My mom has fillings in 16 of her 28 teeth. She’s the eighth of twelve kids, and her dad used hard candies as a reward for quiet at bedtime, so she and her siblings often went to bed with a mouth full of sugar. They didn’t go to the dentist (or any health care provider) except in cases of emergency, and there was always a shortage of healthy food (or any food, really) in the house. So her poor dental health is no surprise.
Poverty, access to transportation, access to dental care, food security, and other factors were all working against her and her family. One thing that wasn’t working against them was their race. Being white confers a set of advantages when it comes to your health, and that’s as true in Colorado as it is anywhere else in the US. Our institutions have a long history of segregating communities of color, concentrating resources in white communities, and designing systems that benefit white people. This leads to preventable differences in the health of our mouths, teeth, and gums. So while many, many white Coloradans are at risk for poor oral health, Coloradans of color are at a greater risk, due to the impact of racism on our laws and policies.
Our data brief, Beyond Brushing: The Impact of Racism on Oral Health in Colorado, dives deep into these issues. Most directly, we know that Coloradans who have dental insurance are more likely to see a dentist (CHAS, 2017), and that fewer Coloradans of color can get dental insurance because of the cost or the availability of it through their employer. But even if you have insurance, there has to be a dentist in your community, and Colorado has widespread shortages of dentists across the state, especially where the concentration of people of color is highest.
And, just having access to a dentist is only a small part of what helps our teeth and mouths stay healthy. Food and nutrition are huge challenges for many families, whether it’s because there are no grocery stores nearby or because poverty is forcing people to go hungry. When we go hungry, we're not getting calcium and other nutrients to keep our teeth strong; we're not chewing, which stimulates saliva production and washes away bacteria; and, the limited food we do get is likely to be the least healthy, which causes decay. Communities of color are more likely to face food insecurity because our systems aren’t adequately meeting their needs. While 17% of white children in Colorado are going hungry, 37% of children of color are going hungry, a despicable inequity made even more cruel by the fact that we have more than enough food to feed every child.
There are many additional ways that systemic racism shows up in oral health, from the high rates of jobs held by people of color that offer no paid health leave to the extreme lack of diversity in the dental health care workforce. One study even showed that 22% of blacks avoided medical care in the US out of concerns about racial discrimination, compared to just 3% of whites. Those concerns are valid: it’s also been shown that most health providers, regardless of their race, have implicit bias against people of color.
We all want healthy teeth, not only because they are critical for basic functioning, like eating and talking, but also because they are intimately tied to our confidence, our ability to get a job, our overall health, and so much more. Our data brief includes over a dozen ways we can take action to improve oral health equity in Colorado. I hope you’ll read through it, and as you’re brushing this evening, think about what advantages or disadvantages you and your teeth had growing up. Then, think about what action you can take tomorrow. Together, we can make changes that we can all smile about!