Racism in oral healthcare settings: Implications for dental care‐related fear/anxiety and utilization among Black/African American women in Appalachia

OBJECTIVE: To explore the association of racism in oral healthcare settings and dental care‐related fear/anxiety with dental utilization among Black/African American women in Appalachia. METHODS: We analyzed self‐report measures of racism in oral healthcare settings, dental care‐related anxiety and fear, recency of a dental visit, and demographic information from 268 pregnant women participating in the Center for Oral Health Research in Appalachia (COHRA) SMILE cohort. All participants self‐identified as African American or Black and resided in Appalachia (i.e., either West Virginia or Pittsburgh, PA). RESULTS: Over one‐third of the participants reported at least one instance of racism in oral healthcare settings, with “not being listened to” due to their race or color as the most frequent issue (24.4%). Clinically significant levels of dental care‐related anxiety and fear were reported by 14.3% of the sample. A mediational model demonstrated that the experience of racism in oral healthcare settings was a significant predictor of dental fear/anxiety, and that dental fear/anxiety was a significant predictor of dental utilization. There was a significant relationship between racism in oral healthcare settings and dental utilization only when mediated by the presence of dental care‐related fear and anxiety. CONCLUSIONS: Together, experiences of racism in oral healthcare settings and dental care‐related fear/anxiety are predictive of decreased dental utilization for Black/African American women living in Appalachia. This study provides insight into racism in oral healthcare settings as a social determinant of dental anxiety/fear and inequities in dental utilization.