Dental Care: Identifying Social Determinants of Oral Health

Dental care is the most common type of healthcare people experience barriers to being able to afford [2]. Consequently, underserved communities face oral health disparities due to socioeconomic barriers. Such as being uninsured, low-income, and living in rural areas located far from dental services. These social determinants of oral health make up for oral health disparities in different communities. Dental care is often inaccessible to underserved communities. To address these disparities and barriers, we must understand how they affect these populations. We also must identify how Remote Area Medical (RAM) can bridge the gaps of these inequities. Finally, we must implement preventive and emergency dental care in these underserved communities.  

The Centers for Disease Control and Prevention (CDC), in a 2024 review on oral health, defines health disparities as “preventable differences in disease impact or opportunities due to some type of disadvantage” [2]. One disadvantage that can lead to oral health disparities is a lack of adequate dental insurance. In 2024, 27% or 72 million US adults did not have dental insurance [1]. Additionally, 62% of older adults in retirement (65+) did not have dental insurance [2]. This disparity is because traditional Medicaid insurance programs do not cover dental care. This leads to adults losing their dental care benefits once they retire.

How Insurance Impacts Access to Dental Care —

Oral health disparities due to lack of insurance coverage are present in working US adults ages 20-64 as well. Untreated cavities are twice as common in 20-64-year-olds with no health insurance (43%) compared to those with health insurance coverage (18%) [2]. Where someone lives is also a determinant of oral health, considering adequate insurance coverage is lower in rural areas (45%) compared to urban areas (68%) [3].  

Like insurance coverage, income levels are an example of financial barriers to dental care in underserved populations. Untreated cavities are almost three times more common in 2-5-year-olds living in low-income households compared to high-income children [2]. Additionally, 60% of 6-9 aged children in lower-income households have cavities compared to 40% of children from higher-income households [2]. Untreated cavities in adolescents are also more common in low-income families (14%) compared to those in higher-income homes (8%) [2]. Periodontitis (gum disease with bone loss) is also twice as common among 20-64 aged adults with low income (60%) compared to those with higher income (30%) [2].

The lack of dental insurance in 65+ aged adults is also representative of their oral health, considering complete tooth loss is over twice as likely in those with lower incomes (30%) compared to those with higher incomes (12%) [2]. Furthermore, in a recent study by Parmar et al., people in rural areas were found to be more likely to live below the poverty line (55%) compared to those living in urban populations (35%) [3]. 

Dental Care in Rural Areas —

Individuals in rural communities experience more barriers in accessing dental services due to geographic isolation from dental health professionals. “As of 2024, approximately 57 million Americans live in a dental health professional shortage area, and about 67% of those shortage areas are in rural communities” [2]. Being geographically isolated from dental care is a significant barrier when accessing dental services, considering that 40% of people in rural areas and 75% in urban areas live within 5 km of dental services [3].

The proximity to dental services affects the frequency of preventative dental visits, given that 35% of rural and 60% of urban residents attend preventative visits [3]. Rural residents experience more severe financial barriers to preventative dental care since they must travel greater distances and spend more money (gas, bus tickets, etc) to attend these visits. Making preventive dental care inaccessible and difficult to prioritize for people who already live below the poverty line and are uninsured. As a result, 45% of rural and 25% of urban residents have untreated dental caries [3]. At a similar rate, people in rural areas (30%) are twice as likely as urban residents (15%) to have periodontal disease [3]. 

The higher rates of untreated dental caries and periodontal disease in rural communities indicate geographic and financial barriers that limit access to dental care. The oral health of rural residents is permanently compromised because it is more difficult for them to receive preventative dental care. A way to address the discrepancies between underserved rural communities and adequately resourced communities is to implement dental sealant programs. Dental sealants can prevent cavities for years but are often inaccessible to low-income, uninsured, and rural individuals. An effective way to ensure underserved children have access to preventive dental care is to implement school sealant programs [2]. Dental sealant programs and similar preventive measures ensure early detection of oral cancer because “60% of oral cancer cases are detected when they are at advanced stages” [2]. 

The key to breaking down barriers to dental care is to increase access and affordability of dental services in underserved populations. Findings from a 2025 Journal of Pharmacy and Bioallied Sciences study conclude that expanding the accessibility of dental services to underserved communities via mobile clinics, Telehealth clinics, and community outreach programs works to address geographic barriers to dental care [3]. Parmar et al. additionally concluded that addressing financial barriers is done by “increasing funding for public health insurance programs and subsidies for low-income individuals” [3]. Other preventative and instructive solutions to these barriers are distributing “informational materials, such as brochures and leaflets, and organizing oral health awareness programs in educational institutions and community settings” [4].  

RAM is Improving Dental Care Across the U.S. —

RAM seeks to break the cycle underserved communities experience due to a lack of preventive and emergency dental care. Rural underserved residents experience socioeconomic barriers to dental care. Care like dental cleanings and check-ins, this care could prevent them from developing oral health issues in the future. The lack of preventive and corrective care early in life leads to an increased need for emergency care later on. This indicates that these socioeconomic barriers create a vicious cycle leading to oral health disparities amongst communities.

RAM seeks to break this cycle by providing both preventive and emergency dental care in rural communities. This is to address the immediate need for emergency dental care. We also provide preventive care to avoid additional emergency care needed in the future. Because RAM is a 501(c)(3) non-profit organization, we do not receive government funding. We rely solely on private donations, grants, and philanthropic contributions. We must ask for financial donations and support to provide resources to underserved communities. Without you, RAM cannot continue to overcome the barriers underserved communities face to dental care. 

RAM Clinics are primarily volunteer run. To volunteer at a clinic with RAM to help remove the barriers to oral health care, please visit www.ramusa.org/volunteer

Learn how RAM’s removing barriers to healthcare, follow us on social media, read our blog, and download our magazine.

Citations — 

[1] CareQuest Institute for Oral Health, Out of Pocket: A Snapshot of Adults’ Dental and Medical Care Coverage. [Online]. Available: https://www.carequest.org/resource-library/out-pocket-snapshot-adults-dental-and-medical-care-coverage. [Accessed: Jun. 3, 2025].  

[2] Centers for Disease Control and Prevention, Health Disparities in Oral Health. [Online]. Available: https://www.cdc.gov/oral-health/health-equity/index.html. [Accessed: Jun. 3, 2025]. 

[3] D. Parmar, J. L. Sailo, S. Sakhamuri, C. Dalapati, S. D. Dutta, S. Arya, and H. Dixit, “Assessment of oral health disparities and barriers to care among underserved populations in urban and rural settings,” J. Pharm. Bioallied Sci., vol. 17, Suppl 1, pp. S445–S447, May 2025. [Online]. Available: https://doi.org/10.4103/jpbs.jpbs_1449_24.  

[4] P. Vaishampayan, J. S. Beniwal, P. Wilk, S. McLean, and A. Jessani, “Unmet oral health needs and barriers to dental services among socially marginalized youth: A scoping review,” Front. Oral Health, vol. 6, Article 1521753, 2025. [Online]. Available: https://doi.org/10.3389/froh.2025.1521753.