The oral health workforce has long struggled with racial, ethnic, gender, and socioeconomic diversity. According to a recent North Carolina Institute of Medicine task force report, White males continue to represent the majority of dentists, while White females have long dominated the dental hygiene profession. This disproportionate representation is especially prominent in North Carolina.
Many factors contribute to the disproportionate race, ethnicity, gender, and socioeconomic representation in the oral health industry and leadership today. This lack of diversity plays a part in the oral health disparities we continue to see. We need systems-level changes to create a future where access and equity in the oral health workforce and care delivery are the norm.
This blog post explores oral health workforce demographics, the key role of integrated care, and more.
Racial & Ethnic Demographics of Oral Health Providers
Research shows historically underrepresented racial and ethnic (HURE) dentists provide care to a significantly higher number of patients who share their race and patients with Medicaid insurance compared with White dentists.
In 2017, 25% of White dentists treated at least one Medicaid patient compared with 46% of Black/African American dentists and 33% of Hispanic dentists. Additionally, 30% of Black/African American dentists and 22% of Hispanic and Asian dentists, respectively, treated 100 or more Medicaid patients compared with just 12% of White dentists.
These numbers underscore the critical role HURE dentists play in advancing oral health access and equity for HURE patients and patients with low incomes by providing disproportionately higher rates of care to these communities.
Improving, yet still, a long way to go to achieve true representation
Sheps Health Workforce NC reports, “Of the recent graduates of NC dental schools between 2017 and 2022, 6% identified as Hispanic, and 14% identified as Black/African American, compared to 2% of NC dentists in 2022 who identified as Hispanic and 9% who identified as Black/African American.” Despite this increase, the dental workforce does not yet reflect the state’s racial and ethnic diversity.
Gender Demographics of Oral Health Providers
When it comes to gender diversity, ADA Health Policy Institute data shows that nationally, “the percentage of dental school graduates who are women grew from 46% to 50.6% between 2009 and 2019, and the percentage of dentists in the workforce who are women grew from 24.1% to 34.5% between 2010 and 2020.”
Although more women are entering dental school and the workforce, they remain unrepresented in leadership positions. Cindy Roark, DMD, of Florida, writes in a Dentistry Today article:
“At its most basic level, a diverse leadership team means a health care organization will naturally have a greater understanding of the populations it serves.”
This highlights the immense value of having both a diverse workforce and diverse leaders within it. From improving health outcomes to increasing access and equity and advocating for systems change, we need representative voices at every level of the health system driving decisions.
Building Wealth & Addressing Inequities
In 2024, the North Carolina Institute of Medicine (NCIOM) Oral Health Transformation Task Force released 14 recommendations in a comprehensive report. The seventh recommendation is: “Increase the number and improve distribution and diversity of members of the dental team in North Carolina with a focus on Medicaid-serving and rural practices.”
Two strategies for the seventh recommendation include:
- Evaluating the Forgivable Education Loans for Service (FELS) program.
- Convening oral health education programs to “identify best practices to address challenges and opportunities to increase the diversity of the oral health workforce.
The FELS program is a crucial component of making paths to dental careers accessible. Although dental school costs are a barrier for many prospective students, according to the American Dental Association (ADA) Health Policy Institute, educational debt levels for dental school graduates vary significantly by race. Black/African American dentists, by far, graduate with the highest levels of educational debt.
When our team spoke with Jen Zuckerman from the Duke World Food Policy Center about equity work, she emphasized the need to consider who financially benefits from a given industry like oral health. Throughout American history, Black/African American communities and communities of color have been structurally left out of many, if not most, opportunities to build generational wealth.
From the GI Bill and redlining to college admissions, loans, and more, “the white community has continually gotten investment through policies, programs, and initiatives,” said Zuckerman. “And communities of color have continually gotten programs and services, which do not build wealth.” Income is a major social driver of health (SDOH) that more diverse employment in high-paying industries like dentistry can significantly impact.
Advancing Equity Through Education & Integrated Care
Education and integrated care are other key components of addressing persistent health disparities and health access and equity issues. Along with supporting a more diverse oral health workforce that represents the population it serves, educating all oral health professionals about SDOH can lead to a greater understanding of how to provide whole-person, whole-community care.
Several of the NCIOM Task Force’s 14 recommendations to deliver equitable, accessible, integrated, high-quality oral health care in our state discuss the need for a diverse oral health workforce and culturally responsive care:
“The composition of the oral health workforce can also influence disparities. Racial and ethnic minorities, as well as individuals from lower socioeconomic backgrounds, are underrepresented in the dental profession. This lack of diversity can lead to cultural and linguistic barriers that impede effective communication and trust between patients and providers. By strengthening the oral health workforce and addressing disparities in access to care, we can work toward achieving equitable oral health outcomes for all populations.” (page 26)
Research shows that up to 80 percent of a person’s overall health can be attributed to SDOH or non-medical factors. These can pose intractable barriers for countless North Carolinians seeking oral health care. Care integration (e.g., social work in dentistry) has been shown to increase access and equity in oral health, benefiting patients and providers alike.
For parts one and two of our Oral Health Care Integration Case Study blog posts, our team sat down with Kelsey Yokovich, MSW, FHLI Community Voice Program Manager, and Jamie Burgess-Flowers, MSW, LCSW, Assistant Professor and the Director of Integrated and Applied Behavioral Sciences at High Point University, 2022-202 Bernstein Fellow, and member of our advisory team, to talk about the value of integrating social work into dental care and education to improve patient care.
They met at the University of North Carolina (UNC) Chapel Hill, where they supported the School of Social Work and Adams School of Dentistry (ASOD) program that provides students with interprofessional workforce development and learning opportunities related to SDOH. Yokovich spoke about the experiences many people face when accessing oral health care and asked an important question:
“What are we doing to serve those communities that don’t look like the oral health providers, that don’t look like the hygienists, that don’t look like the dental assistants? Because that can all create a very traumatic environment for those who even just show up to the dentist.”
Having a health provider who can understand and validate a patient in various ways, including experiences impacted by gender, ethnicity, race, language, and culture, has been shown to improve quality of care.
How Integrated Care Can Bridge Gaps
Social workers bring invaluable knowledge and expertise to dental offices and other medical care settings. By providing education, consultation, and support, they can help oral health professionals deliver better, culturally attuned care to patients and create more accessible, equitable, and inclusive spaces.
Ultimately, this can create a ripple effect, enabling people to develop new relationships with oral health providers and have different experiences in dental offices. Paired with targeted approaches to increasing diversity in the oral health workforce and enabling HURE students to build wealth, these are paths to advancing access and equity.
The Critical Need for Cultural Attunement
In addition to working together through the interdisciplinary UNC program, Yokovich and Burgess-Flowers collaborated on a research paper, Is Competence Enough? Promoting Cultural Attunement in Dental Education, focused on the Hispanic/Latine population, which “is the largest and fastest-growing non-majority ethnic group in the United States but bears one of the highest oral disease burdens in the country.”
According to the abstract:
“Providing culturally attuned care has been shown to be imperative in addressing widespread health disparities for racial and ethnic minority populations across the United States.”
Yokovich describes culturally attuned care models as “focus[ed] on the ability of systems to provide care to patients with their unique experiences in mind, such as their ethnic background and cultural beliefs.”
The term demonstrates a provider’s commitment to adapting to care for each patient’s unique needs and lifelong learning. In comparison, ‘culturally competent’ care denotes a one-size-fits-all approach with a point of completion.
Integrating social work into dental education and social workers into oral health care settings can transform how providers engage with patients and how patients access and experience care.
Opportunities for Action
To build a more equitable oral health system for all North Carolinians, we need policies that address ongoing issues like those rooted in structural racism and create pathways for a more diverse oral health care workforce.
Oral health providers, educational institutions, governmental agencies, and other partners can:
- Read the NCIOM Oral Health Transformation Task Force recommendations to learn about systems-level change strategies to create a patient-centered future.
- Read NCOHC’s 2024 A Portrait of Oral Health for the latest data and research to better understand the oral health landscape in our state.
- Advocate for policies that make dental education more affordable, including loan forgiveness programs, especially for serving rural communities.
- Seek training for yourself and your office on topics like cultural attunement.
- Learn about ways to implement care integration into your practice and work with a social worker to improve patient care.
NCOHC is working alongside our statewide partners to support oral health workforce development. Part of our efforts are guided by some of the NCIOM Task Force recommendations. Stay tuned and engage with us!
NCOHC, a Foundation for Health Leadership & Innovation program, works to advance systems-level changes, improving the overall health and well-being of all North Carolinians by increasing access and equity in care. Sign up for our monthly newsletter to join the network and get involved!
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