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New data shows that changing distribution of race in the U.S. population is not being reflected in the dental workforce, and that racial disparities are evident in the number and student debt levels of Black and Hispanic Americans graduating from dental schools. (Image: StunningArt/Shutterstock)

U.S. dentistry suffering from racial disparities

By Jeremy Booth, Dental Tribune International
April 23, 2021

CHICAGO, U.S.: The U.S. dental workforce is diversifying but is still not representative of the racial and ethnic demographics of the wider population. According to new research by the Health Policy Institute (HPI), Hispanic and Black Americans are significantly underrepresented in the dental profession, and Asian and white Americans hold a disproportionate share of dental jobs. These disparities are also evident in dental education and in reported cost barriers to oral care.

HPI published a series of new infographics in April that showed that Black and Hispanic dentists accounted for 3.8% and 5.9% of the U.S. dental workforce in 2020, respectively. In the same year, Black Americans accounted for 12.4% of the U.S. population, and Hispanic Americans accounted for 18.4%. Asian American dentists represented 18.0% of the dental workforce, despite Asian Americans accounting for just 5.6% of the population. White Americans held 70.2% of dental jobs and accounted for 60.0% of the population.

The HPI data shows that the distribution of race in the U.S. population has changed significantly since 2005; however, it also shows that these changes are not being reflected in the dental workforce.

The distribution of Asian Americans in the population increased over the period—from 4.2% in 2005 to 5.6% in 2020—and this group’s percentage of the dental workforce increased from 11.8% in 2005 to 18.0% in 2020. In 2005, Hispanic Americans accounted for 14.4% of the population and this increased to 18.4% in 2020. In 2005, Hispanic dentists represented 4.2% of the dental workforce, and this increased to 5.9% last year. The distribution of Black Americans within the population remained steady, increasing by only 0.2% between 2005 and 2020, and the percentage of Black Americans in the dental workforce increased by 0.1% over the 15-year period.

The percentage of white Americans in the population decreased from 67% in 2005 to 60% in 2020, and the percentage of white dentists in the dental workforce decreased from 79.8% to 70.2% during the same period.

Racial disparities in cost barriers to dental care

The HPI data showed that racial disparities relating to cost barriers to dental care have increased in the adults’ and seniors’ age groups and decreased for children. In the children’s age group, reported cost barriers to dental care decreased for all racial groups that were included in the data. In 2005, reported cost barriers were the greatest for Hispanic children, at 11%, and this decreased to 6% in 2019. Reported cost barriers for Black and Asian children decreased from 7% to 4% and from 7% to 3%, respectively.

In 2005, cost barriers to dental care were reported by 16% of Hispanic and Black adults, and these increased to 27% and 23%, respectively, in 2019. In 2005, cost barriers to dental care were reported by 12% of white Americans, and this increased to 16% in 2019.

In 2005, 10% of Hispanic seniors struggled to pay for dental treatment, and this increased to 29% in 2019

The most drastic increase in reported cost barriers to dental care was among Hispanic seniors. In 2005, 10% of Hispanic seniors struggled to pay for dental treatment, and this increased to 29% in 2019. Cost barriers were reported by 5% of white and Asian seniors in 2005, and this increased to 11% and 16% in 2019, respectively. For senior Hispanic Americans, cost barriers were reported by 6% in 2005 and by 19% in 2019.

More Asian Americans studying dentistry

The HPI data showed that the U.S. dental student body has diversified since 2005 and that more Asian and Hispanic Americans are enrolling in dental studies. Asian groups currently account for around 25% of all dental students, 18% of the dental workforce and 6% of the U.S. population.

Racial inequalities were evident in the amount of student debt incurred by dental graduates. According to the data, more than 20% of Asian dentists graduate from dental school with no student debt. For Black dentists, just 1% begin their working careers debt-free. In 2019, the average student debt owed by graduating Black dentists was $314,360 (€261,405 at current exchange rates). The average student debt was $283,046 for white dentists, $286,437 for Hispanic dentists and $225,750 for Asian dentists.

Dr. Jessica Meeske, chair of the American Dental Association (ADA) Council on Advocacy for Access and Prevention, commented in a press release that the HPI data presents an opportunity to raise awareness of health disparities. “The ADA has a historic opportunity to lead that change and work for improved oral health of every American through supporting oral health equity and reforms that ensure that anyone who wants a healthy mouth can achieve it, regardless of age, race, disability, and income,” Meeske said.

What was most surprising to me is how far we’ve come in decreasing the gap between children of different races in seeing a dentist, but not adults,” Meeske said. “I suspect this is due to a smaller number of dentists willing to be able to see new adult Medicaid patients.”

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