Nationwide, more than twice as many people in the United States don’t have dental insurance compared to those who don’t have medical insurance. A lack of dental coverage affects both children and adults. People of color are disproportionately left out of coverage.
An estimated 50 percent of children in the United States do not receive regular dental care because of social, economic and geographic barriers to care. Mexican American and Black preschool children have a higher prevalence of cavities than their white peers. More than 50 percent of low-income adults and even 20 percent of those above the poverty line have untreated cavities.
A 2022 National Institutes of Health report highlights many of the disparities in oral health that we see every day in our communities. Many of these disparities exist most acutely in already vulnerable populations, such as those with intellectual and developmental disabilities, children who live in poverty, and the elderly. For many communities, disparities in oral health and access to care have persisted for generations.
Older adults in particular are at risk for poor oral health. They have a higher risk for many oral diseases than any other age group. Many lack dental insurance due to the absence of a universal dental benefit in Medicare, and individuals who have a disability or are retired may have limited funds to pay out of pocket for care. At the same time, many are living with chronic diseases and taking medications that present unique risks to their oral health. Older adults living in underserved urban and rural areas may lack access to providers, and any accompanying physical or cognitive disabilities may further limit their access to care. Poor oral health, including periodontal (gum) disease, has been associated with nearly 60 other health problems, including diabetes, heart disease, respiratory diseases and Alzheimer’s disease.
At a Pacific Center for Equity in Oral Health Care symposium, held earlier this year, participants explored the structural disparities in oral health care through the intersection of racism, ageism, ableism, gender bias and other inequities that have contributed to disparities in oral health. To address these disparities, we’re asking all dental providers to consider these recommendations:
- Recognize personal biases —Take time to reflect on where you are in this process through reflective writing, thinking and self-assessment tools such as an implicit bias test, an ageism quiz and critical reflections.
- Learn about the people and cultures in your own community — Raise your own awareness of local cultures and cultural events. Evaluate the local health care options and social services available to your patients who may need referrals.
- Practice antiracism — Engage in the active process of identifying and challenging racism by changing systems to redistribute power in an equitable manner.
- Practice self-accountability and leading by example — Whether your team is large or small, whether you are in private or public practice, or have a role in advocacy, policy development or legislation, there are guides for team-building and resources to facilitate discussions of equity, racism, goal setting and planning for action. Like every transformation effort, advancing racial and health equity requires leadership.
- Advocate for patients — Reduce barriers in your own practice and understand the social determinants of health. Make a conscious effort to represent the community you serve through artwork, magazines and patient information; collect and assess demographic information to better understand your practice base; consider whether your practice is representative of and responsive to the needs of your base and the surrounding community.
- Empower patients — Hire a diverse team with the knowledge and skills to best support the patients or clients you serve. Implement phone interpretation services for patients whose first language is not English. Consider a physical or virtual “suggestion box” to support those who may be reluctant to speak out or ask questions. Proactively help patients navigate insurance issues.
- Inspire others to participate in the work of inclusion — Start with your own practice and your own team. There is a growing range of study clubs and focus groups that include diverse points of view, as well as professional organizations at the local, regional and national levels. Volunteer, both in dental and non-dental activities, to better understand the needs of your community. This will also raise your profile and engagement as a leader in the community. Spread the message that oral health is a vital part of overall health.
Elisa M. Chávez, DDS, serves as professor of diagnostic sciences and director of the Pacific Center for Equity in Oral Health Care at University of the Pacific, Arthur A. Dugoni School of Dentistry in San Francisco.