Dental. Ugh.

Jessica Lindley

Sep 2

5 min read

I have a question.

Why, in 2026, do we still treat your teeth as though they are somehow separate from the rest of your body?

We talk constantly in healthcare about whole-person care.

We build care management programs around diabetes, cardiovascular disease, behavioral health, kidney disease and dozens of other chronic conditions.

We talk about prevention.

We talk about health equity.

We talk about closing gaps in care.

And then somehow we get to the mouth and say:

Oh, that is dental. Different benefit. Different insurance. Different network. Good luck.

Except the mouth is very much connected to the rest of the person.

Oral health is health

The connection is not theoretical.

The American Heart Association has reviewed growing evidence of an association between periodontal disease and cardiovascular disease, including heart attack, stroke, atrial fibrillation and heart failure.

Researchers are studying several potential mechanisms, including bacteria entering the bloodstream and the effects of chronic systemic inflammation.

That does not mean gum disease has been proven to cause heart disease. It does mean the relationship is significant enough that separating oral health from the rest of healthcare makes less and less clinical sense.

Diabetes provides another obvious example.

The CDC reports that adults with diabetes are 40% more likely to have untreated cavities than similar adults without diabetes. There is also an association between diabetes and periodontal disease, a leading cause of tooth loss.

Here is another number that should get our attention: About 60% of U.S. adults with diabetes had a medical visit in the previous year but no dental visit.

Think about that from a care-management perspective.

We are managing the diabetes — but potentially missing part of the person's health that is directly relevant to managing it.

So why do our benefit structures continue to act as if the mouth belongs to an entirely different healthcare system?

Then I tried to get my teeth cleaned

My recent experience made the disconnect painfully obvious.

I needed something extraordinarily complicated: A teeth cleaning.

I called the dental office my insurance directed me to.

For two days, I tried to get through.

When I finally reached someone, I had been on hold for about 30 minutes.

We went through all of my information.

Then we got to scheduling.

The next available appointment?

December.

And that was not even for the cleaning.

That was for a consultation.

After the consultation, I could schedule the actual cleaning.

Fine. Not ideal, but fine.

Except after going through the entire process, I learned one more thing:

They no longer accept my insurance.

So now I need to call my dental plan, determine which providers are actually in network, start calling offices again and hope I can find someone accepting new patients.

Or I can simply self-pay approximately $150 and get my teeth cleaned.

At some point, the economics become ridiculous.

What is my time worth?

And I work in healthcare

That is the part I cannot stop thinking about.

I understand insurance.

I understand provider networks, benefit structures, managed care, directories, access standards and member navigation.

I know what questions to ask.

And I still spent two days trying to reach an office, 30 minutes on hold and time completing an intake process — only to discover that the provider my insurance directed me to did not accept my insurance.

Now imagine navigating this if you do not work in healthcare.

Imagine being an older adult trying to understand a Medicare Advantage dental benefit.

Imagine being enrolled in Medicaid and trying to determine what adult dental services your state covers — and then finding a provider who accepts your coverage.

Imagine purchasing coverage through an ACA marketplace.

Imagine working an hourly job where 30 minutes sitting on hold has an actual financial consequence.

Imagine having transportation challenges, limited English proficiency or difficulty navigating websites and automated phone systems.

All for a teeth cleaning.

Coverage is not the same thing as access

This is bigger than my annoying experience.

The structure of the dental insurance market itself deserves attention.

In March 2026, the U.S. Government Accountability Office released an analysis of private stand-alone dental insurance markets using 2024 enrollment data.

The findings are pretty remarkable.

In the group dental market, the three largest insurers in each state collectively controlled anywhere from 37.9% to 97.5% of enrollment.

The median?

66.8% of the market was held by the three largest insurers in a state.

In the individual dental market, the median combined share of the three largest insurers was even higher: 69.5%.

And in some states, a single insurer accounted for more than 90% of enrollment.

The GAO also found something else worth paying attention to: research examining concentrated dental insurance markets has found that as insurer concentration increased, reimbursements paid to dental providers generally declined.

That does not prove concentration is responsible for every network-access problem.

But when patients struggle to find participating providers while a small number of insurers hold significant market share, I think it is reasonable to ask more questions about network adequacy, reimbursement and whether the benefit actually translates into care.

We have created an artificial boundary inside the human body

Think about how strange this is.

A health plan may spend enormous resources managing a member's diabetes.

Another benefit structure manages that person's periodontal disease.

A cardiovascular care team focuses on cardiovascular risk and inflammation.

Another network handles the person's gums.

A care manager talks about nutrition and medication adherence.

Dental sits somewhere else.

Different coverage.

Different providers.

Different data.

Different claims.

Different portals.

Different phone numbers.

And then we tell the member we are delivering whole-person care.

We have effectively drawn an administrative line somewhere around the neck.

The body, of course, did not get the memo.

A benefit card is not access

This is a theme I keep coming back to across healthcare.

Coverage on paper does not equal access.

A provider directory is not access.

An insurance card is not access.

A dental benefit buried inside a Medicare Advantage package is not access.

And being technically "covered" does not mean very much when:

the provider listed by the plan does not accept the insurance,
the provider is not accepting new patients,
the first available appointment is months away,
routine preventive care requires multiple appointments,
or the administrative burden of using the benefit exceeds the value of the benefit itself.

At that point, we should stop measuring whether someone has a benefit and start asking whether they can use it.

Maybe it is time to put the mouth back into the person

Healthcare spends enormous amounts of money trying to improve chronic disease outcomes.

We invest in digital engagement.

Navigation.

Care management.

AI.

Predictive analytics.

Member incentives.

Value-based care.

Population health.

And yet one of the most basic components of preventive healthcare remains administratively carved away from the rest of the system.

I am not suggesting that integrating medical and dental care is simple.

It is not.

There are decades of separate financing structures, provider networks, regulations, reimbursement models and benefit design behind the system we have today.

But complexity is not a reason to stop asking whether the model makes sense.

If oral health is connected to cardiovascular health, diabetes, inflammation, nutrition and overall health — and the evidence increasingly tells us that it is — then perhaps our benefit structures should begin reflecting that reality.

Because your mouth is not an optional accessory attached to your healthcare.

Oral health is health.

And getting your teeth cleaned should not require a healthcare strategy consultant.

Digitique Health Strategy & Innovation