More Kids Are in ERs for Tooth Pain. Trump Cuts and RFK Jr.’s Anti-Fluoride Fight Aren’t Helping.

Eight-year-old Jonah woke up one morning in May with a swollen face and a toothache. He refused the painkillers his mother, Geneva Reynolds, tried to give him. He didn’t sleep, didn’t eat and cried constantly.

Within days, Reynolds became so desperate that she and her husband had to physically restrain Jonah, throwing painkillers down his 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 shouldn’t come to this.”

Reynolds couldn’t find a dentist with an opening who could treat Jonah, who is autistic and often resists dental exams due to hypersensitivity and anxiety. Over the course of five days, Reynolds took Jonah to the nearby emergency room twice as he battled persistent pain and a fever from a likely infected tooth with an exposed nerve. Emergency rooms had no dentists; both times the family was sent home with only painkillers and an ice pack.

Across the country, more and more children are going to emergency rooms for preventable dental problems. Dentists, hygienists and researchers have attributed the trend to a shortage of pediatric dental professionals in rural areas and the deterioration of oral hygiene since the Covid-19 pandemic. Tens of thousands of children end up in the hospital each year for dental emergencies, according to Melissa Burroughs, senior director of policy and advocacy at the nonprofit CareQuest National Institute for Oral Health.

Emergency room visits for dental problems not related to physical injuries increased nearly 60% nationally for children under 15 from 2019 to 2022, according to a report released late last year by CareQuest. And local data mirrors this national trend: At Children’s Hospital Colorado in the Denver area, non-traumatic dental cases, such as cavities or gum infections, in its emergency rooms increased 175% between 2010 and 2025, according to hospital spokeswoman Sarah Bonar. In Kentucky, where Jonah lives, children’s emergency room visits for dental problems increased 72% between 2020 and 2024, according to the state.

Policy changes made by the Trump administration are poised to make this trend worse. President Donald Trump’s 2025 federal budget reconciliation law, known as the One Big Beautiful Bill Act, included billions of dollars in cuts to Medicaid, which could force states to limit or drop the public insurance program’s dental coverage for low-income or disabled people. New Medicaid eligibility requirements in some states could affect children’s access to dental care, even if children are guaranteed dental coverage under the program. Research shows that when parents lose Medicaid, even children with coverage are more likely to have untreated cavities and less likely to go to the dentist.

The Trump administration has also encouraged skepticism about fluoride. Decades of research show that fluoride in drinking water and topical fluoride treatments significantly reduce tooth decay and prevent cavities. In recent months, the Food and Drug Administration has warned health professionals against using fluoride supplements, and the Environmental Protection Agency has released an assessment of “potential health risks from fluoride in drinking water.” Health and Human Services Secretary Robert F. Kennedy Jr. called fluoride a “neurotoxin” and an “industrial waste.” A 2025 study in JAMA Pediatrics linked high fluoride levels to lower IQ in children — but only at concentrations far exceeding the recommended level in public drinking water.

Donald Chi, a pediatric dentist at the University of Washington who studies fluoride hesitancy, worries that these anti-fluoride stances will further erode confidence in fluoride treatment. Since the start of 2026, lawmakers in at least 15 states have introduced bills banning or limiting fluoride in public drinking water. Utah and Florida in 2025 became the first states to ban fluoride.

“Will this have an effect on caries rates? » Chi asked. “Absolutely.”

Increase in serious dental cases

Pediatric dentists Katherine Chin and Chaitanya Puranik said they are treating more patients like Jonah at Children’s Hospital Colorado. More serious cases have also become more common. Puranik said he usually sees patients with just one cavity, but now his patients often arrive with tooth decay throughout their mouth.

During the pandemic, many dental practices have closed temporarily and studies show that children have also increased their sugar intake, a major risk factor for cavities. Severe cavities that lead to tooth extraction can affect children’s jaw development, sometimes causing long-term problems with speaking or sleeping.

In the United States, millions of people live in areas where dental care is scarce and there are few dentists within driving distance. Additionally, only one in three dentists treat Medicaid patients, due to low reimbursement rates, which average less than 40 percent of their typical dental costs, according to the American Dental Association.

Children with intellectual or developmental disabilities may particularly struggle to access quality dental care. According to KFF, a nonprofit health news organization that includes KFF Health News, few general dentists have sufficient pediatric training to care for disabled children such as Jonah, who are easily overwhelmed or need to be sedated for an exam. More than 26% of children have special health care 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.

When he was younger, Jonah wouldn’t let his parents brush his teeth, which led to cavities in his baby teeth, his mother said. After Jonah’s first visit to the emergency room, Reynolds found a general dentist with an opening. But unlike a trained pediatric dentist, she said, the dentist didn’t know how to examine Jonah in a way he could tolerate and wasn’t prepared to sedate him. Jonah left without treatment and was soon back in the emergency room when his fever returned.

Emergencies rarely provide solutions

Bradley Weitz, a pediatrician in Washington County, Maine, said he performs “the most horrible cavities” at Down East Community Hospital.

Emergency rooms are often ill-equipped to treat dental problems, Weitz said. Similar to the ER Jonah went to in Kentucky, Down East does not have a dentist on staff. Weitz often finds himself prescribing antibiotics on a temporary basis.

“But a month later they are back because things are picking up,” Weitz said.

As a potential solution, states like Maine and Alaska are proposing using money from the $50 billion Rural Health Transformation Program to expand the oral health workforce or to create specialty dental care centers, which can better serve children with special health care needs in a short time frame. But these initiatives will not solve the loss of coverage predicted by Medicaid cuts. Last year, California awarded $47 million in state grants to develop or expand more than 120 dental facilities to serve patients with special health care needs.

Jonah’s dental emergency cost Reynolds a week of work as a dog groomer and Jonah three days of third grade, plus hundreds of dollars in out-of-pocket expenses.

Eventually, Reynolds found an oral surgeon who extracted the tooth. But even that went wrong, she said. When Jonah became upset over a needlestick, the surgeon threatened to hold him down, Reynolds said. She said the surgeon left quickly after the procedure and never gave her a clear diagnosis about the cause of Jonah’s pain. The procedure resolved his toothache, but Reynolds said more professionals should know how to handle cases like Jonah’s, with sensitivity to families. Four years later, forcing Jonah to take his painkillers is still fresh in his memory.

“It will never leave my mind,” Reynolds said.