Getting to the root of oral health

By David Slipher
L. Douglas Wilder School of Government and Public Affairs

When the subject of preventive health care is broached, oral health is often regarded as a distinct and separate issue. However, for Sarah E. Raskin, Ph.D, associate professor in the L. Douglas Wilder School of Government and Public Affairs at Virginia Commonwealth University, this is not the case. Raskin sees a deep and intimate connection between oral health and overall well-being. Bridging the gap between these two aspects of health is her passion, and she has dedicated herself to finding solutions to disparities in oral health care. Through her work, she’s making a significant impact in areas such as dental safety nets, workforce diversification, community-based research and rural oral health.

According to Raskin’s research, people who identify as experiencing discrimination or indigent treatment in a dental setting are two to four times more likely to describe their oral health as poor/fair, to have not had dental care in two years and to not be planning a future visit for preventive/routine oral care, as in the dental setting. 

“Oral health has a reciprocal relationship with overall health. For example, pregnant people who have periodontal (gum) disease are more likely to deliver preterm or low birth weight babies,” Raskin said. “Having gum disease also substantially increases the risk of poor glycaemic control and end-stage renal disease among people with diabetes.”

Much of Raskin’s research critiques the status quo and historical deficiencies in oral health care, especially systemic factors that exclude racial and ethnic minorities and economically disadvantaged individuals from obtaining care and from pursuing opportunities in the dental professions. To understand these inequities, she’s taking a holistic view of oral health systems and incorporating her training in cultural anthropology into her approach. One constant has emerged — many of the same factors that exclude underserved patients from dental care also prohibit professional achievement among potential dental workforce members.

“Using mixed social science methods such as patient and provider surveys, interviews with oral health policy advocates, and ethnographic observations of service delivery, we can go beyond strict biological understandings of oral disease and cognitive understandings of career paths,” she said. “These underlying forces shape inequities such as societal expectations of what a dentist should look like and how a community member should tolerate being excluded from care.” 

Community partnerships are key to Raskin’s work, and as a VCU School of Dentistry faculty affiliate and member of the iCubed Initiative Oral Health Core, she’s using her expertise to influence best practices to incorporate outreach as a prime component for transforming dental service delivery. She’s partnering respectively at the local, state and national levels with CrossOver Healthcare Ministry, Virginia Health Catalyst and CareQuest Institute for Oral Health. Together with these groups she has worked to reduce missed appointments among dental safety net patients, expand community-based services through dental practice law changes, and document and address how discrimination within dental offices affects patient outcomes.

Her data-driven research, which she makes publicly accessible by publishing in an open-access format as much as possible, represents a sea-change for reframing the conversation around oral health. Through her recognized expertise, connections, and influence on oral health advocates, educators, and scholars, her mission is to make oral health a permanent part of the larger discussion for health equity in all policy planning. 

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