Dental care is a fundamental component of overall health, yet it remains one of the most overlooked areas in healthcare systems worldwide.[1] Within the Minnesota prison system, dental care can only be accurately described as a public health crisis.[2] While medical and mental healthcare receive some degree of attention in public policy discussions regarding inmate care, oral health is often dismissed as a secondary concern.[3] This reality exists despite overwhelming evidence that poor dental care is directly linked to serious health complications, including cardiovascular disease, diabetes, pneumonia, and other systemic conditions.[4] The mouth is not separate from the body; it is a crucial entry point that can indicate, and sometimes magnify, underlying medical issues.

The importance of dental care compared to its access among the general public is even more prominent in correctional facilities, where incarcerated individuals often enter with preexisting dental conditions due to a history of inadequate oral care. Studies have shown that the oral health of incoming inmates tends to follow the trends of people in lower socioeconomic groups of the general population, which, in a word, is bad.^[5] These disparities correspond directly to the lack of preventative services, such as routine dental exams, which begin at adolescence, Between 2016 to 2021, there has been a 10% decrease in the percentage of low-income children and adolescents (ages 1-17) who had a past-year dental visit for preventative oral care.^[6] This number has continued to decline steadily since, and signals a multitude of problems that may arise from this statistic alone.^[7]

This trend is particularly concerning given the well-established “poverty-to-prison pipeline.” It is no secret that mass incarceration disproportionately affects marginalized communities. Approximately 80% of incarcerated individuals in the United States come from low-income communities, and 67% are minorities.^[8] The systemic barriers that prevent people of these backgrounds from accessing dental care outside of prison do not magically disappear once they are behind bars. In fact, these barriers are aggressively reinforced by policies that enable the deprivation of incarcerated individuals of even the most basic healthcare needs, and are wholly ignored by those who put these systems into place.

In the State of Minnesota, the Department of Corrections contracts out for general physical health, mental health, eye health, etcetera, but does not have a contract for dental care.^[9] This absence is not a mere oversight; it reflects a deeper, systemic failure to prioritize oral health as an essential component of medical care. Still, there are valid arguments as to how privatized healthcare contracts in prisons often lead to poor oversight and diminished quality of care^[10], but at the very least, other aspects of prison healthcare have a basic framework whereas dental care is left without even the semblance of a structured system.

The consequences of this neglect are grim. Incarcerated individuals often wait months or even years for dental treatment, enduring severe pain and the progression of preventable conditions. In many cases, the only solution offered is tooth extractions rather than restorative treatments such as fillings, crowns, or root canals.^[11] This reflects a broader pattern in prison healthcare: quick, cost-cutting measures take precedence over comprehensive, patient-centered care. The result is a cycle of suffering in which incarcerated individuals are forced to live with chronic pain and deteriorating health.

The overall failure to provide adequate dental care in Minnesota’s prisons constitutes a commonly overlooked infringement on the fulfillment of inmates’ basic human needs that is in desperate need of reform, however that may look. This is not to say that the state of Minnesota prison dental care is a blatant Constitutional violation, nor is it to say that simple policy reform is going to get the job done. No, the point is that despite Eighth Amendment protections and empty promises of policy redress, what is happening in Minnesota prisons is wrong and that truth needs to be faced truth head-on. Once that is done, we can finally start to take true steps on the path towards solving this atrocity by treating human beings as such.

Among the many obstacles preventing incarcerated individuals from receiving proper healthcare, financial barriers stand out as particularly egregious. In Minnesota prisons, incarcerated individuals are required to pay a $5 copay for each medical visit, including requests to see a nurse or doctor.^[12] While this amount may seem small outside prison, it poses a significant burden for those earning as little as $0.25 per hour^[13]. This system discourages many from seeking medical care, forcing them to endure illnesses or injuries rather than depleting their already limited financial resources. Some exceptions exist, such as for chronic care visits or emergencies, but for many incarcerated individuals, the copay system creates a major barrier to accessing necessary healthcare and only reinforces the class system endured by free citizens.

A powerful research report put forth in 2018 by the Voices for Racial Justice gathered an abundance of data on healthcare in Minnesota prisons, which includes barriers to adequate health, health impacts of incarceration, and an overall reflection of voices in the community.^[14]  This report explained how the DOC uses the system of copayments, where “[o]ne sick charge of $5.00 can cost a person who is incarcerated 20 hours of work if they are being paid 0.25 per hour.”^[15] An anonymous inmate participating in the research report also brought forward the point that when an incarcerated individual has a health complication, it often requires being seen more than once:

How are you gonna afford a five, or 10, or $15 copay. That’s ridiculous. Especially, what if your thing is not resolved, and you need to keep going back and keep paying those copays, so it’s absolutely not affordable.^[16]

This financial strain leads many incarcerated individuals to forgo medical and dental visits entirely, allowing minor health concerns to escalate into severe, untreated conditions.^[17]

Despite repeated calls for reform, Minnesota’s Office of the Legislative Auditor (“OLA”), the entity responsible for reporting audits, evaluations, and investigations of state programs to the Minnesota Legislature, has done little to address these concerns. The OLA’s most recent comprehensive report on Minnesota prison healthcare is over ten years old, from 2014^[18], and rather than calling for systemic change, the OLA merely updated its report to state that the DOC should ensure that “copayment policies are well understood by facility staff and consistently applied.” ^[19] This unclear response completely ignored the concerns brought forward by the people who are being affected by the copay policy daily, the inmates.

While medical care in Minnesota prisons is already inadequate, the situation for dental care is even more alarming. The DOC’s only formal policy regarding dental care is limited to a single vague statement, “A Minnesota-licensed dentist provides and/or directs responsive, clinically appropriate emergency, urgent, and routine dental care to offenders and residents.”^[20] Unfortunately, Minnesota caselaw and first-hand accounts from inmates make it known that the DOC is turning its cheek to this statement, leading to delays and outright denials of treatment.^[21] Preventative services, such as routine cleanings and checkups, are scarce, and many inmates report being left to endure prolonged pain before receiving any form on intervention.^[22]

The DOC has a separate policy stating that a medical, dental, mental health, and sexual assault risk screening must occur within 24 hours of a person’s arrival at a correctional facility.^[23] And while it has been generally accepted that these initial screenings do timely occur, the issue is in the follow-up, where one formerly incarcerated person reported that the DOC “definitely need[s] to get rid of that two year wait for dental check-ups. That’s outrageous. Oral health impacts all of the other health, so you got cats running around with poor oral hygiene.”^[24] In practice, access to follow-up dental care in Minnesota’s prisons is an uphill battle. Incarcerated individuals must submit a formal request to see a dentist, a process that can take weeks or months before an appointment is granted.^[25] And even when a visit is approved, the range of available treatments is often restricted to the most basic procedures.^[26] Fillings, root canals, and other restorative treatments are often denied in favor of extractions, reinforcing a system where pain management is prioritized over long-term oral health.^[27]

Ultimately, improving prison dental care in Minnesota requires a creative approach that combines legislative action, advocacy efforts, and systemic reforms. The ongoing efforts of legal and public health organizations, combined with policy initiatives such as increased funding and community-based care, offer a path forward toward a more humane and effective system. By prioritizing oral health as an essential component of overall healthcare, Minnesota can take meaningful steps toward ensuring that incarcerated individuals receive the care they need, promoting both justice and public health.

[1] Priyanka Gudsoorkar, BDS, M.B.A., M.P.H & Sujay A. J. Mehta, D.M.D., MPH, Revitalizing the Oral Health Agenda: A Call for Integrated Health Policy and Practice, Academy Health (July 16, 2024), https://academyhealth.org/blog/2024-07/revitalizing-oral-health-agenda-call-integrated-health-policy-and-practice-0.

[2] See discussion supra Part II.

[3] See discussions supra Parts III.B, IV.A.

[4] See Robert H. Shmerling, MD, Gum disease and the connection to heart disease, Harvard Health Publishing (Oct. 8, 2024), https://www.health.harvard.edu/diseases-and-conditions/gum-disease-and-the-connection-to-heart-disease; see also Mayo Clinic Staff, Oral health: A window to your overall health, Mayo Clinic (Mar. 14, 2024), https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475.

[5] Health Disparities in Oral Health, Center for Disease Control (May 15, 2024), https://www.cdc.gov/oral-health/health-equity/index.html.

[6] Id.

[7] Preventative Dental Visit – Children in United States, America’s Health Rankings (2022–2023), https://www.americashealthrankings.org/explore/measures/prev_dent_care_overall.

[8] Tihanne Mar-Shall, The Poverty to Prison Pipeline, L. J. for Soc. Just., Mar. 29, 2021, https://lawjournalforsocialjustice.com/2021/03/29/the-poverty-to-prison-pipeline/.

[9] See MN Department of Corrections, Fact Sheet: Medical and Nursing Services, www.MN.Gov (Dec., 2019), https://mn.gov/doc/assets/Medical%20and%20Nursing%20Services_tcm1089-309010.pdf.

[10] See Mar-Shall, supra note 8.

[11]  Keith Crow, Why doesn’t Rush City prison have a dentist?, Spokesman Reporter (Apr. 17, 2024), https://spokesman-recorder.com/2024/04/17/prisoner-dental-care-mcf-rush-city/.

[12] Minn. Stat. § 243.212.

[13] Filiberto Nolasco Gomez, An Update on Prison Labor in Minnesota, Workday Magazine (Jan. 5, 2022), https://workdaymagazine.org/an-update-on-prison-labor-in-minnesota/.

[14] Voices for Racial Justice, Unfit for Human Consumption: Health and Healthcare in Minnesota Prisons, Minnesota Legislative Reference Library (May 2018), https://www.lrl.mn.gov/docs/2019/other/190451.pdf.

[15] Id. at 40.

[16] Id.

[17] Id.

[18]Office of the Legislative Auditor, supra note 12.

[19] Voices for Racial Justice, supra note 20, at 41.

[20] Minnesota Department of Corrections, Dental Services, § 500.055 (2018).

[21] Voices for Racial Justice, supra note 20, at 43.

[22] Voices for Racial Justice, supra note 20, at 43.

[23] Minnesota Department of Corrections, Incarcerated Person Intake Screening and Processing, § 202.040 (2024).

[24] Voices for Racial Justice, supra note 20, at 43.

[25] Voices for Racial Justice, supra note 20, at 43.

[26] See Keith Crow, supra note 11.

[27] See Keith Crow, supra note 11.