Teeth Tell the Truth: Oral Health as a Window into Racial Health Inequity

Ubuntu Village · Public Health & Community Power · East Harlem

You can see a community’s history of neglect in its teeth.

In East Harlem — where Ubuntu Village is rooted — a child’s chance of having untreated dental decay is twice the city average. Dental offices that accept Medicaid are scarce. School-based programs are underfunded and unevenly distributed. For many families, a toothache becomes a chronic condition not because they don’t value their health, but because the system has consistently undervalued theirs. This post traces what oral health disparities reveal about structural racism — and what our ancestors understood about keeping the whole person well, long before dentistry had a waiting room.

The Mouth Remembers What the System Would Rather Forget

The United States Centers for Disease Control reports that Black adults are nearly twice as likely as white adults to have untreated dental decay. Latino children in low-income neighborhoods experience significantly higher rates of early childhood caries than their white peers. These are not random outcomes. They are the legible residue of a healthcare system built with deliberate exclusions.

The American Dental Association did not admit its first Black member until 1965 — a decade after Brown v. Board of Education. Before that, Black dentists trained at exactly two institutions: Howard University College of Dentistry and Meharry Medical College, both founded specifically because Black students were excluded from every other dental school. The discrimination that forced their creation did not simply end when formal segregation ended; it reshuffled into insurance structures, zoning patterns, and funding formulas that we still live inside.

In East Harlem — a neighborhood that is 50% Latino and 29% Black — there is roughly one dentist accepting Medicaid patients for every 3,500 residents who need one. The Upper East Side, three miles south, has some of the highest concentrations of dental specialists in the country. The distance between those two realities is not geography. It is history made physical.

Teeth are not separate from the body. Oral disease is not separate from systemic disease. And dental care deserts are not accidents of geography — they are outcomes of policy choices made by people who did not count our communities as worth investing in. Naming that is not grievance. It is diagnosis. And diagnosis is where healing begins.

What Our Ancestors Already Knew: African Oral Traditions

Before toothpaste came in a tube. Before the fluoride debate. Before dentistry was a profession with an accreditation board and a billing department — our ancestors were keeping their teeth well. The chew stick was not a primitive precursor to the toothbrush. It was sophisticated, plant-based oral technology that modern research has confirmed is clinically effective.

In West Africa, neem (Azadirachta indica) — called dogoyaro in Hausa and used across Nigeria, Ghana, and Senegal — has been harvested as a chew stick for centuries. Research in peer-reviewed journals of periodontology has documented that neem chew stick use reduces plaque formation, inhibits oral bacterial growth, and decreases gum inflammation through the plant’s naturally occurring compounds: azadirachtin, nimbin, and nimbidin. In East Africa, Salvadora persica — the arak tree — has been used from Ethiopia through Kenya and Tanzania. The World Health Organization has formally recognized the arak chew stick as an effective oral hygiene tool. What our grandmothers called hygiene, researchers are now calling evidence-based practice.

In Yoruba tradition, orin ata — chew sticks from various plant sources — were part of the daily rhythm of life. Among the Igbo, plants with known antimicrobial properties were woven into oral care alongside dietary practices that protected the teeth: fermented foods that balanced oral bacteria, bitter leaf that stimulated saliva production, raw foods that naturally cleaned tooth surfaces. These practices reflected an understanding of the mouth as a gateway to the body’s interior that required the same thoughtful tending as any other part of the whole.

The point is not that our ancestors had better technology. The point is that they had developed sophisticated, communal relationships with plants — relationships built through generations of careful observation of what worked. Colonization disrupted those relationships. Urbanization separated communities from the plants. Poverty made the alternatives inaccessible. The grandmothers who knew which branch to chew are gone; the dental clinics that should have filled that gap never arrived. What remains is the gap itself.

How the System Was Built to Keep Us Out

Dental and medical care in the United States have been structurally separated since the 19th century — a division that has never been ideologically neutral. In 1840, when the founding of what would become the first dental school was proposed as a department within an existing medical school, the medical faculty voted to reject the idea. Dentistry went on to develop its own institutions, its own licensing bodies, its own insurance codes — separate from medicine in ways that have persistently disadvantaged communities of color.

The Affordable Care Act expanded health insurance to millions of Americans in 2010 — but explicitly excluded adult dental coverage from the essential health benefits mandated for most insurance plans. Medicaid adult dental coverage is patchwork and state-determined. New York offers it, but at reimbursement rates so far below what private practice costs to run that the majority of dental practices opt out entirely. The result is the care desert we see in East Harlem: technically covered, functionally unreachable.

The workforce mirrors the access problem. Black dentists represent approximately 3.8% of the U.S. dental workforce — against a 13.6% share of the population. Hispanic dentists represent roughly 5.5% against a 19% population share. Research consistently shows that patients of color are more likely to delay or avoid dental care when they cannot find a culturally competent provider — a response rooted not in irrationality but in the documented reality of being undertreated, dismissed, or over-studied in clinical settings. The body keeps the record of how it has been treated by the systems meant to care for it.

Communities of color receive worse dental care, have less access to dental care, and are less likely to have a relationship with a provider they trust — not because they don’t prioritize health, but because the system has historically prioritized them last. When the formal health system fails a community, that community finds other ways. But improvisation is not equity.

East Harlem’s Dental Desert: The Data, and the Human Cost

East Harlem’s Community Health Profile — published by the New York City Department of Health and Mental Hygiene — documented significantly higher rates of dental emergency room visits than the Manhattan average. Public health researchers call this pattern “dental avoidance leading to crisis care.” When preventive and routine dental treatment is inaccessible, minor problems compound. Cavities become infections. Infections become emergency room visits. Emergency rooms are not equipped to treat dental disease; they prescribe antibiotics and refer patients back to dentists — the same dentists who don’t exist at sufficient scale in the neighborhood.

The children carry the weight of this in their bodies. Early childhood caries — dental decay in children under six — is the most common chronic disease of childhood in the United States, five times more prevalent than asthma, and largely preventable with fluoride, dental sealants, and routine care. National data from the CDC’s National Health and Nutrition Examination Survey shows that Latino children ages six to eleven have the highest rates of untreated dental decay in the country. In communities like East Harlem, this largely goes unaddressed until it becomes a crisis.

Children with untreated dental pain miss school. They can’t focus. They don’t eat well — chewing becomes painful, nutrition suffers. An untreated cavity in a seven-year-old is not an isolated dental problem. It is a learning barrier. It is a nutritional deficit. It is a trajectory being set by a gap in the safety net that was never accidental.

Adults fare no better. The American Dental Association’s Health Policy Institute has documented that adults in low-income households are significantly less likely to have visited a dentist in the past year than those at higher income levels — a gap that holds even after controlling for insurance status. The barrier is not only insurance; it is time, transportation, language, trust, and the lived knowledge that clinical settings have not always treated you as fully human. Communities understand what data often fails to measure: the cost of a system that was not built with you in mind.

The Body Speaks What Power Silences: Oral Health and Systemic Disease

The research connecting oral health to systemic disease has been robust for decades and consistently underrepresented in public health conversations about health equity.

The American Heart Association has documented the association between periodontal disease — chronic infection and inflammation of the gums and bone supporting the teeth — and increased cardiovascular risk. The bacteria associated with severe periodontitis, including Porphyromonas gingivalis, have been found in the atherosclerotic plaques of cardiovascular patients. Chronic gum disease elevates systemic inflammatory markers — C-reactive protein, interleukin-6 — that are themselves independent risk factors for heart disease, the leading cause of death for Black Americans. You cannot separate East Harlem’s cardiovascular burden from East Harlem’s dental care desert.

Periodontal disease is also associated with diabetes complications: poor blood sugar control worsens periodontal disease, and periodontal disease worsens blood sugar control — a feedback loop that is especially consequential in communities with high diabetes rates. It is associated with preterm birth and low birth weight. Black women — who already experience maternal mortality at three to four times the rate of white women — face disproportionate rates of periodontal disease. The mouth is not separate from the maternal body. The maternal body is not separate from the community’s history of being undertreated.

This is what Ubuntu medicine has always understood: health is not localized. It is not a mouth condition or a heart condition or a maternal mortality condition in isolation. It is a condition of the whole person, in relationship with their whole community, shaped by the conditions that community has been given — and denied. Treating the symptom without addressing the desert it lives in is like treating a wound without addressing the violence. Necessary, but not sufficient.

What Health Justice Looks Like for Our Teeth

The solutions exist. They are not waiting to be invented — they are waiting to be funded, sustained, and scaled.

School-based dental programs. Mobile dental clinics and in-school sealant programs have demonstrated effectiveness at reaching children who would otherwise never see a dentist. New York City’s school-based dental programs are among the most effective in the country — and chronically underresourced, unevenly distributed, and dependent on grant funding that ends. These are not special programs. They are basic infrastructure that every school community deserves as a right.

Community health workers in oral health. CHWs trained in oral health education bring preventive care, referrals, and trust into homes, churches, and community centers. They are the bridge between the clinical system and the communities that system has failed to reach — and in East Harlem and communities like it, their work is worth far more than what they are typically paid. Investing in CHW oral health programs is not a pilot. It is a model.

Ancestral plant medicine alongside clinical care. Neem, arak, bitter leaf — the oral health traditions our grandmothers carried — sit alongside clinical dentistry, not in opposition to it. The grandmother who chews neem and the dental hygienist who provides preventive care are not in conflict. They are in conversation. Ubuntu health honors both, and does not ask communities to choose between ancestral knowledge and contemporary medicine.

Policy advocacy. For Medicaid reimbursement rates that make it economically viable for dental practices to serve low-income communities. For adult dental coverage to be treated as the medical necessity the evidence proves it is. For federal investment in community health centers with dental capacity, in dental loan forgiveness for providers who serve underserved areas, in the diversity pipeline that produces dentists who look like the communities they serve.

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Ubuntu Village’s vision of health is communal and indivisible. The teeth are part of the body. The body is part of the community. What harms the mouth harms the whole. And when whole communities go without dental care for generations — their children missing school with untreated pain, their elders losing teeth to infections that preventive care would have caught — that harm accumulates not only in individual bodies but in the body politic.

We see it in emergency room data. We see it in school attendance records. We see it in cardiovascular mortality rates. You can see a community’s history of neglect in its teeth. You can also see a community’s future in the investments it decides to make — or refuses to accept any longer.

References

Centers for Disease Control and Prevention. Oral Health Disparities and Inequities. CDC Oral Health Program, 2021.

American Dental Association Health Policy Institute. Dental Care Access and Workforce Diversity Data. ADA, 2023.

NYC Department of Health and Mental Hygiene. Community Health Profile: East Harlem. NYC DOHMH, 2018.

American Heart Association. Periodontal Disease and Cardiovascular Risk. AHA, 2023.

World Health Organization. Oral Health: Key Facts. WHO, 2023.

Kaiser Family Foundation. Dental Coverage and Access for Adults in Medicaid. KFF, 2023.

Mwangi, J.W., et al. “Antimicrobial activity of Salvadora persica extracts against oral pathogens.” Journal of Ethnopharmacology, 2017.

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Related Reading at Ubuntu Village

Displaced and Erased: What Urban Renewal Did to East Harlem — and What Healing Looks Like

When the Church Is the Clinic: Faith-Based Health Advocacy in African and Diaspora Communities

The Body Remembers the Middle Passage: How Intergenerational Trauma Lives in Black Nervous Systems — and How Healing Happens

Food Desert vs. Food Swamp: What’s the Difference — and Why It Matters for East Harlem

Michele Mitchell is the Founder, President & CEO of Ubuntu Village Inc., a 501(c)(3) nonprofit with programs in Kenya, Uganda, and Nigeria. A writer, advocate, and community strategist working at the intersection of ancestral wisdom, public health, and community power, Michele leads Ubuntu Village’s work to center communities as the protagonists of their own healing. She writes from the conviction that science and spirit are complementary, that healing is relational, and that community is the medicine. Read more about Michele, or connect with her on LinkedIn.