Oral Health Is a Civil Rights Issue — Why Don’t We Regulate It That Way?

In May 2025, Florida banned fluoride from its public water systems, becoming the second state to do so. These moves are often framed as victories for personal liberty. But for millions of Americans — especially Black, Latino, low-income, and rural residents — the consequences are real: untreated cavities, systemic infections, and a growing oral health divide.

This divide doesn’t just affect health — it contributes to missed school days for children, job insecurity for adults with visible dental issues, and escalating costs for emergency room visits that could have been prevented with earlier intervention.

Health Equity Excludes the Mouth

While we often speak of health equity, oral health is missing from the national conversation. Despite its links to chronic illness, mental health, and employability, dental care remains legally and structurally separate from the U.S. health system. In effect, we have created a two-tiered approach to prevention — one where oral health protections are optional. This omission fosters a silent epidemic, as communities bear the burden of disease while policy remains inert.

Medicare doesn’t cover dental care. Medicaid leaves it optional for adults. The result? Half of U.S. states provide no comprehensive dental benefits to low-income adults, and even those with private insurance face restrictive caps and exclusions. This regulatory gap isn’t a minor omission — it reflects a deeper legal and ethical failing. The lack of standard coverage means oral health is often treated as a luxury, not a necessity, leading to preventable pain and financial strain for families.

Current federal law mandates access to emergency hospital care regardless of insurance, requires preventive services for children, and prohibits discrimination in medical access. Yet oral health remains excluded from these protections. For populations that are already marginalized, that exclusion has serious consequences: tooth loss, untreated infections, and avoidable systemic disease. In comparison, countries like the United Kingdom and Canada include dental benefits in their public health frameworks — highlighting the preventable nature of these disparities in the U.S.

Fluoride Bans Reveal the Broader Problem

Community water fluoridation has been recognized by the Centers for Disease Control and Prevention (CDC) as one of the ten greatest public health achievements of the 20th century, due to its significant role in reducing tooth decay across the United States. Despite this, recent policy shifts have challenged its implementation.

In 2025, Florida became the second state, following Utah, to enact a statewide ban on adding fluoride to public water systems . This move aligns with Health and Human Services Secretary Robert F. Kennedy Jr.’s directive for the CDC to cease recommending community water fluoridation, citing concerns over potential health risks. However, public health experts warn that such decisions may lead to increased dental health issues, particularly among underserved populations.

Advocacy groups like Moms Against Fluoridation have also influenced public opinion by promoting claims about fluoride’s alleged health risks, despite a lack of consensus in the scientific community. These developments underscore the tension between individual choice and collective public health benefits, highlighting the need for evidence-based policymaking.

In reality, many low-income families cannot afford fluoride toothpaste, lack access to dentists, or live in areas with no oral health infrastructure. Telling these communities that they’re free to “opt in” to prevention — when prevention has been systematically withdrawn — is not empowerment. It’s abandonment. Public health protections shouldn’t depend on ZIP codes, yet that’s exactly what happens when localities roll back equitable interventions.

True choice in health care requires meaningful access. Anything else reinforces inequity. When a system offers theoretical rights but no practical pathway to exercise them, it fails the very people it claims to serve.

Oral Health as a Civil Rights Issue

When legal and policy protections exclude oral care and structural barriers block access, the result isn’t just a policy gap — it’s a symptom of deeper health inequities. A missing tooth can cost a job, erode classroom confidence, or reinforce harmful stereotypes about poverty and responsibility.

We wouldn’t accept limits on vaccines or insulin. Yet we routinely exclude oral health from essential care — a decision that most harms those already marginalized: people of color, immigrants, rural communities, and low-income families. If we’re committed to health equity, racial justice, and economic opportunity, oral health must be treated as fundamental, not optional.

Pathways to Parity

Legal and regulatory parity for oral health must become a policy priority:

• Currently, Medicare does not cover routine dental care, and Medicaid’s adult dental benefits vary by state. This patchwork system leaves many without essential services. Expanding these programs would promote health equity and reduce long-term costs associated with preventable emergency dental visits. It would also align the U.S. with other developed nations that treat oral health as foundational.
• School-based dental sealant programs and community water fluoridation are proven, cost-effective strategies for preventing tooth decay. Recognizing them as essential would ensure access for underserved populations. Public health infrastructure must be inclusive of oral care, especially when we consider the generational impact of early prevention.
• Requiring ethical and legal review for local decisions that may exacerbate health disparities. Local policies, such as fluoride bans, can disproportionately affect vulnerable populations. Ethical review frameworks can help mitigate unintended harms. Just as environmental impact assessments are required for development projects, health equity assessments should precede any decision that could widen disparities.

A Call to Action

Oral health isn’t cosmetic. It is a gateway to general health, dignity, and opportunity. Policymakers, health professionals, advocates, and legal experts must come together to treat oral health as the essential right it is. The path forward requires intentional funding, accountability mechanisms, and a commitment to treating every mouth as if it matters—because it does.