Sarah Hurlbert, MPH, and Peter Shin, PhD, MPH, NACHC Dr. John W. Hatch Center for Science
In 2024, seven million patients relied on Community Health Centers (CHCs) for routine, emergency, restorative, and rehabilitative dental services. With a workforce of over 5,700 full-time equivalent (FTE) dentists, 3,000 dental hygienists, and more than 13,000 additional dental professionals, CHCs delivered 16.8 million dental visits nationwide.
More than 80% of CHCs (1,227 of 1512 CHCs) provided dental care, making them a critical access point for millions of publicly insured Medicare and Medicaid enrollees and low-income patients. Despite this availability, approximately two in three patients still had unmet oral health needs, highlighting persistent challenges in coverage, workforce capacity, and access. Nationally, the gap in dental coverage remains substantial. According to the 2024 State of Oral Health Equity in America survey, 27% of U.S. adults (approximately 72 million people) lack dental insurance.
Preventive Care at the Core, but CHCs Also Address Complex Oral Health Needs
Preventive care forms the backbone of CHC dental care. Oral exams and cleanings (prophylaxis) accounted for 60% of all dental visits. These services are critical for early identification of oral disease and create opportunities to detect signs of systemic conditions. Restorative, rehabilitative, and emergency care address more complex or episodic needs, from fillings and crowns to root canals and oral surgery. While most patients receive routine preventive services, a smaller subgroup require more intensive interventions, emphasizing the balance CHCs must strike between preventive care and high-need, resource-intensive cases.
In 2024, dental sealant rates for children aged 6 to 9 reached about 60 percent in rural and urban CHCs, outperforming the national average of under 50 percent. This demonstrates consistent delivery of evidence-based preventive care across diverse communities, despite workforce and infrastructure challenges.
Table 1. Select Oral Health Services, 2024
| Service Category | Visits | Patients |
| Oral exams | 5,745,891 | 4,758,664 |
| Prophylaxis (adult/child cleanings) | 4,465,963 | 3,545,646 |
| Restorative services (fillings, crowns, etc.) | 3,639,520 | 1,956,436 |
| Oral surgery | 1,152,071 | 889,852 |
| Rehabilitative services (endo, perio, prostho, ortho) | 2,140,803 | 1,061,616 |
| Emergency services | 1,811,076 | 1,533,400 |
Source: 2024 UDS data (HRSA). Includes Look-alikes.
Delivering Care Under Workforce Pressures
CHC dental teams operate on a remarkable scale. On average, each dentist handles over 2,300 visits annually, or about 45 visits per week. Hygienists average an additional 1,100 visits. However, the CHC dental workforce is under considerable pressure, with 21% of dental hygienists and assistant positions vacant and turnover rates of 21% for dentists and 18% for dental hygienists and assistants. These gaps limit capacity to meet patient demand, illustrating both the efficiency of and strain on CHC dental teams.
Providing Care in a Fragmented System
In 2024, CHCs spent more than $5 billion delivering dental services, which translates to about $700 per patient. However, these costs were not fully reimbursed.
- Medicaid: Comprehensive dental services are covered for children in every state, but adult dental benefits vary widely because they are classified as optional under federal Medicaid rules. Some states provide only emergency care; others limit the services or exclude adult dental services entirely.
- Medicare: Routine dental services, including exams, cleanings, fillings, dentures, and most extractions, are not covered.
- Private: Many plans impose annual benefit caps and restrict coverage for restorative and preventive services, functioning more like a discount program than comprehensive insurance.
Preventive dental care is also not considered an Essential Health Benefit for adults under federal law, which means states and insurers are not required to cover it.
Even when patients have dental insurance, access is far from guaranteed. Many dental providers do not accept Medicaid or Medicare due to low reimbursement rates, leaving CHCs as one of the few consistent access points for publicly insured or uninsured patients seeking dental care.
Making an Impact Beyond the Dental Chair
Oral health affects more than just teeth. Pain, infection, and untreated disease can reduce productivity, with Americans losing more than 243 million hours of productivity each year to oral health problems. Untreated dental disease is estimated to cost the U.S. $45 billion annually in lost productivity. Poor oral health can also influence social interaction and employability.
When patients cannot access routine care, they frequently turn to emergency departments (EDs). Between 2020 and 2022, there was an average of 1.94 million ED visits annually for tooth disorders, often resulting only in temporary relief. Redirecting care to CHCs could save the health care system $1.7 billion each year, while providing patients with definitive treatment.
Looking Ahead
Millions of Americans turn to CHCs each year for dental care, often as their primary or only source of services. Strengthening their role means expanding Medicaid and Medicare coverage, particularly for adults, investing in the dental workforce to reduce vacancies and turnovers, supporting sustained funding to allow CHCs to meet patient demand, and integrating medical-dental care to help catch chronic diseases early and to maximize the impact of every visit.
CHCs are essential to delivering dental care that scales, bridging gaps in a fragmented system, and improving oral health outcomes for millions of Americans. Expanding access to oral health services not only improves individual patient health but also enhances workforce productivity, reduces avoidable emergency care, and strengthens the broader health care system.