If you hate going to the dentist, you’re not alone. Dental fear and phobia is a real thing and can make even thinking about going to the dentist scary. But, what about when you want to go to the dentist but can’t make a checkup a reality because you can’t afford it, can’t get to the dentist or there’s a lack of dental care options where you live?

All of these situations are a reality for many people across the nation, according to a new report from WalletHub.

The U.S. Centers for Disease Control and Prevention reports that 36 percent of adult Americans have gone 12 months without seeing a dentist – whether as a result of dental fear, wanting to save money, a lack of access to care or concerns over affordability.

But, skipping the dentist can be even more costly than the price of a checkup.

“When you miss a checkup, issues you may have are not being addressed, which means the potential for serious problems to develop,” said Dr. Ettienne van Zyl, a Rogers, Arkansas, dentist.

It’s not just cavities you’re at risk for; when conditions such as gum disease or tooth decay are untreated, other health conditions such as endocarditis (inflammation of the lining of the heart muscle), diabetes and stroke can occur.

Additional risks include the development of diabetes, Alzheimer’s, dementia, preterm labor and low birth weight in babies.

WalletHub’s report also revealed that whether individuals had access to fluoridated drinking water also made a significant difference in oral health.

“Fluoride plays an important role in strengthening the teeth against acid erosion and the bacteria that cause tooth decay,” van Zyl said.

As part of their report, WalletHub compared the 50 states and the District of Columbia in 26 key indicators of dental wellness. These factors included the cost of dental treatment and how people felt their oral health affected their quality of life.

The top state for oral health was Wisconsin, with a score of 75.69, followed by Illinois and Minnesota.

Arkansas ranked No. 50 out of 51, with a score of 34.63

Mississippi was last on the list with a score of 33.74.

Source: WalletHub. 2020’s States with the Best & Worst Dental Health. 6 February 2020.