More Efforts Needed to Address Dental Care Disparities.
African Americans are less likely than whites to have tooth-preserving root canals instead of tooth extractions, indicating the need for more efforts to address disparities in dental care, according to a new Veterans Health Administration study led by a School of Public Health researcher.
The study, published online in the journal Medical Care, looked at dental records of more than 71,000 veterans who had at least one tooth extraction or root canal therapy (RCT) visit in fiscal year 2011. Root canals are the preferred treatment for diseased or damaged teeth because they save the tooth by removing only the root.
The study found that black patients had the lowest rate of root canals—even when they had the greatest access to dental care. Asian patients had the highest rate of RCT.
“Despite efforts to improve equity, our results replicate earlier findings from more than a decade ago, showing that black patients in the VA system had significantly less likelihood of obtaining this restorative dental procedure compared with white patients,” says lead author Ulrike Boehmer, associate professor of community health sciences.
“This suggests that generic efforts to address racial and ethnic disparities in VA dental care are insufficient, and that more comprehensive and targeted efforts are needed to ensure equity for all.”
In addition to the racial differences, the study found that patients with continuing and comprehensive dental care had a greater likelihood of RCT. Regular dental coverage is less common among black patients than whites, the authors noted.
The study also found that 60 percent of the patients had received no VA dental care and no preventive visits in the year preceding the study period, with black patients less likely than whites to have received prior care.
“These results are highly relevant for current discussions on eliminating racial disparities in care by providing greater access, as in the Affordable Care Act,” Boehmer and her colleagues wrote. “It is worth investigating, for example, why black patients are less often classified as eligible for the most comprehensive dental care.”
Nonetheless, the researchers said, their findings show that increasing health insurance, by itself, is “insufficient to eliminate disparities. Other factors, such as provider decision-making, patient-provider communication, and patient preferences likely have an important role in creating equity in dental care.”
While the VA has been successful in reducing racial disparities in other contexts, Boehmer said, further efforts are needed to understand what is unique about dental care and why inequity persists.
BU-affiliated co-authors on the study include: Dan Berlowitz, professor of health law, policy, and management; Judith A. Jones, professor of health policy and health services research, and Carolyn Wehler, assistant professor of general dentistry, both at the Henry M. Goldman School of Dental Medicine; and Nancy Kressin, professor of medicine at the School of Medicine. The other authors are Michelle Orner and Mark Glickman, affiliated with the Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Hospital.