Millions of rural residents have not seen a dentist in over a year, a recent CDC report reveals. In 2019, before the coronavirus pandemic forced dentists to shut down, 42 percent of adults in rural areas did not receive dental care, according to the survey. In urban areas, roughly a third of adults did not see a dentist that year.

In both groups, people of color and low-income residents were less likely to have seen a dentist in 2019. These disparities were wider in rural areas, where issues such as transportation barriers, dentist and dental hygienist shortages and lack of health insurance are more common. The coronavirus pandemic has likely exacerbated the need, especially for low-income patients, the report says.

“The things that really went by the wayside [with the pandemic] are the maintenance, the routine exams and the cleanings — things that keep people healthy,” said Katherine Jowers, who oversees oral health programs at the Asheville-based Mountain Area Health Education Center. “ … We’re still dealing with very old treatment plans for patients we haven’t seen in two years. Nothing was on fire so they didn’t come, and now all of their plans are completely disrupted and we have to start from scratch.”

Since cavities and other dental problems don’t resolve on their own, what might have been small areas of decay that could have been addressed with a filling have likely advanced to more extensive decay that requires a root canal or even extraction.

Lower-income patients are already predisposed to forgoing preventative dental treatment because of cost, especially if they aren’t in pain, said Anahita Shaya, a dentist at the Brunswick County Health Department.

“People are having to choose between the necessities of life,” she added. “If they’re having to pay for fillings and a cleaning out of their pocket and that’s against having to pay their electric bill or mortgage or rent, [preventative dental care] is not always at the top of the list.”