Community Health Centers Are a Critical Source of Oral Health Care for Underserved Populations

Oral health plays a critical role in overall physical health and mental, social, and economic well-being.[5] Poor oral health can lead to poor school performance and lost workplace productivity losses,[6] lower employability,[7] pain that results in subsequent increased risk of opiate use,[8] and an overall decrease in quality of life.[9] A growing body of evidence links poor oral health with a range of medical complications and chronic illness, including pregnancy complications,[10][11] cardiovascular disease, high blood pressure and stroke.[12] Oral health problems can have particularly serious consequences for older adults, including difficulty chewing and subsequent nutritional deficiencies,[13] social isolation, and an increased risk of cognitive decline and dementia.[14]

Cost is the primary barrier for those with unmet oral health care needs.[15] More than 72 million people nationwide do not have dental insurance, including one-third of all Medicare and Medicaid beneficiaries.[16] Traditional Medicare does not cover routine dental care such as cleanings, nor does it cover dentures or implants.[17] Many managed Medicare (Medicare Advantage) plans provide some coverage for dental services, but enrollees often face high out-of-pocket costs for services beyond basic preventive care.[18] While states are required to cover routine dental services for children under Medicaid’s Early and Periodic Screening (EPSDT) program,[19] dental care is an optional Medicaid benefit for adults, with no minimum coverage requirements.[20] As a result, few states cover comprehensive oral health services for adults. As of 2022, eight state Medicaid programs covered only emergency dental care[i] and 14 states offered only limited dental coverage.[21] Thus, many low-income adult Medicaid beneficiaries face prohibitively high out-of-pocket costs and other insurance restrictions that prevent access to care.[22] Private medical insurance plans generally provide no coverage for routine dental care, although some may cover emergency dental or care required for an ongoing medical condition. Consequently, higher-income insured individuals may purchase separate dental insurance to offset the high out-of-pocket costs.[23] Even with insurance, many low and middle-income people are unable to access a dentist they can afford, or a provider who is willing to accept their insurance.[24]

In addition to financial and insurance-related barriers, millions of people face geographic and workforce-related barriers to oral health care. As of 2024, an estimated 60 million people reside in designated dental health professional shortage areas (HPSAs)[25] that lack a sufficient number of oral health care providers. The majority of dental HPSAs are in rural communities,[26] where residents are more likely to suffer from poor oral health than those in urban areas.[27] Rural areas are also more likely to have lower levels of community water fluoridation,[28] which places residents at greater risk of dental decay.[29]

Health center dental services help bridge these gaps. Services that are not covered by Medicaid, Medicare Advantage plans or private insurance are offered on a sliding fee scale, removing significant financial barriers to accessing care. Grant funding and philanthropic donations may help offset the costs of providing these essential services. 

[i] Emergency services refer to services provided for pain relief and the treatment of infection under state-defined emergency situations; limited services mean fewer than 100 American Dental Association (ADA)-recognized diagnostic, preventive, and minor restorative procedures and a per-person annual expenditure cap of $1,000 or less (NASHP, 2022). 

CHCs Are Essential Providers of High Quality, Affordable and Accessible Oral Health Care

For many patients, CHCs are a lifeline to dental care. As of 2024, more than 84% of all CHCs nationally provide oral health care. The last two decades have seen growth in the number of dental care providers and consequently the number of patients receiving dental health services. CHCs leveraged enhanced federal funding opportunities in the 2000’s to significantly expand oral health services and address unmet dental care needs.[30] The ACA Medicaid expansion helped fuel the expansion of dental services,[31] as did federal capital grant funds to support CHC infrastructure.[32] These funds helped support facility construction including development of dental operatories.[33]

Today, CHCs play an especially important role in rural communities by reducing geographic barriers to access. Health centers operate in Medically Underserved Areas and/or serve designated Medically Underserved Populations, meaning that dental services outside of the CHC are in extremely short supply. CHCs serve one in five residents of rural and frontier regions[34] where they may be the only accessible oral health care provider.

CHC Oral Health Care Utilization and Workforce Trends

In 2024, 6.7 million patients—about 20% of all patients served—accessed CHC dental services, a 31% increase over the 5.1 million patients served in 2020. Oral health visits (including virtual visits) increased by 45% over this period, from 11.3 million in 2020 to 16.4 million in 2024 (Table 1).

While the Covid-19 pandemic exacerbated some recruitment and retention challenges,[35] the CHC oral health workforce grew substantially during this period, adding over 4,000 dental health professionals and staff over the 2020-2024 period (Table 2). The number of dentists increased by 15% from 2020-2024, dental hygienists grew by 21% and the number of other dental staff increased by 32%. Oral health staff now account for seven percent of the total CHC workforce including dentists (5,604 FTE), dental hygienists (3,015 FTE) as well as other personnel such as dental assistants, advanced dental assistants, aides, dental therapists and technicians (Table 2).[36] 

From 2020-2024, the number of most oral health services increased, including oral exams, restorative services (e.g., crowns, bridges, implants), sealants, prophylaxis visits, fluoride, and rehabilitative services (such as endodontic, periodontic, prosthodontic, and orthodontic interventions to restore oral health, function and appearance), while oral surgery and emergency services remained relatively flat (Table 3).

Innovative CHC Oral Health Care Delivery Models

Many CHCs have successfully integrated primary medical and oral health care and implemented workforce models to increase access to dental care.[37] Unlike most primary care practices, health centers commonly have dental providers on site, enhancing ease of access for patients. Some CHCs operate standalone dental clinics as one of their health center locations.[38] Some CHCs have adapted their facilities to better serve patients with disabilities (e.g., larger examination rooms to accommodate wheelchairs, accessible dental furniture).[39] CHCs may operate mobile dental units at schools, and embed oral health care services in other community-based settings like day care centers and elder care facilities.[40]

CHCs may also offer program-specific integrated dental services. For example, from 2017-2020, 10 CHCs participated in the grant-funded Michigan Initiative for Maternal and Infant Oral Health (MIMOH). Modeled after a maternal oral health program at an urban CHC that serves 29,000 patients in southern Michigan,[41] MIMOH integrated full-time dental hygienists into CHCs’ obstetric clinics. The initiative increased the percentage of pregnant patients receiving oral health care at participating CHCs by nearly 20%.[42] Although it was not sustained beyond the grant period, the program demonstrated a successful model for integrating and expanding access to essential services.

Innovative oral health service delivery and workforce models include:

School-based Mobile Dental Care: Kintegra Health (NC)

Founded in 1989, Kintegra Health serves more than 100,000 patients in 17 counties across western North Carolina, one-third of whom are under the age of 18. In 2024, Kintegra Health provided mobile dental services to 5,591 pediatric patients[43] through its Dental ACCESS program, which serves Title I elementary schools[iii] in four counties. Each mobile dental unit is equipped with an X-ray machine and three dental chairs, and is staffed by a dentist and three dental assistants who provide a full range of preventive dental services, including x-rays and sealants. A bilingual patient service representative provides interpretation for Spanish-speaking patients.[44] In 2024, Kintegra Health added intraoral dental cameras to the mobile units, which automatically upload images and X-rays to dentists at Kintegra’s brick-and-mortar clinic locations, allowing for immediate review and treatment planning. All services are provided at no cost to the child or family, although Kintegra Health may bill Medicaid for those patients with Medicaid coverage.[45] If a patient needs dental treatment beyond preventive care, clinic navigators contact the patient’s parent or caregiver to make an appointment at the CHC’s on site dental clinic. Kintegra Health also manages the Childhood Health Outreach Program (CHOP), which provides access to dental care for children served by WIC[iv] and Child Health clinics in two counties.

Integration with Elder Care Services: Harbor Health (MA)

To address unmet oral health care needs among older adults in the community, Harbor Health Services implemented a program to offer dental services in an elder care facility that serves participants of the Program of All-inclusive Care for the Elderly (PACE). PACE supports interdisciplinary teams to provide coordinated, comprehensive medical and social services to adults ages 55 and over, most of whom are dually eligible for Medicare and Medicaid. Rather than receiving care in a nursing home, the program enables participants to remain in their communities.[46] By incorporating dental care into the PACE model, Harbor Health made accessing dental care far more convenient for patients who often face mobility challenges and transportation-related barriers. PACE’s unique financing model initially enabled Harbor Health Services to provide dental services one day per week to PACE participants. In 2016, the clinic expanded availability to four days per week, and it now offers dental appointments Monday through Friday. The dental unit is situated in the facility’s main clinical care area where a dentist sees patients at times coinciding with the PACE-provided transportation services.[47]

Dental Care for Adults with Complex and Special Needs: Family Health Centers (ID)

Family Health Centers’ Advanced Delivery Dental Clinic provides oral health care to adults with complex medical histories, neurodivergence, and other special needs. These patients are among the most challenged when it comes to finding dental health professionals who have the requisite expertise and equipment to treat patients with complex conditions. Since 2022, in response to a critical need within its community, the clinic has used adaptive technology, including intra-oral cameras and a special lift for patients who use wheelchairs, to serve patients who may otherwise face barriers to routine dental care.[48] The clinic also offers oral hygiene education sessions with individual patients and their caregivers to help patients at all ability levels to improve their oral health. Since it is not reimbursed by Medicaid and other payers, the clinic charges $30 for oral hygiene sessions and invites community members to sponsor sessions for patients who are unable to pay.