Behind bars, beyond care: Oral health in incarcerated populations

Introduction

Current data reports over 11 million incarcerated people (IP) worldwide.^1,2 Overcrowding in prisons is one of several factors that contribute to barriers in accessing oral health care.² Oral health disparities among IP remain an overlooked public health concern.^1-5 Data shows that many individuals enter correctional facilities with significant unmet dental needs, including untreated caries, periodontal disease, and oral lesions.³ Extensive evidence indicates that, compared with the general population, IP are at significantly higher risk of oral disease and poor overall oral health.^1-11

Studies show that IP endure higher rates of dental caries, periodontal disease, oral lesions, oral injuries, oropharyngeal cancers, HIV/AIDS-related oral diseases, and overall poor oral health-related quality of life.^2-5 Major contributing factors to the high rates of oral disease can begin prior to incarceration and are connected to factors such as smoking, poor diet, substance misuse, low socioeconomic status, and limited health literacy.³

Studies report that many incarcerated women have not received routine dental care prior to incarceration, contributing to the development of significant oral health problems during imprisonment.^3,6,7 Additionally, all of these issues that amass prior to and during incarceration result in significant challenges after release and hinder reintegration into society.^3-5

Barriers

It is seldom recognized that IP have a constitutional right to unbiased health care under the Eighth Amendment.⁵ However, this population is often disregarded and forgotten when it comes to addressing the significant lack of care. There are numerous systemic barriers that contribute to the access-to-care problem. Predominantly, IP struggle to receive dental care because of a lack of available services and an overall lack of prioritizing oral health. Closely connected to this is the lack of resources such as an available budget and human resources, including dental providers. This ultimately results in extremely long waitlists within institutions, which often leads to a preference for providing the simplest and least expensive treatment—extractions.³

One study found that correctional facilities categorize dental care into emergency dental care, urgent, nonurgent, and limited-value dental care.⁵ Conditions more likely to receive attention include the presence of pain, infection, and broken or lost dentures. Further contributing to the problem, IP are less likely to receive preventive care and oral health education.^3-5 Inmates may be supplied with oral hygiene aids upon intake but often must purchase replacements on their own.⁵

It is common to have a health screening upon intake into a correctional facility. Unfortunately, there isn’t much follow-up after this initial intake screening. One facility in California had almost 1,000 inmates waiting for dental care, and it was reported there were inmates who ended up waiting eight years or more.⁵

Another study highlighted the shortage of providers in the state of Georgia. In Georgia, 12 correctional facilities are located in areas designated as Dental Health Professional Shortage Areas.⁴ Another example in a women’s prison found that there were two dentists responsible for 1,600 patients. This led to long wait periods, unethical procedures, and claims of unprofessional behavior by the dentists.⁴ Some inmates were told they could only have one treatment completed at a time, and others were advised to wait until they were released.⁴

In addition to these systemic barriers, substance misuse can cause many problems in the oral cavity including decay, bruxism, and other related poor lifestyle choices.^2,5,10

Another barrier is the lack of knowledge and information regarding this population and their incredible access-to-care issues. Many in the public sphere are unaware of just how dire the situation is and how little attention is given to this matter. From frontline staff who interact with incarcerated individuals to policymakers, there is limited detailed information regarding disease prevalence, availability of providers, access to services, and research on oral health interventions.⁵

Attitudes and perceptions of providers and inmates

Incarcerated individuals are a vulnerable population that experiences higher dental and medical needs in comparison to other populations.^1-11 Many individuals may present with preexisting health conditions, mental health issues, or substance misuse problems prior to being incarcerated.^5,6 Due to this, another important barrier to be aware of involves perceptions and attitudes toward and from IP. Studies reveal providers mention low reimbursement and concerns of treating a potentially dangerous population, in addition to logistical problems like transferring inmates to an outside provider.^2,5,11

Additionally, it has been reported that providers may believe IP neglect their dental health prior to incarceration and do not value oral health.⁵ However, the role low dental health literacy and affordability plays in the value system of IP has been acknowledged.^5,7,9

Among IP distrust of the system, facility staff, and providers is another barrier to overcome. Many incarcerated individuals experience distrust toward the system, particularly given the loss of personal liberty associated with incarceration.⁵ Inmates experience dental anxiety just like anyone else and yet may not feel the same empathy or person-centered care that is often extended to the general public. Additionally, there can be cultural mistrust toward female health-care providers.⁵ One study shared a female dentist's experience of inmates questioning whether she removed the entire tooth after she performed a tooth extraction.

Challenges faced after release

Many individuals face barriers to care before and during incarceration. However, the challenges faced in accessing dental care after release is often just as significant if not more difficult.^1-11 It may be assumed access would improve after IP are released, and they would be able to receive the same quality of care as those without a history of incarceration. However, research finds many individuals released from prison experience decreased access to medical and dental care compared to those without a history of incarceration.^5,7,10

Individuals who may have had Medicaid prior to incarceration often have their coverage terminated or paused when they become incarcerated. After release, the individual may once again qualify for Medicaid, but coverage does not start immediately and can take weeks or months for reenrollment.

Additionally, dental care is poorly covered or not a covered benefit of Medicaid for adults. In addition to a lack of insurance, formerly IP may have difficulty in providing proof of residency and income, all of which can lead to difficulties finding employment. According to the Bureau of Justice Statistics, approximately one in three individuals released from federal prison in 2010 did not obtain employment during the four years following release.

Another challenge after release is individuals avoid accessing dental care due to the stigma they feel of being a previously incarcerated person.^3,10 When oral health has been neglected and disease is apparent, low self-esteem can be amplified.^3,10 Individuals may want to avoid assumptions based on their appearance or their oral health, judgment from their past that could lead to discrimination, causing individuals not to seek care.^3,10

Tackling the issues

Oral health among IP is a global issue, and addressing it requires a multifaceted approach that includes workforce expansion, education and training, system innovation, and policy change.^5,7,11 One key strategy involves expanding the oral health workforce by training community oral health educators to provide basic preventive services such as povidone-iodine applications, fluoride varnish, silver diamine fluoride, and oral hygiene instruction. In addition, optimizing the scope of practice for dental hygienists and dental therapists may further improve access to care.

Alongside workforce development, prioritizing routine health screenings and preventive interventions is essential for reducing disease burden. Technological innovations such as teledentistry may also enhance access by reducing geographic and logistical barriers to care.^1,7,9,11

Finally, reintegration programs for formerly incarcerated individuals can play an important role in improving access to services after release by helping individuals navigate the health-care system and strengthen confidence in securing employment.¹⁰

Educating both providers and policymakers about the importance of addressing oral health needs within incarcerated populations is essential. A critical step in this process involves shifting perceptions to recognize that incarcerated individuals are not simply criminals being punished, but human beings with legitimate health-care needs. These biases, whether conscious or unconscious, can be addressed through targeted education and training that emphasizes stigma reduction and the importance of providing equitable care.^4,10

Efforts to increase awareness and comfort in caring for this population may begin in dental and dental hygiene education programs. Incorporating structured and well-supported external rotations in correctional settings could improve access to care while also exposing students to a population with significant unmet oral health needs.¹¹

Despite these challenges, organizations continue to advocate for and expand access to care for incarcerated populations. One example in Oregon is the Medical Teams International mobile dental program, which partners with the Deschutes County Sheriff’s Office in Bend to provide monthly services to inmates. Another example is the Washington State Department of Corrections, which implemented the first department-owned and operated mobile dental clinic to serve incarcerated individuals.¹² These initiatives demonstrate emerging models for improving access to oral health care within correctional systems.

Conclusion

Dental care in prisons is often limited and inconsistent. The care an inmate receives depends on the size of the facility, how many staff are available, and the resources available at the facility.^1,5,7,10 Implementation of oral health services in this population is essential for overall health. This article highlights an access-to-care issue for a vulnerable population and emphasizes the need for improved implementation of consistent, comprehensive dental care in correctional facilities.^1-11

Editor’s note: This article first appeared in RDH eVillage newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.

References

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3. Fiegler‑Rudol J, Tysiąc‑Miśta M, Kasperczyk J. Evaluating oral health status in incarcerated women: a systematic review. J Clin Med. 2025;14(5):1499. doi:10.3390/jcm14051499
4. Oral health in incarcerated persons. CareQuest Institute for Oral Health. https://carequest.org/oral-health-in-incarcerated-persons/
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8. Herlick KM, Martin RE, Brondani MA, Donnelly LR. Perceptions of access to oral care at a community dental hygiene clinic for women involved with the criminal justice system. Can J Dent Hyg. 2020;54(3):133-143.
9. Graves WC, Blanks SH, Caplan LS, Erwin KA, Ditslear CS, Treadwell HM. Factors associated with the utilization of community dental services among newly incarcerated adults. J Ga Public Health Assoc. 2017;6(3):341-347. doi:10.21633/jgpha.6.302.
10. Testa A, Jackson DB, Gutierrez C, et al. History of incarceration and dental care use among older adults in the United States. Am J Prev Med. 2024;67(5):705-712. doi:10.1016/j.amepre.2024.06.023
11. Wickramasinghe D, Gray R, Plugge E. Dental education and prison health: a scoping review. J Dent Educ. 2022;86(10):1292-1303. doi:10.1002/jdd.12953
12. Baptise B. The nation’s first DOC owned and operated mobile dental clinic unveiled in Washington state. Washington State Department of Corrections. January 15, 2025. Accessed April 15, 2026. https://www.doc.wa.gov/news/2025/nations-first-doc-owned-and-operated-mobile-dental-clinic-unveiled-washington-state