Dental caries is one of the most prevalent preventable infectious diseases worldwide, with an estimated 2.5 billion people affected. Families with low income have a higher prevalence of dental caries, likely due to multiple barriers to care. Some barriers include lack of access to fluoridated water and dental insurance, financial barriers to accessing preventive dental services, transportation issues, and limited availability of dental services and dentists in minority communities.1
A systematic review and meta-analysis aimed to identify racial gaps in oral health and the underlying factors that contribute to the higher prevalence of dental caries in minority groups.1
The Review
Studies used for this systematic review included data from national oral health surveys, country-based population studies, censuses, or government registries. The population of interest was school-aged children between five and 11 years. There were no restrictions for gender, geographic location, or language.1
An electronic search of nine electronic databases from the inception date of the platform through December 1, 2021, was first conducted. Then, a search of the reference lists of review articles was completed to include any relevant studies identified. A total of 75 publications were included in this systematic review and meta-analysis.1
The Results
This systematic review found that racial minority children aged five to 11 years had significantly higher prevalence and severity of dental caries compared to children who were not members of a racial minority group. Increased prevalence of dental caries has been a common theme among minoritized children for the past 20 years, with the gap in high-income countries widening.1
According to one study reviewed for this systematic review, worldwide, dental caries in deciduous teeth was the tenth most prevalent chronic disease in children and the fourth most expensive condition to treat in children.1
The distribution of dental caries varied across countries, with the highest burden amongst minoritized children from high-income countries.1
| Country | Ethnic Groups With the Highest Caries Burden |
| Australia | Indigenous children |
| New Zealand | Indigenous children |
| Brazil | Indigenous children |
| Canada | Indigenous children |
| United Kingdom | Asian children |
| United States | Black and Hispanic children |
Burden of dental caries in high-income countries1
Many barriers to care were identified, which could be contributing factors to the increased prevalence of dental care in minoritized children. First, dental care is often profit-driven and privatized. This is significant because many minority groups also have low socioeconomic status, leading to unequal access to dental services.1
Public health campaigns are essential to addressing this barrier. However, public health infrastructure and preventative measures often need more funds.1
Secondly, racial discrimination has led to distrust in Western medicine, leading to minority populations avoiding dental care, ultimately increasing poor oral health outcomes. Though biological differences have been investigated as a potential factor in the increased prevalence of dental caries in some minority groups, this systematic review determined racial inequities are likely the driving factor.1
Lastly, the weathering hypothesis was considered. The weathering hypothesis states that “chronic exposure to social and economic disadvantage leads to accelerated decline in physical health outcomes.”2 This is attributed to cumulative stress associated with adversity and marginalization.1
Conclusion
The findings of this systematic review and meta-analysis indicate a need for better access to care for minority children worldwide. Changes suggested by the authors include:1
- Individual level: Dental professionals should strive to understand and respect cultural backgrounds and be aware of their implicit biases.
- Institutional level: More diversity within the dental professional workforce, especially in community clinics. Requiring cultural sensitivity training for dental professionals.
- Community and school level: Implement and promote prevention programs and offer affordable payment options to increase access to services.
- Structural level: Secure more funding for robust, high-quality research to gain knowledge and evidence on racial inequalities. With this knowledge, targeted interventions and policy development can be created.
The authors urge a global commitment to addressing oral health’s social and political drivers to reduce race-based disparities. Dental caries prevalence and severity among school-aged children from racially and ethnically marginalized groups continue to pose a significant public health challenge worldwide.1
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References
- Nath, S., Sethi, S., Bastos, J.L., et al. The Global Prevalence and Severity of Dental Caries Among Racially Minoritized Children: A Systematic Review and Meta-Analysis. Caries Research. 2023; 57(4): 485-508. https://karger.com/cre/article/57/4/485/862750/The-Global-Prevalence-and-Severity-of-Dental
- Forde, A.T., Crookes, D.M., Suglia, S.F., Demmer, R.T. The Weathering Hypothesis as an Explanation for Racial Health Disparities: A Systematic Review. Annals of Epidemiology. 2019; 33: 1-18.e3. https://pmc.ncbi.nlm.nih.gov/articles/PMC10676285/
