Racial Disparity in Dental Care
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Table of Contents
- Understanding Racial Disparity
- Racial Disparity
In 2000, the Office of the Surgeon General released its Surgeon General’s Report on Oral Health in America. As the most comprehensive summary of research on oral health released to that time, it was a groundbreaking report that emphasized the importance of oral health, repeatedly underscoring the importance of oral care as a primary indicator of overall and general health.
The report also established that dental and oral care had improved greatly in the U.S. since the 1960s, but that some Americans were not benefitting from these improvements. It named oral disease as a “silent epidemic” that was affecting our most “vulnerable” citizens, including those in racial and ethnic minority groups. While providing a framework for action, the report called for more research into the apparent disparity in dental and oral health care.
Today, over 20 years later, this racial disparity is still present in oral health and dental healthcare. Across the country and across age groups, individuals from black and Hispanic populations face worse oral health outcomes than non-Hispanic white populations of the same age groups.
What causes this gap in dental health and care? And what can be done to close it? There are no easy answers or solutions, but looking at the past and present may help us to create a better future.
Understanding Racial Disparity in Dental Care
Health disparities are explained by the Centers for Disease Control and Prevention (CDC) as “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”
As in many other aspects of health care, there is a disturbing and undeniable racial disparity in dental care across the U.S. One needs to look at only a few of the many statistics to see that this disparity is evident across all age groups.
These statistics are from data collected by the CDC between 2011 and 2016:
- About 28 percent of non-Hispanic black children aged 2 to 5, and around 33 percent of Mexican American children aged 2 to 5, had cavities in their primary teeth, compared with 18 percent of non-Hispanic white children.
- Compared to non-Hispanic white adults aged 20 to 64, almost twice as many non-Hispanic black or Mexican American adults in that age group had untreated cavities.
- In older adults (65 years and older), the rate of untreated cavities experienced by non-Hispanic black or Mexican American adults was 2 to 3 times higher than that of non-Hispanic white adults.
To try to understand the racial disparity in dental care, one must look further into the history of interpersonal and structural racism and how it has affected various populations.
According to the CDC, significant research shows that the country’s history of racism has greatly affected minority communities. This reaches into every aspect of life, and it fosters many inequities in the health care system.
One must also consider the perception of dental health care in comparison to other types of healthcare. Dental and oral health is often seen as separate from, or less important than, general health. Research has shown this is not true.
Oral health is an important indicator of overall health. Poor oral health may be linked to chronic health problems, respiratory problems, and even heart attacks. Still, the perception of oral health as a more minor concern contributes to racial disparities on oral health.
Because of it, disadvantaged populations are less likely to have awareness of the importance of oral care, researchers and community outreach programs may get less funding and/or support, and communities are less likely to create resources for dental and oral care services.
Socioeconomics, Social Determinants of Health (SDOH) & How They Relate to Racial Disparity in Dental Care
According to the American Psychological Association, socioeconomic status doesn’t just relate to income levels. It reaches to educational achievement, perceptions on social class, and financial opportunities. There is a distinct relationship between race and socioeconomic status, and this extends to access to health care.
Again, the statistics regarding race and socioeconomics make the inequities in our society clear:
- A 2014 study showed that 39 percent of black children and adolescents, and 33 percent of Hispanic children and adolescents, were living in poverty, while only 14 percent of the same age group in non-Hispanic, white, and Asian populations were.
- In 2019, the poverty rate for white populations was 9 percent, compared to 21.2 percent for black populations, 17.2 percent for Hispanic populations, and 24.2 percent for American Indian and Native Alaskan populations.
- In 2019, the average unemployment rate was 6.1 percent for black adults and for American Indians and Alaskan natives, 4.3 percent for Hispanic adults, and 3.3 percent for white adults.
- In 2019, the median weekly wage and salary earnings of full-time workers in 2019 were $706 for Hispanic adults, $735 for black adults, and $945 for white adults. The earning disparity across races was not dependent on industry or occupation.
- In 2013, 12.4 percent of African-American college graduates between the ages of 22 and 27 were unemployed. This is more than double the rate in all college graduates within that age range.
- Black and Hispanic children have higher dropout rates and are more likely to attend high-poverty schools than white children.
The CDC defines social determinants of health as nonmedical factors that affect overall health outcomes. They identify five areas they are focusing on for their Healthy People 2030 campaign.
With taking into account the socioeconomic disadvantages faced by non-white populations, one can take these social determinants of health into consideration when examining racial disparity in dental care.
Healthcare Access & Equity
- Higher unemployment and higher levels of poverty result in less families and individuals with dental insurance.
- Children living in poverty may be less likely to receive preventative dental care or learn to perform daily oral hygiene routines.
- Discrimination and bias may affect the quality of care.
- Findings from 2021 showed over 70 percent of the dentist workforce in the U.S. is white, with black doctors making up less than 4 percent and Hispanic doctors making up less than 6 percent. How does this lack of representation affect the care of disadvantaged races?
Education Access & Equity
- High-poverty schools with fewer available resources may offer less education on oral care literacy.
- Children from low-income homes and those who face discrimination at school are more likely to experience stress and struggle with their education. This stress can negatively impact their health and affect their oral health.
Social & Community Context
- Due to experiencing racism and discrimination, individuals from disadvantaged races may be skeptical of doctors or health care.
- About 22 percent of black Americans report they have avoided seeking medical care for themselves or a family member out of fear of discrimination. This fear likely carries over to dental care and other disadvantaged races as well.
- Longstanding disparities in dental care may have resulted in lower expectations for dental care and outcomes.
- Even with insurance coverage, cost barriers to dental care (including copays, missed time from work, and travel costs) can greatly affect families with limited financial resources.
- Families and individuals struggling with poverty may be living paycheck to paycheck or in debt. In this constant state of stress, stopping to learn more about dental care or teach and enforce their children’s oral care routine may seem like an impossibility.
- Eating a balanced and healthy diet may be a challenge for many individuals and families in disadvantaged communities due to a lack of nutritional education, access to fresh foods, and/or the funds and time to plan and purchase wholesome meals.
Neighborhood & Built Environment
- High-poverty neighborhoods may have less access to affordable fresh fruits and vegetables and more access to fast food and convenience stores, where sugary and unhealthy foods and snacks can create a cavity and plaque-friendly diet.
- High-poverty neighborhoods may be less walkable and less safe, resulting in less physical exercise and fewer healthy lifestyle options.
- Racial and ethnic minorities, as well as people with low incomes, are more likely to live in areas with unsafe air or water and secondhand smoke.
Racial Disparity in Dental Care: Closing the Gap
In 2003, the Office of the Surgeon General released a National Call to Action to Promote Oral Health, which outlined a plan to improve the nation’s overall oral health, particularly among those in disadvantaged minority or ethnicity groups. The plan included steps that many are still advocating for today:
- Change perceptions of oral health. Raise public awareness of the importance of oral health, so that people (including those in disadvantaged populations, those in health care stakeholder positions, and those in community planning positions) understand that oral health is about more than just cavities and fillings — that it’s directly linked to overall general health and conditions like diabetes, respiratory conditions, and cardiovascular health.
- Overcome barriers by replicating effective programs and proven efforts. Preventative measures like water fluoridation and in-class dental sealant services for at-risk children have proved effective in improving oral health, yet these programs have not been organized and implemented nationwide. Making these programs available, and improving dental care access with easier forms and program registration, could help disadvantaged families to receive preventative care.
- Build the science base and accelerate science transfer. Gaining insight into oral health and its relation to diseases could help public health and medical professionals develop protocol and treatments to improve the oral health of children and adults across the country. More research could also be conducted into the oral health and dental care experiences of minority groups to help close the gap in oral health and care.
- Increase oral health workforce diversity, capacity, and flexibility. Having racial representation in the dental workforce may improve a community’s attitude toward dental care and make them more likely to seek care and advice. Initiatives to recruit individuals from underrepresented communities and educate them about careers in dentistry and dental research could ensure a more diverse dental workforce in the near future.
- Increase collaboration. Making connections between the private and public sector to create programs and initiatives to improve oral health in at-risk communities will ensure that the needed oral care infrastructure can be built effectively. Comprehensive programs will require the combined efforts and knowledge of public health communities, medical communities, community groups, and government at the state and federal level.
While racial disparity in dental care exists, progress is being made on this front. As we learn more about the existing landscape, we can better understand what resources can be put in place to change it for the future.
2000 Surgeon General’s Report on Oral Health in America. (July 2000). Office of the Surgeon General (US). Date fetched: October 24, 2022.
Disparities in Oral Health. (February 2021). Centers for Disease Control and Prevention. Date fetched: October 24, 2022.
Disparities in Health and Health Care: 5 Key Questions and Answers. (May 2021). Kaiser Family Foundation. Date fetched: October 24, 2022.
Oral Health Surveillance Report, 2019. (December 2021). Centers for Disease Control and Prevention. Date fetched: October 24, 2022.
Racism and Health. (November 2021). Centers for Disease Control and Prevention. Date fetched: October 24, 2022.
National Call to Action to Promote Oral Health. Office of the Surgeon General (US). Date fetched: October 24, 2022.
Oral Health. World Health Organization. Date fetched: October 24, 2022.
Oral Health: A Window to Your Overall Health. (October 2021). Mayo Clinic. Date fetched: October 24, 2022.
The Link Between Gum Disease and Heart Disease. (May 2022). Penn Medicine. Date fetched: October 24, 2022.
Ethnic and Racial Minorities & Socioeconomic Status. (July 2017). American Psychological Association. Date fetched: October 24, 2022.
Poverty Rate by Race/Ethnicity. Kaiser Family Foundation. Date fetched: October 24, 2022.
Labor Force Characteristics by Race and Ethnicity, 2019. (December 2020). U.S. Bureau of Labor Statistics. Date fetched: October 24, 2022.
Understanding and Addressing Racial Disparities in Health Care. (Summer 2000). Medicare & Medicaid Research Review. Date fetched: October 24, 2022.
Discrimination in America. Harvard Public Health. Date fetched: October 24, 2022.
About Social Determinants of Health (SDOH). (March 2021). Centers for Disease Control and Prevention. Date fetched: October 24, 2022.
Neighborhood and Built Environment. U.S. Department of Health and Social Services. Date fetched: October 24, 2022.
National Call to Action to Promote Oral Health – The Actions. Office of the Surgeon General (US). Date fetched: October 24, 2022.