Gun Violence Exposure Is Linked to Less Dental Care

For decades, the effects of gun violence exposure on overall physical health has largely been overlooked, but a new study shows a startling link: In communities with the highest rates of gun violence, residents are less likely to receive dental care.

“This is the first paper to really look at the connections between dental health and violence exposure, and what we’re beginning to see with this work is the deep connections between gun violence and overall health,” said Daniel Semenza, the study’s lead author and the director of research at the New Jersey Gun Violence Research Center, where the study was conducted.

The study, published in the American Journal of Preventive Medicine in April, is the first of its kind to examine the connection between oral health and firearm exposure. Using data from the Centers for Disease Control and Prevention, its authors analyzed more than 20,000 census tracts within the 100 largest cities in the United States from 2014 to 2022. They found that a 1 point increase in shootings led to a 0.06 percent increase in edentulism, or dental loss. The researchers found that factors like a pervasive sense of fear, chronic stress, and social and economic disruption brought on by firearm violence could potentially contribute to adverse health behaviors, poor oral health, and affect access to dental care.

The research expands on scholarship that has tied higher levels of gun violence in communities to higher rates of diabetes and food insecurity. The cumulative health risks associated with firearm violence are an area of focus for the New Jersey center, whose recent work has examined how gun violence exposure affects residents’ overall well-being, increasing their risk for suicide, depression, and the use of mental health services. The center, housed at Rutgers University, is one of the leading hubs for gun violence research. It is at risk of steep budget cuts as funding for gun violence prevention has come under threat at both the state and federal levels. 

“We need greater access to mobile clinics and, in general, awareness of dental health services,” Semenza said. “A lot of people in high-violence areas may not even be prioritizing going to the dentist, because they have all these other more pressing medical health issues going on as they navigate exposure to violence.”

Research has found that serious health complications — including those that prove fatal — can be caused by poor oral hygiene or lack of dental care. People who have to navigate violence, however, may have limited choices in accessing that care.

According to hospital data, nearly two-thirds of firearm injury patients admitted for care were uninsured or insured by Medicaid. This is similar to dental patients; nearly 70 million Americans do not have dental insurance, and in 2019, 35 percent of American adults had not visited a dentist in the past year. Experts in dentistry have long pushed for Medicaid expansion to cover more dental costs, but they face challenges similar to those of gun violence experts in their efforts to expand gun violence prevention. 

In the study’s conclusions, the researchers note that integrating oral care into gun violence prevention organizations could be essential in mitigating the risks of both gun violence and lack of dental care. But they also propose a more immediate solution: mobile dental clinics.

A lack of access to services is what has motivated the New York University College of Dentistry to launch its various outreach initiatives, and one of its key programs, “Smiling Faces, Going Places,” a mobile dental clinic that has served four of the city’s five boroughs. The vehicles provide oral health services, including exams, X-rays, and cleanings, to underserved communities.

“Access to care is a huge component of public health, whether we’re speaking about oral health or overall health, including violence exposure,” said Cheryline Pezzullo, director of community-based programs at NYU Dentistry. “We have to work at addressing these disparities and disseminating information.”