Racial inequalities abound in the US, and those inequalities start at a very young age. Black infants are 2.4 times as likely to die compared with white infants. Black kids are three times more likely to be expelled from school compared with white kids. And when it comes to oral health, black children are twice as likely to have untreated dental cavities compared with non-Hispanic white children, according to a CDC report released today.

don't underestimate dental pain or the power of an intact smile

Teeth might seem unimportant when compared with other health problems, but that attitude seriously underestimates dental pain and the social capital of having an intact smile. Each year, American children miss about 1.6 million days of school because of dental issues. Children from low-income families — which are predominantly of color — miss more than their wealthier peers, who tend to benefit from dental insurance. Dental pain can impact everything from children's grades to their employment opportunities when they grow older.

credit: CDC



About 10 percent of white children had untreated cavities between 2011 and 2012, compared with 21 percent of black children, 19 percent of Hispanic children, and 16 percent of non-Hispanic Asians. And those differences persist as children grow older, according to the CDC's report. During the same time period, 21 percent of black teens and 18 percent of Hispanic teens had untreated dental cavities. Yet only 13 percent of white teens had untreated cavities — despite the fact that Hispanic, white, black, and Asian adolescents were just as likely to have developed a cavity in their teens. Moreover, white children were about 30 percent more likely to have been treated with dental sealant — a plastic coating that prevents tooth decay — than black and Asian children.

untreated, even though white teens and teens of color were as likely to develop cavities

Dental coverage may explain some of the differences. For low-income families, dental insurance can be hard to come by, and it often takes a backseat to health care coverage. And families that qualify for Medicaid don't always get to benefit from the dental insurance it provides, because few dentists take it. This represents a huge barrier to care, says Stefanie Russell, an epidemiologist who works on oral health at New York University. "Children often see physicians, but they don’t get to see the dentist."

And even if a child has dental insurance, the child's parents might not be able to take them to see a dentist. Taking time off may be difficult for parents who have more than one job — or for parents whose jobs aren't flexible. Cultural differences may also play a role in some cases, Russell says. For example, in some cultures or communities, there’s a sense that "dental problems are inevitable," so "there’s no point in trying to prevent them," she says. And because a child’s oral health is closely related to that of their parents, the issue becomes cyclical.

"Children often see physicians, but they don’t get to see the dentist."

People should ask themselves why these racial differences exist, Russell says. Oral health isn’t discussed enough, despite the many studies that have shown how oral health can impact a person's life. And the problems that poor oral health engenders are long-lasting. "It impacts everything from self-esteem, employability, and missed days of work," Russell says. "If you are in pain, you can’t concentrate."