Separate and Unequal: Policies to Promote Dental Care as Essential and Reduce Oral Health Disparities

Kinika Young and Heavyn Jennings

January 18, 2022

Executive Summary

Dental practices have always been separated from medical practices despite calls, dating back to the 19th century, to integrate dentistry into the primary care delivery system to improve access to care. This separation, along with the commonly held belief that oral healthcare is an optional or supplemental benefit, contributes to poor overall health and wellbeing and compounds access issues. The lack of insurance and inability to pay out-of-pocket for dental care is a significant barrier for many Americans, particularly those with low incomes. Oral health disparities exist based on age, race, income, and geography. People who are under age 21, white, middle- to high-income, and living in urban areas are more likely to have access and utilize dental services than those who are adults, people of color, low-income, and rural residents. Tennessee ranks near the bottom among all states for dental care access and oral health outcomes, as it is one of only three states that do not currently provide dental benefits to adults enrolled in Medicaid. 

Tennessee is on the verge of expanding dental benefits for adults and expanding the capacity of dental care providers, but more can be done. To advance health equity and improve overall health, policies should be implemented that expand the dental care workforce, acknowledge the importance of oral health by integrating dental and medical service delivery to the fullest extent possible, and embrace equitable, value-based care models. Most importantly, adult dental benefits should be mandatory, rather than optional, because oral health is an essential part of overall health and wellbeing.  

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