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In Alabama’s Black Belt, you can drive 60 to 90 miles without passing a single dental provider. According to the Alabama Department of Public Health, several counties—including Perry, Greene, Lowndes, and Wilcox—have one or no dentists at all. Residents often live with chronic pain, untreated infection, or shame so deep they stop smiling altogether. In policy terms, this is a “dental desert.” In human terms, it’s a crisis.
Yet, oral health remains on the periphery of mainstream health policy. Medicare does not cover routine dental care. Medicaid dental benefits for adults are optional, and Alabama is one of a dwindling number of states that provides no comprehensive dental coverage for adults. This leaves millions across the South—particularly in rural or low-income areas—with limited or no access to preventive oral care and disproportionately higher rates of untreated dental disease. Meanwhile, national health equity initiatives often omit dental care from reform efforts, even though it intersects with employment, education, chronic illness, and personal dignity. As the National Institutes of Health’s (NIH’s) 2021 Oral Health in America report notes, this exclusion reflects longstanding policy choices that treat dental care as essential for children but optional for adults—despite clear evidence of its impact on economic productivity, chronic disease, and health equity.