Delaware Latinos struggle with access to dental care
- Latinos are afflicted by a ream of economic and cultural barriers to receiving oral health care in the First State.
- The obstacles are only intensified for undocumented residents, who face fears and complications stemming from their immigration status.
- Many Latinos forego preventative dental care and instead wait until the pain is unbearable to seek urgent and emergency services.
This story was produced by Spotlight Delaware as part of a partnership with Delaware Online/The News Journal. For more about Spotlight Delaware, visit www.spotlightdelaware.org.
Gerardo Leyba Romero wants his molars back.
The two teeth in the back of his mouth have been missing for nearly a decade. A flawed filling procedure in 1994led to the mandatory plucking of the molars years later.
Leyba Romero, a Long Neck resident and native of Mexico, brandished his two dulled front teeth on a recent afternoon. He filed down one front tooth to match its chipped neighbor years ago.
Leyba Romero didn’t see a dentist for seven years during his initial stretch in the United States in the 1990s. A language barrier and the lack of available dental services, alongside their high cost, kept him away for years.
“It’s sad, but it’s reality,” Leyba Romero said amid a nervous chuckle.
Many Latinos in Delaware delay their dental care even longer, if they access it at all.
Latinos are afflicted by a ream of economic and cultural barriers to receiving oral health care in the First State. The obstacles are only intensified for undocumented residents, who face fears and complications stemming from their immigration status.
Many Latinos forego preventative dental care and instead wait until the pain is unbearable to seek urgent and emergency services. The lack of care due to transportation and language barriers can lead to pain, tooth decay and oral disease.
“I had to lose both molars to know that I needed more care,” Leyba Romero said.
Latinos bear one of the highest oral disease burdens in the U.S. with about 15% of Latino adults aged 65 and over having no teeth, studies show. In Delaware, Latinos comprised over 10% of the population, representing over 104,000 people, in 2020, according to the U.S. Census Bureau.
Regular preventative care is largely unattainable for uninsured or underinsured Latinos. Over 36% of Hispanic adults are uninsured in Delaware, according to the Delaware Department of Health and Social Services (DHSS).
Nationally, over 6 million adults lost their dental coverage in 2023 with Hispanic people being twice as likely to have lost dental insurance than white non-Hispanic individuals, according to a CareQuest Institute for Oral Health survey.
Additionally, undocumented Delawareans don’t qualify for Medicaid — a health insurance program that provides coverage to low-income adults and people with disabilities — except in emergency situations.
The lack of coverage leads to a lack of or no oral health care access for Latinos and immigrants. Even with dental insurance, health care deductibles and copays are costly.
“Although there have been some improvements in services for the community, they’re still expensive,” Leyba Romero said.
Lack of access to routine care leads to more invasive and expensive procedures that also place an undue economic burden on the state’s health care system and ultimately taxpayers via Medicaid funding, according to community advocates.
The various health care barriers have fostered clandestine dental operations, which have sprung up amid the lack of official services in the state, according to advocates and residents. The underground, illegal operations are usually led by an unlicensed person who claimed to be a dentist in their home country and now offers low-cost dental services.
The trend, known as “basement dentistry,” happens across the country, with outfits being busted from California to Massachusetts.
The barriers come in the midst of an overall declining number of dentists in the First State — a fraction of which are Latino. In Kent County, there were no working Latino dentists at all, according to a 2022 DHSS Delaware Dentist Survey.
Still, there are a handful of low-cost clinics that offer coverage regardless of immigration and insurance status.
Despite the clinics’ services, however, it often takes weeks or months for new patients to be seen for an appointment, patients reported.
Gina Reyes’ 15 years in the U.S. have been punctuated with only four dental visits — a fragment of the vital 30 visits recommended in that time.
Reyes, a native of Mexico City, only received dental coverage during her time as an agricultural worker on mushroom farms in Kennett Square, Pa. Despite the coverage, Reyes was still saddled with high procedure costs and months-long waits for basic cleanings.
“It’s easier to pull out a tooth than to fix it,” Reyes said, citing the high and often unclear dental costs.
Language and cost have kept Reyes from accessing regular dental care in Delaware.
The inability to access insurance or Medicaid is perhaps the biggest barrier of all to any health care, including dental services, according to Dr. Christine Stinton, chief dental officer at La Red Health Center in Georgetown.
In 2023, La Red had over 2,000 dental patients and nearly 4,000 patient visits, with many of their patients not qualifying for Medicaid. The health center offers health care to Sussex County residents, regardless of insurance or immigration status.
There’s a culture among Latinos to only seek dental care only “when it hurts,” instead of engaging in routine preventative care, according to Dr. Francisco Ramos-Gomez, professor and chair of the Section of Pediatric Dentistry at the University of California, Los Angeles.
Most of Reyes’ mushroom farm coworkers would wait until the toothaches were intolerable before seeking care, she said. When they did seek care, they preferred to have the tooth pulled instead of undertaking necessary high-cost repairs.
Lack of preventative care causes oral diseases and dental problems to significantly worsen over time, leading to increasingly expensive procedures, Ramos-Gomez said. Very few Latino families access dental services in a timely manner.
“It’s a vicious cycle you cannot break,” he added.
A person’s immigration status is one of the biggest barriers keeping immigrants from accessing dental care, according to Ramos-Gomez. Fears around being reported by the system lead to mistrust between providers and families, he added.
Additionally, language is a “huge” barrier that often keeps non-Spanish-speaking dentists from coaching parents on proper preventative care for their children, Ramos-Gomez added. Having Spanish-speaking dentists improves the trust between Latino patients and providers.
In Delaware, about 66% of dentists reported having staff who could communicate in a language other than English, per the DHSS dentist survey. Over 79% of Sussex County dentists reported non-English-speaking staff — the highest percentage in the state.
Legislation to establish a limited medical assistance program for all Delaware children, including undocumented kids, was introduced in the Delaware General Assembly in 2023. House Bill 150 died in committee with the end of the assembly’s legislative session.
The legislation would have cost upward of $15.2 million annually once it was fully rolled out, and would have included dental care, according to the bill’s fiscal note.
Six states and Washington, D.C., have already expanded their fully state-funded health care coverage to adults regardless of immigration status. Those states include California, Colorado, Illinois, New York, Oregon and Washington.
La Red is supportive of a Medicaid expansion that would include all immigrants, regardless of immigration status, Stinton said.
In 2022, Senate Bill 277 established the Dental Care Access Task Force to address dental care access in marginalized communities and expand dental insurance coverage for Delawareans.
The final 2023 task force report recommended a slew of policy reforms to improve oral health care inequities, including cultural competency training for providers. The training would educate staff and providers on how to treat people with language and cultural differences, including varying immigration statuses.
Ramos-Gomez echoed the report’s findings, underlining the importance of cultural competency training for dentists, as well as the importance of increasing diversity in dentists. Patients tend to trust providers who speak their language and understand their culture more, he added.
“We do not match the profile of the population we’re trying to reach,”Ramos-Gomez said. “We don’t really have the appropriate cultural competencies in the providers.”
Just under 5% of dentists were Latino in Delaware, according to the DHSS survey. Nationally, Black and brown dentists are vastly underrepresented in the dental workforce, with Latinos only representing roughly 6% of dentists in the U.S.
The task force report also suggested expanding mobile health services for communities facing transportation barriers by increasing funding for grants for the Division of Public Health’s Bureau of Oral Health and Dental Services.
La Red Health Center, Hope Medical Dental Clinic and Westside Family Healthcare are a few of the clinics offering free or reduced-cost dental services across the state.
In 2020, Medicaid coverage was also expanded to include dental coverage for adults. The benefits cover $1,000 of dental care per year, including exams, cleanings, fillings, sedation, and regular tooth extractions.
Undocumented Delawareans, however, are still largely excluded from these Medicaid benefits.
“It’s when we let time go by, without attention, without service, and when this happens, we unfortunately already lost a tooth,” Leyba Romero, now a soccer coach, said on a recent afternoon.
A former soccer pupil of his has now become a dentist in Mexico. The bygone student has offered to replace his molars many times.
A trip to Mexico eludes him — but it’s alright. Leyba Romero is content with waiting for now.
He won’t let as much time pass in between visits this time.
Need help?
The Eastern Shore Mission of Mercy will be hosting a free two-day adult dental clinic in Salisbury, Md., on Sept. 13 & 14. Alternatively, you can find a list of low-cost Delaware dental clinics and oral health resources in Delaware’s Dental Resource Guide.
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