This blog is part of a series that will highlight how structural racism in the health care system negatively affects the health of individuals of color. Community Catalyst is committed to exposing and dismantling policies, practices and attitudes that routinely produce cumulative and chronic adverse outcomes for people of color in the health system.

The mouth is the gateway to the body and serves as a clear indicator of one’s economic status.  Broken, missing or diseased teeth are an unmistakable sign of poverty, and the consequences are far ranging.  Adults with bad or missing teeth have difficulty finding and keeping a job, and children with oral disease are more likely to struggle in school and have reduced self-esteem.

Oral disease is one of the most common chronic diseases. In children, it is five times more common than asthma.  But it doesn’t stop there—communities of color experience a disproportionate amount of the disease burden. American Indian / Alaska Native children have four-times more untreated decay than white children. Black and Hispanic children are almost two-times more likely to have untreated dental decay compared to white children. 

Figure: Percent with untreated decay among children 3-5 years

<p>Source:  <a href=Indian Health Services Data Brief, April 2015

In a country as prosperous as America, it is not acceptable for children to live in pain, or even die, because our dental care system is out of reach to many poor children of color.  While personal actions like brushing and flossing are often blamed—the problems run deeper. Many low-income, immigrant communities and communities of color do not have adequate access to nutritious food, dentists who accept their health insurance or health professionals who live in their community and speak the same language. These disparities are a result of systemic barriers in access in oral health care that keep structural inequalities in place.  These structural issues require structural solutions.

Improved access to quality dental insurance is a necessary first step

Dental disease is almost 100 percent preventable, and we can do something about the problem. With dental insurance, people are more likely to access treatment before more serious, costly problems arise. This benefits us all.  

Plans released by both the House and the Senate over the last six months (including the Better Care Reconciliation Act and the American Health Care Act), all shared a common thread – they would significantly reduce access to dental insurance as well as health insurance for low-income individuals across the country, hitting communities of color hardest. The proposed cuts to Medicaid in both proposals would be devastating to the 37 million low-income children who depend on its coverage to get medical and dental care.  Further, repealing the ACA would roll back gains in access to dental insurance: We’ve seen significant increase in the number of children and low-income adults who have dental benefits since the passage of the ACA. Put plainly, the recent efforts to repeal the ACA or cut Medicaid took us in the wrong direction. With last week’s win to stop the repeal, it’s time we find ways to get people care, not take it away.  

Delivering culturally and linguistically appropriate care to communities   

Insurance is an important first step, but it does not always equal access. Fewer than 50 percent of children on Medicaid receive a dental visit each year, and even fewer adults. To improve access to care some communities are expanding the dental team to include dental therapists, a provider that works similar to the way physician’s assistants work on the medical team.

Dental therapists have successfully worked around the world for almost 100 years and were originally introduced to the U.S. by leaders in Alaska Native communities. By recruiting students directly from underserved communities, dental therapists in Alaska share the language and culture of people they serve while also creating professional healthcare jobs in underemployed communities. More than 87 percent of dental therapists in Alaska are from the communities they serve. By way of comparison, less than two percent of dentists nationwide are Alaska Native or American Indian. 

Under the off-site supervision of a dentist, dental therapists can deliver care in community settings. Where they are being employed, dental therapists are helping to increase access to care, reduce patient wait times and improve oral health outcomes. In addition to Alaska, Minnesota, Maine, Oregon, Washington and Vermont[i] have authorized dental therapists in all or limited settings. In Alaska alone, dental therapists have increased access to care for over 45,000 people in over 81 communities.

All of our community members should have the opportunity to live a long, healthy life, regardless of their income, education, or ethnic background. Ensuring access to quality affordable oral health care is an important part of that equation, and there are cost-effective steps that we can make that make a difference.

[i] The Swinomish Indian Tribal Community in Washington State exercised tribal sovereignty to employ a dental therapist for a year before state law authorized dental therapists in tribal settings in 2017. In Oregon both tribal and non-tribal settings are integrating dental therapists as part of pilot projects.