Humera Rohail, Sokuntheary Prak, Kathleen Shang
Project Smile Global
June 30, 2024
(Photograph of individual with braces)
June has been recognized as Dental Diversity Month, a time to celebrate the diversity of specialists and raise awareness about how patients' cultural backgrounds affect their oral health. Over the past few centuries, there has been an increasing correlation between socioeconomic status (SES) and poor oral health. This is a significant concern, as over 2.5 billion people worldwide do not have access to dental care, many due to their SES (World Health Organization 3). The lack of equitable access to oral healthcare services, including clinics, hospitals and clean water, is a pressing issue. Despite the availability of these services in Western and industrialized countries, deprived communities in Western countries, such as racial minorities and homeless individuals, lack access to oral health services (Northridge 513). In Central and Eastern Europe, the privatization of dental care has decreased access, despite the presence of third-party payment systems (Northridge 513). Developing countries, including those in Africa, Asia, and Latin America, face challenges due to the low capacity of oral health care systems, which are most commonly found in central hospitals (Northridge 513). These global disparities largely stem from inadequate funds and poor diets, both at the governmental level and within the SES of individuals. Addressing these disparities requires urgent and concerted efforts to ensure equitable access to essential dental services for all populations, regardless of their economic and social status.
(Socioeconomic disadvantage and oral-health-related hospital admissions: a 10-year analysis | BDJ Open)
Various studies have concluded that SES is related to the amount of nutritious food one consumes. One study's results showed that 59% of participants in the lowest quintile of SES shopped at low-cost supermarkets compared to 16% of those in the highest quintile (Pechey and Monsivais). The U.S. Department of Agriculture has also identified that low-cost supermarkets usually offer less nutritious foods (Ver Ploeg). When putting these two claims together, individuals with low SES are more likely to purchase unhealthy foods with a lack of natural fruits and vegetables. Without enough vitamins from healthy foods, people are more likely to develop diseases and other adverse health consequences. Poor oral health can indeed disrupt food intake, but it's also possible that oral health issues are caused by an unhealthy diet. For example, tooth loss has been associated with low intakes of fruits and vegetables, vitamins C, K and E, as well as a high consumption of fatty acids (Kotronia et al). Increased energy intake was also associated with dry mouth, which could lead to increased plaque or gum disease (Kotronia et al). There have indeed been policies made to make an effort toward improving markets in low socioeconomic class regions. For example, New York City's Healthy Bodega program has strived to ensure more availability of low-fat milk, fruits, and vegetables in small corner stores (Ver Ploeg). However, such a small stride alone will not be enough to fight the increasing percentage of oral health issues.
When comparing SES and the rate of adults with dental caries [cavities], it is known that individuals with low SES have a significantly higher prevalence of cavities (Simone et al). A research study review published by the International Journal of Environmental Research and Public Health showed that socioeconomic factors such as educational level, income, occupation, status, and community index influenced the rate of adults between the ages of 19 and 60 who had/have cavities. This review analyzed a total of 189 relevant studies throughout seven databases and saw that the most frequent socioeconomic indicators were schooling and income. It was seen that individuals who knew less about oral health and were unable to afford the necessities for maintaining proper oral health were at a higher risk of developing dental caries, eventually leading to missing teeth and tooth decay (Simone et al). Also, a decline in dental caries was observed in most industrialized countries over the past 20 years due to several public health measures and the use of fluorides. This correlates with accessibility for individuals with higher SES since they can gain more access to dental services, fluoridated water, oral products, and information on the importance of maintaining proper oral health. Another Department of Conservative Dentistry and Endodontics study showed the correlation between SES and dental caries. Compared to high-income patients, who had 1.15% of moderate or extensive lesions, 5.48% of the low-income patients and 10.37% of the middle-income patients had moderate to extensive lesions, which can be represented in Figure 5 (Ramamoorthy 164). The comparison of socioeconomic factors and the rate of dental caries shows that individuals with lower status have a greater risk of developing dental caries due to the inability to access proper oral health information and resources.
As SES and the correlation between poor oral health continue to prevail, reducing the barriers to dental care becomes vital. The Office of Disease Prevention and Health Promotion suggests that integrating oral health into overall health care allows doctors, nurses, and other non-dental professionals to recognize the risk for oral diseases. This primarily benefits those in Africa and Latin America with scarce dental care facilities. Additionally, promoting legislation and policy changes supporting dental care access will allow for adequate funding and increased accessibility. Thus, expanding capacity at state and local levels for the public. However, it is crucial to stress the need for increased research to reduce barriers to oral health care. By undertaking these measures, we can strive for a future where oral health becomes accessible to people worldwide.
To conclude, Dental Diversity Month serves as a reminder of the global disparities in oral health care access. Today, SES continues to have a powerful effect on access to dental care globally, most significantly in less developed countries of Africa, Asia, and Latin America. Closing these gaps requires both improved policies and funding, in addition to prioritizing equitable access to oral health services for everyone, regardless of their
cultural background or SES. By advocating for policy changes and increasing awareness, it is possible to work towards a future where oral health care is a fundamental right accessible to everyone across the globe.
Works Cited
Costa, Simone M et al. “A systematic review of socioeconomic indicators and dental caries in adults.” International journal of environmental research and public health vol. 9,10 3540-74. 10 Oct. 2012, doi:10.3390/ijerph9103540
“Improving Access to Oral Health Care for Vulnerable and Underserved Populations - Healthy People 2030 | Health.gov.” Health.gov, health.gov/healthypeople/tools- action/browse-evidence-based-resources/improving-access-oral-health-care- vulnerable-and-underserved-populations.
Kotronia, Eftychia, et al. “Poor Oral Health and the Association with Diet Quality and Intake in Older People in Two Studies in the UK and USA.” The British Journal of Nutrition, U.S. National Library of Medicine, 14 July 2021, https://doi.org/10.1017/s0007114521000180
Northridge, Mary E., et al. “Disparities in Access to Oral Health Care.” Annual Review of Public Health, vol. 41, no. 1, 3 Jan. 2020, pp. 513–535,
Pechey, Rachel, and Pablo Monsivais. “Socioeconomic Inequalities in the Healthiness of Food Choices: Exploring the Contributions of Food Expenditures.” Preventive Medicine, U.S. National Library of Medicine, July 2016, https://doi.org/10.1016/j.ypmed.2016.04.012
Ramamoorthy Jagadheeswari, Mahalakshmi J, Correlation of Socioeconomic Status and Dental Caries, J Res Med Dent Sci, 2022, vol.10 is. 6, pgs: 161-167.
Ver Ploeg, Michele. “Access to Affordable, Nutritious Food Is Limited in ‘Food Deserts.’” USDA ERS - Access to Affordable, Nutritious Food Is Limited in “Food Deserts,” 1 Mar. 2010, www.ers.usda.gov/amber-waves/2010/march/access-to-affordable-nutritious- food-is-limited-in-food-deserts/.
“WHO Highlights Oral Health Neglect Affecting Nearly Half of the World’s Population.”
World Health Organization, 18 November 2022,
https://www.who.int/news/item/18-11-2022-who-highlights-oral-health-neglect- affecting-nearly-half-of-the-world-s-population #:~:text= The%20report %20 shows%20that%20almost,-%20and%20middle-income%20countries
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