Implicit Racial Bias in Oral Health: A Scoping Review of Students' and Providers' Perceptions

Implicit bias is a form of unconscious bias that can affect judgment, decisions, and behaviors.

This scoping review examined what scientific literature exists about implicit bias demonstrated by dental/dental hygiene students and providers and, when possible, how these implicit biases are associated with patients' oral health outcomes.

This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). This review included English-language PubMed peer-reviewed studies meeting inclusion criteria, published through October 2023, measuring the implicit bias of dental/dental hygiene students or professionals and how such bias can affect patient oral health outcomes.

A total of 363 records were found. After removing duplicates (n = 114) and title screening (n = 60), 54 abstracts were screened, 24 reports were assessed, and 10 were included in the final review. Implicit bias was assessed using the Implicit Association Test (IAT), Brief IAT (BIAT), and Color-Blind Racial Attitudes Scale (CoBRAS). BIAT scores revealed a pro-White unconscious racial bias in clinical decision-making among dental professionals, and additional IAT results suggested implicit racial preferences for European Americans over African Americans; non-White participants showed more positive implicit preferences toward African Americans in comparison with White participants. Studies using CoBRAS suggest moderate levels of color-blind racial attitudes among students and professionals, indicating an unawareness of racism and a need to further understand the implications of bias on patient outcomes.

Despite small sample sizes and a lack of racial/ethnic diversity that limit their generalizability, the included studies provide evidence for implicit racial bias held by some dental/dental hygiene students and professionals that may affect the oral health outcomes of patients. Training to increase awareness of and reduce implicit bias among those providing oral health care is an important first step to providing a more equitable health care system for all patients.Knowledge Transfer Statement:Despite small sample sizes and a lack of racial/ethnic diversity that limit their generalizability, the included studies provide evidence for implicit racial bias held by some dental/dental hygiene students and professionals that may affect the oral health outcomes of patients. Training to increase awareness of and reduce implicit bias among those providing oral health care is an important first step to providing a more equitable health care system for all patients.