurance, even basic preventive care is a significant expense for low-income individuals and families. A routine cleaning costs $100 to $200. A filling can cost $150 to $300. A root canal can run $700 to $1,500. For a family living paycheck to paycheck, these costs are often simply out of reach. The result is that dental care gets deferred until problems become emergencies.

When low-income individuals do seek emergency dental care, they often end up in hospital emergency rooms. ERs can prescribe antibiotics and pain medication, but they generally cannot perform dental procedures like extractions or fillings. This means the underlying problem persists while the visit generates a hospital bill that adds to the patient's financial burden.

The effects of income on dental health begin in childhood and accumulate over a lifetime. Children from low-income families have nearly twice the rate of untreated cavities as children from higher-income families. These early disparities set the stage for more serious dental problems in adulthood, creating a cycle that is difficult to break.

Racial and Ethnic Disparities

Racial and ethnic disparities in dental health are pervasive and well-documented. Non-Hispanic Black adults, Hispanic adults, and American Indian and Alaska Native populations all experience higher rates of dental disease compared to non-Hispanic White adults.

• Non-Hispanic Black adults: Higher rates of untreated tooth decay and periodontitis. More likely to report not visiting a dentist in the past year due to cost.
• Hispanic adults: Higher rates of untreated decay, particularly among those who are uninsured. Language barriers and immigration-related concerns can further limit access to dental care.
• American Indian and Alaska Native populations: Among the highest rates of dental disease in the country. The Indian Health Service (IHS) provides some dental care, but chronic underfunding limits capacity.

These disparities are not simply a result of individual behavior. They reflect systemic factors including historical segregation, unequal distribution of dental providers, differences in insurance coverage, and the social determinants of health. Communities of color are more likely to be in dental deserts, areas without enough dentists to serve the population, and are more likely to face economic barriers to care.

Geographic Access: Dental Deserts

Geography plays a major role in dental access. Dental deserts, areas where there are not enough dentists to serve the local population, are found across the country but are concentrated in rural communities, low-income urban areas, and tribal lands. The Health Resources and Services Administration (HRSA) designates these as Dental Health Professional Shortage Areas.

In dental deserts, even people who have insurance and can afford care may not be able to find a dentist. Many dentists choose to practice in suburban and higher-income areas where patients can pay out of pocket or have private insurance. Fewer dentists accept Medicaid due to low reimbursement rates, which further limits access for low-income patients in underserved areas.

For people living in dental deserts, getting to a dentist may require traveling long distances, taking time off work, and arranging transportation. These logistical barriers compound the financial barriers, making dental care practically inaccessible for many families.

The Medicaid Dental Coverage Patchwork

Medicaid is the primary safety net for low-income Americans, but its dental coverage for adults is wildly inconsistent. Federal law requires Medicaid to cover dental services for children under 21 through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. For adults, however, dental coverage is optional, and states make their own decisions about what, if anything, to cover.

Only 11 states plus the District of Columbia currently offer extensive adult dental benefits through Medicaid, including coverage for preventive, basic, and major dental services. Some states offer limited benefits, covering only emergency extractions or pain relief. Others offer no adult dental coverage at all. This means that a low-income adult in one state may have access to comprehensive dental care through Medicaid, while a similar individual in a neighboring state has no dental coverage whatsoever.

Even in states that do offer Medicaid dental benefits, low reimbursement rates discourage many dentists from participating. A dentist may receive 50 to 70 percent less from Medicaid than from a private insurer for the same procedure. This economic reality means that Medicaid patients often face long wait times and limited choices when seeking dental care.

Community Health Centers and Other Resources

Federally qualified health centers (FQHCs) are one of the most important resources for underserved communities. These centers provide dental services on a sliding fee scale based on the patient's ability to pay. They serve patients regardless of insurance status and are located throughout the country, often in the communities that need them most.

There are more than 1,400 community health center organizations operating in over 15,000 service delivery sites nationwide. Many of these centers include dental clinics that provide cleanings, fillings, extractions, and other services. You can find a health center near you at findahealthcenter.hrsa.gov.

Other resources for affordable dental care include dental schools, which offer supervised care at reduced rates, state and local dental programs, charitable organizations that provide free dental clinics, and dental discount plans that offer reduced fees at participating providers. While these resources help, they cannot fully compensate for the systemic gaps in dental coverage and access.

Policy Solutions and the Path Forward

Addressing dental disparities requires action at multiple levels, from policy changes to community investments. Several approaches are being pursued or proposed:

• Expanding Medicaid adult dental coverage: Requiring states to provide comprehensive dental coverage for adult Medicaid recipients would provide a baseline of coverage for low-income adults nationwide.
• Adding dental to Medicare: Legislation like H.R. 2045 would add dental, vision, and hearing coverage to Original Medicare, benefiting millions of seniors who currently lack dental insurance.
• Increasing Medicaid reimbursement rates: Higher reimbursement rates would encourage more dentists to accept Medicaid patients, reducing wait times and expanding access.
• Expanding the dental workforce: Training dental therapists and dental hygienists to provide certain services can expand access in underserved areas. Several states have already authorized these mid-level providers.
• Investing in community health centers: Expanding the capacity of FQHCs to provide dental services, including adding dental clinics to centers that currently lack them, would directly benefit underserved communities.

Dental disparities are a health equity issue. When access to dental care depends on your income, your race, or your zip code, the health care system is failing the people who need it most. Understanding these disparities is the first step toward demanding change. For more on the specific challenges facing older adults, read about the dental care crisis for seniors and the coverage gap created by Medicare's dental exclusion.