Oral health policy experts from Harvard School of Dentistry discussed barriers to equitable health care Wednesday night in a webinar hosted by the Office of the Vice Provost for Advancement of Learning.
The webinar featured Kathryn Hayes, chair of HDSM’s Department of Oral Health Policy and Epidemiology and dental public health program director, and Hawazin Elani, assistant professor in the department.
“Dental and oral diseases are a silent epidemic that places a burden on certain populations,” Hayes says. “These population groups are people from lower socio-economic groups and racial and ethnic groups who don’t receive the care they deserve.”
Children from low-income households experience tooth decay (cavities caused by bacterial buildup) at disproportionate rates, Hayes said.
“This is the most common disease of childhood,” Hayes says. “And we see huge disparities in oral health due to this disease.”
“If you look at the lowest-income children, more than 50% of them experience tooth decay,” Hayes said. “The lower your income, the more sick you are.”
Erani said income disparities in oral health care extend to adults as well: “About 26 percent of all adults in the United States have untreated tooth decay.”
She explained, “Regardless of age, income, or insurance source, the most common or most commonly cited barrier to receiving dental care is usually cost.”
Hayes added that children belonging to different ethnic groups also have different rates of tooth decay. “Hispanic children have the highest rates of tooth decay,” Hayes said. “And a lot of that is really due to access issues. They don’t have the right access.”
Hayes said it’s important to recognize these disparities because the general public “doesn’t realize there’s a really strong relationship between oral health and overall health.”
Inequitable access to oral health care also means many children need surgery to treat cavities, Hayes said.
“The real problem in this country is that too many children between the ages of two and six are being treated in the operating room for severe tooth decay,” Hayes said. “This is a failure in our system.”
Hayes said dentists should strive to understand how to best serve marginalized populations.
“A simple example is keeping dental offices open after 5 p.m.,” Hayes said. “These are things we hear all the time from the community.”
Erani said inconsistent enforcement of the Affordable Care Act has resulted in uneven oral health insurance coverage across states.
“So it ranges from not being reported at all to being reported very extensively,” Elani said.
To “reduce these disparities,” Elani advocated for policies that would encourage more people to become dentists and dental therapists, health care professionals trained to provide preventive care.
Elani emphasized the importance of allowing more dentists to practice in order to “increase access to low-income people, especially in rural areas where there is a shortage,” adding that there are only about 150 practicing dentists in the country. He added that there was only one.
Hayes emphasized the need to consider socio-economic factors to address disparities in oral health care.
“It’s more than just looking at your teeth,” she said. “It’s about looking at the system.”
