Behind Bars – The Overlooked Crisis of Oral Health in Prisons

The Eighth Amendment in the United States prohibits cruel and unusual punishment, which mandates that prisoners must be protected from “deliberate indifference to their serious medical needs”, which includes dental care.

However, despite being the only population in the United States with a constitutional right to healthcare, incarcerated individuals usually face extreme barriers to accessing basic dental services. This issue disproportionately affects marginalized communities, especially Indigenous people, African Americans, and the Latinx community, who are incarcerated at rates significantly higher than white populations despite making up a smaller percentage of the overall population. Canadian incarceration statistics show similar patterns. Indigenous inmates represent 30% of incarcerated individuals in federal prisons, despite only being five percent of the total Canadian population. This over-representation of racialized communities is due to several factors, including systemic barriers and neo-colonial policies. The Indian Act in Canada and U.S. segregation laws have created lasting systemic racism in the justice system, shaping how courts and policing operate today. These laws laid the groundwork for racial profiling and unequal access to legal and social services, particularly for Indigenous and Black communities. For example, practices like carding in Canada and stop-and-frisk in the U.S. disproportionately target racialized groups, while both countries show clear racial disparities in sentencing and access to fair trials. Over-policing, under-protection, and limited service access for marginalized populations are contemporary examples directly rooted in these historic acts and policies.

Incarcerated individuals have long been the forgotten population of many regions; however, whistle blowers and other reports have been raising alarms regarding prison conditions for decades. With the rise of social media, we are even more likely to hear from previously incarcerated people and hear their experiences within the prison system. From this comes a growing yet mainstream concern, prisoner oral health. Accessing specific health services in federal services is difficult due to what is deemed essential, despite the United Nations calling for the same access to services for incarcerated people as their local community. With the privatization of dental care within Canada and the US, of course, this means it is even harder for those who are incarcerated. This is where the neglect and inaccessibility of oral health intersect with broader systems of incarceration and punishment.

Oral health access in prisons is a silent crisis. A report revealed alarming statistics: over 50% of incarcerated individuals reported experiencing dental problems while incarcerated. The dental care they do receive is usually limited to emergency procedures, like extractions to relieve pain, rather than restorative work such as fillings, root canals, or crowns. The Federal Bureau of Prisons’ policy went as far as to say that “dental care will be conservative”, indicating that preventative or restorative treatments were not an option. Rodney Roberts spent eight years in prison for a crime he did not commit. During that time, he had three teeth extracted for three minor cavities. “They could have filled some of the cavities, capped or crowned my teeth, but I was never given that option,” he shared. He also suffered ongoing pain after the procedures due to not being prescribed proper pain medication. After his release, the condition of his teeth left him self-conscious and unable to enjoy even his favourite meals.

This bare minimum approach stems not only from resource constraints but also from a lack of dental staff available. At one California federal prison, nearly 1,000 inmates were on the wait list for dental care, with some waiting up to eight years to be seen. When inmates finally do get care, many testify that dentists often “just gave painkillers or pulled the tooth”, further compounding trauma and limiting long-term options. The way dentistry is marketed to both professionals and patients often overlooks marginalized environments such as prisons. This contributes to a lack of staffing and limited access to care in these settings. Dental education should do more to emphasize that oral health care is a right and that dentistry must serve all communities, including those that are routinely excluded. Privatization complicates this issue further. For example, when prison dental services make a contract with a for-profit company, cost-cutting becomes a priority rather than comprehensive patient care. This often leads to understaffing, rushed appointments, and restrictions on complex or expensive procedures, ultimately affecting the quality of care for incarcerated individuals. An example of this is a privately held correctional healthcare company known as Wexford Health Sources, which has contracts with 100 prisons. Former employees reported that patients at one of their correctional facilities in Illinois received “poor healthcare” and that a dental assistant had used the same needle on two patients.

Such treatment, or rather the lack of it, not only causes physical pain. Oral health is deeply linked to self-esteem, social engagement and even employability. The absence of visibly decayed teeth can significantly hinder an individual's ability to secure jobs after release, especially those involving face-to-face interactions like customer service or sales. Even in seeking employment, many have complained that it is much harder to find employment as employers make judgments based on physical appearance right away. Formerly incarcerated people already face major socioeconomic barriers, and poor health becomes another obstacle in their battle to reintegrate into society.

The impact of incarceration on oral health is not just limited to the time spent behind bars. Upon release, access to dental care remains limited because of high costs, lack of insurance, and re-entry challenges. Many formerly incarcerated individuals prioritize finding housing and employment over addressing dental needs, even though oral infections and periodontal disease can severely impact overall health. Similar trends persist even internationally. In India, for example, a study of life-sentence inmates revealed a 97.5% prevalence of dental caries, with over 60% requiring tooth extractions and nearly 98% needing basic oral hygiene instruction. Globally, incarcerated populations consistently report poorer oral health outcomes than the public, exacerbated by institutional neglect and systemic inequities. Comparing international data helps reinforce advocacy by showing that prison-related oral health disparities are not isolated issues; instead, they are part of a global pattern that demands coordinated solutions that are human rights-based.

Recognizing these injustices, some reforms have been proposed. Advocates call for oral health screening upon entry to prison, better training for dental teams, and the integration of oral health into re-entry planning. Policies like teledentistry, fluoride access, and expanding Medicaid dental benefits are gaining attention as essential tools to close these gaps. There is strong expert consensus that access to dental care, both during incarceration and after re-entry, is closely linked to overall well-being and can help prevent recidivism. Untreated dental pain often leads individuals to self-medicate or avoid employment opportunities, increasing the risk of returning to incarceration. The treatment of incarcerated people is often inhumane, and continuing to deny one of the most vulnerable populations access to essential care does not lead to rehabilitation, but rather the opposite. If we believe that dental care is a human right, then this must also extend to incarcerated individuals, including comprehensive and dignified care.

Acknowledgement: We thank Dr. Rachael Nolan for her insightful review and valuable feedback on earlier drafts of this piece.

Authors: Yara Shaban and Ashleen Parmar