Oral Health in the United States – Inequalities and Disparities in Care

Having good oral health is essential to one’s quality of life and overall well being, as I learnt last winter. A bad case of wisdom tooth infection presented as throbbing pain that radiated from my jaw to my neck, leading to sleepless nights and a trip to the emergency room. A 10-day antibiotic regimen resolved the infection, but I spent the following months in a general state of anxiety and frustration as I waited to undergo wisdom tooth extraction surgery. The procedure was backed up all the way to summer, due to the limited availability of oral surgeons in the Ann Arbor area, and the fact that only a handful of clinics accepted my UM international student insurance. Back in Hong Kong, where I am from, the waiting time for a procedure like this would have been 2 weeks at most. But, I still count myself lucky. My insurance covered most of my surgery costs, and the quality of care I received at the University of Michigan School of Dentistry was nothing short of excellent. This situation could have been much worse if I were an American who happens to be from a lower socioeconomic background with limited or no insurance. 

On the American Dental Association website, self-reported data on oral health and the associated well being collected from 14,962 adults show that 47% of those with low household income had fair or poor condition of the mouth and teeth, compared to 33% in the middle household income group and 15% in the high household income group.1 39% in the low household income group agreed that they found life in general to be less satisfying due to the condition of their oral health, and 29% in the same group thought that the appearance of their mouth and teeth affected their ability to interview for a job, potentially feeding into a toxic cycle of poverty and worsened oral health.1 Cost, inconvenient location or time, and trouble finding a dentist were among the most common reasons for not visiting the dentist more frequently, or lack of visit within the last 12 months among adults from all income, age, or insurance groups.1  These data show that much change is needed when it comes to reducing inequality in oral health and access to oral care.


Positive changes in access to oral care within the last decade include an increase in Medicaid spending on oral health care.2 13% of the national oral health care spending in 2020 was financed by public programs such as Medicaid, compared to only 4% in 2000.2 However, barriers to care remain in place, such as provider shortages, difference in provider availability across geographic locations, low oral health literacy, and considerable differences in public spending on oral health care across age groups (17% of total spending among children vs less than 2% among the elderly).2 A lot still needs to be done on both federal and state levels to resolve these disparities. 


References:

https://www.ada.org/resources/research/health-policy-institute/coverage-access-outcomes/oral-health-and-well-being


Quiñonez C, Jones JA, Vujicic M, Tomar SL, Lee JY. The 2021 report on oral health in America: Directions for the future of dental public health and the oral health care system. J Public Health Dent. 2022;82(2):133-137. doi:10.1111/jphd.12521

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