Journal of Oral Health and Community Dentistry

Register      Login

VOLUME 15 , ISSUE 2 ( May-August, 2021 ) > List of Articles

Research Articles

Evaluating Race and Oral Health in the Four Largest States in United States of America

Sarah Bettag, Viyan S Kadhium, Tarek Metwally, Shernel Thomas, Romesh P Nalliah

Keywords : Barriers, Dental health, Health insurance, Oral health

Citation Information : Bettag S, Kadhium VS, Metwally T, Thomas S, Nalliah RP. Evaluating Race and Oral Health in the Four Largest States in United States of America. J Oral Health Comm Dent 2021; 15 (2):55-63.

DOI: 10.5005/jp-journals-10062-0104

License: CC BY-NC 4.0

Published Online: 26-10-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Background: In the United States, racial oral health disparities have shown to be as fundamental as democracy itself. Medicaid and the Affordable Care Act (ACA) have helped alleviate some of those disparities but have not eradicated them. The political structure of the United States affords great freedom to each state that develop regionally specific policies for their own state. Each state in the United States varies in terms of health policy, political position and resources. Therefore, the barriers they face and the most widely accepted solutions will vary from state to state. Due to the state-by-state variation, it is difficult to imagine a nationwide policy that could help. The current analysis targets the four largest US states by population—California, Florida, New York, and Texas. Aim and objective: The aim of our study is to understand and describe trends in oral health outcomes and the existence of any racial disparities in oral health by closely examining sociopolitical trends in the four largest states (by population)—California, Florida, New York, and Texas. Materials and methods: Data from the Behavioral Risk Factor Surveillance System (BRFSS) were used to produce this report. We evaluated data between 1999 and 2016 for the four largest states in the United States (by population)—California, Florida, New York and Texas. Trends were identified in the oral health markers in adults aged 18 years and older. Responses were categorized according to participants’ self-reported race and ethnicity. Results: White adults in all four states were more likely to visit a dentist than black and Hispanic adults. White adults over the age of 65 years were less likely to have lost six or more teeth and also less likely to be edentulous. White adults aged 18–64 years were more likely to have retained all teeth than black and Hispanic adults. Conclusion: Despite major improvements in oral health care within the United States, disparities still exist and vary from state to state and is not accorded with the same importance as general health care is. And that certain races/minority groups still experience disproportionate and unacceptable health care compared to their white counterparts.

  1. U.S. Department of Health and Human Services. Oral health in America: a report of the surgeon general. 2000. Available from:
  2. Disparities in oral health. Centers for Disease Control and Prevention; 2019. Available from:
  3. Malvitz DM, Barker LK, Phipps KR. Development and status of the National Oral Health Surveillance System. Prev Chronic Dis 2009;6(2):1–7. PMID: 19289009.
  4. Bennadi D, Reddy CVK. Oral health related quality of life. J Int Soc Prev Community Dent 2013;3(1):1–6. DOI: 10.4103/2231-0762.115700.
  5. Access to dental care in Medicaid: spotlight on nonelderly adults. Kaiser Family Foundation; 2016. Available from:
  6. Drury TF, Garcia I, Adesanya M. Socioeconomic disparities in adult oral health in the United States. Ann N Y Acad Sci 1999;896(1):322–324. DOI: 10.1111/j.1749-6632.1999.tb08129.x.
  7. Social determinants of health. Healthy people 2020; 2020. Available from:
  8. Nalliah RP, Virun V, Dhaliwal G, et al. Fifteen-year gap between oral health of blacks and whites in the USA. J Investig Clin Dent 2019;10(3):e12415. DOI: 10.1111/jicd.12415.
  9. Survey Data & Documentation. Centers for Disease Control and Prevention; 2020. Available from:
  10. Behavioral Risk Factor Surveillance System. Atlanta (GA): Centers for Disease Control and Prevention. 2013. Available from:
  11. Florida Medicaid's covered services and HCBS waivers: dental services. Agency for Health Care Administration; 2020. Available from:
  12. HPSA Find – HRSA data. Health Resources & Service Administration; 2019. Available from:
  13. Logan HL, Catalanotto F, Guo Y, et al. Barriers to Medicaid participation among Florida dentists. J Health Care Poor Underserved 2015;26(1):154–167. DOI: 10.1353/hpu.2015.0000.
  14. Bureau of Dental Health. The impact of oral disease in New York state. 2006. Available from:
  15. Surdu S, Langelier M, Moore J. Utilization of oral health services by medicaid-insured adults in New York, 2012–2013. Oral Health Workforce Research Center, Center for Health Workforce Studies, School of Public Health, SUNY Albany; 2016. Available from:
  16. Norris L. New York and the ACA's Medicaid expansion. Health Insurance; 2018. Available from:
  17. NHE Fact Sheet. Centers for Medicare & Medicaid Services; 2020. Available from: Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.
  18. Citizens Budget Commission. Medicaid in New York. 2006. Available from:
  19. Search for Dental Programs. American Dental Association; 2020. Available from:
  20. United States Census Bureau. QuickFacts: New York; 2020. Available from:
  21. Population Clock. United States Census Bureau; 2020. Available from
  22. Cruz GD, Chen Y, Salazar CR, et al. The association of immigration and acculturation attributes with oral health among immigrants in New York city. Am J Public Health 2009;99(Suppl. 2):S474–S480. DOI: 10.2105/AJPH.2008.149799.
  23. Smith C, Young CE, Jessee G, et al. Texas Medicaid and CHIP in perspective. Texas Health and Human Services Commission; 2017. Available from:
  24. Blackwelder A, Shulman JD. Texas dentists’ attitudes toward the Dental Medicaid program. Pediatr Dent 2007;29(1):40–46. PMID: 18041511.
  25. Dunkelberg A. Texas Medicaid Data. Every Texan; 2017. Available from:
  26. Texas Dental Association. Building better oral health: a dental home for all Texans. Tex Dent J 2008;Suppl:1–56. PMID: 19363885.
  27. Nasseh K, Vujici M. The impact of Medicaid reform on children's dental care utilization in Connecticut, Maryland, and Texas. Health Serv Res 2015;50(4):1236–1249. DOI: 10.1111/1475-6773.12265.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.