African Americans' Oral Health: 5 Barriers Examined

By Karen Horace, DDS

There’s an old saying, “When white folks catch a cold, Black folks get pneumonia.” We see this in the current pandemic: overall U.S.  life expectancy fell by 1.5 years, with African Americans losing three years of life expectancy. Similar outcomes are seen in oral health: almost one-third of Black children have had cavities in their baby teeth, compared to one-fifth of White children.

Oral health is inextricably linked to chronic diseases most often seen in our community, including stroke, heart disease and diabetes. That’s why bringing awareness to barriers of oral health care isn’t just part of creating a healthier smile, it’s about creating a healthier you – and a healthier community.

Shortage of Black dentists

While I’m proud to be a Black dentist myself, we only make up 3.8% of the dentist workforce in the United States, despite African Americans making up 12.4% of the population. To add to that, the fraction of Black dentists is  essentially unchanged over the past two decades, despite gains made by other minority groups. Studies show that Black patients have  better health outcomes when treated by Black providers.

Shortage of Black dental students

Two decades ago, just 4.7% of dental school enrollees were African American. In 2019, it was 5.8%. Despite these gains, the percentage of Black dental school enrollees isn’t reflective of the overall population. This can be traced to the lack of progress amongst dental schools in recruiting underrepresented students. In a recent statement, the American Dental Education Association points out that: “What is truly necessary to impact the recruitment of underrepresented dental students is to grow the pool of eligible applicants through pathway programs in high school, middle school or even earlier.”

Lack of dentists in communities of color

Access to care starts with being able to see a dental provider in your community. A 2002 study from the South Carolina Rural Health Research Center found that African Americans, Hispanics and Native Americans were more likely to live in Health Professional Shortage Areas. Black providers are  most likely to practice in communities of color and they’re more likely than any other race to treat low-income patients, especially young children covered through the Children's Health Insurance Program. Addressing the shortage of Black providers wouldn’t just impact our community, but all underserved communities.

Providers and prejudice

It’s important to remember that health care providers are people, and people may carry some bias, or, preconceived ideas of a person or group. As a dental provider myself, I’m making efforts to actively work through my implicit biases so that I can deliver the best quality of care. Unfortunately, we as health care professionals still have a lot of work to do. In a recent survey by the University of Michigan Medical School, one in five patients reported experiencing discrimination in the health care system – with racial discrimination being the most common.

The economic divide and access to care

Due to a multitude of factors, many historic and systemic, economic inequality affects people of color at a different rate than White Americans. People of color are less likely to be able to afford out-of-pocket costs and are less likely to have employer-based insurance coverage. Thanks to the Affordable Care Act, access to care has increased across the board, but most significantly among people of color. Another step that can be taken: adding dental coverage to Medicare, in support of all 63 million of its beneficiaries, many of whom are seniors and disabled folk of color.

While these barriers to care continue to present challenges to all communities of color, I look to our past not only for hope – but for pride. Despite adversities, African Americans have made significant advancements in the field of public health to  circumvent an unequal health care system. As the Association for the Study of African American Life and History notes, “…Black people have embarked on self-determination, mutual aid and social support initiatives to build hospitals, medical and nursing schools and community clinics… to provide spaces to counter the economic and health disparities and discrimination that are found at mainstream institutions.”

In finding hope for the future, I also look at fellow Delta Dental providers, like Registered Dental Hygienist, Travis Tramel. Driven by a passion for service, Travis operates a mobile dental clinic in Southern California, offering cleanings as well as oral health education to grade school children. For Travis, it’s about more than just dental care:

“To see the looks on their faces and to see people of color operating a dental clinic in their school has been rewarding. They come up to me, now wanting to understand the educational road I took to get into the dental profession. They always say, ‘we’ve never seen anyone who looks like us, so it’s not a profession we see ourselves doing.’”

While there is much being done, there’s still a long road ahead to achieve equity for all. I personally attended Howard University, an HBCU, for dental school and had the privilege of being instructed by a very diverse set of providers. Being taught by women and a multiracial, multiethnic group of providers, exposed me to both general dentists and specialists from different background. It made my decision to become a specialist in periodontics seem quite attainable. It wasn’t until many years later that I realized just how small the community of dentists and dental specialists of color were. It is my wish for young people of color who want to become dentists, that they see this calling not as something unique, but as an achievable pursuit.

Dr. Karen Horace is a graduate of Howard University School of Dentistry and an Atlanta-based practicing periodontist. She is also a dental consultant for Delta Dental of California and co-lead of Delta Dental’s employee resource group, Alliance of Black Employees – or ABLE.