Source: Health Policy Institute of Ohio
Dental experts are warning that the simultaneous erosion of Medicaid and fluoridation under the Trump Administration could exacerbate a crisis of rural oral health and reverse decades of progress against tooth decay, particularly for children and those who rarely see a dentist (Source: “As Opposition to Fluoride Grows, Rural America Risks a New Surge of Tooth Decay,” NPR, March 26, 2025).
“If you have folks with little access to professional care and no access to water fluoridation,” said Steven Levy, a dentist and leading fluoride researcher at the University of Iowa, “then they are missing two of the big pillars of how to keep healthy for a lifetime.”
Nearly 25 million Americans live in areas without enough dentists — more than twice as many as prior estimates by the federal government — according to a recent study from Harvard University that measured U.S. “dental deserts” with more depth and precision than before.
The American Dental Association has estimated that only a third of dentists treat patients on Medicaid.
The Harvard study identified over 780 counties where more than half of the residents live in a shortage area. Of those counties, at least 230 also have mostly or completely unfluoridated public drinking water, according to a KFF Health News analysis of fluoride data published by the Centers for Disease Control and Prevention. That means people in these areas who can’t find a dentist also do not get protection for their teeth from their tap water.