How We Can Advance Oral Health Equity

The COVID-19 pandemic disproportionately harmed Black, Hispanic, and other people of color, sparking renewed attention on America’s oral health disparities. While some communities face higher hurdles to good oral health than others, promising solutions exist to achieve greater equity. Policy and health care leaders can do more to advance equitable access to services, including in dental care.

The Importance of Oral Health Equity

Dental access and services are inequitably distributed, pushing good dental health out of reach of many. Improving oral health equity is vital to communities’ overall health and economic well-being.

When people can’t support their dental needs, it can hurt other areas of the body. For example, dental disease is associated with dangerous pregnancy complications. It is also a risk factor for dementia and can make it harder to manage chronic conditions, such as diabetes.

These inequities also take a financial toll. Without access to affordable care, a preventable problem can become a crisis. In such circumstances, many Americans resort to their hospital’s emergency department for care. Data suggest that having inadequate dental coverage, or lacking coverage altogether, makes it more likely that someone will regularly seek dental relief this way.

Most hospitals cannot treat the root of a person’s suffering but only provide painkillers or antibiotics. These visits cost our health system billions of dollars each year. In 2019, they cost $3.4 billion overall. Advancing oral health equity would ensure a better use of resources and improve community oral health.

A Snapshot of Oral Health Disparities in America

According to a 2021 CareQuest Institute survey, roadblocks to care and the resulting burden of dental disease fall hardest on people with low incomes and on communities of color:

• People with low incomes are three times more likely than higher-income people to say they could not afford to treat a dental disease symptom they faced in the past year.
• Black and Hispanic adults are three times more likely than white peers to have never seen a dentist.
• Black adults are 68% more likely than white adults to have a dental problem that has not been addressed.

The COVID-19 pandemic deepened these disparities. For instance, 65% of people who lost health insurance in the public health crisis had one or more dental problems but could not get needed care.

Barriers to Oral Health Equity

Several factors shape our oral health and access to care, including where we are born, live, and work. Health leaders note that these circumstances have significant impacts.

In a Boston Globe article, Myechia Minter-Jordan, MD, MBA, and president and CEO of CareQuest Institute, and Michael Curry, president and CEO of the Massachusetts League of Community Health Centers, point to the reality that “social determinants — like food access, affordable housing, transportation, child care, public safety, and more — account for 80% of a person’s health status, with access to health care making up only 20%.”

Other experts observe how current systems place steeper barriers to good oral health in the path of people with lower incomes and communities of color.

Patrick Smith, DMD, MPH, clinical assistant professor at the University of Illinois Chicago, has examined oral health disparities for several years. In a blog post, he shares that “the narrative will likely always be that white populations collectively have better oral health, simply because they tend to fall on the better end of the spectrum of how social determinants affect health.”

Data affirm that racism and economic inequity drive several barriers:

• Nearly half of Black, Asian, and Hispanic adults experience racial discrimination in dental settings, compared to one in three white peers.
• People experiencing poverty who lack dental insurance are more than two times likelier than higher income people to have unmet dental needs.
• When people living in poverty do seek care, they spend 10 times more of their annual income family income on services than people with higher incomes.

Variation in state Medicaid programs illustrates how policy decisions compound these harms, worsening health for people of color with limited resources. Due to centuries of structural inequality, Medicaid disproportionately covers people of color. Studies show that 4 in 10 Black and Hispanic adults live in a state where Medicaid does not cover any adult dental care, or only covers adults’ emergency benefits.

Smith asserts that smart leadership and targeted funding can lift these barriers. “Balancing the scale with interventions to reduce inequities will require more resources, priority, and political will.”

Changing Policy to Reduce Inequities

Policy and health leaders can act to advance oral health equity. Effective solutions include strengthening dental coverage and embracing innovations to place care within reach of more people.

One critical step is expanding adult dental benefits in Medicaid and Medicare. Advocates and policymakers are making progress winning better coverage. Between 2020 and 2022, seven states added, expanded, or restored Medicaid adult dental benefits in some way. Federal policymakers slightly expanded Medicare’s dental benefits. Moving forward, leaders must protect and build on these gains.

Other efforts to advance oral health equity include:

• Adopting dental therapy to expand access to care. Dental therapists specialize in commonly needed services, such as filling cavities, and can work outside of clinics. They are often from the historically marginalized communities they serve. These providers can effectively expand access to affordable, culturally competent care.
• Integrating oral health into primary care. Doctors can support patients’ dental health by incorporating oral health assessments and similar care into appointments. With help from initiatives like Medical Oral Expanded Care (MORE Care), medical teams can get necessary technology and strengthen relationships with dental partners to develop strong referral networks.
• Expanding teledentistry. The COVID-19 pandemic increased awareness of virtual medical and dental care. People value teledentistry, with 86% saying they would recommend it to others. This strategy can connect currently underserved communities to care while wisely using finite resources.

Investing in these solutions can open the door to care for more people and those most in need — and we can inch ever closer to improving the oral health of all.