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Ethical Dilemma: Access to Care—Is it Really a Crime? by Jack Dillenberg, DDS, MA

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Many Townies have identified “Access to Care” as a crime. Not being sure what perspective some have taken to reach this conclusion, I thought that I would look at it from a few vantage points. I asked myself: Why would someone consider access to care a crime? Do I consider this a crime? Why?

In a general sense it might be a crime that in the country that spends the most on health care and has a deep-rooted commitment to help fellow human beings, we find ourselves with an “access” problem.

Though there are a lot of dentists in America, a significant number of them do not choose to treat poor people, those with dental insurance, or those with complex medical, mental or intellectual disabilities, but instead only treat patients who can pay cash and fit comfortably into their practices. This, in itself, can create an inability for a large number of those with dental needs to receive care in a dental office and thus seek services in an emergency room, community clinic or not seek services at all, contributing to the “access” issue. It isn’t a crime for dentists to choose this option or a crime for patients to seek care in other available locations.

Maybe it’s a crime that we do not have a health care system in place—including real dental insurance—that appropriately compensates dentists for the care they provide. I believe that if dentists were fairly reimbursed for the services they provide, and have simplified administrative procedures to follow from both the public and private dental insurers, many more dentists would participate in the various dental insurance plans and publicly funded programs.

There are critical issues facing many Americans in these difficult economic times. Specifically, even if someone is motivated to maintain their health and wellness, poverty limits their ability to follow through on their efforts to be healthy. Additionally, those in the shrinking middle class are faced with difficult choices such as paying for dental work, college tuition for children, car repairs or medications. Many are being squeezed out of the health care system and have to make these types of choices. Is that criminal?

There is also the situation where an individual may have dental insurance, transportation, financial means, and a ready, willing and able dental provider and they still do not access appropriate dental care. This group makes up 50 percent of the population. This, to me, is an issue that we have to address if we hope to get this population to value good oral health and show up at the dental office.

Many Americans do not value good oral health and see it as an “elective” procedure, only accessing care when in pain. This requires educating the American public and non-dental health providers about the importance of maintaining good oral health through patient accountability of ongoing preventive activities. It also includes emphasizing the association between oral health and overall health. We talk about this a lot but we, and our professional organizations, have not done an effective job at convincing the public to value and insist on receiving quality dental care. We need to develop a meaningful, effective nationwide marketing campaign—not some “cutesy” ads—that is focus-group tested and gets serious about the health issues involved.

I believe that a mobilized, educated public will be the best ally to “decriminalize” the access issue in the eyes of many Townies. Raising the percentage of Americans, who show up at the dental office, even by a few percentage points, would significantly improve the access numbers. Not doing this might be the real crime.

  Author's Bio
Dr. Dillenberg is the inaugural Dean of A.T. Still University’s Arizona School of Dentistry & Oral Health. He received his Master’s Degree in Public Health from the Harvard School of Public Health and completed his dental education at New York University, College of Dentistry. Dr. Dillenberg is a Board Member of the American Association of Developmental Medicine and Dentistry, the Association for Prevention Teaching and Research, the Caplin Family Foundation and is the Vice Chair for First Things First Southeast Maricopa Region and Board Chairman for the Center for Oral Health.
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September 2025
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