Dental anxiety and oral health in American Indian and Alaska natives.

OBJECTIVE: American Indian and Alaska native (AI/AN) individuals report distrust of the healthcare system. This study explored associations between having either high levels of dental distrust or high levels of dental care-related fear and anxiety ("dental anxiety") and oral health outcomes in AI/AN adults. METHODS: The 2022 State of Oral Health Equity in America survey included the Modified Dental Anxiety Scale and asked to what extent respondents agreed with the statement, "At my last oral health visit, I trusted the oral health provider I saw", and asked about self-rated oral health and presence of a dental home. RESULTS: AI/AN individuals (N = 564) who reported low dental trust (n = 110) or with high dental anxiety (MDAS≥19; n = 113) reported significantly worse overall and oral health and were significantly less likely to have a dental home (p < 0.05 used for each analysis). CONCLUSION: Dental distrust and dental anxiety can significantly impact oral health and dental utilization in AI/AN communities and are important intervention targets to improve AI/AN oral health.

Discrimination and Dignity Experiences in Prior Oral Care Visits Predict Racialized Oral Health Inequities Among Nationally Representative US Adults.

Racism, an oppressive and fallacious sociopolitical hierarchy, is a fundamental cause of oral health inequities worldwide. Everyday discrimination is associated with worse self-rated oral health, toothache and adult tooth loss, and lower oral care utilization. Few studies examine discrimination or microaggressions within oral care settings or their effects on oral health outcomes. We adapted the seven-item Everyday Discrimination Scale to the oral care setting (EDSOC); developed a four-item Dignity in Oral Care Scale (DOCS); fielded them to a probability-based nationally representative sample of US households as part of the 2022 State of Oral Health Equity in America survey (SOHEA, n = 5682); and examined associations between EDSOC and DOCS scores and three outcomes: self-rated oral health, duration since last oral care visit, and planning for future preventive/routine oral care. Nearly, all EDSCOC and DOCS measures were significantly associated with oral health outcomes. Discrimination experience in dental settings had an additive effect on reporting fair/poor oral health and a suppressive effect on planning a future dental visit. Indignity experience doubled-to-quadrupled the likelihood of reporting fair/poor oral health, not having visited a dentist in 2 years, and not planning a future oral care visit. Racio-ethnically minoritized patients may experience the unjust double bind of resolving urgent dental or completing preventive services needs amidst being treated in a discriminatory manner or without dignity. Oral health stakeholders should invest more effort to understand relationships between racism and oral health outcomes and introduce evidence-based interventions to ultimately abolish this societal harm.