Unequal Dental Care Access: Racial/Ethnic Disparities and the Magnifying Role of Social Determinants

Background: Access to regular oral health care is a crucial component of preventive health care, contributing to overall well-being and reducing long-term health disparities. However, significant racial and ethnic disparities in the utilization of dental care persist, particularly in racially marginalized communities. While these gaps are well-documented, understanding the variation within each group remains understudied, despite the importance of addressing these disparities through effective social work interventions. This study aimed to address the following two questions:1) Do racial/ethnic differences exist in the likelihood of recent dental care access, after controlling for demographic and socioeconomic factors? 2) To what extent do within-group differences in dental care access vary across racial/ethnic groups?

Methods: We analyzed the 2022 Behavioral Risk Factor Surveillance System (BRFSS) data from adults aged 18 or older (n = 62,018), excluding observations with missing data on key variables. Participants self-identified as White, Black, Hispanic, Asian, or Multiracial. The primary dependent variable was oral health care access, defined as whether the participant had received a dental checkup within the past year. We estimated a binary logistic regression model adjusting for demographic and socioeconomic factors, including sex, household income, language, metropolitan status, and insurance coverage. Due to a small amount of missing data, we conducted a complete case analysis.

Results: Race/ethnicity was significantly associated with dental care access (p < .001).
Compared to White participants, Black participants had significantly higher odds of reporting access to dental care (aOR=1.50, p < .001), while Hispanic (aOR=0.81, p < .001), Asian (aOR=0.69, p < .001), and Multiracial (aOR=0.78, p < .001) participants had significantly lower odds. Margins analysis revealed the largest within-group disparities among Asian and Multiracial participants, with predicted probabilities of dental care access ranging from 58% to 71% by insurance status and 66% to 75% across income levels, indicating that lack of insurance may exacerbate existing disparities in these groups. In contrast, Black and White participants showed smaller within-group differences. After adjusting for demographic and socioeconomic factors, these patterns still emerged consistently.

Conclusion: Significant racial/ethnic differences in dental care access were observed, along with notable within-group disparities, particularly among Asian and Multiracial populations. While Black participants demonstrated relatively high levels of access, Asian and Multiracial participants exhibited both lower average access rates and greater internal variability. Hispanic and White participants had moderate overall access, with some variation observed among Hispanic individuals, whereas Black and White groups showed more consistent utilization patterns. These findings underscore the need for race-conscious strategies that go beyond structural factors and explicitly incorporate culturally and linguistically appropriate approaches. For Asian and Multiracial communities in particular, disparities may stem not only from lack of insurance but also from cultural perceptions of oral health, language barriers, and limited trust in healthcare systems. It highlights that culturally tailored outreach and public health efforts—grounded in social work practice—are essential to improving access and promoting oral health equity. Public health programs must prioritize these groups by ensuring that services are not only affordable but also culturally responsive and community-informed.