FYI

The minority population of the United States is growing — the U.S. census put it at nearly 40% in 2019. Despite this, ethnic and racial disparity persists within the dental industry, both in terms of who receives care and who provides it.

Gaps in dental care for minorities are significant

While the gap has closed somewhat in the past decade, utilization of dental care among minorities, including Blacks, Hispanics and Native Americans, still significantly trails that of whites.

• While almost half of white adults visited a dentist between 2017 and 2018, fewer than a third of Black and Hispanic adults did, according to data from the American Dental Association’s Health Policy Institute. This gap was even more pronounced among seniors.
• Black adults are also far more likely to have untreated tooth decay and lose their teeth by age 65 than whites.
• While they fare slightly better than minority adults, children of color visit the dentist less often than white children, are less likely to receive preventive care and are more likely to have untreated decay.
• Among Native American children, more than 40% have untreated tooth decay, compared with only about 10% for white children.

For people of color, cost is a significantly greater barrier to dental care than it is for their white counterparts. And this gap is growing — since 2005, the cost of seeing a dentist has increasingly become more of an issue for Black and Hispanic adults and seniors than it has for whites.

• In 2019 almost 30% of black seniors reported that the cost of dental care was an issue, compared with only about 10% for white seniors.
• The number of Black seniors reporting cost as a barrier to care has increased nearly 20% since 2005.
• The number of white seniors who reported cost as a barrier has increased only 6% during the same period.
• Cost has become less of a barrier to dental care for minority children since 2005, in part because dental services for children are now a mandatory benefit within Medicaid.

Language can also create a barrier to dental care. For instance, a study found that limited English proficiency is related to oral health and dentist visits. Among the groups studied, Spanish-speaking Hispanics reported the poorest oral health, most infrequent dentist visits and fewest teeth. Limited English proficiency can also be a barrier to dental care for some Asian populations.

There’s also a significant lack of diversity among dentists

Blacks, Hispanics and Native Americans are severely underrepresented among dentists in the United States, and this situation has remained largely unchanged for more than a decade. 

• As the white population of the United States has decreased during the past 15 years, so has the number of white dentists. However, whites are still overrepresented, with 60% of the population contributing more than 70% of its dentists.
• Asians are significantly overrepresented, contributing 18% of the country’s dentists despite making up only 5.6% of the population.
• Meanwhile, the Hispanic population in the United States has increased to around 18% from 14% during the same period. Despite this, the percentage of Hispanic dentists in the U.S. has increased only slightly, to 6%.
• For the Black community, both its percentage of the population and the dental pool has remained unchanged, making up only about 4% of the country’s dentists despite comprising more than 12% of the population.

Among dental assistants, situation is more encouraging. More than 30% of registered dental assistants are Hispanic and 7% are Asian, and the majority are women. However, Blacks are also underrepresented here; fewer than 7% of dental assistants are Black.

Looking toward the future, there is some cause for optimism.

• The number of women dentists in the U.S. is increasing. They’re also more ethnically diverse than their male counterparts, with a larger percentage of Hispanics and Blacks.
• Applications to dental schools by underrepresented minorities have risen, increasing to more than 15% in 2015 from 12% in 2000.
• Dental school enrollments were also up during the same period, with underrepresented minorities making up about 5% more of the student population in 2015 than they did in 2000.
• Dental school enrollment among Native Americans has seen significant gains, according to a 2019 study.

However, the 2019 study also found that Black enrollment in dental schools is stagnant. And despite the growing dental school enrollment numbers among minorities, population parity among U.S. dentists is still a long way off. 

For example, dental school enrollees from underrepresented minorities in 2015 totaled less than 2% of the dentists needed to achieve true parity among dentists in the United States.

Why diversity matters

Minority dentists are crucial to ensure that diverse communities have access to dental care. Studies have shown that while minorities make up a disproportionately small percentage of the country’s dentists, they provide a disproportionately large share of the dental care to our nation’s minority and underserved communities.

• 40% of Black dentists report that more than half of the patients they serve are Black.
• Native Americans dentists report than more than 20% of their patients are Native American, even though Native Americans make up less than 2% of the U.S. population.
• Minority dentists also serve a much-higher-than-average number of patients on public insurance than do white dentists.
• Conversely, while white dentists make up the majority of dentists in the U.S., they’re also the least likely to participate in Medicaid or the Children’s Health Insurance Program (CHIP).
• More than half of Black, Hispanic and Native American children are insured through Medicaid and CHIP or another form of public insurance, as opposed to only about a quarter of white children.

Trust is another issue. Studies have indicated that minorities, particularly those in lower socioeconomic brackets, often have a higher level of distrust for physicians than do whites. 

However, when treated by a physician of their own race or ethnicity, not only are minority patients more trusting, they’re also more likely to be satisfied with their level of care, receive preventive care and agree to necessary procedures.

How to make your practice more culturally inclusive

Cultural awareness and sensitivity has become more important than ever for an inclusive practice. A great way to ensure that your practice is inclusive is to develop cultural competence.

An important part of cultural competence is taking action, with the goal of improving your service and creating better outcomes for your patients. Another crucial component of cultural competence is being able to communicate effectively with your patients:

• Try to learn a few relevant phrases (hello, goodbye, please, thank you, open your mouth) for your low English proficiency patients. To help you communicate with Spanish-speaking patients, Delta Dental offers a downloadable English-to-Spanish phrase guide for dentists.
• Ask whether anyone on your staff is at least partly fluent in another language — you might already have a valuable resource. If not, considering hiring staff members who are bilingual or multilingual. Don’t forget to update your Delta Dental directory listing to reflect the languages you and your staff speak.
• Make health and wellness materials available in relevant languages. Delta Dental offers a variety of Spanish-language health education materials, including Grin! magazine and wellness videos.

How Delta Dental can help

Delta Dental offers a variety of resources to help you create a culturally inclusive practice.

• Delta Dental’s Language Assistance Program (LAP) offers enrollees interpretation via telephone in more than 170 languages.
• On-site interpreters are also available for Delta Dental enrollees with limited English proficiency — at no cost to the enrollee or you. (Onsite interpretation services require at least 72 hours advanced notice.
• You can learn more about the LAP by logging in to Provider Tools and navigating to the Reference Library.

As part of our commitment to fight racism and build minority representation in the dentistry profession, Delta Dental plans to partner with universities to provide scholarships for qualified applicants who are Black, Hispanic or represent other communities of color.

Finally, to advance dental health and access, the Delta Dental Community Care Foundation also supports dozens of agencies and nonprofits that provide dental care to underserved and minority populations.