In the early 1970s, only 5 percent of employees of large companies had dental insurance, while only 13 percent lacked medical insurance. By 2008, only one in every six lacked health insurance, but one in four lacked dental insurance. According to “Health Insurance is a Family Matter,” dental care is the largest unmet health need among U.S. children and adults. The reasons are complex.
Dental Not Considered Medical
The reason dental care was excluded from early health insurance coverage was that dental work was not performed by physicians or hospitals, according to "Jonas and Kovner's Health Care Delivery in the United States." Dentists were not considered full medical professionals, thus their work was not considered medical care by insurance.
Until preventive dental care by dentists was proven effective, dental care consisted of only repairs and removal of teeth and replacement with dentures. This meant that dentistry was historically relatively inexpensive. Because cavities occurred slowly and could be managed with pain medicine, they were also not considered emergencies for which insurance would be justified. The dental visit could be delayed until money was saved or payment alternatives arranged.
Health insurance became common because of wage freezes during Word War II. This led to medical insurance through employers becoming widespread. Dental insurance was not commonly offered and it did not spread.