Underserved Families Still Face Major Barriers to Dental Care

Jill Malmgren


While the landscape of children’s dental health has improved in regard to dental coverage and increased pediatric dental benefits in some states, families still face major barriers to care. Parents with low incomes must often navigate a minefield of non-clinical challenges to access even the most basic dental services for their children.

One of the most serious barriers to care, particularly in rural areas, is a lack of transportation. Without effective or affordable means of transportation, a simple one-hour dental visit can take up to five times as long and cost a parent an entire day’s wages. America’s ToothFairy is collaborating with mobile and school-based programs that directly address this challenge by delivering free dental services to children at school.

Cass Community Health Foundation (CCHF) is a nonprofit clinical program supported by America’s ToothFairy that serves children from low-income families in Cass County, Missouri. CCHF operates the only dental safety net clinic for underserved children in the county, which doesn’t have any public transportation.

America’s ToothFairy awarded CCHF a ToothFairy Grant to help it expand its school-based services to nine out of 10 school districts in the county. The dental screenings, preventive services, and oral care products it provides are the entirety of available dental care for thousands of children.

Lack of access to dental providers willing to accept Medicaid patients is another substantial barrier. While a family may have 10 dental providers located nearby, it is not uncommon for none of them to accept Medicaid patients. For children in need of more intensive dental procedures, this problem can be much worse.

In Arkansas, where America’s ToothFairy operates its Arkansas Oral Health Zone, there is just one hospital in the entire state that opens its operating rooms for dental procedures. Making a cross-state journey that necessitates transportation, accommodations, and other expenses creates significant challenges for families already in financial hardship.

For parents and caregivers with language or cultural barriers, navigating the intricacies of the health system can be extremely intimidating. Lack of understanding of insurance coverage options and medical terminology can cause parents and caregivers to delay dental care much longer than is healthy for their child. Unfortunately, many of these children end up in the emergency room, where they may receive no resolution to their underlying dental condition.

Perhaps the most significant barrier to care remains a financial one. A review of California Health Interview Surveys revealed that one in five families cited “unaffordability” as a primary reason for not receiving needed dental care in the prior year. Delayed treatment only exacerbates the problem, often making necessary dental procedures even more costly.

Aiming to address these and other barriers to care, America’s ToothFairy will award its 2018 ToothFairy Grant funding to nonprofit dental clinics providing vital school-based services, treating children in rural areas, and expanding delivery of services for children with special needs.

Community Dental Care (CDC), a safety net clinic serving families throughout Minnesota, received a $5,000 ToothFairy Grant sponsored by 3M Oral Care last month. The grant will help expand CDC’s school-based dental sealant program, which provides oral health education and preventive dental services to 4,000 diverse, low-income students at 23 high-risk elementary schools in the St. Paul/Minneapolis metro area.  

“Some of the children participating in our sealant events have never seen a dentist, and others have not been seen in a number of years,” said Ann Copeland, director of programs at CDC.

“By going on-site at schools, we break down some of the barriers that prevent children from accessing dental care, such as limited English proficiency, lack of insurance, fear/distrust of the medical community, transportation issues, and lack of knowledge about oral health and the importance of preventive care,” Copeland said.   

Approximately half of CDC’s participants last year were referred to local dentists for emerging or urgent dental needs, which illustrates the great need for their school-based intervention. 

Another focus for America’s ToothFairy in 2018 is encouraging interprofessional collaboration so that parents and caregivers receive important pediatric oral health information. Because non-dental health providers are much more likely than dentists to see young children, it is essential to equip health professionals of all specialties with tools to educate parents about recommended oral healthcare practices.

FirstHealth Dental Care is a not-for-profit dental clinic serving underserved children in North Carolina. America’s ToothFairy awarded FirstHealth a $5,000 ToothFairy Grant last month to expand an innovative collaboration between its clinic and the Special Supplemental Nutrition Program of the local Women, Infants and Children (WIC) office.

Using the program’s regular nutritional visits as a platform, FirstHealth’s Dental Navigator provides each family a one-on-one oral health educational lesson, oral care products, and a referral to a dental home. This collaboration allows the WIC Nutritionist and Dental Navigator to reinforce their counterpart’s instruction, making the educational sessions more impactful for both health teams.

Though we still have a long way to go in reducing barriers to care for vulnerable children, innovative clinical programs like these are creating new models for care with real promise for reducing childhood tooth decay and improving oral health outcomes for kids in our communities.

Ms. Malmgren, executive director of America’s ToothFairy: National Children’s Oral Health Foundation, has more than 15 years of leadership experience across a variety of industries. She began her career in dentistry in 2006, serving as director of operations for the Sheets & Paquette Dental Practice and the Newport Coast Oral Facial Institute. In 2011, she relocated to Charlotte, NC, where she joined the America’s ToothFairy team and later assumed the role of chief operating officer. As executive director, she aims to continue to expand the organization’s role as a valued resource provider for nonprofit clinics and community partners delivering oral health education, preventive services, and treatment for underserved children.

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