Towards an Epistemic Understanding of Racial Inequities in Dental Care: A Philosophical-Conceptual Framework Informed by a Hermeneutics-Guided Review

Abstract How can the ways we produce and value knowledge generate racial inequities in oral health? This article presents an investigation of this new, epistemic determinant of oral health, analysing how Black patients may have their reports, experiences and concerns systematically discounted during dental care. Drawing on the epistemic injustice theory, we develop a philosophical-conceptual framework, informed by a hermeneutics-guided, narrative review of the literature, to posit the epistemic mechanisms underpinning this phenomenon. According to our conceptual framework, biomedically-oriented and whiteness-influenced dental education and the epistemically unequal character of health systems and training intertwine, generating a pattern of systematically compounded discredibility by dental staff towards Black patients. We then apply this conceptual framework to quantitative, qualitative, and review oral health studies, searching for empirical markers and evidence that further inform our understanding while shedding new epistemic light on their findings. In conclusion, we contend that, considering our results, structural changes in dental education and clinical organisation play a fundamental role in addressing these injustices, and highlight the need for further research on epistemic injustice in dentistry to better understand its implications for equitable health care.