Courage + Love = Essential Ingredients to Achieving Oral Health Equity

Zulayka Santiago, MPA
Director, NC Oral Health Collaborative

When I was nine years old I began to see the world for what it is: heartbreaking and beautiful, all at the same time. We had been living in Kenner, LA for three years by then, having moved there from my birthplace, Puerto Rico. My sister and I had just begun to acclimate to the new language, our new school, and the cold weather. My mother was working as a housekeeper and nanny for the Blooms, a family in town that had 5 adopted children, the father was a lawyer, and the mother was dying of cancer.

At this young age I began to see the stark differences between their large home (my mom sometimes brought my sister and I along to help) and our small 2-bedroom public housing apartment. Their private school (all 5 children went to an impressive looking catholic school) and our public school. We were lucky enough to have Medicaid for a period of time, which enabled us to get the medical care we needed, but dental care was another story.

I remember having to accompany my mother one time as she drove one of the older Bloom kids, David, to his dentist appointment. The office was located in a new office building, everything was clean, colorful and sparkly. Much to my delight, the waiting area was filled with books and toys. The appointment went quickly, and when David came out of his appointment, he had a huge smile on his face and was thrilled to report that he had no cavities!

A few months later, it was time for our dental visit. We didn’t head to a shiny office building, instead we went to somebody’s home across town. More specifically, we went to their garage. There, a make-shift dental office had been established. A gently used dentist chair, a sink near the wall, and all the basic equipment need to provide the dental care we were seeking at a much lower price. Overall it was a positive experience—aside from the needles and drilling (my sister and I were not cavity-free). The dentist was kind, his wife was welcoming to us, they were both warm, and most importantly, spoke to my mother in her native language.

I’ve now learned that those clinics are ‘clandestine dental clinics’, established by dentists trained in Latin America, who are unable to get their licensure/credentials in the US due to language or other barriers. There have been some horror stories associated with these clinics, but I’m grateful to report that our family had no complaints. Which is a good thing, because I don’t think we would have been able to access care otherwise.

These differences in access to healthcare, education, and living situations are still quite prevalent across the US. Differences that result in the exacerbation of health disparities, which are particularly heartbreaking in low-income communities because of the many other barriers they contend with. Health equity is defined by the Oral Health 2020 network as the attainment of the highest level of health for all people. At the heart of the concept of health disparities is a concern about social justice—that is, justice with respect to the treatment of more advantaged vs. less advantaged socioeconomic groups when it comes to health and health care.

Part of our work at the NC Oral Health Collaborative is to help highlight some very important facts:

  1. The mouth is indeed part of the body, and oral health is an essential part of overall health.
  2. Tooth decay is the most common chronic disease of early childhood. In fact, it’s a condition that is 2-3 times more common than asthma or obesity.
  3. Dental care remains the greatest unmet health need among U.S. children. Children with untreated tooth decay not only suffer pain and infection, they have trouble eating, talking, socializing, sleeping, and learning, all of which can impair school performance.
  4. Left untreated, dental disease can lead to emergency room (ER) visits, hospitalizations, and even death.

The saddest, or perhaps the most inspiring aspect of this situation is that it is TOTALLY PREVENTABLE. Sad because we’ve let things get this bad, inspiring because we can now choose to make things better. We can harness our tremendous wisdom, skills and resources to ensure that ALL of our children have access to essential preventive services. In NC we’ve done a great job of ensuring that young children have access to fluoride varnish treatments in their pediatric visits through the nationally-recognized Into the Mouths of Babes program. However, there is another essential aspect to prevention that we are not doing so great at: dental sealants: plastic coatings placed on the chewing surfaces of teeth

According to the Centers for Disease Control and Prevention, dental sealants can reduce decay by 80 percent in the two years after placement, and continue to be effective for nearly five years. Because sealants are such an effective means of preventing tooth decay, they have been endorsed by the American Dental Association. Dental sealants are one-third the cost of a filling, so their use can save patients, families, and states money. Sealant programs based in schools are an optimal way to reach children—especially low-income children who have trouble accessing dental care.

Yet despite all of this compelling evidence, NC has not yet maximized access to and use of this preventative measure. It is time for us to do everything within our power to ensure that as many children as possible can easily access this service that could have significant impact on children’s performance in school and their future contribution to the economic base of our state as adults. This will require both a change of mindset and a willingness to address systemic barriers to progress. This is one of the main priority areas for the NCOHC in 2017, and of course we’d invite all of you to join us in this endeavor!

Achieving oral health equity will require focused and ongoing efforts to address historical and contemporary injustices-AND the systems that perpetuate inequities. This is not easy work, but in this time of political upheaval and uncertainty in the US, it is more important than ever that we did deep to connect with our courage to take on this necessary work. “Love” becomes an active verb when we are willing to engage the work required to bring it to life. In the words of Martin Luther King Jr.:

“What is needed is a realization that power without love is reckless and abusive, and that love without power is sentimental and anemic. Power at its best is love implementing the demands of justice, and justice at its best is love correcting everything that stands against love.”