It has been predicted that the White population will no longer comprise the majority in the United States in 2060 , indicating that it is imperative to understand the expanding healthcare needs of minority communities. Specifically, subpar levels of oral health alter an individual’s quality of life in terms of speech, mastication, self-esteem, social interactions, educational attainment, career achievement, as well as their emotional state . Additionally, poor oral health is associated with a higher rate of chronic diseases such as diabetes  and heart disease . Nationwide, minority children such as Hispanic and non-Hispanic Black children are more likely to present with carious lesions and lesions of higher severity compared to non-minority children . Nationally, 51 million school hours are missed by children yearly due to dental concerns . A systematic review showed that poor oral health was significantly associated with the increase of poor academic performance and absenteeism . Among the adult population, those living in poverty have higher rates of caries. African Americans and Mexican Americans have more untreated caries than their White counterparts and periodontal disease is more prevalent in African Americans and lower socioeconomic levels [8–9].
As of 2020, Utah’s estimated population is 3.28 million, a significant increase of over 68% from the numbers declared back in 2000 . The 2018 Census in Utah reported 85.7% White, 2.4% Asian, 1.3% Black or African American, 1.1% American Indian/Alaska Native, 0.9% Native Hawaiian/Other Pacific Islander, 5.4% another race, and 3.2% of two or more races, while 14.2% was of Hispanic, Latino, or Spanish origin. Critically, in 2018, over one-in-five individuals in Utah were a minority, with 26.5% of those under the age of one classified as a minority .
Currently, 66% of Utah counties are designated as dental Health Professional Shortage Areas (HPSAs) , with approximately 54% of Utah’s population residing in one of these areas . Of the dental HPSA counties, 84% of them are classified as both low-income and geographic HPSA sub-categories. For primary care HPSA counties in Utah, 50% of the population seeking for services were low-income HPSA, while 50% were geographic HPSA. These findings suggest that socioeconomic factors influence attainment of dental care to a greater extent when compared to primary care in the state of Utah.
Qualifying for Medicaid in Utah does not guarantee oral healthcare access. Dental care beyond emergency coverage is a service available only for Medicaid members who are pregnant, disabled, blind or children qualifying for Early Periodic Screening, Diagnostic and Treatment . Medicaid members who are not eligible for dental coverage may receive Medicaid services by providing payment at the time of service at a rate equivalent to the rate Medicaid would pay for a qualifying member. Additionally, while the Patient Protection and Affordable Care Act provided a large expansion of health coverage in Utah, it failed to identify oral health as one of the 10 essential health benefits for all age groups, with the exception of dental pediatric services . Utah’s development of a health insurance exchange marketplace did not improve access to dental insurance. With limited Medicaid coverage for oral health services available for adults in place and no plan for Medicaid expansion, oral health access remains a serious concern in Utah.
Nationwide, emergency department (ED) visits for dental conditions are increasing at more than triple the rate of all other medical conditions combined . In Utah, between 2007 and 2017, there were approximately 56,000 admissions to the ED for dental emergencies, costing the state over 50 million dollars . Among the ethnic groups analyzed, Black/African American individuals had the highest rate of visits to the ED, followed by American Indian and Hispanic individuals. Nationwide, approximately 320.8 million work hours are missed annually by employed individuals due to dental visits or problems .
In Utah, there are many specific populations that have ill-defined access to oral healthcare. To our knowledge, there were no reports on the oral health status or needs of the following populations: refugees, individuals with mental and physical disabilities, older adults, Latinos/Hispanics, Native Americans, ex-Fundamentalist LDS, homeless individuals, LGTBQ individuals, patients with cancer, and patients with a substance use disorder.
This study analyzed the oral health needs of individuals in HPSA regions in Utah through the use of a retrospective analysis of survey data collected as part of the standard of care from outreach activities of the University of Utah School of Dentistry. Ultimately, the aims were to better understand and report on the oral health status of Utah's population, particularly those from underserved minority communities, which will allow for the future development of focused strategies in meeting their oral healthcare needs, including targeted seeking of funds for treatment from Federal and State authorities.