The Consensus Statement on Future Directions for the Behavioral and Social Sciences in Oral Health (Consensus Statement) is a transformational contribution to oral health research synthesizing a wide array of conceptual, methodological, and disciplinary concerns and offering strategies to improve scientific inquiry. The Consensus Statement explicates global oral health equity as a foundational concern of our field. Given this context, a key concern is missing from the statement: oppression!
BackgroundOnly twelve percent of dentists in 2020 self‐identified as being Black, Latinx, or “Other,” which includes American Indian. Moreover, the proportion of dentists from these groups profoundly fails to reflect the demographic composition of the U.S. overall. Evidence‐based, ethically‐grounded approaches are needed to successfully and continuously recruit and retain Black, Latinx, and American Indian dental students. We explored the barriers and opportunities to sustainable pathways to the dental profession.MethodsWe conducted focus groups in 2021 with current Black, Latinx, and American Indian dental students and key informant interviews with dental school administrators using elicitation guides developed for this project. We completed a thematic analysis of data to identify and check findings to strengthen validity.ResultsWe identified the following successes, challenges, and opportunities for recruiting Black, Latinx, and American Indian dental students. Successes include institutional investment to build and sustain pathways, yet many of these practices are institution‐ or administrator‐specific and may defy replication. Challenges are more widespread, and include weak accreditation standards; systemic bias and failure to consider candidates holistically in admissions decisions; costs associated with admissions test preparation and volunteer shadowing; transportation, geography, school culture and language/citizenship status. Opportunities include mentoring, scholarships, removing bias from admissions, institutional financial investment in pathway programs, and peer norming among programs.ConclusionBuilding sustainable pathways involve early support of students, removing systemic biases, and institutional commitments to equity to create a workforce to meet population needs.
Major sociohistorical processes have profound effects on oral health, with impacts experienced through structural oppression manifested in policies and practices across the lifespan. Structural oppression drives oral health inequities and impacts population‐level oral health. In this global perspective paper, we challenge old assumptions about oral health inequities, address misleading conceptualizations in their description and operation and reframe oral health through the lens of intersecting systems of oppression. Furthermore, we emphasize the need for oral health researchers to explore causal pathways through which oppression harms oral health and engage in social science concepts to understand the root causes of oral health inequities fully. Finally, we call on policymakers, dental scholars and decision makers to consider health equity in all policies and to take a systems‐oriented approach to effectively address oral health inequities.
Objective
Little is known about the scope and role of discriminatory experiences in dentistry. The purpose of this study is to document the experiences that American Indian/Alaska Native (AI/AN), Black, and Hispanic dentists have had with discrimination.
Methods
This study reports data from a 2012 nationally representative study of dentists documenting experiences with discrimination during their dental careers or during dental school by the setting of the discrimination, the providers' education, and geographic location. This study does not differentiate between levels of discrimination and focuses holisticly on the experience of any discrimination.
Results
Seventy‐two percent of surveyed dentists reported any experience with discrimination in a dental setting. The experiences varied by race/ethnicity, with 49% of AI/AN, 86% Black, and 59% of Hispanic dentists reporting any discriminatory experiences. Racial/ethnic discrimination was reported two times greater than any other type.
Conclusions
Experiences with racial/ethnic discrimination are prevalent among AI/AN, Black, and Hispanic dentists, suggesting that as a profession work is needed to end discrimination and foster belonging.
In this paper, we seek to understand feminization of the dentist workforce moving beyond previous research that has looked at gender in isolation. We contend that little consideration has been given to how gender interacts with other important social identities such as race/ethnicity to influence the opportunities and barriers that female dentists encounter during their dental career. We argue that the scholarly debate about the feminization of the dentistry has not acknowledged the intersectionality of women's lives. Intersectionality describes how multiple social identities (such as race/ethnicity, gender, and class) overlap and interact to inform outcomes, creating disadvantages and/or privileges. Our thesis is that the increasing feminization of the dentist workforce is complicated and paradoxical, creating both opportunities for women and gender imbalances and blockages within the profession. To support our thesis, we critically reviewed the literature on feminization and analysed UK and US workforce data. While the female dentist workforce in both the UK and the US has increased significantly over the past decade, the growth in the number of female dentists was not equal across all racial/ethnic groups. The largest increase in the number of female dentists was among White and Asian women. Viewing the feminization of the dentist workforce through an intersectionality lens exposes the multiple and complex experiences of women, as well as the power dynamics in dentistry. Feminization in dentistry demonstrates the importance of presence, privilege, and power. Based on our assessment of the dentist workforce, dentistry may be less inclusive, despite being perceived as more diverse. Further research should explore how power and privilege may operate in dentistry. Dentistry should embrace intersectionality to provide an inclusive evaluation of equity in the workforce.
Racism is understudied in the oral health literature at the same time that race is overutilized as an explanatory factor in study design. Social and behavioral methodologies offer conceptual models that can be used to include racism in dental public health questions. In addition, interdisciplinary and mixed methods approaches allow for understanding racism as an underlying cause of social and health disparities and exploring solutions that address historical, institutional, social, political, and economic drivers of oral health inequity, while recognizing the limits of measuring racism quantitatively. In a collective acknowledgement of the limitations of conventional methods, there are new opportunities to explore how qualitative and mixed methods research can serve as drivers for both social justice and health equity, while building and sustaining a diverse research workforce that can better close these disparities and offer antiracist solutions to oral health inequities.
While other disciplines have made progress in advancing their science and practice of their research around health equity, oral health has made less progress. Despite special issues and consensus statements, there are opportunities for oral health research to contribute to this needed work, as the world battles pandemics of disease and racism. The purpose of this commentary is to operationalize how we can better integrate with intentionality and sustainability equity, diversity, and inclusion into oral health research. Knowledge Transfer Statement: By following best practices related to equity, diversity, and inclusion, oral health researchers may be able to advance the study of health equity, grow a diverse research workforce, and better respond to pressing public health problems.
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