Why There Really Aren’t Enough Black Dentists
The impact of systemic racism on an oral healthcare crisis and how to fix it
There’s been ample research highlighting the fact that patients, particularly marginalized ethnic minorities, feel greater comfort and trust with doctors that look like them. Racial concordance or shared racial identity between patients and medical providers has a direct correlation to increased patient satisfaction and improved patient outcomes. In dentistry, Black patients often seek out Black dentists because they are sympathetic to their needs and expectations. Fear and mistrust of White dentists stem from the century-long era of racial segregation in the United States that followed slavery when most Black patients were limited to care from only Black providers or restricted from obtaining care from a dentist altogether. The legacy of racism actively presents today in racial bias being widely reported with regards to quality of care where White doctors often do not properly assess levels of pain in Black patients and implicit bias subconsciously influencing their treatment recommendations for Black patients. As reported in the Journal of Dental Research, dentists’ racial bias has resulted in a greater likelihood of extractions in comparison to root canal treatment for Black patients presenting with a broken-down tooth and symptoms of irreversible pulpitis.
Black Patients Seeking Black Dentists
Given the long history of mistreatment of Black patients by the medical establishment, many Black patients prefer doctors who look like them. However, if you’re a Black patient seeking a Black dentist, it might be extremely difficult to find one. Making up only 3% of the dental workforce compared to 13% national population, Black dentists are severely underrepresented in the profession. More concerning is that the American Dental Association reports that diversity, equity, and inclusion interventions to support admissions have had little benefit to Black students over past 20 years as the percentage of Black dentists has remained unchanged while the percentages of Asian dentists has doubled to nearly 20% and that of White dentists has remained higher than national parity at almost 70%.
The fact that the U.S. dental workforce does not reflect the racial demographics of the country has had profound implications for oral health disparities that impact how Black patients experience dental care. Furthermore, racism in healthcare is expensive as inequities of the US Healthcare System cost $320 billion in annual federal spending and are expected to reach $1 trillion by 2040 if unaddressed. A shortage of Black dentists also contributes to the persistent wealth gap between Black and White Americans as it reduces access to the opportunity for economic mobility that practicing dentistry traditionally provides.
The Root of the Problem
So, why are there so few Black dentists in the United States and how can we resolve this issue? In order to better understand and address racial inequities in oral healthcare, one must appreciate their foundational causes, which are rooted in slavery and racial discrimination, and also acknowledge the nation’s legacy of social injustice. For many Black dentists, access to the profession is not a straight line path. It has been well documented that the history of racial discrimination in the United States has led to huge disparities in education levels and most significantly wealth, which is a driver of professional opportunity. In order to advance racial equity in the profession, considerations must be given to the economic and social patterns of resistance that aspiring Black dental students face at every level of their lives.
Diversity is not a monolith so strides to include all groups in dentistry must consider that different diverse groups have different experiences because of race. Efforts to include Black dental students must fully accept that the black experience is one of prolonged discrimination, financial challenge, and too often exclusion. Given existing income and wealth disparities that manifest from racially discriminatory practices and policies in healthcare, housing, education, banking and criminal justice, the lack of racial diversity in the dental profession is not surprising.
Communities that lack access to dental care also lack access to other social and economic determinants of health, like education and professional‐wage jobs. According to the Federal Reserve Survey of Consumer Finances, in 2019 the median white household held $188,200 in wealth — 7.8 times that of the typical Black household, which is only $24,100. Due to lower wealth and household incomes, Black dental students start out with a significantly smaller financial endowment compared to their White peers. Financial investment into Black dental students in the form of scholarship is requisite to advance equity in the profession. Ultimately, structural racism plays out in dentistry on both the provider and patient sides: marginalized communities lack both access to care and to the profession.
Why Diversity in Dentistry is an Imperative
The lack of ethnic diversity in dentistry makes it a profession that is often perceived by the Black community as resistant to racial inclusion. The small number of Black dentists appears in all parts of the field. There are few practicing Black dentists and few black students enrolled in dental schools. Also absent are Black faculty to help groom a culturally competent workforce and perform research to address disparities. For example, dental anxiety as a pathway through which perceived experiences with racism may impact oral health outcomes. Additionally, diversity helps to address racial and ethnic health care disparities by improving patient and community-centered care and enriching the pool of policy makers. According to a study by Journal of Dental Education on color-blindness among dental school faculty at the University of Florida, researchers affirmed that critical examination of the history of racism, personal racism, whiteness, and advocacy are needed in dental school education and faculty training to reduce racism in dental academia.
While severely underrepresented, Black dentists care for the most marginalized populations including upwards of 50% of all Black patients, with an average patient mix that is nearly 50% Black. Their disproportionate shouldering of vulnerable populations is further highlighted in the treatment of children. Fewer than a third of U.S. dental practices treated any patients on public insurance in 2020. Although severely underrepresented in the profession, Black and Hispanic dentists are twice as likely compared to White dentists to treat Medicaid beneficiaries. Unfortunately, due to the historically inequitable structure of oral health care in the United States, dental decay although widely preventable is still the leading chronic disease of early childhood and access to dental care is limited for the millions of children — disproportionately children of color — who rely on Medicaid and the Children’s Health Insurance Program. Increasing the number of Black pediatric dentists, as well as other specialists, is crucial to achieve oral health equity.
Where do we go from here?
The need to bring Black dentists up to parity with their population share is an urgent call to action for the nation as a whole as this disparity affects all patients, the economy, and overall population wellness. According to the Department of Health and Human Services, 19,714 additional Black dentists are essential to address the inequity and it has been argued that such a goal would take three generations to achieve, requiring a dynamic long term strategy. Recruiting, funding, and promoting more Black dentists would improve racial concordance between minority patients and practitioners, which is associated with increased access to care, better communication, and increased likelihood of being offered and accepting appropriate care. Thus, it is imperative to level the playing field for Black dentists by institutions taking earnest steps to dismantle structural racism in order to create a more inclusive dental profession and equitable society.
Dr. Brigitte White is a cosmetic dentist in the Washington, DC metro area and adjunct faculty at University of Pennsylvania School of Dental Medicine. Follow her on Instagram, Spotify, and Youtube.
