How Culture Affects Oral Health Beliefs and Behaviors

Each February, the American Dental Association (ADA) sponsors National Children’s Dental Health Month to raise awareness about the importance of oral health. Developing good habits at an early age and scheduling regular dental visits helps children get a good start on a lifetime of healthy teeth and gums. Good oral health contributes significantly to overall good health during a person’s lifetime.

Studies indicate that children from low-income and minority families, children with special needs, and children raised in rural areas of the U.S. shoulder a disproportionate burden of oral disease, adding to the list of health disparities among some disadvantaged populations. Contributing factors may include lack of community water fluoridation, dental workforce shortages, and the high cost of care and limited access to dental insurance. Cultural beliefs, values, and practices are also often implicated as causes of oral health disparities, yet little can be found in the dental literature that isn’t epidemiological in nature. In other words, the literature demonstrates disparities in oral health rather than identifying specific oral beliefs and practices among different cultural groups. 1

Indeed, cultural influences overlap with dental health literacy, socioeconomic status, and personal experience in complicated ways, but it is possible to identify some common beliefs and care-seeking practices around oral health that are culturally-based and significantly different from the western dental medicine model. This article will suggest four domains that shape people’s cultural beliefs and practices related to oral health: 1.) help-seeking and preventive care, 2.) oral hygiene practices, 3.) beliefs about teeth and the oral cavity, 4.) the use of folk remedies. Additionally, a list of interesting and useful culturally-related oral health facts are presented.

Help-Seeking and Preventive Care

Many cultural groups don’t have a strong preventive orientation when it comes to their health care, and this is definitely true when it comes to oral health. People often seek care only when there is a problem. An individual might go to the dentist for a painful tooth after suffering with it for a while, and then simply expect to have the bad tooth extracted. Advanced interventions to save a bad tooth, such as root canals and crowns, may be common in the U.S. and other western countries, but are often the privilege of only wealthy people in other cultures.

Oral Hygiene Practices

In many cultures there is little understanding of gum disease. Brushing the teeth may be done to remove left over food from the mouth, but the concept of removing plaque and tartar is less well-understood. It follows that the use of dental floss, mouth rinse, and tongue cleaners may be virtually unheard of and might be viewed with skepticism. Americans are known around the world for being obsessive about perfectly straight bleached white teeth. Hollywood movies and American TV promote the importance of pearly white American smiles.

Beliefs About Teeth and the Oral Cavity

In many cultures the esthetic appearance of teeth may be important, but having “healthy” teeth and gums is not connected to appearance in a direct way. Red or swollen gums, bleeding gums, painful chewing, loose teeth, receding gums, all these symptoms of gum disease may be ignored as long as the visible teeth “look good”. An interesting example comes from China where the appearance of teeth is psychosocially important. Having nice looking teeth can influence social interaction. However, a person with carious or discolored front teeth…is considered to have low intellectual competence.2

Use of Folk Remedies

In some traditional cultures there is a preference for using traditional remedies and cures either in place of western medicine or in conjunction with it. Use of herbs or healing methods like acupuncture and moxibustion are common. Pain in any area of the body, including oral pain, is treated using culturally-accepted remedies passed down through generations. For example, in some African American families the use of cotton balls soaked in aspirin solution, alcohol or salt water is a well-known home remedy for pain and swelling.3

Additional Culturally-Related Oral Health Facts

The Crucial Link Between Primary Care Providers and Oral Health Care

Since dental decay can start as soon as teeth erupt, to be effective, preventive oral health strategies need to target children early when transmission of oral bacteria from mother to infant commences and eating habits are established. Since infants and children are seen by their primary care providers (medical) frequently during the first two years of life, there is an opportunity for these practitioners to promote oral health and refer children for dental care. However, primary care providers receive limited training in prevention of oral diseases, while general dentists care for young children, but their small numbers nationwide made such services unavailable to most children. High-risk children usually have dental insurance through medicaid, but the percentage of dentists participating in Medicaid is low. Only one in five children covered by Medicaid actually receives preventive dental care.

Cavity Free at Three: One promising program in Colorado that seeks to tackle the challenge of preventive dental care for high-risk children is Cavity Free at Three. This three-year, statewide effort was developed to help prevent oral disease in young children. The effort aims to engage dentists, physicians, nurses, dental hygienists, public health practitioners and early childhood educators in the prevention and early detection of oral disease in pregnant women, infants and toddlers. Risk assessment, patient and family education, and fluoride varnish application done in primary care offices are key components of this program. Read more at http://www.cavityfreeatthree.org/

Conclusion: Health care is a cultural construct arising from beliefs about the nature of disease and the human body, and it follows that cultural issues are central to the delivery of effective preventive care and illness intervention- both medical and dental. As the link between primary care providers and oral health care for children becomes more and more important in reducing overall health disparities, it is important to consider the cultural aspects of oral health – treatment seeking-behaviors, hygiene practices, and beliefs about the relationship between teeth and the health of the entire body.

Resources

1, 2, 3, 7 Yogita Butani*, Jane A Weintraub and Judith C Barker “Oral health-related cultural beliefs for four racial/ethnic groups: Assessment of the literature” BMC Oral Health 2008 This article is available from: http://www.biomedcentral.com/1472-6831/8/26 © 2008 Butani et al; licensee BioMed Central Ltd.

4 Henderson L, Millett C, Thorogood N: Perceptions of childhood
immunization in a minority community: qualitative study. J Emerg Nurs 2008, 21(6):569-70.

5 Yellowitz JA, Goodman HS, Farooq NS: Knowledge, opinions, and practices related to oral cancer: results of three elderly racial groups. Spec Care Dentist 1997, 17(3) 100-104.

6 Mendoza FS: The health of Latino children in the United States. Future Child 1994, 4(43–72)

7 Mikhail BI: Hispanic mothers’ beliefs and practices regarding selected children’s health problems. West J Nurs Res 1994, 16(6):623-638

8 Peter K Domoto, Mark A Egbert, Elinor A Graham. Dental injuries due to African traditional therapies for diarrhea. West J Med 2000;173:135-137