The sounds of suction and other dental tools drone in the background as Joseph Kunchik, chief dental officer for Lorain County Health and Dentistry, examines 20-year-old Jesus Cruz. Cruz is in pain after delaying dental care because he could not afford it.
“I stayed up at nights crying because of this," Cruz said. "And then eating, I'm not able to use the whole left side of my mouth.”
Lorain County Health and Dentistry is a nonprofit that provides affordable oral care in a county that is considered an oral health desert — or “dental health professional shortage area,” according to a 2024 report by the Ohio Department of Health. That means there is an “insufficient number of dentists for the population of the county,” the report said. Thirteen other Northeast Ohio counties were named in the report.
Lack of access to dental care can lead to poor dental health in surrounding populations — and a range of non-dental health issues, too, Kunchik said.
“If you have poor oral health, there's a correlation where gingival inflammation creates, sugar issues or diabetes issues," he said. "Another thing, there’s a correlation between poor periodontal health and the oral cavity and the likelihood of low birth weights and preterm labor.”
Oral health problems represent such a threat because teeth are a pathway to other organs.
"Think about how close your mouth is to your airway and to your brain," Dr. Suparna Mahalaha, associate professor at the Case Western Reserve School of Dental Medicine in the Department of Community Dentistry, said. "So, you don't want to have unchecked infection in some of these areas. The worst circumstance is death."
A problem of attraction
Other Northeast Ohio counties named as oral health deserts include Tuscarawas, Coshocton and Wayne. Many are partially rural, such as Lorain County, or largely rural, such as Tuscarawas County.
“It is challenging just to attract any medical providers to rural areas," said Tuscarawas Health Department’s Jennifer R. Demuth. "Oftentimes, dentists want to go to a larger area where there are a higher number of people and a higher number of people who have dental insurance.”
Many dentists also prefer larger cities because a larger number of patients means they can earn higher incomes.
Tuscarawas only had five dentists in 2021, requiring residents to travel long distances to get care, Demuth said.
Also, most of the county’s dentists also do not accept Medicaid, adding another barrier for low-income residents, she said.
“One out of every five Tuscarawas County adults struggles just to pay for their utility bills, their rent, putting food on the table," Demuth said. "When you're worried about having food for your children, dental isn't as high a priority until it becomes a serious problem.”
The Tuscarawas Clinic for the Working Uninsured helps address the problem, she said. The clinic partners with local dentists to negotiate reduced-cost dental care.
Too few local dentists are one reason why Coshocton County had one of the highest rates in Ohio of residents using emergency departments to get their oral health care.
But this does not address root causes of patients’ problems, CAREQUEST Institute for Oral Health’s Rebekah Mathews said.
“When they present in the ED, they're really only able to get maybe some antibiotics and some painkillers to help to address the infection and pain,” she said.
To attract more dentists to counties like Coshocton , many states offer student loan repayment programs for recent dental school graduates.
In Ohio, dentists and dental hygienists practicing in dental shortage areas get up to $25,000 annually in loan forgiveness for the first two years of service and $35,000 annually for the third and fourth years.
Another way to make up for having too few dentists is to integrate medical care with dental care, Mathews said. For example, doctors can provide children with care when it is difficult to see a dentist.
“So that is a way to really help to elevate the focus on oral health as a part of a well child visit,” she said.
A similar approach could also help adults during their checkups. A proposed study in 2026 would focus on oral health integration for adults and people with disabilities in several rural counties in Ohio, including Holmes, Mahoning, Stark and Trumbull.
