Structural Racism and Oral Health Inequities of Black vs. non-Hispanic White Adults in the U.S.

Smith, Patrick; Wright, Wanda; Hill, Brittaney

doi:10.1353/hpu.2021.0007

Cited by 13 publications

(16 citation statements)

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“…At the same time, Richmond's population of residents born outside of the U.S. is almost half that of the United States proportion (7.03% versus 13.7%, [33]). Thus, U.S.-born health care safety net patients in Richmond Virginia may be disproportionately more exposed throughout their lives to a variety of factors that harm oral health such as racially biased exclusions from dental care or sub-optimal treatment decisions [34,35], political determinants of health such as redlining and inadequate access to healthful foods [36], or commercial determinants such as excess exposure to commercial tobacco outlets [37]. In other words, in contrast to the historically advantaged index groups (e.g., white, middle class) to whom minoritized groups are compared in population-level oral health studies (e.g., [24,26,28,29]), many or most participants enrolled in our study may have experienced deleterious conditions that negatively affect their oral health above and beyond income constraints, including but not limited to geographic and schedule barriers to care, structural ethno-racism and xenophobia, and dental benefits absence from Virginia's adult Medicaid benefit prior to 2020.…”

Section: Discussionmentioning

confidence: 99%

Oral Health, Health Service Utilization, and Age at Arrival to the U.S. among Safety Net Patients

Raskin

Rasnick

Kohlmann

et al. 2022

IJERPH

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Background: Immigrants’ oral health disparities have not been adequately investigated using a lifecourse approach, which investigates the cumulative effects of risk and protective exposures among other considerations. Methods: We examined self-reported oral health outcomes and health care appointment outcomes among a sample of patients enrolled at a federally qualified health center in Richmond Virginia (N = 327) who were categorized into three groups by approximate age at arrival to the U.S. Results: Study participants who arrived to the U.S. prior to age 18 had better retention of natural dentition, better oral health related quality of life, and a lower proportion of dental appointments to address pain than those who arrived after age 18 or were born in the U.S. Conclusions: Im/migrants’ differentiated oral health outcomes by age at arrival to the U.S. suggest the relevance of lifecourse factors, for example the cumulative effects of risk and protective exposures, and confirm the merits of lifecourse studies of im/migrants’ oral health.

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Section: Discussionmentioning

confidence: 99%

Oral Health, Health Service Utilization, and Age at Arrival to the U.S. among Safety Net Patients

Raskin

Rasnick

Kohlmann

et al. 2022

IJERPH

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“…Racialethnic health inequities have been documented for a range of health outcomes, including higher mortality, the recent COVID-19 pandemic [14], psychiatric disorders, cardiovascular disease, cancer, HIV/AIDS, diabetes, and other chronic and infectious diseases [15,16]. A higher prevalence of untreated tooth decay (caries), severe periodontal disease, and complete or partial edentulism have been observed among racially marginalized groups [17][18][19][20]. The prevalence of dental caries has been disproportionately high among minoritized racial and ethnic groups, despite pronounced changes in related risk factors, treatment, and access to treatment of oral diseases [18,20].…”

Section: Introductionmentioning

confidence: 99%

A Global Perspective of Racial–Ethnic Inequities in Dental Caries: Protocol of Systematic Review

Nath

Sethi

Bastos

et al. 2022

IJERPH

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Though current evidence suggests that racial–ethnic inequities in dental caries persist over time and across space, their magnitude is currently unknown from a global perspective. This systematic review aims to quantify the magnitude of racial/ethnic inequities in dental caries and to deconstruct the different taxonomies/concepts/methods used for racial/ethnic categorization across different populations/nations. This review has been registered in PROSPERO; CRD42021282771. An electronic search of all relevant databases will be conducted until December 2021 for both published and unpublished literature. Studies will be eligible if they include data on the prevalence or severity of dental caries assessed by the decayed, missing, filled teeth index (DMFT), according to indicators of race-ethnicity. A narrative synthesis of included studies and a random-effects meta-analysis will be conducted. Forest plots will be constructed to assess the difference in effect size for the occurrence of dental caries. Study quality will be determined via the Newcastle–Ottawa Scale and the GRADE approach will be used for assessing the quality of evidence. This systematic review will enhance knowledge of the magnitude of racial/ethnic inequities in dental caries globally by providing important benchmark data on which to base interventions to mitigate the problem and to visualize the effects of racism on oral health.

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“…13,19 The underlying causes of inequity are rooted in structural racism. 20 Antiracist practices and a focus on social and political determinants of health have been proposed as ways to support health equity. 21,22,23 However, changes in practice and focus alone only scratch the surface of deep-seated inequity; lasting change could come from reimagining health care delivery streams, integrating medical and dental services, and implementing a reimbursement system that emphasizes value and patient-centered outcomes.…”

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confidence: 99%

“…54 Addressing racial inequities and discrimination within health care has been described as a "wicked" problem because this problem is complex, has multiple stakeholders, and is tough to solve. 20,44 We contend that separating oral health care from medicine is another contributor to that wicked problem. 34 The current dental care system is not designed to address social disparities, rarely considers determinants of health, and does not address the inequities it causes.…”

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confidence: 99%

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Health Equity Needs Teeth

Fleming

Frantsve‐Hawley

Minter‐Jordan

2022

AMA Journal of Ethics

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People who are poor or members of communities of color face inequitable oral disease burden. Continued separation of dental and oral health from general medical care exacerbates inequity and forces members of underserved communities to seek nontraumatic dental emergency care in hospital emergency departments. This trend is unnecessarily costly and results in antibiotic prescriptions and pain management that are neither restorative nor responsive to patients' primary complaints. Value-based approaches to health care need to unify mouth care with general medical care, motivate medical-dental interprofessional practice, promote oral disease prevention, and support restorative dental care. Value-based approaches to health care must also innovate fiscal structures (eg, payment models, data sharing) to improve health outcomes for everyone.Weekend Mouth Pain Imagine it's Saturday evening at 6 pm, and you find yourself in pain-a pain not from a hurt foot or shoulder, but a throbbing, radiating pain in your mouth that feels as if your head and ears are on fire. You cannot sleep or eat. Previously, the pain was dull and only bothered you when you ate something sweet or cold. But now, at 6 pm on a Saturday, you find yourself in extreme pain and unable to function. While you are employed, your minimum wage job does not provide dental insurance and you live in a state that does not provide comprehensive, adult dental benefits through Medicaid. Consider also that when you saw your physician 3 months ago for your check-up to renew your blood pressure prescription, you mentioned the tooth bothering you. It is likely that your physician did not examine your mouth or refer you to a dentist for care. You thought the tooth could wait! To make things worse, because of your lack of dental coverage and your inability to pay for the out-of-pocket expense of dental care in a private practice office, you do not have a dental home to call for an emergency appointment. The last time you saw a dentist was at a charity dental event in the local college's gymnasium several years ago. In the United States, where should you go and what should you do?

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Structural Racism and Oral Health Inequities of Black vs. non-Hispanic White Adults in the U.S.

Cited by 13 publications

References 0 publications

Oral Health, Health Service Utilization, and Age at Arrival to the U.S. among Safety Net Patients

Oral Health, Health Service Utilization, and Age at Arrival to the U.S. among Safety Net Patients

A Global Perspective of Racial–Ethnic Inequities in Dental Caries: Protocol of Systematic Review

Health Equity Needs Teeth

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