Harvard School of Dental Medicine Affiliates Discuss Disparities in Oral Health Care at Webinar

Experts in oral health policy from the Harvard School of Dental Medicine discussed barriers to equitable health care in a webinar hosted by the Office of the Vice Provost for Advances in Learning Wednesday evening.

The webinar featured Catherine Hayes, the chair of the Department of Oral Health Policy and Epidemiology and program director of dental public health at HDSM, and Hawazin Elani, an assistant professor in the department.

“There’s a silent epidemic of dental and oral diseases that burden certain population groups,” Hayes said. “These population groups are those from lower socioeconomic groups and racial and ethnic groups that don’t have the access to care that they should.”

According to Hayes, children from lower-income households experience dental caries — tooth decay caused by the buildup of bacteria — at a disproportionate rate.

“It’s the most common disease of childhood,” Hayes said. “And it’s a disease for which we see tremendous oral health disparities.”

“If we look at the children from the lowest income groups, greater than 50 percent of them have experienced decay,” Hayes said. “The lower the income, the higher disease.”

Elani said income disparities in oral health care extend even to adults, saying that there are “about 26 percent of all adults in the U.S. who have untreated decay.”

She explained that “the most common or the most cited barrier to accessing dental care, regardless of age or income or source of coverage, is usually cost.”

Hayes added that children belonging to different ethnic groups also experience disparate rates of dental decay. “Children who are Hispanic have the highest rates of decay,” Hayes said. “And a lot of that is really because of access issues — they don’t have adequate access.”

Hayes said recognizing these disparities is important because the public “is not aware of this really strong relationship between oral health and general health.”

Inequitable access to oral health care also means many children require operations to address dental caries, Hayes said.

“It’s a real problem in this country that we have so many children between the ages of two and six that are treated in the operating room for severe dental caries,” Hayes said. “This is a failure of our system.”

According to Hayes, dental practitioners should work to understand how to best serve marginalized populations.

“A simple example: keeping a dental office open after 5 p.m.,” Hayes said. “These are things we hear all the time from the community.”

Elani said that inconsistent implementations of the Affordable Care Act led to spotty oral health care coverage across different states.

“So it can range from no coverage at all to very extensive coverage,” Elani said.

To “reduce these disparities,” Elani advocated for policies incentivizing more people to become dentists and dental therapists, who are health care practitioners trained to give preventative care.

Elani stressed the importance of authorizing more dental therapists to practice in order to “increase access to low-income individuals, particularly in rural areas where we have shortages,” adding that there are only about 150 active dental therapists in the country.

Hayes emphasized that addressing disparities in oral health care requires examining socioeconomic factors.

“It’s not just about looking at teeth,” she said. “It’s about looking at the system.”