This retrospective service evaluation considers the oral health of children with disabilities in post‐Soviet Lithuania. It identifies that they have extensive dental decay and that the predominant course of dental treatment for children with disabilities is tooth extraction under general anesthetic. There is little in the way of specialist service provision, preventative care, or oral health promotion for this group. This study adds to the literature by identifying and emphasizing the impact on oral health of the sweeping economic and political changes, the move toward deinstitutionalization, and new economic trends such as a market economy. In particular, the lack of social welfare support, high levels of child poverty, poor educational outcomes, and the privatization of the oral health‐care system has served to increase oral health inequity for marginalized groups. The outcome is an increase in oral health inequalities for children with disabilities and an urgent need for policy and reform.