Courtney Sands couldn't escape the throbbing ache in the back of her mouth. The Pennsylvania mom needed root canals and crowns for two molars to get rid of the pain-triggering infection.

But a trip to an endodontist this spring triggered a different type of pain — one that has become familiar to many dental patients. Before the specialist would begin the drilling procedure, his office staff demanded that she pay thousands of dollars upfront.

Sands returned one week later to get crowns for her two molars. Even though she had dental insurance through her job and her husband's, she had to pay before she received care. So she charged more than $6,000 on a credit card with a high interest rate.

The dental insurance plans eventually reimbursed her a fraction of what she'd paid to treat her oral health emergency. One dental insurer gave her $1,000, the other $395.

Sands might be considered among the lucky Americans when it comes to dental care. More than half of U.S. adults don't have consistent access to dental care, and untreated issues such as oral infections can harm overall health. Although many people face these barriers to routine care, dental coverage has gained little traction among political leaders.

Vice President Kamala Harris and former President Donald Trump, have traded barbs over abortion and lowering the price of insulin. One health-related topic neither candidate has emphasized is how to extend dental care to the tens of millions of Americans who lack insurance.

Covering oral care, it turns out, is a popular stance: an overwhelming number of voters want leaders to shore up the nation's patchwork dental care system.

About nine in 10 voters support adding a dental benefit to Medicare, according to a poll of 1,000 registered voters commissioned this summer by the nonprofit CareQuest Institute for Oral Health, which is focused on access and equity, and the Oral Health Progress and Equity Network. The issue has nearly universal support among Democratic voters and 85% support from Republicans.

Neither Harris nor Trump mentions extending dental coverage in their platforms or major speeches. The candidates' priorities in their Sept. 10 debate included the price of groceries and the future of the Affordable Care Act, but neither has consistently advocated for dental care or oral health.

The need for it is undeniable. Nearly 69 million U.S. adults did not have dental insurance or access to routine oral health care last year, according to CareQuest. Millions more lost dental insurance last year when states began to unwind Medicaid coverage for people who signed up during the COVID-19 pandemic.

Medicare, the federal health insurance program mainly for adults 65 and older, does not offer routine dental coverage. Nearly half of Medicare enrollees had not visited a dentist in more than a year as of 2018, according to an analysis by KFF, a nonprofit health policy organization.

"Far too many people in this country have discovered that oral health care is too expensive and out of reach," said Melissa Burroughs, director of public policy at CareQuest. "Yet this issue has been really on the back burner when it comes to policy conversations and the political commitment to addressing it."

More important than abortion?

The CareQuest online poll asked voters to rank nine health topics they considered most important. Adding dental coverage to Medicare ranked the second most important topic, trailing only lower prescription drug costs.

Voters ranked Medicare dental benefits ahead of abortion rights and the future of the Affordable Care Act, topics that get plenty of airtime with the Democratic and Republican presidential contenders. Voters also prioritized dental benefits over access to mental health services, the cost of insulin, medical billing transparency, the opioid crisis, and Medicare eligibility changes.

"This is one of the most popular things in health care, according to voters, and we can't let it continue to fade into the background," Burroughs said.

Consumers who enroll in private Medicare Advantage plans typically have the option of choosing plans that cover dental, hearing, and vision care, but the terms and coverage vary by plan and vendor. Seniors who enroll in traditional government-run Medicare can buy dental insurance. Still, nearly half of Medicare enrollees did not have dental coverage as of 2019, according to KFF.

The 2024 Democratic Party platform calls for adding dental, vision, and hearing to Medicare but it does not detail how it would pay for such benefits, other than "making the wealthy and big corporations pay their fair share."

The Republican plan does not address dental care or oral health.

CareQuest said additional polling showed voters in three closely-watched states broadly supported Medicare dental benefits. More than 90% of voters in Michigan, Ohio, and Pennsylvania supported adding dental benefits to Medicare.

That's no surprise to Sands, who lives in Factoryville, northwest of Scranton, Pennsylvania. She works as a nurse and her husband also has steady employment. But the out-of-pocket costs from her dental emergency mean they have less cash to pay for supplies to continue a do-it-yourself home renovation. She said she has prioritized paying off her credit card balance.

Congress could take on dental care fixes

Although dental care hasn't led the party's campaign speeches, the Biden administration and members of Congress have proposed ways to fill dental gaps.

The administration finalized a rule earlier this year that would give states the option of adding adult dental insurance coverage as part of their Affordable Care Act plans. The 2010 health care law didn't extend dental coverage to adults, but states were required to offer pediatric dental care as an essential health benefit for ACA plans.

Two companion bills in Congress would extend dental coverage through Medicare, Medicaid, and the Veterans Administration and increase the number of dentists, dental hygienists, and dental therapists nationwide. Bernie Sanders, a Vermont Independent, introduced the Comprehensive Dental Care Reform Act of 2024 in the Senate in May. On Tuesday, Rep. Debbie Dingell, D-Michigan, introduced a version of the bill in the House.

Neither bill is scheduled for a vote, and the Congressional Budget Office has not estimated how much the legislation would cost.

Dingell said too many people avoid the dentist because they fear the bill they will get.

"A lack of dental care can worsen other serious medical conditions, but without adequate coverage, millions of Americans go without the critical oral care they need," she said when she introduced the bill last week.

Organizations representing dentists say they support efforts to expand Medicare dental coverage.