Racism and oral health equity in the United States: Identifying its effects and providing future directions

Abstract

While racial/ethnic oral health inequities have been documented for many years in the United States, the potential role of racism has not been examined until recently. In fact, the common practice has been to attribute racial/ethnic disparities in oral health to low socioeconomic position and/or the lack of access to care. In contrast, racism is considered a fundamental cause of a broad range of adverse health outcomes for racial/ethnic minorities. Emerging evidence on oral health suggests that racism can affect access to oral health and clinical decision-making by acting as a social determinant of health (SDoH). Specifically, SDoHs may affect access to quality dental care due to the lack of dental insurance, low dentist-population ratio in racial/ethnic minority communities and the lack of diversity in the dental profession. We describe potential mechanisms through which racism can affect important SDoHs that are essential to oral health equity, outline recommendations to mitigate its existing negative effects and propose interventions to minimize pathogenic effects of racism on oral health outcomes in the population.

Racism in oral healthcare settings: Implications for dental care‐related fear/anxiety and utilization among Black/African American women in Appalachia

“…Other possible coping responses include being assertive and changing providers [35], if possible. Findings from this study support the need for dentistry to pursue anti‐racist care with Black/African American women, through education and policies that focus on racism as a social determinant of oral health [36], to ensure that Black and African American patients are listened to, provided good quality service, and treated with respect.…”

Oral health inequities: Recommended public policies to achieve health equity

“…An approach to fulfill the second priority is to foster the inclusion of racial and ethnic minority dental students and faculty. To improve racial and ethnic diversity in dental admissions, Borrell and Williams 38 have suggested the following: (1) linking improvements in the racial and ethnic diversity of a given school's student body to that school's accreditation; (2) expanding dental curriculums to include multidisciplinary approaches; and (3) providing more incentives to recruit and retain racial and ethnic minority dentists to work in underserved communities. Dental schools should foster the recruitment and retention of diverse faculty and staff representing the populations they care for 17…”

“…The dental workforce's lack of racial and ethnic diversity has important implications for oral health equity, by increasing the number of underserved areas across the country, thereby creating "dental deserts" in the rural and low-income communities where minorities live. 38 Currently there are 6,463 dental health professional shortage areas (HPSAs) in the United States and its territories, covering a population of 67 million. The projected number of dentists required to remove the HPSA designation is around 11,567.…”

“…45 Research on the diversity of the dental workforce has shown that dentists from racial and ethnic minority groups, specifically African American and Hispanic dentists, are more likely to practice in underserved areas, and to accept public or government-provided insurance. 38,46,47 In addition, studies in patient engagement have found higher satisfaction levels with clinical practitioners from their own cultural and racial and ethnic backgrounds. 38,48…”

“…38,46,47 In addition, studies in patient engagement have found higher satisfaction levels with clinical practitioners from their own cultural and racial and ethnic backgrounds. 38,48…”