Historical Barriers to Dental Access in America and The Oral Systemic Connection

At OroMed, we believe that oral health is not an optional service, it’s a vital part of whole-person care. Yet for much of America’s history, dental access has lagged behind medical access, leaving millions without the preventive and restorative services they need. Federally Qualified Health Centers (FQHCs) and community health centers, designed to be the backbone of healthcare for underserved populations, have often struggled to fully incorporate dental care into their service models. 

Understanding why this gap exists requires looking back at historical, financial, cultural, and systemic barriers. Only by recognizing these challenges can we move forward with solutions that truly integrate oral health into the broader healthcare system, solutions that align with the well-documented oral-systemic connection. 

Through Seamless Integration of OroMed Services, the Barriers to Care are Coming Down

The Historical Divide Between Medicine and Dentistry 

One of the earliest barriers stems from the way medicine and dentistry evolved as separate professions. Unlike in many other countries, the United States trained doctors and dentists in different schools, governed them under different licensing systems, and funded their care through separate reimbursement pathways. 

This structural separation meant that when community health centers emerged in the 1960s, their focus was squarely on medical care. Dental was not seen as part of “core health.” Instead, it was considered an add-on or specialty service. This historical divide created a mindset that persists in some ways today: body health on one side, mouth health on the other, even though science now tells us these systems are deeply interconnected. 

Financial and Policy Barriers 

Another major factor is the financing of dental care. Unlike primary medical care, dental care has historically received far less federal and state support. For FQHCs, which rely heavily on grant funding and Medicaid reimbursement, this lack of sustainable financing created a significant hurdle. 

Adult dental benefits under Medicaid vary widely by state. In some states, there is little or no coverage for adults, leaving health centers with no clear pathway to recoup the costs of providing dental services. Even when coverage exists, reimbursement rates are often too low to sustain a robust program. 

Without consistent financial support, many health centers hesitated to invest in the infrastructure, staffing, and equipment necessary to establish dental programs. As a result, dental access for low-income and underserved populations remained fragmented and uneven. 

Workforce Challenges 

Recruiting and retaining dental professionals has been another persistent barrier. Dentists, hygienists, and dental assistants are often in short supply, particularly in rural and underserved areas where FQHCs operate. 

Unlike physicians, who may be incentivized to work in underserved areas through loan repayment programs or pipeline initiatives, dental professionals have historically had fewer opportunities to offset the financial burden of their training by serving in community-based clinics. 

This workforce shortage created a vicious cycle: without available providers, health centers couldn’t build sustainable dental programs. Without those programs, communities continued to face limited access, further widening disparities. 

Competing Priorities: Medicine First 

When FQHCs were first established, the primary focus was on addressing medical shortages in underserved communities. Chronic diseases such as diabetes, hypertension, and asthma were seen as urgent public health priorities. Dental care, by comparison, was labeled “secondary” or “elective.” 

This prioritization meant limited resources—staffing, funding, facility space—were directed first to medical services. Dental was often deferred until a later phase, if it was added at all. The downstream effect was predictable: millions of patients at health centers continued to lack access to preventive and restorative oral healthcare, despite clear need. 

Awareness Gaps and the Rise of the Oral-Systemic Connection 

Perhaps the most significant shift in recent decades has been scientific evidence demonstrating the oral-systemic connection: the undeniable link between oral health and overall health. Poor oral health has been associated with worse outcomes in heart disease, diabetes, pregnancy, and even cognitive decline. 

Yet, for much of the 20th century, this connection was under-recognized. Policymakers, funders, and even many healthcare leaders did not prioritize dental care because the broader system failed to recognize its role in preventing and managing systemic disease. 

As awareness of the oral-systemic connection has grown, the urgency to integrate oral health into primary care has become clear. Today, the challenge is less about proving the need and more about overcoming the entrenched barriers that have kept dentistry siloed for so long. 

Infrastructure and Capital Costs 

Building dental programs requires more than providers and funding, it requires significant infrastructure investment. Unlike medical exam rooms, dental clinics need specialized chairs, X-ray machines, sterilization equipment, and more. For health centers operating on tight margins, these upfront costs have often been prohibitive. 

Grant opportunities can help, but they are competitive and inconsistent. Many centers have had to delay or limit dental expansion because the capital costs simply outweighed their available resources. 

Uneven Expansion Across the Country 

The result of these combined barriers is an uneven landscape. Some health centers, supported by strong state Medicaid programs or visionary leadership, have successfully integrated dental services. Others have struggled to move beyond medical care, leaving large gaps in oral health access. 

This patchwork approach has led to geographic disparities, with patients’ ability to receive dental care at their health center depending largely on where they live. In many rural or low-income urban areas, access remains minimal, perpetuating cycles of poor oral and overall health. 

The Path Forward: Integration Guided by the Oral-Systemic Connection 

At OroMed, we see integration as the path forward. Recognizing and acting upon the oral-systemic connection means ensuring that oral health is not siloed or secondary, but rather a core part of every patient’s healthcare journey. 

Practical strategies include: 

• Embedding dental providers within primary care teams. 

• Expanding teledentistry to reach rural patients. 

• Advocating for stronger Medicaid adult dental benefits and fair reimbursement rates. 

• Building workforce pipelines that support dentists and hygienists in choosing careers within community health. 

• Leveraging grants and partnerships to offset infrastructure costs and create sustainable programs. 

The ultimate goal is equity: ensuring that every patient, regardless of geography or income, can access the oral healthcare they need as part of comprehensive health. 

Healing the Barriers to Whole-Person Health 

The barriers that have historically kept dental care out of health centers are real and complex, rooted in history, policy, workforce shortages, and funding gaps. But these barriers are not insurmountable. 

By acknowledging the importance of the oral-systemic connection, health centers and their partners can chart a new course, one where oral health is fully integrated into primary care.

At OroMed, we are committed to advancing that vision and ensuring that dental care is no longer treated as optional, but as essential to whole-person health. 

If you would like to learn more about how OroMed integrates preventive dental evaluations into existing health center workflows without added cost to the health center, book your demo today to find out.  

Book Your Free Demo