How Gaps in Pediatric Dental Care Fuel Cycles of Poverty and What We Can Do About It

At the age of 16, my family fell apart, and my siblings and I ended up in foster care. Before my foster family eventually offered to take me in, my biological family simply didn't have the necessary infrastructure to support regular oral health checkups or guidance on how to maintain oral hygiene.

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According to the Centers for Disease Control, 17% of low-income children between the ages of two and five have untreated cavities in the U.S., and this number jumps to 23% when they become adolescents. In addition to the long-term health effects of not being proactive about dental care, having "bad teeth" can be shameful for kids and teenagers and can be a barrier to employment as an adult.

That being said, navigating oral health can be difficult without the right resources. At the age of 16, my family fell apart, and my siblings and I ended up in foster care. By 17, I was a high school dropout. When families experience hardship and trauma, everything other than the essentials falls by the wayside. Before my foster family eventually offered to take me in, my biological family simply didn't have the necessary infrastructure to support regular oral health checkups or guidance on how to maintain oral hygiene.

Although our specific circumstances were in some ways unique, it's sadly not uncommon for children to face life-altering experiences that cause substantial financial impact or make it difficult to perform everyday tasks. Death, divorce, natural disasters and more can all uproot our lives suddenly, forcing us to contend with new and difficult circumstances. In the U.S., nearly 11 million children are living in poverty and hundreds of thousands of kids are navigating our imperfect foster care system.

Experiencing adverse childhood events impacts us into adulthood, and this is true for our teeth as well. Patients who lacked pediatric dental care early in life typically incur high costs or copious amounts of debt later due to life-impacting, progressive oral health issues such as gingivitis and periodontitis. I've had to spend a significant amount of money on costly dental appointments to correct and address oral health issues that arose as a result of delayed care earlier in my life. Due to how expensive dental care can be — for example, the average cost of a crown is over $1,000 — it's not uncommon for adults to be forced into debt when trying to regain control over their oral health. This healthcare debt can exacerbate existing financial issues and make it difficult to achieve financial stability.

Despite widespread misconceptions, dental care shouldn't be viewed as a luxury available only to those who can afford it. Untreated dental issues can lead to serious medical complications. For instance, ongoing untreated gingivitis can result in tooth loss, and a lack of proper oral healthcare can affect our overall health — from cardiovascular disease to pneumonia. One 2018 study published in the European Journal of Preventive Cardiology that looked at nearly 1 million individuals' health data found a correlation between tooth loss and coronary heart disease in both men and women. The longer we put off oral healthcare, the more serious and costly our overall health problems can become.

As with many other areas of healthcare, there are numerous barriers that make it difficult for patients to take a preventative approach to oral health. A primary issue, which affected me as a child, is money. According to a June 2022 report from the Kaiser Family Foundation, four in 10 adults currently have debt due to medical or dental bills. The KFF study found that dental care was the fourth leading cause of healthcare debt, with between 45% and 52% of U.S. adults saying they owed for dental work. This study quantifies my own lived experience of incurring costs over time due to earlier delayed care.

Fear and embarrassment can also impact patients' decisions to delay care. Poor oral health is deeply stigmatized, and not all dental providers are trained in taking a nonjudgmental approach. Some patients have also had painful or traumatizing prior experiences seeking oral healthcare, which can make them wary of going back. A German study published in the BMC Oral Health in November 2021 found that embarrassment about the state of one's current oral health was a major factor in preventing patients from visiting the dentist. Shame is real, and dental providers with nonjudgmental and trauma-informed practices can do a lot to reinstate trust in patients who may have experienced stigmas or feel afraid.

Poverty is a public health issue, and oral health is no exception. In addition to the costs that can incur from delays in care, people with poor oral health often struggle to be taken seriously for higher-paying job opportunities that might provide better dental insurance. It's crucial that we recognize the impact that ignoring preventive and ongoing dental work is having on people's ability to escape poverty and create lasting financial stability.

The good news is that there are steps the oral health industry can take to help people more regularly access preventative dental care. First, the industry can begin by addressing staffing shortages better, ensuring that people who want to see a dentist are able to do so. Second, we can continue to upgrade dental office technology to make booking appointments faster and less intimidating and allow patients to more easily access and understand their dental records. Finally, we should continue to invest in mobile dental services that can directly serve schools and other pediatric communities, removing barriers to access—especially for kids who may lack a parental figure to manage oral health appointments and ongoing care.

Preventative oral care should be a right, not a luxury. And it's time we started approaching it this way.

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