Farrell Brenner and Angela Y. Zhang
Eight-year-old Jonah awakened one May morning with a swollen face and a toothache. He refused the ache remedy that his mother, Geneva Reynolds, tried to provide him. He didn’t sleep or eat and cried continuously.
Within a number of days, Reynolds grew to become so determined that she and her husband needed to bodily restrain Jonah, dumping ache remedy down his throat as he screamed in ache.
“It broke our hearts,” stated Reynolds, who lived in Georgetown, Kentucky, on the time. “And I remember just thinking that it shouldn’t have to come to that.”
Reynolds couldn’t discover a dentist with a gap who might deal with Jonah, who’s autistic and infrequently resists dental exams as a result of hypersensitivity and nervousness. Over the course of 5 days, Reynolds took Jonah twice to a close-by emergency room as he struggled with persistent ache and a fever as a result of a possible contaminated tooth with an uncovered nerve. The ER had no dentists; each instances, the household was despatched dwelling with solely ache remedy and an ice pack.
Across the nation, extra youngsters are coming into ERs for preventable tooth issues. Dentists, hygienists, and researchers attributed that pattern to a scarcity of pediatric dental care professionals in rural areas and worsening oral hygiene because the covid-19 pandemic. Tens of hundreds of youngsters find yourself within the hospital for dental emergencies annually, based on Melissa Burroughs, senior director of coverage and advocacy on the nationwide well being nonprofit CareQuest Institute for Oral Health.
ER visits for tooth issues unrelated to bodily accidents rose almost 60% nationally for youngsters underneath 15 years outdated from 2019 to 2022, based on a report launched late final 12 months by CareQuest. And native information displays that nationwide pattern: At Children’s Hospital Colorado within the Denver space, nontraumatic dental circumstances, equivalent to cavities or gum infections, in its ER elevated 175% from 2010 to 2025, based on hospital spokesperson Sarah Bonar. In Kentucky, the place Jonah lives, youngsters’s visits to the ER for dental issues rose 72% from 2020 to 2024, based on the state.
Policy adjustments underneath the Trump administration are poised to worsen the pattern. President Donald Trump’s 2025 federal funds reconciliation legislation, referred to as the One Big Beautiful Bill Act, referred to as for billions in cuts from Medicaid, which can pressure states to restrict or drop dental protection from the general public insurance coverage program for these with low incomes or disabilities. New eligibility necessities for Medicaid in some states might have an effect on youngsters’ entry to dental care, although youngsters are assured dental protection underneath this system. Research reveals that when mother and father lose Medicaid, even youngsters with protection usually tend to have untreated cavities and less likely to go to a dentist.
The Trump administration has additionally promoted skepticism about fluoride. Decades of research present that fluoride in ingesting water and topical fluoride therapies dramatically scale back tooth decay and stop cavities. In current months, the Food and Drug Administration warned health professionals towards the usage of fluoride dietary supplements and the Environmental Protection Agency released an assessment of “potential health risks of fluoride in drinking water.” Health and Human Services Secretary Robert F. Kennedy Jr. has referred to as fluoride a “neurotoxin” and “industrial waste.” A 2025 examine in JAMA Pediatrics linked excessive ranges of fluoride with decrease IQ in youngsters — however solely at concentrations far exceeding the advisable stage in public ingesting water.
Donald Chi, a pediatric dentist on the University of Washington who research fluoride hesitancy, worries that these anti-fluoride stances will additional erode belief in fluoride remedy. Since the beginning of 2026, lawmakers in at the very least 15 states have launched payments prohibiting or limiting fluoride in public ingesting water. Utah and Florida in 2025 grew to become the primary states to enact fluoride bans.
“Will that have an effect on cavity rates?” Chi requested. “Absolutely.”
Severe Dental Cases Rise
Pediatric dentists Katherine Chin and Chaitanya Puranik stated they’re treating extra sufferers like Jonah at Children’s Hospital Colorado. More extreme circumstances have turn into extra widespread, too. Puranik stated he used to sometimes see sufferers with just one cavity, however now his sufferers are sometimes coming in with tooth decay all through their mouth.
During the pandemic, many dental workplaces closed temporarily, and research present youngsters additionally elevated their sugar intake, a significant threat issue for cavities. Severe cavities that result in tooth extraction can have an effect on children’s developing jaws, generally inflicting long-term issues with talking or sleeping.
Millions of individuals reside in dental care shortage areas within the U.S., with scant dentists inside driving distance. On high of that, solely 1 in 3 dentists deal with Medicaid sufferers, as a result of low reimbursement charges, that are on common less than 40% of their typical dental costs, based on the American Dental Association.
Children with mental or developmental disabilities might particularly wrestle to entry high quality dental care. Few normal dentists have adequate pediatric coaching to care for teenagers with disabilities equivalent to Jonah, who’re simply overwhelmed or must be sedated for an examination, according to KFF, a well being data nonprofit that features KFF Health News. Over 26% of children have particular well being care wants, and people youngsters are twice as likely to have unmet dental wants. Their mother and father are additionally more likely to report challenges discovering a dentist.
When he was youthful, Jonah wouldn’t let his mother and father brush his tooth, which led to cavities in his child tooth, his mom stated. After Jonah’s first go to to the ER, Reynolds discovered a normal dentist with a gap. But not like a skilled pediatric dentist, she stated, the dentist didn’t know tips on how to study Jonah in a manner he might tolerate and wasn’t ready to supply sedation. Jonah left with out remedy and was quickly again within the ER when his fever returned.
ERs Rarely Provide Solutions
Bradley Weitz, a pediatrician in Washington County, Maine, stated he’s fielding “the most horrifying cavities” at Down East Community Hospital.
ERs are sometimes ill-equipped to deal with dental issues, Weitz stated. Similar to the ER Jonah went to in Kentucky, Down East has no dentists on employees. Weitz typically finds himself prescribing antibiotics as a brief measure.
“But a month later, they’re back again because it’s flaring up again,” Weitz stated.
As a possible resolution, states equivalent to Maine and Alaska are proposing to make use of cash from the $50 billion Rural Health Transformation Program to develop the oral well being workforce or to create specialised dental care facilities, which may higher serve youngsters with particular well being care wants on quick discover. But these initiatives gained’t handle the lack of protection anticipated from Medicaid cuts. California final 12 months awarded $47 million in state grants to develop or develop over 120 dental services to serve sufferers with particular well being care wants.
Jonah’s dental emergency price Reynolds per week of labor from her job as a canine groomer and Jonah three days of third grade, plus a whole bunch of {dollars} in out-of-pocket prices.
Eventually, Reynolds discovered an oral surgeon who extracted the tooth. But even that went poorly, she stated. When Jonah grew to become upset over a needle stick, the surgeon threatened to carry him down, Reynolds stated. She stated the surgeon left shortly after the process and by no means gave her a transparent prognosis of what brought on Jonah’s ache. The process did resolve his toothache, however Reynolds stated extra professionals ought to know tips on how to deal with circumstances like Jonah’s, with sensitivity to the households. Four years later, forcing Jonah to take his ache meds nonetheless lives recent in her reminiscence.
“That will never leave my mind,” Reynolds stated.
KFF Health News is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Learn extra about KFF.
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