Understanding Disparities in Oral Health

Oral Health Is Improving Over Time, But Faster for Some Than Others

The nation’s oral health has greatly improved since the 1960s, but not all Americans have equal access to these improvements.¹ Some racial/ethnic and socioeconomic groups have worse oral health² because of social determinants of health (SDoH)—conditions in the places where people are born, live, learn, work, and play.^{3, 4} For example, some groups of people:

• Can’t afford to pay out of pocket for dental care, do not have private or public dental insurance, or can’t get time off from work to get to dental care.
• Live in communities where they don’t have access to fluoridated water and school sealant programs, healthy foods, and/or public transportation to get to dental appointments.

Regular preventive dental care is essential for good oral health to so one can find problems early when they are easier to treat, but many don’t get the preventive or early care they need. More people are unable to afford dental care than other types of health care.⁵ Traditional Medicare does not cover routine dental care; therefore many lose their dental benefits upon retirement. In addition, many low-income adults do not have public dental insurance. Medicaid programs are not required to provide dental benefits to adult enrollees, so dental coverage varies widely from state to state. There are several states that provide no coverage or only emergency coverage.

Health Disparities Directly Impact Several Minority Groups

According to the The Glaring Scope of Racial Disparities in Oral Health report from the CareQuest Institute for Oral Health, disproportionate health disparities exist for Black, Hispanic, and American Indian/Alaska Native individuals which lead to significant consequences for oral health and beyond, such as lesser access to dental care, untreated tooth decay, and tooth loss.⁶ Some key findings in this 2022 report include:

• 9% of Black adults felt they didn’t get a job due to their smile vs. 2% of whites.
• 15% of Black and 9% of Hispanic parents say their children’s dental health affected their school attendance or performance vs. 2% of whites.
• Black adults were at least 2.5 times more likely than white, Hispanic, or Asian adults to have gone to a hospital emergency department for dental care.
• Nearly 1 in 6 Black adults (16%) reported having lost at least 6 teeth due to tooth decay or gum disease, compared to white (12%), Hispanic (9%), or Asian (3%) adults.

At Cigna, we are committed to addressing SDoH to make quality oral health care a reality for all customers and their families, regardless of age, race, ethnicity, disability, sexual orientation, gender identity, socioeconomic status, geography, preferred language, and other factors. As members of the Cigna network, our dental providers can also drive health equity by providing linguistically and culturally appropriate care to their patients. It is incumbent on all of us to try to understand what other SDoH barriers they may be facing. 

1. National Institute of Dental and Craniofacial Research. Oral Health in America: A Report of the Surgeon General. National Institutes of Health, US Department of Health and Human Services; 2000.

2. Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health. 2011;32:381– doi:10.1146/annurev-publhealth-031210-101218

3. Social Determinants of Health. Healthy People 2030. https://health.gov/healthypeople/priority-areas/social-determinants-health

4. Braveman P, Gottlieb L. The social determinants of health: it’s time to consider the causes of the causes. Public Health Rep. 2014;129 (suppl 2):19– doi:10.1177/00333549141291S206

5. Vujicic M, Buchmueller T, Klein R. Dental care presents the highest level of financial barriers, compared to other types of health care services. Health Affairs. 2016;35(12):2176–21

6. CareQuest Institute for Oral Health. The Glaring Scope of Racial Disparities in Oral Health. Boston, MA: June 2022.