(WITHDRAWN) An Ecological Review of Social and Environmental Determinants of Oral Health Disparities

Background: While social work has historically played an important role in medical health care, dentistry has for the most part, not included a social work model of care as part of its operation. However, oral health is crucial to the general health and well-being of individuals and the population at large. In 2016, the Federation Dentaire International World Dental Federation adopted a new definition of oral health, encompassing the dynamics of genetic and biological factors, social environment, physical environment, health behaviors and access to care, and elements that modify oral health including age, gender, culture, income. This definition of oral health incorporates social determinants of health and supports the understanding that oral diseases can be socially patterned.

Methods: This study presents a conceptual framework for investigating oral health disparities based on Bonfenbrenner’s (1994) ecological system theory. First, we present the conceptual framework that examines oral health disparities under a range of individual, neighborhood, and policy factors. We then organize and review the related literature within the context of the proposed model. The purpose is to provide an empirical knowledge base that can inform the development of health policies and services. The presentation concludes with suggestions for welfare policy and practice on how to improve oral health disparities for disadvantaged population.

Findings: At an individual ecology level, low-income and minority populations have the highest levels of untreated dental disease and are the very ones who lack access to high quality care (Henshaw et al., 2018). For example, the prevalence of periodontitis was 20% greater among Hispanics and Blacks than among Whites, while the rate of untreated dental caries was twice as high among Hispanic and black children compared to White children. Poverty directly limit African Americans and other minority groups access to quality health care. Further, persistent stress from poverty and subtle racism creates health risk through physiologic pathways (Scott & Wilson, 2011). At macro level, neighborhood conditions affect oral health in diverse ways, including physical safety, social networking, oral health care information, and the supply of dental care providers. Distinct oral health disparities exist among those residing in medically and dentally underserved rural and urban areas. Further, at policy level, health insurance inequalities contribute to oral health disparities. Access to oral health care is mediated through the availability of private dental insurance or poorly funded public oral care. Private dental insurance facilitates the use of preventive oral care and mitigates negative effects of oral disease. Public oral health care funds preventive care but few eligible persons actually receive or benefit from it.

Implications: Persistent and consequential oral health disparities exist within the U.S. population. Reducing these oral health disparities is central to the overall goal of improving population health. Changes are need in resources allocation, community outreach and education, and social and public policy in the provision of effective oral health care and access. This study has implications for prepare social work professionals to address oral health disparities through interdisciplinary collaborations with dental health professionals via research, education and practices.