In Miami-Dade, Hispanics visit the dentist less than any other ethnic group. Here’s why.

BY LAUTARO GRINSPAN DECEMBER 11, 2019 06:00 AM 

Dental students, medical practitioners, academics, and policy-makers converged in a recent community event in Miami-Dade College, where they discussed disparities in local access to oral care.

Among the issues raised was the fact that Hispanics in Miami-Dade County visit the dentist less than any other ethnic group.

In 2016, the most recent year for which Florida Department of Health data is available, only 59.8% of Hispanic adults had visited the dentist in the past 12 months. By comparison, 71.5% of the white, non-Hispanic adult population (and 67.8% of the black adult population) had gone to the dentist in that same stretch of time.

“Whether you are talking about oral health, or access to medical insurance, or even housing, you’re always going to find that the people who are at a disadvantage happen to be minorities,” said Camilo Mejia, Networks Director at Catalyst Miami, a local nonprofit that helped organize the recent oral health equity summit. “This is just a different dimension of how poverty manifests itself in the community.”

Latinos’ disadvantage when it comes to oral health is a well-documented phenomenon.

According to a recent report by the Hispanic Dental Association based on a national survey, 65 percent of Hispanics experienced at least one oral health issue in the past year compared to 53 percent of the general population. And more than one-third of Hispanic respondents said they had suffered oral health problems painful enough to impact their daily activities over the past year, compared to just one in five in the general population.

With respect to Miami-Dade Latinos’ more limited access to dental care, experts cite a number of possible contributing factors.

“For Hispanics, some of the barriers for not seeking needed dental care include lower rates of insurance coverage, the high cost of dental treatment, [...] long waiting time, and language barriers,” said Dr. Claudia Serna, assistant professor of public health at Nova Southeastern University. “As a result, the hospital emergency department may become a place where many receive dental care.”

Mejia said that what works against Latinos and other minority groups isn’t a lack of healthcare practitioners in the area (“There are more than enough dentists here to cover everyone’s needs,” he said), but rather low rates of reimbursement to providers accepting Medicaid, the national health program for low-income individuals and families.

“For a dental procedure, the difference between the private sector and the public sector is that where you get reimbursed $20 for performing a procedure with Medicaid, you might get $120 to $150 by private insurance,” he added. That makes working in “poorer neighborhoods” less desirable.

In part because current Medicaid reimbursement rates are so low, only 28.9 percent of Florida dentists participate in Medicaid or CHIP, the Children’s Health Insurance Program. That makes finding affordable care even more difficult.

LOGISTICAL HURDLES

It’s not just affordability concerns keeping people from going to the dentist.

“It’s also transit issues, and limited hours of operation at dentist offices. More logistical things,” said Mejia. “If you are a working parent but you don’t have a car, and you rely on Medicare, and you live in a poor neighborhood, but you work nine to five on the other side of town, are you really going to have the time to take two buses to take your kids to the dentist, especially if you don’t have sick days? Not really.”

Having a clinic that takes Medicaid stay open until around 10 p.m. could make dentist visits more feasible for many low-income families, Mejia said.

Immigration concerns could also be in play.

Shaken by the Trump administration’s tightening policies on immigration, some members of immigrant communities nationwide have retreated into the shadows, reportedly forgoing medical care in the process.

Mejia said he’s noticed that newfound reticence to seek healthcare among Miami immigrants as well.

“A lot of people are afraid to go get care at community health centers, or to go get care anywhere,” he said. “The language that’s been used on immigration created this sense of persecution against Hispanics.”

CULTURAL INFLUENCES

In a 2014 study, researchers found that cultural perceptions around oral care could also explain some of the disparities in health outcomes observed in the Hispanic community.

In addition to having less access to care, researchers wrote, Hispanics were also “less likely to believe in the need for regular professional dental care [and] more likely to have misperceptions about oral health and conditions.”

Dr. Scott Tomar, a public health dentist at the University of Florida’s College of Dentistry, said he comes up against “attitudinal barriers” in an outreach program he helps run in southwest Florida.

“In that community, the large majority of the families that we serve are relatively recent immigrants. [...] In many of the countries from which they come you went to a dentist when there was a problem,” he said. “The idea of going for preventive care was just not a social norm.”

Mejia added the crux of the issue is not culture but rather access and affordability.

“People do get it. They do understand that oral health is key to overall health,” he said. “But it’s more like Maslow’s hierarchy of needs. When people are buried in debt and they don’t have a car and they’re undocumented and the transit system is ineffective, oral health is going to rank at the bottom of the totem pole, at the bottom of the hierarchy.”

He added: “So it’s not really a matter of poor Hispanic or Haitian people not getting it. It’s more of a matter of access.”

Hispanics visit the dentist less than any other ethnic group. Some of the barriers they face include lower rates of insurance coverage, high cost of dental treatment, long waiting times, and language barriers. 

MIAMI HERALD FILE

LAUTARO GRINSPAN is a bilingual reporter at the Miami Herald and el Nuevo Herald. He is also a Report for America corps member. Lautaro Grinspan es un periodista bilingüe de el Nuevo Herald y del Miami Herald, así como miembro de Report for America.

https://www.miamiherald.com/news/local/immigration/article238114059.html