Access to Care
Millions of Americans still lack access to both oral health care and primary health care. We are witnessing this situation in the dental world every day, but have you ever thought about how not being able to access dental care at all can be a cause of the opioid crisis? It's a link that is seldom discussed in our clinical textbooks; however, in reality, the link between access and addiction is key to patient safety.
Millions of Americans still lack access to both oral health care and primary health care. We are witnessing this situation in the dental world every day, but have you ever thought about how not being able to access dental care at all can be a cause of the opioid crisis? It's a link that is seldom discussed in our clinical textbooks; however, in reality, the link between access and addiction is key to patient safety.
The Barrier
The primary concerns are precisely what one would anticipate: cost, inadequate insurance coverage, and dental professionals’ scarcity. For many families, a dental visit is a luxury they simply cannot afford. When someone is in extreme pain from an abscess or severe pulpitis but cannot afford a dentist, they usually end up in the Emergency Room. The problem is that ERs are not set up to do actual dental work. They cannot do tooth extraction or perform a root canal. Instead, they often provide a quick fix. This is reflected in the data that nearly 2.1 million people visit the ER annually for dental issues, and over 50% of them are prescribed opioids as a result (Allareddy et al., 2014). This is a direct barrier to safe care because we are prescribing narcotics to bridge a gap in access, rather than fixing the dental problem. Research has shown that even a short five-day supply of opioids can lead to long-term dependence (Shah et al., 2017). So, because the patient could not access a dentist for a permanent fix, they were unintentionally put on a path toward potential addiction. If hygienists were able to get to patients quicker through preventive care or community outreach, then most of these emergency dental visits and the following opioid prescriptions would be avoided.
The primary concerns are precisely what one would anticipate: cost, inadequate insurance coverage, and dental professionals’ scarcity. For many families, a dental visit is a luxury they simply cannot afford. When someone is in extreme pain from an abscess or severe pulpitis but cannot afford a dentist, they usually end up in the Emergency Room. The problem is that ERs are not set up to do actual dental work. They cannot do tooth extraction or perform a root canal. Instead, they often provide a quick fix. This is reflected in the data that nearly 2.1 million people visit the ER annually for dental issues, and over 50% of them are prescribed opioids as a result (Allareddy et al., 2014). This is a direct barrier to safe care because we are prescribing narcotics to bridge a gap in access, rather than fixing the dental problem. Research has shown that even a short five-day supply of opioids can lead to long-term dependence (Shah et al., 2017). So, because the patient could not access a dentist for a permanent fix, they were unintentionally put on a path toward potential addiction. If hygienists were able to get to patients quicker through preventive care or community outreach, then most of these emergency dental visits and the following opioid prescriptions would be avoided.
The Intersection of Access and Prevention
There is a direct and critical link between healthcare access and the opioid crisis. Opioid addiction is a major reason behind the high numbers of displaced persons; a slight problem at first may spin out of control to an addiction that affects all the facets of a person's daily survival. A toothache can turn out to be a final straw to someone who is already at the edge of losing stability. If the intention is to genuinely solve the opioid problem, the healthcare system needs to put first real dental care that will lead to a complete healing rather than the short-term remedy of a drug prescription. Many patients only come to the dentist when they are already in serious pain. By that point, the problem is usually worse and harder to manage. But when people come in regularly, we can treat small problems before they turn into big ones. Fixing the issue early often means less pain, simpler treatment, and no need for strong opioid medications.
There is a direct and critical link between healthcare access and the opioid crisis. Opioid addiction is a major reason behind the high numbers of displaced persons; a slight problem at first may spin out of control to an addiction that affects all the facets of a person's daily survival. A toothache can turn out to be a final straw to someone who is already at the edge of losing stability. If the intention is to genuinely solve the opioid problem, the healthcare system needs to put first real dental care that will lead to a complete healing rather than the short-term remedy of a drug prescription. Many patients only come to the dentist when they are already in serious pain. By that point, the problem is usually worse and harder to manage. But when people come in regularly, we can treat small problems before they turn into big ones. Fixing the issue early often means less pain, simpler treatment, and no need for strong opioid medications.
Access to a dental team means access to Non-Opioid Alternatives is one of them. For example, a massive study of 58,000 patients proved that combining ibuprofen and acetaminophen works better than opioids and is much safer (Moore et al., 2018). We also use practical strategies that don't involve pills at all. Long-acting nerve blocks can keep patients comfortable for hours after they leave us. We can teach them about using cold packs in the first 48 hours to reduce swelling and give clear instructions on rest and hygiene to prevent complications (Niyonkuru et al., 2024). If the actual source is treated, we remove the cause of the pain rather than just masking the symptom.
Proposed Solutions
There are several promising solutions to improve access and reduce opioid risk. For one, Colorado is leading the way by expanding the scope of practice for hygienists. This is huge because it allows us to work more independently in places like schools or rural clinics, basically bringing the care directly to the people who need it most instead of waiting for them to find us. By granting authority to Dental Therapists (SB22, 219), the state has created mid-level providers with the capability of performing definitive cares such as fillings and extractions directly in places where dentists are scarce (Colorado General Assembly, 2022). Going further, the 2025 Sunset Dental Practice Act (SB25, 194) has led to an increase in hygienist autonomy, making it possible for these practitioners to provide unsupervised preventative care. This will gain a potential path to independent prescriptive authority for antibiotics and non-narcotic pain relief (StarChapter, 2025). The legislative shift allows dental professionals to assess patients early and guide them before their pain becomes so severe that they go to the ER and receive opioid prescriptions.
There are several promising solutions to improve access and reduce opioid risk. For one, Colorado is leading the way by expanding the scope of practice for hygienists. This is huge because it allows us to work more independently in places like schools or rural clinics, basically bringing the care directly to the people who need it most instead of waiting for them to find us. By granting authority to Dental Therapists (SB22, 219), the state has created mid-level providers with the capability of performing definitive cares such as fillings and extractions directly in places where dentists are scarce (Colorado General Assembly, 2022). Going further, the 2025 Sunset Dental Practice Act (SB25, 194) has led to an increase in hygienist autonomy, making it possible for these practitioners to provide unsupervised preventative care. This will gain a potential path to independent prescriptive authority for antibiotics and non-narcotic pain relief (StarChapter, 2025). The legislative shift allows dental professionals to assess patients early and guide them before their pain becomes so severe that they go to the ER and receive opioid prescriptions.
We’re also seeing teledentistry become a real game-changer. It’s a great way to triage patients remotely so they don't feel like the ER is their only choice when they’re in pain. It is evidenced by a study that once geographical barriers are lifted through teledentistry, the number of dental visits can be increased by 25% in deprived areas (Johnson et al., 2022). In addition to improving access, this technology has a major cost-saving advantage as 80% of users say that their expenses were less when compared to the traditional in-person visits (Chatterjee et al., 2024).
Another big move is integrated care, which is when we put dental screenings right inside regular doctors’ offices. Such a medical-dental integration (MDI) model makes it possible for providers to access shared electronic health records and communicate with each other in real time (Burkhart, 2025). Integrated healthcare models facilitated over 7.5 million patient visits in 2025 alone, helping early disease identification through shared medical records (Burkhart, 2025). Effective national coordination reveals that integrated models have decreased the percentage of dental patients visiting ER for dental issues by almost 30% and reduced opioid prescriptions for tooth pain by 50% (CDC, 2025). This solution prevents pain from escalating to the point where opioids are necessary.
Capstone Project Development
Personally, this capstone project focuses on addressing a practice area that initially seemed a bit complex and confusing to me. However, it was through my readings, peers' recommendations, and reflecting on my clinical experience that I gradually narrowed my focus to the concept of the dental hygienist being a connecting link. It is well known that dental hygienists stay the longest with patients; therefore, we are the ones who can gain their trust and spot the warning signs that others may overlook.
Personally, this capstone project focuses on addressing a practice area that initially seemed a bit complex and confusing to me. However, it was through my readings, peers' recommendations, and reflecting on my clinical experience that I gradually narrowed my focus to the concept of the dental hygienist being a connecting link. It is well known that dental hygienists stay the longest with patients; therefore, we are the ones who can gain their trust and spot the warning signs that others may overlook.
For instance, one issue is xerostomia. Use of opioids can induce dry mouth, which in turn leads to higher chances of getting caries, infections, and experiencing pain (Korczeniewska et al., 2025). It thus becomes a vicious circle where the patient would keep on needing treatments and thus possibly require more painkillers. By grasping this kind of interrelation, I was able to get a better picture of how oral health issues could be the first signs of wider systemic or behavioral problems. Early detection by dental hygienists allows for counseling and non-opioid interventions, preventing severe oral health issues or painful interventions.
Though it might seem awkward to bring up the substance use topic while in the clinical setting, it is something that just cannot be avoided. The Surgeon General states in his report that addiction is neither a character defect nor a moral failing that people should be blamed for, but rather a persistent illness that should be treated with the same expertise and kindness as heart disease, diabetes, and cancer (HHS, 2016, p. v). With this point of view, I saw my role in a different way, not only as a hygienist giving preventive care to my patients, but also as a supporter of my patients in need without judging them.
Final Thoughts
At the end of the day, having the ability to give a drug such as Naloxone means that dental hygienists are in a position to respond instantaneously to a patient's medical emergency. It also strengthens our role in preventing such cases. These actions demonstrate that expanding access to dental care and emphasizing the preventive role of hygienists not only enhances patient overall health and safety but also helps reduce the unnecessary use of opioids. Being well-informed and standing up for patients means that we make sure that no one will suffer a life risk only because they do not have access or insurance, or because the problem started with just a toothache.
At the end of the day, having the ability to give a drug such as Naloxone means that dental hygienists are in a position to respond instantaneously to a patient's medical emergency. It also strengthens our role in preventing such cases. These actions demonstrate that expanding access to dental care and emphasizing the preventive role of hygienists not only enhances patient overall health and safety but also helps reduce the unnecessary use of opioids. Being well-informed and standing up for patients means that we make sure that no one will suffer a life risk only because they do not have access or insurance, or because the problem started with just a toothache.
References
Allareddy, V., Rampa, S., Lee, M. K., Allareddy, V., & Nalliah, R. P. (2014). Hospital-based emergency department visits involving dental conditions: profile and predictors of poor outcomes and resource utilization. Journal of the American Dental Association (1939), 145(4), 331–337. https://doi.org/10.14219/jada.2014.7
Chatterjee, S., et al. (2024). Evaluating the impact of teledentistry on patient outcomes, diagnostic accuracy, and satisfaction in a prospective observational analysis. Cureus, 16(2), e54424. https://doi.org/10.7759/cureus.54424
Chatterjee, S., et al. (2024). Evaluating the impact of teledentistry on patient outcomes, diagnostic accuracy, and satisfaction in a prospective observational analysis. Cureus, 16(2), e54424. https://doi.org/10.7759/cureus.54424
Colorado General Assembly. (2022). SB22-219: Regulate dental therapists. https://leg.colorado.gov/bills/SB22-219
Colorado Revised Statutes § 12‑30‑108; 109; 110. (2024). Division of professions and occupations.
Dionne, R. A., & Gordon, S. M. (2015). Prescribing opioid analgesics for acute dental pain over time. The Journal of the American Dental Association, 146(4), 213-215. Prescribing Opioid Analgesics for Acute Dental Pain: Time to Change Clinical Practices in Response to Evidence and Misperceptions - PubMed https://pubmed.ncbi.nlm.nih.gov/27517474/
Johnson, T., et al. (2022). Teledentistry for underserved populations: An evidence-based exploration of access, outcomes, and implications. Journal of Research in Medical and Dental Sciences, 10(11), 32–37.
Korczeniewska, O. A., Eliav, E., & Arany, S. (2025). Medication-induced xerostomia: Cross-sectional analysis of salivary flow, intraoral aching, and anxiety. Journal of Clinical Medicine, 14(18), 6624. https://doi.org/10.3390/jcm14186624
Moore, P. A., Ziegler, K. M., Lipman, R. D., Aminoshariae, A., Carrasco-Labra, A., & Mariotti, A. (2018). Benefits and harms associated with analgesic medications used in the management of acute dental pain: An overview of systematic reviews. The Journal of the American Dental Association, 149(4), 256-265.e3. https://doi.org/10.1016/j.adaj.2018.02.012
Niyonkuru, E., Iqbal, M. A., Zeng, R., Zhang, X., & Ma, P. (2024). Nerve blocks for post-surgical pain management: A narrative review of current research. Journal of Pain Research, 17, 3217–3239. https://doi.org/10.2147/JPR.S476563
Shah, A., Hayes, C. J., & Martin, B. C. (2017). Characteristics of initial prescription episodes and likelihood of long-term opioid use; United States, 2006–2015. Morbidity and Mortality Weekly Report (MMWR), 66(10), 265–269. https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm
StarChapter. (2025, August 6). SB25-194 is now law—But what does that mean for Colorado dental hygienists? https://codha.starchapter.com/blog/SB25-194_rule_making_timeline
U.S. Department of Health and Human Services (HHS), Office of the Surgeon General. (2016). Facing addiction in America: The Surgeon General’s report on alcohol, drugs, and health. https://www.hhs.gov/sites/default/files/facing-addiction-in-america-surgeon-generals-report.pdf