WORCESTER MEDICINE
Oral Health
Oral Health and Local Disparities Hugh Silk, MD, MPH Vanessa Villamarin, BS
W
aking up with a right-sided headache every day made
getting ready for seventh grade a taxing chore. The bursts of pain shooting down my jaw throughout the day and night made simple tasks difficult and made concentrating almost impossible. I was having my first dental complication while experiencing a lack of access to care. No child should go through that experience. -Vanessa Villamarin
new patients, and eight are English speaking only. According to the American Dental Association (ADA), dentists in Massachusetts are predominantly white/non-Hispanic (65-70%), with <4% being Black and <5% Hispanic/Latino. This data highlights the need for a more diverse provider population and more dentists in Worcester to accept MassHealth.
why is oral health important?
dental health in the time of covid-19
Caries are the most common chronic childhood illness in the United States according to the Centers for Disease Control and Prevention (CDC). Children ages 5 to 19 from low-income households are over twice as likely (25%) to have caries compared to children from higher-income households (11%). Furthermore, among children aged 3 to 5 years, the largest racial and ethnic disparity in oral health is seen in Mexican-American and non-Hispanic Black children. Complications from untreated dental caries include infections and pain which can affect speaking, eating, and concentrating. Children with poor dental health have more school absences and receive lower grades than those with good dental health.1 These racial disparities continue into adulthood; CDC data shows that non-Hispanic Blacks and Mexican-Americans aged 35 to 44 years experience untreated tooth decay at twice the rate of non-Hispanic whites and 1 in 4 women of childbearing age have untreated caries. Notably, children of mothers who have high levels of untreated caries are greater than three times as likely to also have caries.2 Only a third of Black, Hispanic, or Asian women see a dentist during pregnancy. Compare this to their white counterparts where 50% see the dentist. What is contributing to these disparities? To be clear, there is no biological reason for Black or Hispanic Americans to have more dental pathology; this occurs due to systemic and institutional racism and bias. This is not an indictment of individuals but instead, a reflection of the flaws of our healthcare, health education system, and society. These issues impact a large percentage of our population, as Worcesterâ&#x20AC;&#x2122;s population is 21% Hispanic/Latino, 13% Black or African American, and 21% persons in poverty.3 access to dental care in worcester
The MassHealth database reports 33 dental practices in the city of Worcester accepting MassHealth and four practices accepting Health Safety Net. However, of these 33 practices, only 18 are currently accepting
The populations at higher risk of experiencing disparities in oral health care (Black and Hispanic/Latinx) are the same populations who are disproportionately affected by COVID-19. Due to the risk of viral transmission through aerosol-generating procedures, the ADA recommended postponement of elective dental services in March 2020 and advised offices to remain closed with the exception of emergency care until April 30th. As dental offices opened, working down the backlog of preventive services for those with no dental issues, leaves the vulnerable with more serious issues waiting in long lines for care. future steps
The most common oral pathologies (dental caries and periodontal disease) are preventable. There are several strategies that we should implore locally to reduce the inherent disparities. pregnancy
Children born to mothers with caries are more likely to have caries. In addition, periodontitis has been associated with an increased risk of preterm birth, low birth weight, and preeclampsia.4-6 Pregnancy is a teachable moment. Potential initiatives could include more dental offices designating chair times for pregnant patients to ensure that they are seen by a dentist at least once during their pregnancy. In addition, prenatal oral health education should be
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