Eight-year-old Jonah woke up one morning in May with a swollen face and a sore tooth. He refused painkillers that his mother, Geneva Reynolds, tried to give him. He didn’t sleep or eat and was crying all the time.
Within days, Reynolds became desperate and, together with her husband, physically restrained Jonah and poured painkillers down Jonah’s throat as he screamed in pain.
“It broke our hearts,” said Reynolds, who was living in Georgetown, Kentucky, at the time. “And I remember thinking, “It doesn’t have to happen that way.”
Reynolds was unable to find an open dentist who could treat Jonah, who has autism and often refuses dental exams due to his hypersensitivity and anxiety. Dr. Reynolds took Jonah to a nearby emergency room twice over a five-day period because he was suffering from persistent pain and fever from a tooth with exposed nerves that may have become infected. There was no dentist in the ER. In both cases, the family returned home with only painkillers and ice packs.
Nationwide, more children are being admitted to the ER with preventable dental problems. Dentists, hygienists and researchers attribute this trend to a shortage of pediatric dental professionals in rural areas and worsening oral health conditions since the COVID-19 pandemic. Tens of thousands of children end up in the hospital each year with dental emergencies, said Melissa Burrows, senior director of policy and advocacy at the national health nonprofit CareQuest Oral Health Institute.
From 2019 to 2022, emergency department visits for dental problems unrelated to physical trauma increased by nearly 60% nationwide for children under 15, according to a report released late last year by CareQuest. And local data reflects that national trend. Children’s Hospital Colorado in the Denver area saw a 175% increase in non-traumatic dental cases, such as tooth cavities and gum infections, in the ER from 2010 to 2025, said Sara Bonner, a hospital spokeswoman. In Kentucky, where Jonah lives, the number of children visiting emergency departments for dental problems increased 72% from 2020 to 2024, according to the state.
Policy changes under the Trump administration threaten to worsen this trend. President Donald Trump’s Federal Budget Reconciliation Act of 2025, known as the “One Big Beautiful Bill Act,” calls for billions of dollars to be cut from Medicaid, which could force states to limit or exclude dental insurance coverage from public insurance programs for low-income and disabled people. Some states have new eligibility requirements for Medicaid that may affect your child’s access to dental care, even if your child is guaranteed dental coverage under the program. Research shows that when parents lose Medicaid, even children with insurance are more likely to have untreated cavities and less likely to go to the dentist.
The Trump administration has also fostered skepticism about fluoride. Decades of research have shown that fluoride in drinking water and topical fluoride treatments dramatically reduce cavities and prevent tooth decay. In recent months, the Food and Drug Administration has warned medical professionals against the use of fluoride supplements, and the Environmental Protection Agency has released an assessment of the “Potential Health Risks of Fluoride in Drinking Water.” Secretary of Health and Human Services Robert F. Kennedy Jr. called fluoride a “neurotoxin” and an “industrial waste.” A 2025 study in JAMA Pediatrics linked high levels of fluoride to lower IQ in children, but only at concentrations far above recommended levels in public drinking water.
Donald Chee, a pediatric dentist at the University of Washington who studies fluoride hesitancy, worries that this anti-fluoride stance will further erode trust in fluoride treatments. Since the beginning of 2026, lawmakers in at least 15 states have introduced bills to ban or limit fluoride in public drinking water. Utah and Florida became the first states to enact fluoride bans in 2025.
“Does it affect tooth decay rates?” Chi asked. “absolutely.”
Severe dental cases are on the rise
Pediatric dentists Katherine Chin and Chaitanya Puranik said they are treating more patients like Jonah at Children’s Hospital Colorado. More severe cases are also becoming more common. Puranik said he used to typically see patients with just one cavity, but now he frequently sees patients with cavities all over their mouths.
During the pandemic, many dental offices were temporarily closed, and studies show sugar intake, a major risk factor for tooth decay in children, has also increased. Severe cavities that lead to tooth extraction can affect a child’s developing jaw and, in some cases, cause long-term problems with speech and sleep.
Millions of people in the United States live in dental underserved areas, with few dentists within driving distance. What’s more, only one in three dentists treats Medicaid patients because reimbursement rates are low, averaging less than 40% of regular dental costs, according to the American Dental Association.
Children with intellectual or developmental disabilities may have particular difficulty accessing quality dental care. Few general dentists have sufficient pediatric training to care for children with disabilities like Jonah, according to KFF, a health information nonprofit that includes KFF Health News. More than 26% of children have special medical needs, and these children are twice as likely to have unmet dental needs. Their parents are also more likely to report difficulty finding a dentist.
Jonah’s mother said that when he was young, his parents wouldn’t let him brush his teeth, which caused cavities in his baby teeth. After Jonah’s first ER visit, Reynolds found a general dentist with an opening. But unlike trained pediatric dentists, this dentist didn’t know how to examine Jonah in a way he could tolerate and wasn’t prepared to administer sedatives, she said. Jonah left without receiving treatment and soon returned to the ER with a return of fever.
ER rarely provides a solution
Bradley Weitz, a pediatrician in Washington County, Maine, said he treats “the scariest cavities” at Down East Community Hospital.
Weitz said ERs are often ill-equipped to treat dental problems. Like the Kentucky ER that Jonah visited, Downeast doesn’t have a dentist on staff. Weitz often prescribes antibiotics as a temporary measure.
“But a month later, they’re back again because it’s flared up again,” Weitz said.
As a potential solution, states like Maine and Alaska are proposing to use funding from the $50 billion Rural Health Transformation Program to develop oral health workforces and create specialized dental centers that could suddenly better serve children with special medical needs. However, these efforts do not address the expected loss of coverage due to Medicaid cuts. Last year, California awarded $47 million in state grants to develop or expand more than 120 dental facilities serving patients with special medical needs.
Jonah’s dental emergency cost Reynolds a week at work as a dog groomer, three days of Jonah’s third-grade year, and hundreds of dollars in out-of-pocket expenses.
Eventually, Reynolds found an oral surgeon who extracted the tooth. But that didn’t work either, she said. When Jonah became upset about the needle stick, the surgeon threatened to hold him down, Reynolds said. She said the surgeon left immediately after the surgery and did not make a definitive diagnosis as to the cause of Jonah’s pain. Although the procedure resolved his toothache, Reynolds said more professionals need to know how to treat cases like Jonah’s with family sensitivity. Four years later, the incident in which she forced Jonah to take painkillers is still vivid in her memory.
“That never leaves my mind,” Reynolds said.
