For the Most Vulnerable Poor, Lack of Dental Care Is a Barrier

Throughout the San Fernando Valley, there are pocket communities of working poor, non-English-speaking residents whose voices often go unheard. We recently had the opportunity to listen to their concerns about their dental care and oral health.

The Surgeon General’s Report on Oral Health refers to “a silent epidemic” of oral diseases among the most vulnerable sectors of American society, including children of the poor, the elderly and many members of racial and ethnic minority groups, particularly recent immigrants. Immigrant families have few economic resources and are unlikely to be insured or have Medicaid coverage. Their immigration status places them at increased risk: They move often, have less money, and less insurance and access to dental care than U.S. citizens. Lack of access to care is a detriment to their becoming successful wage earners, because poor oral health, with attendant discomfort and pain, contributes to a diminished sense of self-confidence.

We spoke with 250 poor, immigrant parents from the northeast Valley about their own oral health and dental care and that of their children. Although their most common sources of dental care were private dentists and public dental programs, most of them reported their oral health as fair or poor. Some indicated that they used a hospital emergency room for dental care.

More than two-thirds had no dental insurance. Those without coverage reported that insurance was too expensive or that they had an employer that does not provide dental insurance. Many families were also ineligible for public benefits, such as Medi-Cal.

It is not surprising that most of those without insurance did not use dental services within the year. Those who did not access services listed a number of barriers, usually cost, but also fear of dentists, long waiting times, no transportation and uncertainty about where to go for care.

By far, the most cited reason for not seeking care was not having an identifiable place to receive dental services. In fact, those without a dentist were 10 times more likely not to have used dental services within the year than those who identified a dentist or a dental program in their community. Moreover, most of those families were not familiar with any public dental programs.

Children suffer. They were more likely to not have received dental care if their parents did not have a regular dental provider. Parents who rated their child’s oral health as poor were three times less likely to use dental care than those who rated their children’s oral health as good or excellent. Similarly, children residing in households with six or more people were nearly three times more likely not to have used dental care within the year.

We asked parents what would make a visit to the dentist a better experience. Being able to communicate with their dentist, preferably in their own language, was the primary response. Many said that they would most prefer a dentist who explains treatment to them in a way they can understand.

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This study points to a need for culturally targeted oral health resources that are accessible and sensitive to immigrant populations. To this end, we recommend a family-centered approach to improving their oral health. Public agencies and community-based organizations need to work together to design culturally appropriate oral health education programs that target the extended family households characteristic of immigrant communities.

To change the oral health and accessibility of dental care for recent immigrants, educational programs should be provided at community centers, schools, housing communities and other public places. For this to happen, we need culturally and linguistically competent health educators trained to engage in oral health promotion. These efforts should be linked with a network of community practitioners, dental schools and the larger dental profession.

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More so than medical care, dental care presents a great social and economic barrier for the working poor and indigent immigrant communities. Dental care is an increasingly important issue for California policymakers because of its impact on the overall health of the community. Good oral health and appropriate appearance, including a friendly smile, play critical roles in obtaining and maintaining employment.

Both the number of immigrants and the children of immigrants have been steadily increasing in the northeast San Fernando Valley and throughout the state. Children who receive quality dental care are better able to succeed in school. To achieve the promise of upward mobility, these children need to gain access to oral health promotion, preventive services and dental care. It also makes good economic sense to provide these services as early as possible. Such programs will lessen the economic burden of providing expensive dental care for them as adults, and will also facilitate their ability to compete in California’s economy.