The University Record, April 5, 1999

Economic barriers keep African Americans away from the dentist

By Amy Reyes
News and Information Services

A U-M study published in the most recent issue of the Journal of Public Health Dentistry shows that African Americans and whites have similar dental health care habits, but African Americans see the dentist less often for routine visits.

The study found that 13 percent of African Americans had never visited a dentist for a routine visit, compared with 1 percent of whites. African Americans said the lack of money or dental insurance were reasons why they avoid routine visits.

"Those figures really concern me. Interventions are needed to reach out to those who only use dental services for acute problems and those who never receive dental care," says David L. Ronis, senior author of the study titled, "Preventive Oral Health Behaviors among African-Americans and Whites in Detroit."

Ronis, a research scientist with the School of Nursing and the Department of Veteran Affairs Medical Center, conducted this study for the Institute for Social Research (ISR) in conjunction with he School of Dentistry.

Ronis and his colleagues compared the oral health behaviors of African Americans and whites through personal interviews with 384 African Americans and 358 white adults living in the Detroit tri-county area. Research subjects, who were 18 years of age or older, were asked about their brushing and flossing habits and dental visits.

African Americans in the study tended to have lower family incomes; 37 percent of African Americans and 16 percent of whites had family incomes of less than $20,000 annually.

African Americans were much more likely than whites to depend on Medicaid for dental insurance coverage (13 percent vs 2 percent). Because Medicaid payments to dentists are low, some dentists avoid treating Medicaid patients, Ronis says.

"We found that people who were on Medicaid were least likely to get regular checkups, even less likely than people who didn't have insurance. Part of the problem might be finding a provider who will accept Medicaid. Increasing Medicaid reimbursement rates would probably increase access to care for people."

There was virtually no difference in how often African Americans or whites brushed and flossed their teeth. More than 95 percent of both groups said they brushed daily; however, whites were more likely to brush all parts of their teeth (92 percent of whites, compared with 85 percent of African Americans). African Americans and whites flossed just as often; whites, however, were more likely to floss all of their teeth (64 percent of whites and 47 percent of African Americans).

"Our study shows that much of the difference in preventive oral health behavior can be explained by income. If African Americans and whites had the same socioeconomic status, many of these differences in oral health behaviors probably wouldn't exist,'' Ronis says.

The study was co-authored by W. Paul Lang, associate professor at the School of Dentistry who was principal investigator of the project; Cathy L. Antonakos, assistant research scientist with the School of Nursing and formerly with ISR; and Wenche S. Borgnakke, senior health science research associate, School of Dentistry.

The project was funded by the National Institute of Dental and Craniofacial Research of the National Institutes of Health.