Diversity, Equity, and Inclusion

Board takeaway

• Find the barrier: When prevention or treatment is not reaching a child, ask what makes care difficult to obtain or use.
• Respond: Equity requires responding to those barriers, and inclusion requires a setting where families feel respected and can participate.
• Where to act: AAPD supports these efforts in patient care, office training, education, leadership, and community policy.

Address bias without assuming individual behavior

• The policy connects children’s oral health with discrimination, social conditions, and professional opportunity.
• It asks clinicians and institutions to examine both deliberate and unintended bias.
• Population-level disparities identify inequities to address; they do not justify assumptions about an individual family’s behavior or preferences.

Define the three terms

• Diversity: differences in individual and social characteristics—age, race, ethnicity, sex, sexual orientation, gender identity, language, religion, origin, geography, family structure, abilities, and socioeconomic circumstances. Housing, mental health, body image, and veteran status also fall within this concept.
• Equity: fairness and justice sustained through structural and systemic action. Health equity requires addressing avoidable inequalities, past and present injustices, and health care disparities while valuing everyone equally.
• Inclusion: equitable access to resources and opportunities in an environment where people feel safe, respected, engaged, and valued.

Oral health inequities and their drivers

• The policy reports especially high documented early childhood caries prevalence among American Indian/Alaska Native and Native Hawaiian children, and greater caries prevalence among non-Hispanic Black and Mexican American children than non-Hispanic White children.
• Dietary counseling and preventive care matter, but sustained improvement also requires addressing social determinants.
• Structural racism operates through laws, policies, and institutions. Lending and employment practices can affect income, insurance, education, housing, food security, stress, and neighborhood resources.
• Housing instability, food deserts, inflexible work schedules, transportation limitations, and care costs can obstruct dental services, nutritious food, and safe fluoridated water.
• Literature cited by the policy reports poorer care quality even after accounting for access, socioeconomic status, and education; reduced perceived oral health and self-efficacy; fear-related appointment avoidance; and caregiver concerns about unmet needs and inattentive care.

Act in the office, workforce, and community

• Greater representation of underrepresented groups in health professions can support trust with marginalized families.
• The policy connects workforce diversity and equity with provider training, recommended Medicaid reform, and workforce expansion.
• Intentional and unintentional biases can influence treatment decisions, office policies, practice environments, and relationships.
• Cultural competency education should address discriminatory assumptions and behaviors. Training may increase awareness and encourage respectful care; implementation can be constrained by inadequate social supports for children's needs.
• Policy and research: AAPD supports social and economic policies, research, and initiatives addressing determinants of racial and ethnic oral inequities.
• Dental offices: AAPD encourages DEI training.
• Education: AAPD urges less biased applicant and trainee evaluation and stronger DEI curricula.
• Broader inclusion and community collaboration should promote dignity and respect for all families.

Common board traps

Answer aloud

A caregiver misses visits and reports transportation problems. How does this policy inform your response?

Ask about transportation and other barriers respectfully and consider whether office policies make care harder to obtain.

• Prevention and treatment planning should account for social circumstances and available support.
• Missed visits should prompt an effort to understand and reduce the barrier rather than an assumption about the caregiver's motivation.

What DEI actions does AAPD specifically encourage?

AAPD encourages office training, less biased evaluation of applicants and trainees, stronger educational curricula, and policies, research, and initiatives that address inequitable social determinants.

• These actions apply to professional opportunities and to the conditions affecting children's access and oral health.