The Impact of Socioeconomic Status on Oral Health
The United States is 9th in dental health in the world. While oral health may seem like only a problem in the UK, some improvements could be made here as well. In high school, I decided to become a Certified Dental Assistant in Texas through the Dental Assisting program in my junior and senior years because I wanted to help improve oral health in my community. Working in dentistry has never been seen as glamorous, it is an important profession that plays a large role in public health. The program at my school was the smallest one with a class size of 15 students in comparison to classes of 50+ students for pharmacy, nursing, assisting, and more. I loved becoming a dental assistant because it showed me how much work needs to be done for oral health, especially in marginalized communities with lower socioeconomic status.
Socioeconomic status impacts oral health from the beginning of a child’s life. To improve oral health for families, there needs to be education and priority starting at birth. The first permanent tooth a child grows is a molar. They grow it at age 6. It is their first permanent tooth and will be with them for the rest of their life. However, at 6 years of age, children often do not understand the importance of keeping their teeth in clean condition. Working as a dental assistant in clinics let me see how many children have bad dental health. Parents do not put enough emphasis on brushing their teeth which causes them to develop dental caries. From this young age, it is important to maintain good oral health and have strong habits. Children have the biggest problem building these habits. As a dental assistant, part of my training and job routines was to educate and help people understand the importance of brushing their teeth regularly. Originally it seemed ridiculous to me that I would have to do something that seemed so simple. While working, I found that there was a great need for education like this for parents and children. People with a lower SES have to work long hours outside of the traditional 9 to 5. It is harder for them to find and make time when the majority of dental offices close at 5 p.m. Because of this, they do not have time to teach their children proper dental hygiene habits. “They found that supervised toothbrushing for a 5-year-old school children was effective in underprivileged groups, as was targeting nutrition and broad oral health education of mothers.” (Goodwin 109) There needs to be oral health promotion education integrated into schools and the health system to tackle the gap in oral health between socioeconomic statuses. Health promotion is one of the best ways to bridge the gap.
I did rotations at periodontists, endodontists, pediatrics, and orthodontics. During these rotations, I got to see a variety of dental disciplines and saw that health education was needed. I would see hundreds of patients with bad oral health hygiene because of their socioeconomic status (SES). The bad oral habits they developed as a child carried over with them as they became adults. This resulted in things such as root canals resulting from dental caries being left over time and dental caries resulting from poor oral hygiene. All of which are easily preventable with proper brushing and flossing. However, when working in more affluent areas, this does not happen as often. The families in the locations have more access to doctors and receive better dental health education. Their parents understood the importance of good oral habits and installed these habits into their children which is hard to happen in other socioeconomic groups.
A large amount of these marginalized populations live in healthcare deserts. These physicians are always overworked and underserved. Because of this, patients often have to wait long hours or months till their appointment. Growing up, I was a very sick kid. I got sick nearly all the time and had to leave school for the doctor. These doctor’s visits took hours of wait regardless of whether I had an appointment or not because I lived in a medically underserved area. I spent numerous hours sitting in a lobby filled with the cries of children, and adults asking nurses when they would be next, and just be full of chaos. Even for simpler appointments such as my annual dental cleaning, I would spend half of the day for a simple procedure. The doctors were extremely overworked and exhausted. This leads to dental caries and health problems being overlooked by the dentist. It takes so long to get an appointment and get serviced that I found that patients would regularly go months and years before visiting a dentist again. Children need to visit every year because their teeth and mouth changes drastically as they grow. As they get older, if they do not receive these yearly appointments and cleanings, they will not do so as they get older.
An estimated 77 million Americans do not have dental insurance. this issue is increased in rural towns and city areas with predominantly Black, Hispanic, and Asian populations. This issue has only been exacerbated by the COVID-19 pandemic. It was already enough to get low-income populations into the dental office for annual cleanings and checkups. It is estimated that dental health is one of the most prevalent non-communicable diseases. It also accounts for 1/5 of out-of-pocket expenses. Because of this, it is ever more important to emphasize and promote dental health. However, for a large majority of dental insurance and Medicaid, a lot of basic oral health requirements are not covered. Things such as braces, retainers, and others are not usually covered unless the situation is drastic, but all of these things improve oral hygiene and need to be covered.
A patient’s SES plays a large role in determining their oral health. It is estimated that people with lower SES have more dental caries and more. The coronavirus pandemic has increased the gap and widened the disparity as well. It has affected marginalized populations way more. “Oral diseases are highly prevalent, expensive to treat, and have considerable negative impacts on individuals’ quality of life. Moreover, oral health inequalities are persistent…with worse oral health observed among vulnerable and lower socioeconomic groups worldwide.” (Abbas 606) There needs to be a greater focus on making dental care universal and dental insurance is often left out of the conversation. It took 14 years for the World Health Organization to highlight oral health in the 74th World Health Assembly. At USC, students are required to have health insurance but are not required to have dental insurance. This is just one of the many ways dental care is not prioritized in any way.
With the pressures of the pandemic, Goswami found that parents cared less for their children’s teeth during the pandemic. It significantly impacted daily life worldwide, especially in families. Parents and children were suddenly working at home all day and were thrown out of their usual routines. Maintaining good oral hygiene from a young age is crucial to prevent dental and periodontal problems throughout a child’s life. Oral health declined overall during the pandemic, but it declined the hardest in lower SES groups. There is so much work that needs to be done. Until the bridging the gap of oral health between socioeconomic statuses is prioritized, they will live like second-class citizens.
Works Cited
Abbas, Hazem, et al. “The role of science communication and academic health advocacy in improving population oral health and tackling inequalities.” Community Dentistry and Oral Epidemiology (2023).
Dickson-Swift, Virginia et al. “The impact of COVID-19 on individual oral health: a scoping review.” BMC oral health vol. 22,1 422. 22 Sep. 2022, doi:10.1186/s12903–022–02463–0
Goswami, Mridula et al. “Attitude and practices of parents toward their children’s oral health care during COVID-19 pandemic.” Journal of the Indian Society of Pedodontics and Preventive Dentistry vol. 39,1 (2021): 22–28. doi:10.4103/jisppd.jisppd_478_20
Goodwin, Michaela, Michelle Henshaw, and Belinda Borrelli. “Inequities and oral health: A behavioural sciences perspective.” Community Dentistry and Oral Epidemiology 51.1 (2023): 108–115.
