In early December, Dr. Michal Herman, a seasoned dentist with over 25 years of experience, received an email that echoed a troubling pattern in her professional life. A teacher from a Newark school had reached out about a 6-year-old student with severe dental issues—his teeth were rotting, and he was homeless.
When the boy arrived at the KinderSmile Foundation’s office in Essex County, Herman quickly assessed the situation: 16 of his 22 teeth needed urgent attention, including fillings, extractions, or baby root canals. For Herman, this wasn’t an isolated case; it was a stark reminder of a larger issue. “We see this all the time,” she said, noting that untreated dental decay among children in New Jersey, particularly those from low-income families, is a significant and recurring problem.
New Jersey’s children suffer from untreated tooth decay at alarming rates, with over a third affected—substantially higher than the national average. Advocates and experts point to the systemic lack of access to dental care for low-income families as the driving force behind this public health crisis.
A Struggling System for Low-Income Families
Despite New Jersey being home to some of the wealthiest households in the country, many of its poorest children are being left behind when it comes to dental health. Even in a state with high-income residents, those living in poverty often struggle to find affordable and timely dental care. A key factor: many dental practices in the state simply do not accept Medicaid, the government insurance designed to assist low-income individuals.
According to the New Jersey Health Care Quality Institute, a recent “secret shopper” survey found that only 49% of the 824 general and pediatric dental offices listed as Medicaid providers would actually accept appointments for a child on Medicaid. Some practices claimed to accept Medicaid but were incorrect, while others were unreachable despite repeated attempts. This lack of accessibility has led to the conclusion that less than 10% of New Jersey’s 4,500 dental providers are accepting Medicaid at all.
Linda Schwimmer, CEO of the Health Care Quality Institute, emphasized the gravity of the situation: “Dental health is critical to infection rates, good nutrition, being focused in school—and it’s one of the largest health disparities we have.”
Health Disparities and the Medicaid Challenge
The challenges in dental care mirror broader health disparities in New Jersey, where middle- and upper-class families benefit from some of the nation’s top-tier medical networks, while low-income and minority communities face much poorer health outcomes. State Health Department data reveals that approximately 36% of New Jersey third graders suffer from untreated tooth decay, a significant jump from the national average of 20%. African American and Hispanic children, as well as those from lower-income neighborhoods, bear the brunt of this epidemic.
While Medicaid is designed to close the gap in health access, its effectiveness is severely limited by low reimbursement rates and a shortage of providers willing to accept the insurance. Oral health advocates argue that this undermines efforts to improve the dental health of disadvantaged children.
Financial Barriers and the Strain on Dentists
The New Jersey Dental Association’s Orville Morales pointed out that the low payment rates from Medicaid for common procedures are a major deterrent for dental practices. For instance, a routine new-patient exam typically costs $90, while Medicaid reimbursement is only about $25. Similarly, a basic tooth extraction costs $190, but Medicaid reimburses only around $75.
These rates are among the lowest in the nation, and they have remained stagnant since 2007. As a result, many dentists, particularly in private practice, are unable to absorb the financial losses associated with Medicaid patients. “Some of the rates are less than a manicure,” Dr. Herman quipped, highlighting the financial strain on dental practices.
This situation is compounded by the general reluctance to treat children, who require more time and patience in the dentist’s chair. Unlike adult patients, children can be anxious or uncooperative, necessitating longer appointments that can be less profitable for practices that operate on a volume-based business model.
Problems with Provider Directories
Adding to the confusion is the inaccurate and outdated information in Medicaid provider directories. The same survey by the Health Care Quality Institute revealed that nearly 37% of practices listed as accepting Medicaid for children do not, in fact, do so. Schwimmer called these faulty directories “ghost networks,” arguing that they create false hope for families trying to secure dental care.
A Child’s Struggle for Treatment
The boy with severe dental decay is one of many children in New Jersey who will require extensive dental work. His treatment at KinderSmile will involve multiple visits, with a dentist working on small sections of his mouth at a time to manage pain and ensure proper healing. However, even after this treatment, his long-term dental health remains uncertain, as the child faces numerous challenges—developmental disabilities, a parent battling cancer, and homelessness.
Dr. Herman’s hope is that the child will be able to continue receiving care and avoid further deterioration of his oral health. But given the many obstacles in the way, that outcome is uncertain. “We hope he’s able to come back regularly so this doesn’t happen again,” she said, a sentiment echoed by many dental professionals fighting to address the oral health crisis among low-income children in New Jersey.
This ongoing struggle highlights the urgent need for systemic changes to ensure that all children, regardless of their economic status, have access to essential dental care. Without reform, the divide between New Jersey’s wealthiest and poorest children will continue to widen, with serious consequences for their overall health and well-being.
Related topics:
Global Dental Market on the Rise: Demand for Advanced Treatments and Technology Drives Growth
Dental Service Pricing and Issues in Macedonia: A Conversation with Dr. Marijan Denkovski
Impact of Rheumatoid Arthritis on Peri-Implant Diseases and Implant Survival: A Five-Year Study
