Cost, Fear Kept Many Coloradans From the Dentist

More than one in four Coloradans (25.7% of respondents, which equates to roughly 1.5 million people) did not visit a dentist or hygienist in the past 12 months, according to the 2023 Colorado Health Access Survey (CHAS). Their reasons varied, but the cost of care and fear of dental pain were cited as key barriers.

The CHAS asked Coloradans to rate the health of their teeth and gums and whether they had dental insurance that pays for some or all of their routine dental care. The survey also asked whether respondents had visited a dentist or hygienist in the past 12 months and about specific reasons they didn’t get the care they needed.

Oral Health in Colorado

While most Coloradans believed their oral health to be excellent, very good, or good, nearly one in five (17.6% or about a million people) reported having fair or poor oral health. And one in 20 (5.8%) reported having dental pain that affected their ability to fully participate in regular daily activities like school or work. Put another way, an estimated 330,000 people in Colorado are not living as fully as they could because of dental pain.

Rural Challenges

Coloradans in urban areas reported better oral health (good, very good, or excellent) than those in rural areas (83.0% compared with 78.3%). In Douglas County, nine in 10 people reported good oral health (92.3%).

But people’s oral health varied widely by location. More than three in 10 Coloradans in the San Luis Valley (32.5%), Pueblo County (31.4%), and southeast Colorado (31.0%) reported fair or poor oral health.

Insurance

Insurance was also a significant indicator of whether Coloradans had good oral health. Nearly one in five Coloradans (18.6%) did not have dental insurance to cover some or all of their routine dental care.

And that lack of insurance affected their oral health. Two in five people (42.1%) without dental insurance reported fair or poor oral health. That’s four times the rate of people with private insurance.

Barriers to Care

Coloradans were asked about problems they experienced when they needed dental care. Cost was cited almost twice as often as any other barrier.

Cost of Care

About a third of Coloradans from certain racial and ethnic groups — Black or African American (35.9%), Hispanic or Latino (34.7%), multiracial (35.2%), and Coloradans of some other race (32.3%) — did not see a dentist or hygienist in the past 12 months.

About one in five people (17.2%) did not seek dental care that they needed due to cost. The cost of care was a bigger barrier for American Indian and Alaska Native (31.4%), Hispanic or Latino (22.3%), multiracial (20.1%), Black or African American (19.8%), and Asian (18.3%) Coloradans than for white Coloradans (15.0%).

Understandably, people who could not afford food or housing also could not pay for oral health visits. More than two in five people who did not eat enough because they could not afford food (42.5%) also reported fair or poor oral health. And almost half of Coloradans who were worried about having stable housing in the next two months (45.7%) reported fair or poor oral health.

Fear of Pain

One in 10 (9.6%), which equates to more than half a million Coloradans, avoided the dentist because they were afraid of pain from the procedures. Adults ages 19-49 more often cited their fear of pain as a reason for avoiding the dentist.

Other Barriers

Nearly one in 10 Coloradans (8.0%) reported that they couldn’t find a dentist or hygienist that they could relate to. While the CHAS doesn’t dig deeper into this disconnect, the data show that about two in five Coloradans who speak a language other than English at home (37.9%) did not visit the dentist in the past 12 months (compared with 23.7% of people from English-speaking households).

An oral health provider shortage may be one reason Coloradans who sought care did not get it. About one in 20 people who didn’t see the dentist (4.2%) couldn’t get an appointment because the dental office or clinic was not accepting new patients. And 3.1%, which equates to about 170,000 Coloradans, didn’t have a dental office or clinic in their communities. Provider shortages may also explain why people living in rural areas reported fair or poor oral health more frequently (21.8%) than people in urban areas (17.0%).

More than one in 20 Coloradans (6.9%) did not see an oral health provider in the previous 12 months because they did not understand their oral health benefits. Coloradans with every type of insurance reported this issue, but Medicaid members were three times more likely than other insurance holders to do so. This may be why about a third of Coloradans with Medicaid (35.3%) did not see a dentist or hygienist in the past year.

In 2023, one in 20 Coloradans (5.2%) reported that they did not visit a dentist in the past 12 months because they were concerned about catching COVID-19. And 3.9% of people who didn’t see a dentist in the past year (about 218,000 people) didn’t have transportation to an office or clinic.

Other Health Impacts

Good oral health is connected to better overall health and vice versa. Of the people who reported having fair or poor oral health, nearly a half million people (46.1%) had poor general health. Nearly half of Coloradans who said they had fair or poor oral health (47.6%) also reported eight or more days of poor mental health in the past month. And more than a quarter (26.6%) who did not see a dentist in the past year also did not see a doctor during that same timeframe.

Policy Implications

Many barriers stand between Coloradans and better oral health. The cost of dental insurance, cost of oral health care, and cost of living keep hundreds of thousands from getting the care they need. A lack of providers across Colorado, and especially in rural areas, limits access to care. Policies that could improve oral health across the state include those that build workforce pipelines, address affordability issues, help Coloradans (especially Medicaid members) understand their oral health benefits, and create opportunities for oral health care in local, nontraditional settings.