Action for Dental Health

These troubling facts tell the story:

• 181 million people living in the U.S. did not visit the dentist in 2010, according to the ADA’s Health Policy Resources Center analysis of MEPS and U.S. Census data.
• Nearly 50% of all people over age 30 are suffering from some form of gum disease, according to the Centers for Disease Control and Prevention (CDC).
• Nearly one in four children under the age of five already have cavities, according to CDC figures.

For more facts on the dental divide in America, view this ADA infographic (PDF).

The causes of our country’s dental health crisis are varied and complex. But we know that for each of us – and the nation as a whole – it’s never too late to improve our oral health. Action for Dental Health focuses on three main objectives:

1. Providing care now for people suffering from untreated disease
2. Strengthening and expanding the public and private safety net
3. Preventing dental disease through advocacy and education

These objectives are supported by seven potential solutions:

1. Emergency Department referrals. Many people without dental coverage don’t seek treatment until their dental pain grows so severe that it sends them to a hospital emergency room. But most hospitals can’t provide comprehensive care, so the problem often isn’t solved. Dentists around the country are working with hospitals to get these patients out of emergency departments and into the dental chair —the right place for the right treatment.
2. Community Dental Health Coordinators (CDHCs). These professionals address barriers to effective oral health care by working with people who typically do not see the dentist for a variety of reasons — including poverty, geography, language, cultural barriers and a lack of perspective on the importance of regular dental visits. CDHCs typically work in underserved areas such as inner cities, remote rural communities and Native American lands.
3. Fluoridation. Decades of research show that fluoride in public water supplies is effective in reducing dental decay by at least 25 percent in children and adults, even in an era when fluoride is widely available from other sources such as fluoride toothpaste.
4. Medicaid reform. Most state Medicaid dental programs fall short of providing the amount and extent of care — both preventive and restorative—needed by low-income beneficiaries. This is especially true for low-income adults, many of whom have virtually no access to dental care through Medicaid. The ADA advocates for increased dental health protections under Medicaid, especially in states that have yet to agree to Medicaid expansion, and helps more dentists work with community health centers and clinics to provide care for those in need.
5. Federally qualified health centers. These safety-net facilities provide oral health care for underserved populations. When private-practice dentists contract with these centers, they are able to provide care for many people — including children on Medicaid — without increasing the centers’ brick-and-mortar and staffing costs. Patients benefit, because quality care can be quickly and efficiently delivered, alleviating much of the backlog experienced by many health center dental programs.
6. Collaboration with other health professionals and organizations. Coordination among dental and medical professionals can help more people and families understand that dental health is a crucial part of overall health. For example, the dental health of a parent can affect the health of babies and children. With minimal training, physicians, nurses, and others can dramatically increase the number of patients and caregivers who receive basic dental health education. These professionals also can be trained to recognize conditions that should be addressed by a dentist.
7. Mission of Mercy and Give Kids A Smile. Mission of Mercy events are temporary dental field hospitals that provide free dental care to the underserved. In 2019, there were 28 Mission of Mercy events across the country. These events served more than 26,600 people, providing $23 million in free services. Give Kids A Smile events unite dentists with others in their communities to provide care for underserved children. One of the program’s overarching goals is to provide each child with a dental home. At these local events, dentists and other team members volunteer their time to provide screenings, treatments and education to children.

Inappropriate and continuous use of hospital emergency departments for non-traumatic dental care contributes to rising healthcare costs and lack of appropriate care for people across the economic spectrum. A growing number of people rely on episodic emergency department treatment instead of seeing dentists who can treat the complex, underlying problems of dental pain — a step that can prevent future dental emergencies.

Every year, there are more than 2 million visits to hospital emergency departments for dental pain. Many of these visits can be referred to dental clinics, saving the healthcare system an estimated $1.7 billion and getting people the kind of care they need right now.

While emergency departments can provide pain relief and treat infection, few hospitals have dentists on staff. Most cannot provide comprehensive dental care, so patients are typically prescribed painkillers or antibiotics. This does not treat the underlying cause of the problem, and as a result, nearly 40% of patients return to the emergency department.

The Emergency Department Referral Initiative is an effective model for helping urgent care and primary care work together to improve access to comprehensive, preventive dental care, which will reduce overall costs and improve outcomes.

Dentists across the country are collaborating with hospitals to refer emergency department patients to dental offices and clinics where they can receive appropriate, effective treatment that is significantly less expensive than that available in a hospital.

• Emergency Department ER visits for dental health care cost three times as much as a visit to the dentist, averaging $749 if the patient isn’t hospitalized, amounting to $1.6 billion annually (one-third of which is paid by Medicaid).
• In 2009, abscesses and dental caries – both largely preventable conditions – accounted for nearly 80 percent of dental-related emergency room visits, according to the Healthcare Cost and Utilization Project.
• In 2018, there were approximately 663,000 non-traumatic dental conditions (NTDCs) emergency department visits and approximately 7,500 inpatient admissions for non-dual-eligible adults ages 21-64.
• In 2018, emergency department use for non-traumatic dental conditions (NTDCs) among Medicaid-enrolled, non-dual-eligible adults ages 21-64 varied by state but were generally higher for adults ages 21-34, with a national rate of 2,794 visits per 100,000 adult beneficiaries compared to 1,989 visits per 100,000 adult beneficiaries ages 35-64.
• Studies have shown that the uninsured and Medicaid patients seek dental care in emergency departments the ER more frequently than those with insurance.
• Women aged 21 to 34 are the most frequent users of emergency departments ERs for dental problems. As states cut adult dental Medicaid benefits in an attempt to reduce healthcare costs, these costs are simply shifted to the emergency department ER to provide palliative care for preventable dental conditions.
• Visits to the emergency department ER for dental pain can range from $400 to $1,500, as compared with $90 to $200 for a visit to the dentist. The most extreme cases of untreated dental infections have cost hundreds of thousands of dollars in hospitalization, and some have ended in tragic yet preventable deaths.

To learn more, read Emergency Department Visits for Dental Conditions Fell in 2013 (PDF). a paper from the Health Policy Institute.

For over 75 years, community water fluoridation has been a public health measure benefitting entire communities. Decades of research show that fluoridation is safe and effective in preventing tooth decay. The addition of fluoride to public water supplies was named one of 10 great public health achievements of the 20th century by the Centers for Disease Control and Prevention.

While easy access to fluoridated water delivers proven benefits, there are many reasons why communities may not choose to fluoridate their water, including misinformation and myths about current programs and challenges in ensuring that water supplies are optimally fluoridated once a program is established.

Action for Dental Health seeks to ensure that at least 77% of the population has access to optimally fluoridated water by 2030.

A cost-effective way to prevent decay

Community water fluoridation is one of the most efficient ways to prevent tooth decay. The cost of a lifetime of water fluoridation for one person is less than the cost of one filling. Even though the savings vary from location to location, we know that community water fluoridation saves money, even in smaller communities. Research shows that fluoridated water reduces tooth decay by at least 25% in both children and adults.

“Water fluoridation is the best method for delivering fluoride to all members of the community, regardless of age, education, income level or access to routine dental care,” according to Surgeon General Vivek H. Murthy. “Fluoride's effectiveness in preventing tooth decay extends throughout one's life, resulting in fewer — and less severe — cavities. In fact, each generation born over the past 70 years has enjoyed better dental health than the one before it. That's the very essence of the American promise.”

Working with communities

Action for Dental Health partners with communities to increase access to water fluoridation by providing state and local support for dentists who advocate for fluoridation in their areas.

We prepare local dentists for meetings with decision-makers and provide them with the necessary tools and information to guide the discussion. We also join with other leading health organizations such as the American Medical Association, the American Academy of Pediatrics, the Centers for Disease Control and Prevention and the World Health Organization to support fluoridation across the country and the world.

More resources on fluoridation

ADA Action for Dental Health: Fluoride in Water 

ADA Fluoride Clinical Guidelines 

Fluoride information from the ADA Science and Research Institute (ADASRI)

ADA advocacy on fluoridation and fluoride use

A Mom's Guide to Fluoride by Dr. Brittany Seymour

ADA video: Why fluoride in your tap water is a good thing