Not long ago, Dr. Suzanne Fournier saw a 16 -year -old patient with a swollen face and difficulty breathing. Fournier, a dentist who trains in an urban hospital in Louisiana, had to extract six teenage teeth; He was finally intubated and admitted to the intensive care unit because his airways had closed.
He survived, but Fournier fears that there are more children like him through the country that could get closer to the state of their oral health. “I really worry that someone will die because he has an abscess cavity that turns into infection, and he will not be able to access care,” she said.
In the United States, 27% of adults have no dental insurance, according to the most recent State of equity of oral health in America By the Carequest Institute for Oral Health, a non-profit organization which advocates in the name of best oral health care. This represents around 72 million Americans. In comparison, 9.5% of adults have no health insurance. And although many children can get dental care via Medicaid or the Health Insurance Program (CHIP), low reimbursement rates mean that many dentists will not accept these insurance plans, leading to dental care deserts across the country. Only on Half of all children on Medicaid Used any dental service in one year, according to a KFF analysis.
Now dentists say they fear that a perfect storm of public policy changes can worsen oral health across the country. Cups offered in Medicaid would mean that fewer people will be able to access dental care, because the Federal Government Endowment purges places such as the Division of Oral Health Prevention in US Centers for Disease Control and Prevention (CDC). In addition, like states, including Florida and Utah, Vote to prohibit the addition of fluoride For drinking water and other states are considering similar prohibitions, dentists say that the oral health of children and adults will suffer.
“We are already faced with a oral health crisis,” explains Melissa Burroughs, director of public policy for Carequest. “Medicaid cuts and the withdrawals of water fluoridation are the two greatest ways whose oral health crisis is likely to be exacerbated.”
Why dental care is a reflection afterwards
America has long separated the dental health of medical health. In most cases, Medicare, the federal health insurance program for the elderly, does not cover dental care at all. Dental care via Medicaid varies considerably from state to state, and states are not required to include dental coverage for adults, although they are required to include it for children. People who go to the affordable health care market for health plans cannot buy a dental insurance plan independently unless they also buy a medical health regime. And the subsidies offered to low -income families on the health market do not apply to dental plans.
Even these people with dental insurance coverage often find that their plans Don’t cover much Apart from dental cleaning and assessment. According to a recent investigation From the PAN Foundation, a defense of health care.
Not having dental health care can have major consequences. Dental caries and gum disease can exacerbate other health problems And lead to heart disease, low birth weight during pregnancy and even respiratory diseases. Adults who present themselves to emergency services for dental pains are often found with opioid prescriptions, which can lead to dependence. If children’s teeth hurt, they may have trouble eating, causing bad nutrition; If they suffer, they are likely to sleep badly. The CDC believes that 34 million hours of school are lost each year due to unforeseen dental problems.
Learn more:: Science behind fluoride in drinking water
“You can find many studies that find associations between poor dental care and things such as pneumonia and diabetes and heart disease,” said Dr. Lisa Simon, a specialist in internal medicine that started his career as a dentist, then went to the medical school to focus on oral health care. “But even if you did not think of any of these things, how important is it to have a central characteristic in our face as we want, and not to live with pain, and to be able to take nutrition?”
Simon trains in Massachusetts, a state with one of the best dental safety nets in the country and the generous benefits of Medicaid compared to those of other states. But she always sees people who have found themselves in use because of potentially fatal septicemia of dental infection, patients who cannot start chemotherapy because they cannot pay to remove their infected teeth, people who will not even let it look in their mouths because they are so shame. In Massachusetts, less than a third of dentists accept Medicaid, who is close to the national average.
“I went down to Haiti nine times, and I have never seen the level of decomposition I saw when I worked in Florida,” explains Fournier, the dentist of Louisiana, who previously practiced in Florida.
She and other dentists fear that the MEDICAIDID COUPS who are looming to exacerbate the problem; When state budgets are tight, dental care is often one of the first things to do. The Massachusetts, for example, reduced the coverage of Medicaid for dental care for adults in 2010 in the aftermath of the great recession; Dental -related visits to a safety security hospital increased by 14% in the two years after Medicaid cuts.
Fluorine prohibitions are worried dentists
Fournier recently testified before the House of Representatives of Louisiana regarding Bill 2 of the Senate, which sought to make more difficult for localities to add fluoride to their drinking water. (In Louisiana, only around 38% of people are served by community water systems that fluores their water.)
The bill was rejected in a committee, but bills aimed at restricting access to fluorine have been presented in other states, including Northern Carolina, Massachusetts, Ohio and Nebraska, according to Carequest. The bills to prohibit the addition of fluoride in drinking water have already passed through Utah and Florida. Some local counties have already voted In 2025 to ban the fluordia independently.
They are probably influenced by the Make America Healthy Again movement, led by Robert F. Kennedy Jr., Secretary of the Ministry of Health and Social Services. He called fluoride a “dangerous neurotoxin” and said he wanted the CDC Stop recommend fluoridation. In May, the FDA announced that it was trying to remove the fluorine ingestion tablets market.
Learn more:: What if the fluoride is removed from your water
Dentists predict long -term and expensive health problems if communities continue to eliminate water fluoride. A recent study published in Jama Health Forum have found that the elimination of fluoride from the supply of public water would be associated with an increase of 7.5% in dental caries and would cost around $ 9.8 billion over five years. Places that have removed fluoride from their water supply have increased dental problems; In Canada, for example, Calgary deleted fluoride in 2011, saw a significant increase In the cavities, and now reverse the course and adds fluoride.
Dr. Jeff Ottley, a dentist practicing in the Panhandle of Florida, says that he noticed when his region ceased to fluorize his water in 2014. He saw an increase in the number and gravity of the cavities in children. The recent ban on fluoridation in Florida will affect children and adults, he says, in particular because the Florida Medicaid program barely offers the advantages for adults. “We are going to have more diseases, larger cavities and some of these children will have to go to hospital because their cavities will be so bad,” he said.
Out of reach solutions
Oral health defenders claim that in recent years the country has increased in improving access to dental care. For example, an invoice presented in the Senate In March, Medicare would need to cover teeth, vision and hearing.
And some states have, in recent years, extended Medicaid advantages to cover dental services for adults. This can eventually save long -term money; When Colorado has chosen to extend the adult Dentals of Medicaid under the Act respecting affordable care, a supplier of safety nets has seen a 22% decrease In dental extractions, according to Carequest. When states are increasing how many dentists can be reimbursed by Medicaid, more dentists are registered as suppliers of Medicaid, which turned out Increase children’s dental visits.
But the defenders say that they fear that all these progress will now be reversed and that oral health in the United States, especially for children, will suffer.
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“I think we are at this balancing point where if we can get things done, there is the real opportunity for millions of people to obtain dental care,” said Simon, doctor and dentist of Boston. “But we have already seen it – each time there is a budget deficit, dental care is the first thing on blocking.”
The irony of this to many dentists is that providing people with preventive care can really save money over time. The children of Medicaid who received fluoride treatments saved between $ 88 and $ 156 each for their state programs, A study found. Water fluoritation is another preventive policy that saves money: in 2024, the Estimated CDC The fact that providing communities with fluorinated water for a year saves $ 6.5 billion in dental treatment costs and leads to 25% less cavities.
But some of these preventive ideas are not likely to go far, explains Amy Niles, the director of the mission of the Pan Foundation. “In this country, we do not always kiss the importance and value of preventive care to prevent diseases later,” she said.
Fournier, the dentist of Louisiana, is relieved that her testimony and that of other health professionals have helped to persuade the legislators of Louisiana to abandon the bill on fluorine. But it is still competing in a health care system that makes it so difficult to provide preventive care for oral health.
“Our goal is aligned with RFK Jr., which is to make Americans healthy,” she said in His testimony. But, she says, America does not seem interested in waged a war N ° 1 Chronic disease In children: dental caries.