Rural dental providers are facing compounding challenges making it more difficult to treat patients and operate their practices.
Here are three areas straining rural dental care access:
Medicaid cuts
Low Medicaid reimbursements are putting dentists in a tight financial position, particularly for rural providers whose patient base is primarily made up of Medicaid recipients. Compounding the issue is federal budget cuts that are expected to create a turbulent situation for both providers and patients.
HR 1, enacted in July 2025, is expected to lead to a decrease in Medicaid spending by nearly $1 trillion over the next 10 years. The bill has been criticized by many organizations, with many leaders denouncing the bill’s cuts to healthcare. Some states have also enacted or begun considering dental benefit changes as a way to save money in light of these cuts. For example, Colorado implemented a $3,000 annual cap for dental benefits, while Washington, California and Idaho have cut reimbursements rates.
Wade Rakes, CEO of the CareQuest Institute for Oral Health, told Becker’s that the organization has partnered with the National Association of Community Health Centers to bring greater attention to the need for high-quality oral healthcare and support for safety net providers.
“The pressure on the overall system, when you pull hundreds of billions of dollars out of Medicaid, is going to come to their doorsteps, and is going to increase the level of pressure that many of these small tax-exempt, nonprofit organizations are going to be facing,” he said. “The centers have made their case consistently, but again, because much of the impact of the bill was backloaded — meaning passed in one year, but really the effectuation coming in 2027 — there are a lot of unknowns, but what we do know from history is that this is going to put a tremendous amount of pressure on an already strained system.”
Fluoride
Community water fluoridation began being contested in 2023 after the National Toxicology Program concluded in a report that higher levels of fluoride exposure are associated with lower IQ in children. Several organizations have criticized the research methodology used for the report and reiterated their support for water fluoridation. Still, several states and municipalities began enacting or weighing legislation to ban water fluoridation. Florida and Utah became the first two states to ban public water fluoridation statewide last year.
HHS Secretary Robert F. Kennedy Jr. has also taken issue with water fluoridation several times since stepping into his role. During an April 2025 cabinet meeting, he reportedly said fluoride made kids “stupider,” and said he plans to scale back the amount of fluoride in the country’s drinking water. During an appearance on Fox News, he admitted the U.S. will see “probably slightly more cavities,” referring to this increase as a “balance.”
An increase in oral health issues among patients stemming from reduced fluoride levels could further strain dental providers at a time when wait times for appointments are already high and clinics and practices continue to struggle with ongoing workforce shortages.
“If we eliminate community water fluoridation, we’re going to go back to a time when, as I did early in my career, working as a pediatric dentist before there was water fluoridation, I was doing quadrant dentistry all day long,” Rick Valachovic, DMD, the executive director of the NYU Dentistry Center for Oral Health Policy and Management, told Becker’s. “I think that pulling fluoride out of the water is going to dramatically impact the level of caries and then the sequelae of, either restoration or extraction.”
Practice closures
Several dental clinics have closed in recent years over financial challenges as operational costs surge in healthcare. Becker’s has reported on numerous closures just in 2026.
A dental clinic operated by the Hamilton County Health & Social Services Division in Chattanooga, Tenn., closed in July because of operational and supply cost increases. The dental clinic experienced a 47% increase in operational expenses and a 513% jump in supply costs over the past five years. Buffalo, N.Y.-based Kaleida Health also announced the closure of Gundlah Dental Clinic in Olean, N.Y., over financial headwinds and workforce limitations. A spokesperson told Becker’s that the closure is part of a $200 million strategic plan to strengthen the health network’s long-term sustainability and enhance patient care. The clinic has faced ongoing financial performance challenges, workforce limitations and reimbursement pressures, incurring losses exceeding $800,000 over the last five years.
The closure of clinics could lead to increased emergency department visits at local hospitals. However, hospitals are facing the same challenges as dental clinics, with some having to make the same difficult decision to shut down.
More than 100 rural U.S. hospitals have closed in the past decade, with 110 closing since 2015, according to a July 21 Center for Healthcare Quality and Payment Reform analysis. The report also found that 700 rural hospitals across the U.S., or about one-third of all rural facilities in the country, are at risk of closing due to severe financial challenges.
“Rural communities suffer significantly higher incidences of disease because of access challenges, particularly around specialty care and disease management in oral health. If there is not an emergency department available, or if the hours have changed, that is only going to make what is already an existing crisis in oral health for individuals in rural communities that much harder,” Mr. Rakes told Becker’s. “What it will do is add pressure to the system that is only going to increase the overall costs for everyone in the system, including those state payers in their programs.”
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