A guest blog by Stormy Fiscel, RN, BSN, Health & Nutrition Manager at Area Five Agency Head Start

Access to dental care remains a serious challenge for many low-income Hoosiers. Oral health is closely connected to overall health, school readiness, and long-term well-being, yet financial, systemic, and logistical barriers often prevent families from getting needed care. As the Health and Nutrition Manager for the Area Five Agency Head Start, which serves low-income children across Cass, Fulton, and Wabash counties, I have seen this firsthand through the experiences of the families we work with. Data from our programs also highlights the depth of these challenges and offers insights into how community-based solutions make a difference.

Barriers to Dental Care Among Low-Income Children

Affordability, Insurance Gaps, and Limited Coverage

Affordability is one of the most persistent barriers facing Area Five Head Start families. Some children enroll without dental coverage, while others have insurance that does not adequately cover restorative services. Area Five Head Start’s Program Information Reports show that 8% of children lacked health insurance at enrollment in 2023–2024, and 6% lacked insurance in 2024–2025. Even when children qualify for Medicaid, families often struggle to find providers who accept it, especially pediatric dentists willing to treat very young children with advanced decay.

Out-of-pocket costs for exams, fillings, and extractions can be overwhelming, causing families to delay or forgo treatment. Area Five Head Start’s Program Information Reports show that only 56% of children had a dental home at enrollment in both the 2023–2024 and 2024–2025 program years. A dental home means access to continuous, accessible care from an oral healthcare professional for preventative and responsive treatments. This means that nearly half of children lacked a consistent and supportive environment for maintaining oral health.

Dental Debt and Delayed Treatment

Dental debt is an especially difficult and often overlooked barrier. Families I work with report being encouraged to apply for Care Credit (deferred high-interest credit cards) or payment plans when they cannot afford services upfront, which can add interest and stretch costs over years. Treatment for preschool children with severe decay can cost up to $10,000 per child. For low-income families, this debt becomes both a financial burden and a source of stress, often leading to postponed follow-up care or avoidance of dental visits altogether. Over time, untreated dental issues worsen and require more urgent, complex, and costly interventions, creating a cycle that is difficult to break.

Geography, Transportation, and Provider Shortages

Geography and transportation create additional barriers, especially in rural areas. According to our Area Five Head Start Community Assessment, there are no local pediatric dentists serving the communities where Area Five Head Start sites are located, including Logansport, Rochester, and Laketon. Families often must travel 45 minutes to an hour one way to reach providers in Kokomo, Lafayette, Fort Wayne, or South Bend. For parents working hourly jobs, arranging transportation, taking time off work, and coordinating childcare can make even one appointment feel unmanageable.

Housing Instability

Housing instability further complicates dental care access. At enrollment, Area Five Head Start identified 23 homeless families who experienced challenges such as needing to delay necessary and preventative care to cover immediate needs such as shelter, food, and safety, even when children experienced tooth pain or visible decay. Even for families who do have a place to call home, high housing costs in our community—which was cited as a top concern of 495 surveyed clients in 2024—impacts capacity to afford oral health treatments. Housing also intersects with challenges such as those of geography and transportation in accessing oral health services.

Food and Fluoride Access

Diet and food insecurity also increases the risk of dental decay. Many low-income families rely on processed foods and sugary drinks as they are accessible, affordable, and shelf stable, but excessive consumption of these contributes to tooth decay. Area Five Head Start’s Health History and Nutrition Assessments show that some children are allowed to sip juice or sweetened beverages from bottles or sippy cups throughout the day by parents, with many not realizing how harmful the sugars can be for baby teeth. Even as we engage in educational opportunities around this, we also recognize that sugary drink access links to broader questions of food affordability and accessibility within different communities.

Compounding oral health harms from processed foods, lower exposure to fluoride adds to vulnerability for low-income children and increased risk for tooth decay. Fluoride strengthens enamel and prevents decay, but not all the communities we serve, as many are rural, have fluoridated water, and families may not be able to afford fluoride toothpaste or professional treatments such as fluoride varnish and sealants. The result is that many children who need fluoride for strengthened teeth might not be able to access it.

Language Barriers and Health Literacy

Language barriers and access to health literacy supports can also affect care-seeking behavior in households we see at Area Five’s Headstart. Some families do not view dental care as urgent for young children, especially for “baby teeth,” or may not understand the long-term consequences of untreated decay. Language barriers are a core part of this, as many oral health materials exist in English with limited alternatives. For many immigrant families we work with, language barriers compound with other challenges such as limited insurance and unfamiliarity with the healthcare system.

Existing Supports That Are Making a Difference

The barriers discussed above create a significant oral care need among the low-income population we work with in Head Start. According to Area Five Head Start’s Program Information Reports, 37% of enrolled children required oral health treatments such as restoration, pulp therapy, silver diamine fluoride, and extraction in 2023–2024, and 36% required these treatments in 2024–2025.

Aware of the challenges that many families face in accessing the care they need, Area Five Agency Head Start takes an approach of coordinated, community-driven support to improve outcomes for low-income families. From the application process onward, we ask families about health and dental insurance and support them in applying when eligible. For uninsured or underinsured families, staff connect them with providers in our community who offer sliding-scale fees, donate services, and community-based financial support. Children’s health information is tracked throughout the year by staff, including insurance status, dental homes, exams, and follow-up care, guided by federal EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) standards. Building these strong relationships between Head Start staff and families also supports education, trust-building, and improved health literacy for families.

Prevention of dental decay and the importance of oral health is reinforced daily in our Head Start classrooms as children receive free access to drinking water and are supported in brushing their teeth with fluoride toothpaste. Teachers use the Brush! Oral Health Curriculum to provide age-appropriate oral health education and reinforce healthy habits early.

Even as we encourage healthy habits among the children we work with, we recognize that oral health is a community-wide commitment, with local partnerships being a cornerstone of success. Area Five Head Start works with the local Indiana Health Center’s dental clinic, Donated Dental Services, and a broad network of local dental providers. This network connects families with pediatric dental specialists who help reduce costs by sharing the financial burden across dentists, families, Head Start, and community organizations.

An example of what is possible when healthcare providers and community programs align efforts is our partnership with Parker Family Dentistry. Providers Dr. Travis Parker and Dr. Esi Parker serve as volunteer consulting dentists, supporting program planning, procedures, and direct care. They provide free, on-site dental exams and silver diamine fluoride treatments, along with donated restorative care in their office. Because the office is located directly across the street from Area Five’s largest Head Start center, barriers related to transportation, missed work, and scheduling are significantly reduced for low-income families in need. Shared interpretation services and coordinated appointments further ease the burden on families. During the 2024–2025 program year, Parker Family Dentistry donated $6,363 in in-kind dental services for Area Five Head Start children.

Measurable Outcomes and Moving Forward

The impact of our extensive efforts in Area Five Head Start to improve oral health is measurable. During the 2023–2024 program year, dental home access (defined as continuous, accessible, and professionally-provided preventative and responsive oral healthcare) rose from 56% at enrollment to 96% by year-end. In addition, 95% of children had a professional oral exam, and 74% of those with oral health diagnoses received needed care. These increases came from our classroom and community efforts to ensure that children saw professionals for preventative and responsive oral health treatments. These successes increased in following years. By the end of the 2024–2025 program year, 98% of children had a dental home, 95% had a professional oral exam, and 90% of children with oral health diagnoses received recommended treatment within the same year.

The experiences of Area Five Agency Head Start highlight both the barriers low-income Hoosiers face in accessing dental care and the power of coordinated community solutions to overcome them. Addressing dental debt, improving provider availability, and reducing logistical burdens will require continued collaboration, trust, and continued innovation. As seen in our efforts at Area Five Head Start, when families are supported holistically—financially, culturally, and logistically—oral health access improves, disparities shrink, and children are given a healthier start.