Racial and socioeconomic disparities in health from population-based research to practice-based research: the example of oral health.

Oral health serves as an excellent model for understanding social disparities in health. Associations among race, socioeconomic status, oral health, and dental care are strong. Multiple points along the dental care process allow investigation of disparities and mechanisms; and there are multiple types of treatment services (ranging from those that all patients and clinicians would likely agree on, to multiple treatment options, to discretionary treatments). Florida Dental Care Study (FDCS) data are used to provide examples of these concepts. Without regard to whether the dental care system was ultimately entered, the FDCS found substantive social differences in 1) incidence of need; 2) responsiveness to this need; and 3) propensity to seek preventive services. Once the dental care system had been accessed, substantive social differences were still evident with regard to 1) clinical condition; 2) awareness of treatment options; and 3) treatment discussions and recommendations. Once differences in clinical condition were taken into account, and once analysis was limited to persons who had entered the dental care system, social differences in receipt of care were still evident. Findings suggested that although dental care was effective at treating and preventing certain oral conditions, social differences in treatment effectiveness were evident.