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Oral Health Disparities in New York by Bridget Walsh

By Bridget Walsh

Most people don’t know a great deal about oral health. For example, did you know that tooth decay is a communicable disease? Or that it is the most common chronic childhood disease? These facts are largely unknown by the public and policymakers because, despite the terrible human cost and the significant health costs associated with dental disease, oral health rarely garners the same attention as other health issues. 

Oral health—the health of the teeth, the gums and the rest of the mouth—is not usually included in what we traditionally consider health care. Think about it for a moment. Most people receive their dental care outside the usual medical setting and pay for care with dental, not medical, insurance. Payment systems are largely separate, services are not integrated and there is not always an association between medical and dental providers. And yet, the mouth is connected to the rest of the body in significant ways. It allows us to eat and speak. It communicates our feelings. It protects us from germs. In fact, more and more research indicates that the health of the mouth impacts conditions such as lung and heart disorders, diabetes, pregnancy and obesity.

Good oral health is “not just” the absence of disease, but the full ability to use the mouth for everyday functions such as eating, smiling, speaking. While oral health focuses specifically on issues presenting in the mouth—including the teeth, tongue, gums, and the entire oral cavity—oral health is inseparable from physical and mental health.

There are many examples of how oral health effects, and is affected by, the health of the whole body. When oral health is compromised, it can lead to increased risk for diseases such as cardiovascular disease or stroke. Oral disease has been linked to complications in pregnancy and childbirth and to respiratory, gastrointestinal, rheumatologic, and immunological issues. The influence goes the other way, too: other health conditions can affect the mouth, as when medication side effects lead to a dry mouth and thereby increase the risk of cavities or gum disease. Furthermore, oral health has unique psychological and social elements. Because the mouth is a prominent part of personal appearance, people with visible signs of oral disease are negatively judged and socially stigmatized, with consequences for their mental health as well as other influences on well-being, such as employment outcomes.

The 2021 report by the National Institute of Health, Oral Health in America, makes the point that the benefits of good oral health extend beyond the individual to families and communities. When considering oral health from a population perspective, it becomes clear that the burden of oral disease falls most heavily on subgroups that have limited economic resources, low levels of educational attainment, poor access to dental care, and lower levels of social influence or political capital. This leads to recognizable oral health disparities and inequities that are the result of differences in the availability of social and economic health-promoting resources that are largely avoidable and amenable to policy action—including access to affordable, healthy foods, professional dental prevention and treatment services, and dental insurance.

There is no question that for the last century, and particularly in the last few decades, the oral health of New Yorkers has improved substantially. The decline in dental disease is a testament to the efforts of health professionals and individuals, public health investments, government policies, educational institutions and health care organizations. However, the improvements are not uniform and some populations continue to experience a high degree of oral health problems.

Poor oral health is largely reserved for low-income and marginalized residents of the United States – including New York. People of color, Tribal, low-income, uninsured, immigrant, individuals with disabilities, and rural communities all have significantly less access to dental care and, unsurprisingly, more oral health problems – problems that can be so severe they can turn lives upside down. Poor oral health is so readily preventable there is no justification for children, seniors, and adults to have to live with the pain, disfigurement, and stigma of preventable, treatable disease. In 2021, fewer than 30% of adult New Yorkers covered by Medicaid saw a dentist and only 25% had a preventive dental visit. Only 50% of Medicaid-enrolled children saw a dentist and 40% had a preventive visit. 

We know what causes oral health problems such as tooth decay, and there are also many programs that have shown promise in preventing disease and improving health. However, there are many factors keeping families and individuals from accessing these programs or even accessing regular dental care from an appropriate provider. A recent study by the Center for Health Workforce Studies found that over 2.8 million New Yorkers live in dental health professional shortage areas, and majority live in rural areas. 

The Schuyler Center for Analysis and Advocacy is a statewide, nonprofit, policy analysis and advocacy organization working to shape policies to improve health, welfare and human services for all New Yorkers, especially children and families experiencing poverty and impacted by inequity. For many years we have focused our attention on dental disease in children and programs to prevent disease and promote the integration of medical and dental care. However, it became apparent from oral health policy conversations in recent years that it is time for a thoughtful, data-informed, multi-stakeholder conversation about improving access to care through workforce changes. 

Recently, the Schuyler Center was awarded a grant from the CareQuest Institute for Oral Health to support work focused on developing workforce recommendations to address the tremendous unmet need for preventive and routine oral health care among much of New York’s population, especially low-income New Yorkers. During 2024, the project is incorporating the experience of consumers, particularly historically marginalized New Yorkers and others impacted by provider shortages into a final report of recommendations to reduce unmet need by expanding and strengthening the oral health workforce. The project has also allowed for the development of data from the Oral Health Workforce Research Center at the University at Albany Center for Health Workforce Studies.

The project is presenting a series of webinars on oral health and potential ideas to ease workforce shortages. Anyone is invited to attend the webinars. All the webinars and materials, including the data, are available on our webpage, Oral Health Workforce | SCAANY.  We will publicize that report and additional materials at the end of the year.

Recognition of the importance of good oral health has been growing among policymakers, medical providers, and human service providers as it becomes more evident that the lack of access to regular dental care increases costs for the health system, contributes to consumer medical debt, reduces the economic productivity by limiting participation in the workforce and results in unnecessary suffering. Focusing on prevention is key as is developing a diverse, accessible workforce that meets the needs of individuals. 



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