Who Gets to Smile? The Unequal Reality of Dental Care in the U.S

By: Ishan Kapoor

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As someone preparing for a career in dentistry, I have spent a lot of time learning about oral health, not just the science behind it, but also the real-life barriers that keep people from getting the care they need. One thing I have come to understand is that oral health is not just about brushing, flossing, and visiting the dentist twice a year. It is also about access, equity, and making sure that everyone, regardless of where they live or how much money they make, has the chance to maintain a healthy smile. Right now, that is not the case for millions of people in this country.

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The Cost Problem

One of the main reasons people avoid going to the dentist is because it is too expensive. According to the American Dental Association, about one-third of adults in the United States do not have dental insurance. And for many who do, their coverage is limited. Most plans help with basic cleanings but offer little support for more serious care like fillings, root canals, or crowns. The out-of-pocket costs are often too much, especially for people living paycheck to paycheck.

Dental care is also treated as something separate from regular healthcare in the United States. For example, Medicare does not cover most dental services, even though many seniors need them. Medicaid only covers dental care for adults in some states, and even then, the coverage is usually limited to emergency treatment. That means millions of adults are left with no real options unless they can pay the full cost themselves. This lack of affordable coverage helps explain why so many Americans, especially adults and seniors, delay or skip dental visits altogether. As shown in the chart below, cost barriers are most common among low-income adults, with nearly 30% of those under the federal poverty level reporting they couldn’t afford needed care. Seniors in lower income brackets also face high rates of unmet dental needs, highlighting how income and age intersect to deepen the crisis in dental access.

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The Access Problem

Even when people can afford to pay or have some form of insurance, they still may not be able to get the care they need. Many low-income neighborhoods and rural areas do not have enough dentists or clinics. These places are known as Dental Health Professional Shortage Areas. Right now, over sixty-eight million people live in areas where there are not enough dental providers.

This leads to long wait times, limited appointment availability, and the need to travel far for care. Transportation can be a major issue, especially for the elderly, people with disabilities, or those without access to a car. As a result, many people delay treatment until the pain becomes unbearable. By then, the problem is usually much worse and harder to fix.

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Who Is Most Affected?

While dental access is a national issue, it affects some groups more than others. Children from low-income families, older adults, immigrants, and people of color are much more likely to suffer from untreated dental issues. According to the National Institute of Dental and Craniofacial Research, Black and Hispanic children have much higher rates of untreated cavities than white children. These early problems can lead to trouble eating, difficulty speaking, missed school, and even long-term health complications.

Older adults face their own challenges. Many lose dental insurance after retirement, and without coverage, they struggle to afford dentures, gum disease treatment, or other basic services. This can impact their ability to eat properly, speak clearly, and feel confident in public. It can also lead to bigger health issues.

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What We Can Do

There are several steps that could help close the gap in dental access:

• Provide Medicaid dental coverage for adults in every state

• Support more community dental clinics and mobile programs

• Offer loan forgiveness and scholarships to dentists who work in underserved areas

• Bring medical and dental care closer together so providers can share information and support early treatment

• Teach kids and families about oral health early through school programs and outreach

As someone who aspires to be a dentist, I know that my role will not only be to treat patients, but also to understand the barriers that keep people from getting care in the first place. I want to be part of the solution. Everyone deserves the chance to have a healthy smile, no matter their background, income, or zip code.

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Fixing the oral health gap in America will take time, but it starts with awareness. Whether it is pushing for better policies, volunteering at free clinics, or simply talking about the problem, every effort matters. Smiles should not be a privilege. They should be something everyone has the right to protect.