New research exposes a deep dental divide across the country

Thirty percent of financially struggling adults in the US have said they went without needed dental care over the previous year because it was more than they could afford—this is compared to 10% of financially stable adults. This is according to the latest data from United For ALICE, a US research organization that drives innovation, research, and action to improve life for households in hardship.  

ALICE (standing for Asset Limited, Income Constrained, Employed), exposes a substantial oral health gap between individuals who can and cannot afford household basics—linking financial hardship with less access to dental care and poorer health outcomes. 

Who is ALICE? 

ALICE households bring in less than the basic costs of housing, childcare, food, transportation, healthcare, and technology, plus taxes—but since their income is above the Federal Poverty Level, they often don’t qualify for assistance. Combined, ALICE households and those who are financially struggling fall below the ALICE Threshold of Financial Survival and, in 2023, made up 42% of all households nationwide. That’s nearly 55 million households that struggled to make ends meet. 

The ripple effects of skipping the dentist 

The latest research reveals that in 2024, 13% of adults below the ALICE Threshold said they had not visited a dentist in five or more years, compared to 7% of adults above. Skipping the dentist can have heartbreaking consequences, as shown in the personal stories captured by the United For ALICE photo essay, “Paying the Price: When Dental Care is a Luxury.” 

“Oral health is a window into our overall health and wellbeing,” said Kiran Handa Gaudioso, president of United For ALICE. “When we postpone or forgo dental visits, it doesn’t just affect our smiles. It can lead to serious health issues impacting our confidence, our ability to work and our quality of life. Basic dental care should never be a luxury. It’s a necessity that helps ALICE, and our communities, to thrive.” 

What else does the research uncover? 

ALICE data shows that across the US: 

• In 2024, adults below the ALICE Threshold were nearly twice as likely to have lost six or more teeth due to decay or gum disease as financially stable adults. 

• Approximately 38% of households in hardship were in communities that lacked dental services nearby in 2023. 

• The dental divide starts early: In 2023, 79% of parents below the ALICE Threshold had children who received dental care over the previous year, compared to 89% of parents above. 

Making matters worse, dental insurance is far less available than medical insurance. About 26% of adults nationwide lacked dental insurance in 2024—leaving many without coverage for even basic preventive care. 

Turning data into action 

“This research gives us more than numbers. It offers a roadmap,” said Stephanie Hoopes, PhD, national director of United For ALICE. “By pinpointing where and why access to dental care breaks down, we can help policymakers, providers and communities design targeted solutions that close the gap. That’s how real progress begins—with accurate data that sparks action.” 

Take the first step. Dive into the national and state-level data on the ALICE and the Dental Divide webpage.  

Author’s note: ALICE and the Dental Divide was funded by the CareQuest Institute for Oral Health