Bridging policy and practice: Advancing access to oral health care

McAllister Castelaz, D.M.D., is a dental clinician and policy expert serving as a dental policy consultant for the Wisconsin Medicaid program, where she develops and operationalizes clinical dental policies. Previously, as clinical and community care director at Virginia Health Catalyst, she led initiatives in teledentistry and strategic partnerships to improve access to care. Her expertise in evidence-based policy and sustainable program design drives her commitment to advancing equitable oral health solutions.

As a board-eligible public health dentist with experience in federally qualified health centers and safety net dental programs, I’ve seen firsthand how oral health policies shape access to care. Now, as a policy consultant for my state’s Medicaid dental program, I work at the intersection of policy and practice — translating systemic challenges into meaningful solutions. Access to oral health care is often discussed as a singular issue, but it is multifaceted. Social drivers of health, including food and water security, transportation, and health literacy, play a significant role in whether individuals can seek, receive and benefit from dental care.

For many, cost is the most significant barrier to care. Medicaid expansion and enhanced reimbursement rates improve affordability, but coverage doesn’t always translate to utilization. Policies that incentivize provider participation — such as reducing administrative burdens and ensuring fair compensation — are critical for increasing access. Additionally, integrating oral health into public health initiatives like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP) can connect families with both dental care and nutritional counseling. Even when patients have coverage, they often struggle to find a provider, especially in rural and underserved areas. Workforce shortages limit availability, and investing in loan repayment programs, leveraging the skill sets of expanded-function dental auxiliaries and supporting safety net clinics helps bridge these gaps. Mobile dental clinics, school-based sealant programs and on-site care for long-term care facilities also extend access to populations that might otherwise go without care.

Transportation barriers and geographic challenges further complicate care delivery, making teledentistry an essential solution for triage, preventive services and consultations. However, access to safe drinking water is just as important to oral health as clinical care. Community water fluoridation remains one of the most cost-effective and equitable methods for preventing tooth decay, yet water insecurity, whether due to lack of access to public water systems or distrust in water quality, can diminish its impact. Public water system improvements, transparency in water quality monitoring and education about the benefits of fluoridation are critical in maintaining public trust and ensuring community water fluoridation’s preventive benefits reach the most vulnerable communities.

Health systems must also accommodate diverse patient needs, including flexible scheduling, extended hours and culturally competent care. Integrating oral health into primary care settings can streamline referrals and improve care coordination. Providers trained in dietary guidance should also understand how social drivers, such as food insecurity, economic instability and cultural food preferences, relate to nutritional choices and oral health outcomes. These systemic factors influence whether patients can follow dietary recommendations, underscoring the importance of addressing oral health literacy and nutrition in a way that is both accessible and realistic.

Public-private partnerships play a crucial role in shaping policies that reflect real-world challenges while ensuring they translate into action. Advocacy efforts led by dental associations, Medicaid agencies and community organizations can push for policies that expand access and protect patient rights. Equitable access to oral health care requires active participation from both public and private sectors. By leveraging the strengths of each, we can transform policies from ideas into sustainable solutions that improve health outcomes for communities in need.