Oral healthcare inequalities: Black women in Brazil have higher tooth loss prevalence

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Oral healthcare inequalities: Black women in Brazil have higher tooth loss prevalence

A recent study used intersectionality, considering the multiple, overlapping and cumulative factors of poverty, as a methodological tool to investigate racism and gender inequalities in oral healthcare. (Image: Nelson Antoine/Shutterstock)

CAMPINAS, Brazil: Differences in socio-economic status, sex and race may impact equal access to healthcare. Diving deeper into the topic, researchers have recently sought to examine whether there is a link between tooth loss, race and sex. Their findings showed that black women in the city they studied in Brazil experienced a higher prevalence of tooth loss compared with both white women and white or black men in the city. The data highlighted the impact of racial and gender inequalities in Brazil and pointed to the need to implement anti-racist and anti-sexist healthcare policies.

“Historical poverty—the result of racial inequalities—affects the black population in various ways, including access to healthcare. There are epidemiological studies in other areas of healthcare on mortality issues, but the production of scientific knowledge for oral healthcare is still limited,” lead author Dr Lívia Helena Terra e Souza, a researcher in the School of Medical Sciences at the University of Campinas, told Dental Tribune International (DTI).

Discussing the rationale for the study, she commented: “Black women are underprivileged in several health indicators, such as accessing preventive exams, suffering more obstetric violence and having higher mortality from COVID-19. However, most epidemiological studies include race as a category and do not study it as a variable.”

Race- and sex-based inequities in oral healthcare

The research used data from the health survey of the municipality of Campinas. The findings showed that 52% of the participants had lost at least one tooth and that there were major differences in oral health related to race and sex. For example, the study reported that tooth loss was 19% more frequent among black women than white men. Among women, it was found to be 26% more frequent for black women than for white women. Among blacks, it was found to be 14% more frequent for women than for men. “Under any criteria studied, black women are the most affected by tooth loss, apparently evidencing racism in oral healthcare,” Dr Souza noted.

Historical context

The study holds some implications for dentistry, but before reflecting on its importance, it is crucial to understand the historical context of racial inequality. Dr Souza explained: “The results show that race can be considered a concept socially constructed by historical dynamics and power relations. Socio-economic status is strongly impacted by racial inequalities, and the black population has lower income and lower educational level and tends to live in places of high social vulnerability.”

“In addition to economic determinants, it is necessary to consider other disadvantages which are still present in various dimensions of life, even after the abolition of black slavery. Racial minorities, in this case blacks, can biologically incorporate the effects of racism, with exposure to everyday discrimination. Adversities throughout life, such as poverty, psychosocial stress, stereotypes and housing context, can affect physical and mental health, altering cardio-circulatory, metabolic and immunological function,” she told DTI.

Considering the oral health context, Dr Souza noted that it is possible that inequities related to poverty, level of education or discrimination in healthcare still exist. “An important reflection must be awakened when thinking about oral healthcare. We are dealing with individuals with unique and varied trajectories,” she explained.

In light of the findings, Dr Souza stated that it is important to implement policy changes in healthcare to improve access to oral healthcare. She concluded: “Race and sex are not isolated categories. It is necessary to expand public healthcare policies and to build and strengthen them with anti-racist, anti-sexist principles to address poverty.”

The study, titled “Race (black-white) and sex inequalities in tooth loss: A population-based study”, was published online on 13 October 2022 in PLOS ONE.

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