The Health Divide: Dental care was already woefully inadequate in many communities. Now it’s getting worse.
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July 21, 2025
Dr. Eleanor Fleming was nine months into conducting a five-year federally funded study of unconscious bias in dentistry when the government cancelled her grant in April as part of the Trump administration’s sweeping cuts to health and science research. Like many researchers who abruptly lost funding in recent months, Fleming was soon notified her university job would be terminated.
But this is about more than one researcher, a Black expert in dental public health who was honored as an American Dental Association rising star just four years ago and is now losing her job as assistant dean of diversity, equity and inclusion and as clinical associate professor at the University of Maryland School of Dentistry.
This is a story about the hollowing out of the already inadequate system of dental care for marginalized communities, a longstanding issue that warrants more media attention than it gets.
“It boggles my mind that you will have so many great stories about health problems and health equity questions,” Fleming said. “Opioid abuse and substance use disorder, folks looking at the built environment, people talking about the mortality and morbidity faced by Black women and women of color and their infants. The list goes on and on and on and on, and rarely does oral health make it on the radar.”
Bad teeth, of course, don’t cause waves of death, as overdoses do. And since the nation’s first dental school was established in 1840, dentistry has been separate from medicine — different training paths, insurance providers, places to get care. It can be easy to overlook how powerfully teeth affect overall health.
“Somehow we operate as though the mouth is separate from the body,” Fleming told me.
That struck home. In my seven years as a health and medical reporter at daily newspapers, I recall writing only one dental-related story. It was about several patients who died in a local dentist’s office because nitrous oxide was poorly administered.
But there may be no more instantly visible mark of health care inequities and economic inequality than the condition of our teeth — the difference between the straight, gleaming white smiles of the affluent and the mottled and missing teeth all too prevalent in low-income communities of color and rural communities. In a survey from the American Dental Association, more than a quarter of low-income people said the appearance of their teeth hampers their ability to interview a job.
Untreated cavities are nearly three times more common in low-income children ages 2 through 5 than in higher-income kids, and the disparity persists in all age groups. Black adults have severe gum disease at 2.5 times the rate of white adults. Rates are disproportionately high in Hispanic and Native American communities, too. Without treatment, gum disease can cause tooth loss. That’s one reason why more than one in four Black Americans over age 65 suffer complete tooth loss, more than double the rate of their white peers.
Federal policy upheavals and massive budget cuts will make dental health worse.
In April, the administration eliminated the Centers for Disease Control and Prevention (CDC) Division of Oral Health, which provided guidance on critical public health issues such as infection control in dental offices.
Dental clinics around the country are already shutting down in the face of funding cuts and Medicaid budget shortfalls, according to Becker’s Dental & DSO Review, a trade publication. They include a Michigan nonprofit dental practice with six offices in underserved communities. The county-run emergency dental clinic in Santa Ana, California. The pediatric dental services at a community clinic in Maine.
In June, a judge ordered the government to restore hundreds of research grants, Fleming’s among them, saying they were rooted in discrimination. But for the most part, the policy changes and the pain they cause won’t be remedied anytime soon.
Here are three ways the government is dismantling dental care for the people who need it most.
1. Medicaid cuts
States are not required to cover dental care for adults on Medicaid, not even pregnant women. It’s no surprise, then, that dental benefits are often the first to go when state budgets shrink. Forty-one states now offer varying degrees of dental coverage through Medicaid. As they scramble to make up for historic losses in federal funding, expect states to limit coverage to emergencies or drop it altogether.
The ADA Health Policy Institute has published a state-by-state analysis of the impact of eliminating Medicaid dental benefits. History shows it’s not good. When the Illinois Medicaid program dropped all but emergency dental coverage, surgical interventions increased by 100%, and hospital admissions increased 128%.
States are required to provide dental benefits to children covered by Medicaid and the Children's Health Insurance Program. But in a budget crunch, states may reduce payments to providers, which are already so low most dentists don’t treat these children.
2. Barriers to dentist training
Nearly 25 million people in the U.S. live in dental care shortage areas, defined as one dentist per 5,000 people. The problem is especially acute in low-income rural areas, where it affects more white residents, and in predominantly Black and Hispanic urban neighborhoods. A Harvard epidemiologist has mapped the problem nationwide down to the level of groups of blocks.
Black and Hispanic dentists are more likely to practice in underserved communities. But fewer than 4% of dentists are Black, a figure that hasn’t budged in years. The share of Hispanic dentists increased from 2005 to 2020, but at nearly 6% they too are underrepresented.
The Trump administration’s recently passed megabill puts dental training even further out of reach for students of color, who are often the first in their families to go to college. The bill lowers how much students can take out in federal loans, setting a $50,000 a year limit for dental (and medical) school. That would cover in-state tuition at a handful of public dental schools but not out-of-state tuition or tuition at private dental schools, which run as high as $122,000 a year.
3. War on fluoride
In 1999, the CDC hailed fluoridated drinking water as one of the 10 great public health achievements of the 20th century. Now Health Secretary Robert F. Kennedy Jr. says it’s a “neurotoxin” linked to lower IQ, neurodevelopment disorders, and bone cancer and fractures.
At excessive levels, fluoride, a mineral, can cause health problems. An estimated 1.5% of children in the U.S. are exposed to too much fluoride in their water, and that should be addressed. Meanwhile, more than 45% of children get less than the recommended level. Kennedy has said he plans to tell the CDC to stop recommending water fluoridation. Utah and Florida recently banned it, and at least 14 other states have taken up similar legislation.
Kennedy has acknowledged that bans will result in more cavities. Researchers at Harvard and Brigham and Women’s Hospital ran the numbers: Over five years, removing fluoride from water nationwide would result in 25 million more decayed teeth in children. Uninsured children and those on public insurance would bear the brunt since they’re less likely to receive preventive tooth care any other way.
Windsor, Canada, across the border from Detroit, removed fluoride from drinking water in 2013. Five years later, the percentage of children who had tooth decay or needed emergency care had increased by 51%. The city put fluoride back into the water in 2022.