On the fight against racism in dentistry

Systemic racism in dentistry isn’t a recent development. Many persons of color have been acutely aware of it for some time due to firsthand experiences in dental practices and the health-care system in general. However, it may seem like a new concept to some, because many are just now starting to listen.

The Black Lives Matter movement is affecting real change in society, and one of those changes is that white Americans are learning about the oppression that people of Black culture face daily. In dentistry, racism affects both dental professionals and patients. In fact, myriad studies have demonstrated the reality of systemic racism in dentistry and the emotional, physical, and social harm that can come of it.¹

Sobering statistics

Most people are somewhat aware that poverty doesn’t affect white Americans at the same rate that it does Blacks, Hispanics, and American Indian/Alaska Natives. A survey from the Kaiser Family Foundation shows that 9% of the white Americans, 22% of Blacks, 19% of Hispanics, and 24% of the American Indian/Alaska Natives live below the poverty line.² In other words, by percentage, more than twice as many Blacks and American Indian/Alaska Natives live under the poverty line as whites.

This socioeconomic disparity affects access to dental care because dental services aren’t included in adult Medicaid in many states. When Medicaid dental is available to adults, the next challenge is finding a clinic that accepts it. It can be especially difficult to find clinics that accept Medicaid in rural areas.

When Black patients do have access to dental care, the quality of that care is often influenced by conscious or unconscious biases held by dental professionals. One survey from JDR Clinical & Translational Research found that in cases where either a root canal or tooth extraction is necessary, Black patients are much more likely to have their teeth extracted than white patients.³ As we all know, the problem with this outcome is that missing teeth can have lifelong esthetic, social, and health effects. There is no shortage of dentists who would agree that, all things being equal, teeth-saving procedures are preferable to extractions.

It’s not just Black patients who face systemic racism in dentistry. A report by the Journal of Public Health Dentistry found that 40% of Black dentists have more than 50% Black patients of record that are.⁴ We already know that a disproportionate number of Black patients live below the poverty level, which indicates that they may face disproportionate challenges to find the resources necessary to pay for their dental care. The result is that Black dentists are not able to earn as much as their white counterparts.⁴ It isn't difficult to imagine how this situation would create additional professional challenges, such making it more difficult to pay off student loans; having a reduced ability to update offices with emerging technology; and being at a disadvantage of attracting new patients, including affluent ones. Many of these dentists understandably end up moving their practices to more affluent neighborhoods, leaving impoverished communities with reduced access to care.

How can white dentists help their non-white colleagues?

Black dentists often make less money than their white colleagues, have more stressful jobs, work more hours, have clients with more severe oral health issues, and even face discrimination from white patients.⁴ To overcome the systemic challenges that have created this situation, many dentists—especially white dentists—are now asking what they can do to change this.

Here are four things white dental professionals can consider as they begin to address this problem in earnest:

• Be antiracist—Show unapologetic support for Black dentists by emphasizing Black excellence.
• Hire Black dentists and staff—Don’t hire one Black person and consider that sufficient. Systemic racism will likely still manifest itself in a practice if there’s only one minority on the team.
• Don’t place an extra burden on minority colleagues—It’s not the job of Black dental professionals or other minorities to teach others about systemic racism. White dental professionals can affect change by embracing the responsibility to inform themselves about this problem.
• Patient population—Lastly, if there are dentists who want to directly help increase access to care, they can consider moving their practices to a disadvantaged community. This course of action is substantial and takes self-sacrifice, as it most likely means a pay cut. But if you are a white dentist and feel deeply motivated to address this issue, you may be willing to help affect change even if it means a change in your financial situation. 

Small solutions to a big problem

White dentists can’t end systemic racism in a day, but they can take small steps to make minority patients more comfortable in their clinics. But what is the first step?

If you are a white dentist, recognize that your office is most likely a "majority space," and you might not even be aware of the oppression that others feel when they step into your clinic. You may never truly fully understand the impact of racial oppression, as you may never experience it for yourself. But you can make an effort to be more aware of it and take actions to alleviate it.

Start by taking a look around your clinic. Ask yourself these questions:

• Are people of all racial groups represented proportionally in artwork, photographs, and magazines?
• Do you have minority dentists on your team?
• Do you have an interpreter available if a client’s first language isn’t English?
• Do you make an effort to have a proportionate number of minority patients?

The American Academy of Family Physicians offers simple steps you can take to create a practice where people of all cultures, races, and income levels feel welcome and represented:⁵

• Provide interpretation services.
• Choose brochures and pamphlets with images of minorities.
• Offer magazines and reading material that aren’t just geared toward majority/white culture.
• Make diversity training for all staff and dentists mandatory.
• Decorate the office for a variety of cultural holidays.

The takeaway

The systems that support systemic racism weren’t built in a day, and they certainly won’t be dismantled in one. But there are small steps white dentists can and must take to get the process started. Take these suggestions and expand upon them. As more white dentists do, the dental community will begin to set an example of how systemic racism can one day be completely dismantled for the benefit of providers and patients alike.

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