When you think of what it means to be healthy, oral health may not be the first thing that comes to mind. Tooth decay, despite being the most common chronic childhood disease in the United States, is often overlooked. In addition to being the #1 chronic disease among children, dental caries, commonly referred to as cavities, disproportionally affect low-income communities of color. This disparity continues into adulthood as well, with non-Hispanic Black and Mexican American adults between 35 and 44 years old experiencing untreated tooth decay at almost twice the rate of non-Hispanic white adults. Much like the disparities in other aspects of health, oral health disparities have several root causes including access to affordable dental care, cultural barriers between providers and patients, shortage of culturally and linguistically appropriate providers, transportation issues, and aggressive marketing by unhealthy food and beverage companies that target vulnerable communities . At the population level, when individuals find it difficult to attain their full health potential, these disparities diminish health equity for entire communities.
Poor oral health also affects children’s ability to learn in school and develop socially. Severe pain associated with dental caries can interfere with a child’s ability to concentrate at school and interact with other children during crucial periods of their development. The longer a person goes without seeking care for a dental issue, the more they suffer elsewhere in their lives. Lack of treatment, then, amplifies the effects of easily preventable and treatable dental caries among adults and children. Consequently, poor oral health bleeds into other aspects of well-being forcing communities into a catch-22, where a lack of resources leads to tooth decay that ultimately limits a person’s advancement towards the resources necessary to prevent tooth decay to begin with.
This vicious cycle especially pertains to adults, whose unmet oral health needs interfere with their ability to work. As a result, individuals and families face income losses in addition to the discomfort and health issues associated with poor oral health. The difficult decision between earning wages or seeking dental care can be particularly difficult among low income families for whom wage loss of even a few hours can be detrimental. Avoiding dental care for financial security may inevitably have negative effects, however, as basic dental issues may worsen and result in the need for more intensive procedures. In this case, receiving necessary treatment is likely to have an even greater impact on an individual’s or family’s income. The sad irony in this situation is that the adults most vulnerable to oral health problems are those most hurt by seeking dental care.
The severity of oral health disparities in the Latino community and its subsequent impacts on the social and physical well-being of Latinos, illustrate the urgency of oral health reform among Latinos. The links between oral health and overall well-being make the potential impacts of oral health interventions far reaching and comprehensive. A major jump off point is informing individuals of how important oral health is, and ensuring access to dental care and disease prevention measures from an early age. Severe dental care provider shortages, and low reimbursement rates for services provided to Medicaid patients exacerbate the social and structural factors contributing to health disparities; however the significant improvements in oral health over the past 50 years show that prioritizing these types of initiatives can be successful.
While administrative barriers to oral care must be addressed, oral health disparities cannot be overcome without acknowledging the social and structural issues in our communities. The research up to this point is clear: Latinos are disproportionately affected by oral health issues that continue to go untreated. A crucial component in overcoming these disparities is the voice of the Latino community itself. The fact that this issue is only beginning to be addressed on a comprehensive, national scale indicates a large gap between the communities affected by oral health disparities and oral health reform that must be recognized. Interacting with individuals in the Latino community who fulfill various roles can provide an excellent perspective through which we can approach these issues.
As public health and oral health advocates work to improve policies designed to reduce inequity, we applaud their efforts to inform their policies and actions directly from the community. When we ask community members about barriers to oral health, we find that sometimes the answers are far removed from the dentists’ chairs and are much more pedantic. When one listens to those experiencing the greatest inequities, we find that lack of hope and personal efficacy, public transportation limitations or economic insecurity can be just as important as the availability of providers that accept lower-income patients. As we continue our work to advance equity in oral health, we will continue to work closely with our community partners to make sure that we are getting closer to oral health for all in a manner that works for all.
