Impact of structural and interpersonal racism on oral health and dental services

To analyze the role of racism in oral health and access to dental services, considering two impact pathways: structural racism and interpersonal racism.

A cross-sectional study with 686 undergraduate students, which analyzed two categories of outcomes: those related to oral health (self-perception, oral health impairment, and tooth loss) and those related to access to/perception of the quality of dental services (access to services, recent use, and evaluation of care). Exposures were race/color, racial discrimination, and characterization of the neighborhood environment. Prevalence ratios were estimated using Poisson regression with robust variance, with adjustments guided by directed acyclic diagrams.

Black and brown people had a higher prevalence of negative self-perception (black: PR = 1.56; 95%CI 1.14-2.13; brown: PR = 1.53; 95%CI 1.14-2.05), tooth loss (black: PR = 1.99; 95%CI 1.33-2.97), lack of access to dental services (black: PR = 3.08; 95%CI 1.06-8.95; brown: PR = 3.78; 95%CI 1.49-9.59), and negative evaluation of care (black: PR = 1.63; 95%CI 1.08-2.45; brown: PR = 1.64; 95%CI 1.12-2.39). Racial discrimination was associated with lack of access (PR = 4.34; 95%CI 1.45-12.95), recent non-use of services (PR = 1.74; 95%CI 1.31-2.31) and negative evaluation of care (PR = 1.51; 95%CI 1.01-2.25). And living in neighborhoods with fewer physical and social problems was associated with a lower prevalence of negative self-perception (PR = 0.70; 95%CI 0.54-0.90), compromised oral health (PR = 0.87; 95%CI 0.76-0.99), lack of access (PR = 0.42; 95%CI 0.18-0.98), and negative evaluation of care (PR = 0.56; 95%CI 0.40-0.79).

The findings show that racism impacts oral health through structural and interpersonal channels and highlight the urgency of broad and effective strategies to reduce the inequities affecting racialized groups.