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Covid-era Dental Coverage Gone. Low-income Americans at risk


By Dr. Joel Strom

The official end of the COVID-19 public health emergency has kicked off a nationwide “unwinding” of coverage that had previously been renewing automatically. This includes pandemic-era Medicaid dental coverage which had been used by almost 14 million Americans, including over 2.3 million people in my native California.

Good oral health is one of the surprise factors in overall human health. Taking care of your teeth reduces inflammation, decay, and gum disease, which themselves are linked to heart, organ, and pregnancy issues. That’s partially why in 2022 California lawmakers invested tens of millions of dollars into new dental offices which will serve at-risk populations.

But lawmakers can only do so much, which is why California’s Health and Human Services Agency is one of many state health agencies scrambling to provide a safety net for millions of residents facing losing health insurance. And there is much that Americans can do for ourselves, including brushing and flossing daily, avoiding sugary foods and drinks, and activating enamel-building saliva by chewing healthy foods or even neutral products like sugar-free gum.

These are simple solutions that can reduce the need to see a dentist while low-income people find new coverage. And they can save lives.

For example, during the height of the Covid lockdowns, an autistic child on Covered California was in my office after it appeared that the hospital did not recognize that the patient needed to have his wisdom tooth extracted. They simply gave him antibiotics and sent him on his way. I made an immediate referral to a local oral surgeon who extracted the tooth and saved the young man from a likely lengthy hospital stay.

Another seemingly healthy patient came to the office for his routine dental hygiene appointment. We noted that his gums were bleeding heavily despite no obvious reason for this change in his condition. We referred him to his general practitioner, who referred the patient to a medical specialist and the patient was diagnosed with a very rare condition which likely would have resulted in a stroke or heart attack soon. He received trial medication which extended his life for 12 years. Without that simple dental cleaning appointment, he would never have known of this condition.

The benefits of good oral health also make their way into the womb. About one out of 10 babies in America is delivered prematurely. The number is even higher among certain groups, including those in some minority communities. Many mothers were unable to access good dental care during the pandemic, and the loss of Medicaid coverage makes it essential that expecting mothers follow good hygiene health regimens. Inflamed and irritated oral tissue are normal during pregnancy, and can result in a systemic inflammation which can increase the risk of early-term deliveries.

Thankfully, Americans have cheap options for good oral health. Brushing, flossing, and reducing sugar intake are obvious. And chewing itself generates saliva and neutralizes acids, especially right after a meal. Cheap sugar-free gum can replace unhealthy snacks while going for a walk, driving to work, or watching a movie. Combining prevention with pro-active saliva creation can help avoid the discomfort and stress of oral health problems and visits to the dentist – and, one large study in Malawi indicates, may prevent health risks to pregnant women and their babies.

As a medical professional, I watched with dismay as restrictive healthcare policies took their toll across the patient spectrum. Cancer checks were delayed, parents were unable to be in hospitals with their newborn children, and regular oral health appointments were canceled by the thousands. Ending the COVID emergency is a belated and necessary step, but nobody should be left in the cold. They need to keep their teeth healthy while figuring out long-term solutions for great oral health.


Originally published in RealClear Health.


Dr. Joel Strom has been a dentist for 40 years, served as a member of the California State Dental Board, and was the only dentist advisor to the National Institutes of Health council.