Access to adequate dental care is a vital aspect of overall health and well-being. However, people with lower incomes often face multiple barriers that impede their ability to maintain good oral health.
While the nation’s oral health has improved overall, not all Americans have equal access to these improvements. A CDC report argues that racial/ethnic and socioeconomic groups experience worse oral health outcomes due to social determinants of health.
A key reason why dental care is the most unmet healthcare service is because dental insurance does not provide as attractive benefits as other healthcare services.
Despite the introduction of new and expensive dental technologies, dental insurance benefits for insured adults have failed to adjust in a similar measure; and as many employers opt to shift the cost of insurance to beneficiaries, the gap between the cost of dental care and what insured adults are able to pay has further increased.
Barriers to Oral Care Access
According to the CDC fact sheet, various barriers prevent certain groups from accessing dental care as follows:
Limited Financial Resources
One of the primary reasons for poor dental care among individuals with low incomes is the limited financial resources available to them. Dental treatments, including preventive care, cleanings, fillings, and other necessary procedures, can be costly. Individuals with low incomes may struggle to afford regular dental visits or necessary treatments, leading to delayed or neglected dental care.
Lack of Dental Insurance
Many low-income individuals do not have access to comprehensive dental insurance, or their coverage may be limited, only including basic services. Without proper insurance, the cost of dental procedures can become a significant burden, making it difficult to seek timely and necessary care. In 2015, approximately 29% of people in the United States had no dental insurance, with older adults facing even higher rates of 62%.
Limited Availability of Affordable Dental Providers
In many areas, there is a shortage of dental providers who accept low-income patients or offer affordable care options. This scarcity of accessible dental providers can present a significant challenge for individuals with limited financial resources, as they may struggle to find nearby dentists who can accommodate their needs within their budget.
Transportation and Geographical Barriers
Transportation and geographical barriers further exacerbate the challenges faced by low-income individuals in accessing dental care. Many may live in areas where dental clinics are scarce or located far away. Limited access to reliable transportation can make it difficult to travel to dental appointments, leading to missed or delayed care.
Lack of Oral Health Education
Low-income individuals often face a lack of oral health education, which can result in poor dental care habits. Without proper knowledge about oral hygiene practices, preventive care, and the importance of regular dental visits, individuals may neglect their dental health, leading to more severe dental issues over time.
Inconsistent Dental Coverage Across Social Groups
According to a report published by the Urban Institute’s Health Reform Monitoring Project, one in five adults, who have taken full-year health insurance, claim that they are unable to pay the cost of dental care. Paying for dental care is particularly a big concern for low and moderate-income adults.
According to the report, dental care topped the list of unaffordable services in the survey at 20.1 percent, followed by prescription drugs at 13.3 percent, medical tests for follow-up care at 11 percent, medical care at 10.4 percent, physician care at 10.3 percent, specialist services at 5.6 percent, and contraception at 2.0 percent. Generally, the proportion of adults with any unsatisfied need for care accounted for 28.2 of the sample group.
Even with the provision of healthcare coverage to millions of Americans who were previously uninsured via the Affordable Care Act, the lack of dental care continues to be a big concern as indicated below:
- 9 percent of the adults with unmet needs reported that dental care was the only unmet need, while 42.5 percent reported that dental care was only one of their unmet healthcare needs
- 8 percent of the sample group, most of whom were low-income adults with insurance, reported that their dental care needs were unmet because of affordability.
- The availability of dental coverage for children and adults are very different. This is because states are required to include pediatric oral health benefits in their Medicaid programs in order to receive federal funding, but adult care is optional.
- Owing to the Children’s Health insurance Program, oral health benefits are available for even low-income children, but not adults. Additionally, the Affordable Care Act acknowledges oral health care as an “essential benefit” for children, though not for adults. Plus most Medicare plans don’t account for dental care.
- The challenge of affording dental care was not a concern for only adults in poverty. According the report, 23.8 percent of insured adults with household incomes of between 139 percent and 399 percent of the federal poverty level said that they could not afford dental care.
- 4 percent of insured adults with a household income greater than 400 percent of the federal poverty level said that they could not afford to pay for dental care.
- The proportion of insured adults with unmet dental care needs is higher among those adults whose coverage was not provided by their employers. The survey showed that 34.9 percent of adults were insured with public coverage, compared to 23 percent of adults with private, non-group coverage.
- Untreated oral disease has significant consequences for individuals and society. Over 40% of low-income and non-Hispanic Black adults have untreated tooth decay. This leads to school absences, decreased productivity, and financial losses, with billions of dollars lost annually.
- The appearance of the mouth and teeth can affect an individual’s ability to interview for a job. Nearly 18% of all working-age adults and 29% of those with lower incomes report that their oral health impacts their job prospects.
The correlation between low income and poor dental care is a complex issue influenced by multiple factors. Addressing it requires comprehensive efforts, including improving access to affordable dental care options, expanding dental insurance coverage, increasing the availability of dental providers in underserved areas, and promoting oral health education among low-income communities.
By addressing these barriers, we can work towards ensuring that individuals with low incomes have equal opportunities for maintaining good oral health and overall well-being.