A new study by Duke University faculty member Bei Wu, PhD, finds that older blacks and Mexican-Americans are more likely to have decayed and missing teeth than are non-Hispanic white individuals. They are also less likely to visit the dentist for checkups. This is the latest study to conclude that oral health disparities persist among racial and ethnic groups in the US, and that multiple clinical approaches are required to reduce these disparities.
Wu holds faculty membership in the Duke University Center for the Study of Aging and Human Development, the Duke Global Health Institute, and Duke University School of Nursing, where she also serves as Director of International Research. Her new study was published in the Journal of Public Health Dentistry in June.
While an increasing number of studies have examined oral health disparities across race/ethnicity in the US, this is one of a limited number of studies that focuses on older adult minorities.
The study evaluated the frequency and number of decayed, missing and filled teeth among more than 4,300 adults aged 60 and older based on dental and health examinations and interviews collected by the National Health and Nutrition Examination Survey between 1999 and 2004. Approximately 61% of the individuals included in the study were non-Hispanic white, 17% non-Hispanic black and 21% Mexican-American.
Wu’s research documents significantly higher numbers of decayed teeth among blacks and Mexican-Americans, but fewer numbers of filled teeth among these populations than among whites.
Wu and her research team found that blacks had an average of three to four more missing teeth than whites and about four more missing teeth than Mexican-Americans. Mexican-Americans had the highest number of decayed teeth. Both racial/ethnic groups had many fewer filled teeth than whites, particularly blacks who had two to three filled teeth compared to about seven filled teeth among whites. However, both blacks and Mexican-Americans were less likely to have lost all of their teeth when compared with white populations.
“Oral health disparities are persistent across racial/ethnic groups for older Americans despite the fact that differences between groups typically diminish when socioeconomic, health-related and behavioral factors are considered in the models,” said Wu. “These disparities could reflect a historical lack of access to, or knowledge of, dental care among racial/ethnic minorities, lifetime dietary habits, lifetime prevalence of negative health behaviors and differences in oral health beliefs.”
Factors such as increased age, lower levels of education and income, smoking and diabetes were likely to be associated with having a higher number of missing teeth. Individuals who retained more natural teeth were more likely to be married, engage in moderate or vigorous physical activity, and have more frequent dental checkups.
The study concludes that regular dental visits and healthier behaviors, such as nonsmoking, less alcohol use and more physical activity, may contribute to improved oral health for elders.
As the US continues to see a shift toward an aging population, researchers call on policy makers, public health officials and health care providers to better understand how social factors and medical conditions together may contribute to racial and ethnic disparities in oral health. To reduce racial and ethnic oral health disparities, researchers emphasize it is important to improve access for dental care for minority elders. They also argue it is critical to increase older adults’ knowledge of the importance of oral health, oral hygiene and preventive dental care services. They also encourage more culturally-competent programs and services for minority communities that recruit more underrepresented minorities to the dental professions and enrich dental education curriculum.
Other researchers on the study include Brenda Plassman of Duke University Medical Center, Jersey Liang of the University of Michigan, Corey Remle of Wake Forest University and Lina Bai of the University of Pittsburgh.
