Oral health is more than just a smile. Oral health encompasses gum vitality, tooth decay, tongue conditions, and even jaw and tonsil maintenance. But it doesn’t stop there. Studies have documented links between gum health and brain health, heart health, cancer risk, and stroke risk. In other words, oral health impacts the well-being of the entire body.  

As with overall body health, oral health is linked to both individual behaviors and individuals’ social circumstances. Flossing and brushing are important to oral well-being, but even people who take all these steps might still face barriers beyond their control in accessing the resources they need to maintain their oral health. Policy efforts to address the oral health crisis recognize that individuals can only do so much—we all need a strong starting point to ensure that we can look after our health. Identifying barriers to oral health allows us to understand what prevents people from accessing what they need to keep their mouths healthy.  

Income and healthcare affordability are directly linked with the ability to access oral healthcare. In Indiana, over one in four Hoosiers paid more than $500 for out-of-pocket dental expenses in 2024. High dental costs create barriers, contributing to over one in ten adults in Indiana having unmet dental needs and increasing their health risks. Not being able to afford and access oral healthcare is tied to worse oral health outcomes, with increased instances of tooth decay, oral cancer, dental trauma, and tooth loss among low-income individuals, even when adjusting for individual-level oral health hygiene practices such as flossing and brushing regularly. This means that even when individuals in lower -income communities did the same healthy behaviors for their oral well-being (e.g. flossing, brushing, etc.), they still faced worse outcomes. 

In addition to paying for oral healthcare, purchasing healthy and nutritious food is a barrier that many families face. While nutritious food is critical for a variety of health-related outcomes, it is especially critical for oral well-being, where it helps growing healthy bacteria in the mouth and growing and retaining strong teeth. These properties make sufficient nutrient intake through healthy food particularly important for children, as undernourishment is associated with a 60% increase in likelihood of oral health difficulties such as tooth decay. Yet as with paying for dental care itself, healthy food that promotes oral well-being is nationwide more expensive and more difficult to access. This is worsened for Hoosiers in food deserts that leave families—particularly those with low incomes—with fewer nutritious and fresh options.  

Connected to both food access and overall affordability of dental care is the ability to get transportation to clinics or providers that offer dental care. At the national level, individuals who have to drive a half an hour or more to access dental care are considered as living in a “dental desert.” These dental deserts make it difficult for residents to access dental care even in the best of times for routine preventative visits, and can create difficult situations for individuals with emergency dental needs, who often must instead seek out an emergency room for treatment. Individuals living in dental deserts are 26% less likely to see a dentist, ultimately raising concerns about other health conditions that could arise because of delayed dental and oral care. In rural states like Indiana, transportation is a significant challenge due to the lack of public transportation available in rural communities and means individuals must travel long distances to access oral healthcare. In 2024, more than 1 in 10 Hoosiers lived over 30 minutes away from their dental treatment center, categorizing them as living in a dental desert and making it difficult to access routine and intensive dental care. Another 2024 study in Indiana noted that a higher number of dentists and dental hygienists are practicing in urban areas as opposed to rural communities, even when accounting for the different populations that urban and rural communities have. This crisis is further worsened in four counties that have been left entirely without dental providers (Brown, Switzerland, Union, and Warren). The concern is that individuals in these communities will then go without dental care, particularly as some dental treatments prevent you from driving afterwards due to anesthesia. Skipping these treatments, however, is risky and ultimately creates further health risks later on. One Hoosier, interviewed by the Institute as part of a project on medical debt, mentioned transportation both as a challenge to accessing dental care and other medical appointments, saying, “I was having really bad teeth issues, so I was paying cash and I had paid over like $2,500, you know, to try to fix issues. And then...I couldn't pay any more…I'm a waitress...and then I have my kids. I don't have any vehicle. So just even that, like getting my baby back and forth to doctor's appointments or, you know, taking my kids to school like it's always such a struggle to find a ride.” 

Geography, food accessibility, and dental care affordability/accessibility are some of the most common known barriers that individuals face when maintaining oral well-being. Importantly, each of these areas of inaccessibility is not any one person’s fault. We all try our hardest to look after our well-being in our mouths and bodies, but where we live and the resources we have can lead to different outcomes in the long run. Individuals who struggle with oral well-being are often stigmatized but experience conditions beyond their control. Stereotypes around poor oral health outcomes push thinking that centers individuals’ shortcomings (i.e. lack of dedication to brushing regularly, laziness around flossing, gluttony for buying sugary foods) and lead to social and professional exclusion and isolation. Another Hoosier, also interviewed as part of an earlier medical debt project, expressed mental health struggles and stigma associated with dental debt, saying, “It affects a lot of aspects of my life. Stress. So it's a constant, overwhelming.” 

At the Institute, we recognize the ways in which dental debt and experiences accessing care can impact across parts of an individual’s life. We are pleased to launch a year-long project focused on analyzing and addressing these core systematic barriers that impact health and wellbeing, (including oral health), with support from the CareQuest Institute for Oral Health. We encourage anyone wanting to share their experiences with oral healthcare or engaging in innovative partnerships to bring oral health resources to their community to reach out and share their story. You can sign up to participate in a virtual interview about your experiences with oral healthcare, or stay tuned for future ways to get involved by joining our email list.