Dental Visit in United States

United States

Oral health is a vital component of overall health. Oral diseases such as tooth decay, dental caries (cavities) and periodontal (gum) disease are common and can cause pain, tooth loss and oral infection if left undiagnosed and untreated. Poor oral health is also associated with chronic conditions such as heart disease and diabetes. One in 4 adults in the United States has untreated cavities and nearly half of adults ages 30 and older show signs of gum disease.

Cost of care is the most common reason reported for not having visited the dentist within the past year, even among adults with private dental insurance. The annual cost of dental care was nearly $136 billion in 2018, representing 3.7% of total U.S. health care spending. Patients’ out-of-pocket costs accounted for approximately 40% of this cost — nearly $55 billion.

Inadequate access to oral health services can result in the overuse of emergency departments as a primary or only source of care. Between 2000 and 2010, the number of individuals who sought care for dental conditions from an emergency department almost doubled.

According to America’s Health Rankings data, populations with a higher prevalence of an annual dental visit include:

• Women compared with men.
• Adults ages 65 and older compared with those ages 18-44.
• Asian and white adults compared with American Indian/Alaska Native Hispanic, multiracial and Black adults.
• College graduates compared with adults with less than a high school education.
• Adults with an annual household income of $75,000 or more compared with those with incomes less than $25,000.
• Adults without a disability compared with those with either a self-care or independent living difficulty.
• Adults living in metropolitan areas compared with non-metropolitan areas.
• Adults who identify as straight compared with LGBQ+ adults.

Moreover, uninsured or underinsured adults are less likely to receive necessary dental care than those with insurance.

Some states have allowed mid-level dental professionals, such as dental therapists, to provide routine preventive and restorative treatment typically only performed by dentists. Such expansions of the dental workforce have increased access to cost-effective essential services, particularly for underserved populations.

Other strategies to meet the dental needs of underserved groups include:

• Integrating oral health care as an essential part of overall health care.
• Increasing access to oral health care and expanding dental health care capacity.
• Decreasing financial barriers to dental care.
• Supporting dental students of diverse backgrounds, including minority, low-income and rural students.
• Increasing Medicaid reimbursement rates to dental care providers.
• Training dental care providers in cultural sensitivity and providing interpretation services to remove cultural and language barriers. 

School-based cavity prevention programs effectively increase children's dental care access. These programs offer multicomponent cavity prevention provided by dental hygienists at schools.

Healthy People 2030 has several oral health goals, including increasing the proportion of children, adolescents and adults who have used the oral health care system in the past year.

Institute of Medicine, Committee on Oral Health Access to Services, and National Research Council, eds. Improving Access to Oral Health Care for Vulnerable and Underserved Populations. Washington, D.C.: National Academies Press, 2011. https://doi.org/10.17226/13116.

Kim, Pearl C., Wenlian Zhou, Shawn J. McCoy, Ian K. McDonough, Betty Burston, Marcia Ditmyer, and Jay J. Shen. “Factors Associated with Preventable Emergency Department Visits for Nontraumatic Dental Conditions in the U.S.” International Journal of Environmental Research and Public Health 16, no. 19 (September 30, 2019): 3671. https://doi.org/10.3390/ijerph16193671.

Koppelman, Jane, Kelly Vitzthum, and Lisa Simon. “Expanding Where Dental Therapists Can Practice Could Increase Americans’ Access To Cost-Efficient Care.” Health Affairs 35, no. 12 (December 1, 2016): 2200–2206. https://doi.org/10.1377/hlthaff.2016.0844.

Malecki, Kristen, Lauren E. Wisk, Matthew Walsh, Christine McWilliams, Shoshannah Eggers, and Melissa Olson. “Oral Health Equity and Unmet Dental Care Needs in a Population-Based Sample: Findings From the Survey of the Health of Wisconsin.” American Journal of Public Health 105, no. S3 (July 2015): S466–74. https://doi.org/10.2105/AJPH.2014.302338.

National Institutes of Health. “Oral Health in America: Advances and Challenges.” Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research, 2021. https://www.nidcr.nih.gov/sites/default/files/2021-12/Oral-Health-in-America-Advances-and-Challenges.pdf.

“Oral Health Care: Can Access to Services Be Improved?” n.d. Health Policy Institute (blog). Accessed November 24, 2022. https://hpi.georgetown.edu/oralhealth/.

Starr, Jacqueline R., Ryan R. Ruff, Joseph Palmisano, J. Max Goodson, Omair M. Bukhari, and Richard Niederman. “Longitudinal Caries Prevalence in a Comprehensive, Multicomponent, School-Based Prevention Program.” The Journal of the American Dental Association 152, no. 3 (March 1, 2021): 224-233.e11. https://doi.org/10.1016/j.adaj.2020.12.005.

Vujicic, Marko, Thomas Buchmueller, and Rachel Klein. “Dental Care Presents The Highest Level Of Financial Barriers, Compared To Other Types Of Health Care Services.” Health Affairs 35, no. 12 (December 2016): 2176–82. https://doi.org/10.1377/hlthaff.2016.0800.