Inequality Creates Roadblocks in Oral Health Care

Many Americans don’t have adequate access to oral health care. We look at the factors contributing to the disparity.

By Susan Richards

Healthcare in general, and dental care specifically, has come a long way since the days when an abscessed tooth often spelled doom for the 18th century patient. Unfortunately, there’s still not much to smile about for the U.S. population that is impacted by low income, lack of insurance, race, ethnicity, education or location.

According to the Centers for Disease Control (CDC), many Americans have substandard healthcare due to social determinants of health, which refers to the conditions of where they are born, live, and work. These determinants will affect how they can pay for their care as well as how accessible services and programs may be.

Income and Insurance

Long before our contemporary advocates for universal healthcare, President Harry Truman tried to launch his own national health plan post-World War II, believing that “healthy citizens constitute our greatest natural resource.” His efforts failed amid vigorous pushback from both the American Medical Association (AMA) and the American Dental Association (ADA). Years later, President Lyndon Johnson signed Medicare into law, giving Truman much of the credit.

Although preventative dental care is considered essential, many Americans are finding it more financially out of reach than other health care. The CDC reported that almost a third of the U.S. population had no dental insurance in 2015. Public health initiatives for low-income Americans have evolved since Truman’s day, however, they still have their limitations. Medicaid programs that include dental coverage for adults currently aren’t available in 15 states, and many senior citizens lose access to routine dental care under Medicare.

As a result of these deficits, an estimated 40% of adults (aged 20-64) without private health insurance, or in the low-income bracket, have untreated cavities. Thanks to the advent of fluoridated water in the 1970s, children’s oral health has improved. However, those between the ages of 2 and 19 in low-income families have 2-3 times the percentage of untreated cavities when compared to higher-income households. These children are less likely to receive, or have access to, preventative sealants.

In addition to out-of-pocket expenses, poor dental health is costly in other ways. Untreated oral disease contributes to an estimated loss of more than $45 billion in productivity, and dental emergencies result in a loss of over 34 million school hours. The appearance of the mouth and teeth can also influence a person’s ability to get hired – due to both their own self-image and the employer’s bias.

Minority Disparity

Not surprisingly, certain racial and ethnic minority groups in the U.S. are impacted by the disparities in oral health care even further. The CDC data shows non-Hispanic Black or Mexican American adults to be almost twice as likely to have untreated cavities as White adults. Additional numbers from recent years reveal:

  • 33% of Mexican American and 28% of Black children (aged 2-5) have had cavities in their primary teeth, compared with 18% of White children.
  • Almost 70% of Mexican American children (aged 12-19) have had cavities in their permanent teeth, compared with 54% of White children.
  • More than 90% of adults (aged 65 and over) have had cavities, with older Black or Mexican American adults presenting 2-to-3 times the rate of untreated cavities than older White adults.
  • Severe periodontal disease is more prevalent in those over 65, Mexican American and Black adults, as well as smokers.
  • The survival rate for Black men with oral pharyngeal cancer is 21% lower than it is for White men.

Diversity in the Dental Workforce

And the racial disparities don’t just exist for the patients lacking oral health care. According to a report by the Health Policy Institute (HPI), the dentist workforce does not racially reflect our country’s population. In 2020, approximately 70% of U.S. dentists were White, compared to 60% of the overall population being White. The most notable discrepancies appear between the Hispanic and Black workforce:

  • 5.9% Hispanic dentists vs. 18.4% Hispanic Americans
  • Only 3.8% of dentists are Black compared to 12.4% of the population

These numbers ultimately impact oral healthcare access to low-income Americans as 63% of Black dentists participate in Medicaid, compared to 39% of White dentists and 50% of other races, including Hispanic and Asian.

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There are further roadblocks for some Americans in receiving proper oral healthcare. Those in rural communities may lack access to dental education and school programs, fluoridated water or healthier foods, as well as convenient transportation to the dentist’s office. Adults of all ages who don’t complete high school show a much higher rate of untreated cavities than those with at least some college. 

Another divide in dental care appeared when COVID-19 entered the chat. The virus has hit the minority population particularly hard, and the suspension of services last year only magnified the need – and inequity – in oral health. According to an article in U.S. News, some dentists struggled to pay for additional PPE while treating emergency patients who had little or no income due to the pandemic.

Solutions and Change

An in-depth review in the National Center for Biotechnology Information (NCBI) confirmed that people in the U.S. who are low-income, uninsured, rurally-located, and/or minorities are more likely to have poorer access to quality dental care. The authors’ conclusion, however, is that these disparities are “unnecessary and avoidable, and also considered unfair and unjust.”

Indeed, they consider oral health care a social justice issue that calls for targeted interventions, more health policy support, and a life course approach to eliminate these equity gaps.

The CDC, in coordination with the Healthy People 2030 initiative, identifies public health priorities to help the well-being of the country; with oral health being one of the leading health indicators.

Disparities in oral health care put disadvantaged people at an increased risk of poor health. Pursuing equality in oral health care requires the attention of dental professionals as well as leaders in public health and medicine. While the challenge of providing care to all who need it may not be easy, it’s a good reminder that dental care is health care.

Author: Susan Richards is a staff writer at DOCS Education. With over 20 years of experience in local journalism and business marketing, Susan’s career includes award-winning feature writing, as well as creating content with context for a wide variety of industries.

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