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Dental Initiative Topic of Interest #4

Bureau of Health Professions
Division of Scholarships and Loan Repayment

The NCCC conducted an Internet-based search of juried literature on indigenous, natural and alternative practices in oral health care. Very little information was found that addressed the beliefs and practices of diverse racial, ethnic and cultural groups. The research agenda will need to be expanded in order to respond to the call to eliminate oral health disparities.

Selected Findings from Literature Review

Oral health disparities continue to be prevalent among racially and ethnically diverse groups.
Members of racial and ethnic groups experience a disproportionate level of oral health problems (Surgeon General's report on Oral Health, 2000). Caries and periodontal disease and tooth loss, particularly associated with chronic illness such as diabetes, remain prevalent among African Americans, Native American, Alaskan Natives and Mexican American groups. Oral cancer is nearly twice as high among some racially diverse groups, especially African American men, as it is in Whites. Only 15% of Whites receive annual examination for oral cancer, but far fewer African Americans and Hispanics (<6%) receive this important screening examination (CDC Wonder, 2001). The literature also reveals disproportionate disparities among children who are homeless, from low-income families, and those with special health care needs or disabilities. Refer to Topic of Interest 3 - Disparities in Oral Health.

Oral health practices among diverse cultural groups are not well documented.
The NCCC conducted an extensive internet-based search on indigenous, natural and alternative oral health practices to prepare this topic. The results revealed a scarcity of studies that address the indigenous oral health practices of culturally diverse groups. Few studies were found that were conducted within the past ten years; more were noted in the international literature. When compared to U.S. studies, the international literature not only focused on oral health disparities, it also explored the beliefs and traditions of indigenous populations, including the use of faith healers.

There were few studies that focused on diverse perceptions and beliefs in oral health.
Individuals from different cultures have different understandings of dental health and symptoms (Strauss, 1996; Gilbert et al, 2000; Davidson et al, 1997). The literature documents a number of salient issues that are highlighted as follow.

  • Davidson et al (1997) found differences among various cultural groups in numerous areas on oral health beliefs influencing the likelihood of visiting the dentist: 1) seriousness of oral disease; 2) fear of pain at dental visit; 3) benefit of prevention; 4) benefit of plaque control; and 5) efficacy of the dentist.
  • Comparing people who visit the dentist regularly to those who visit the dentist when they have a problem with their teeth, Gilbert et al (2000) found that people believe different things about what causes toothache pain, bleeding gums, and tooth loss. Answers varied from untreated dental cavities, untreated gum disease, heredity, poor diet, poor dental hygiene, dental injury, avoidance of regular dental care, to poor general health.

  • In Strauss (1996), twice as many White elders (42%) as African-American elders (21%) reported their teeth have a positive impact on their confidence. African-Americans in this study reported more negative impacts related to their teeth than Whites. African-Americans and Whites differed significantly in how they rated the positive impact of teeth in a number of areas, including but not limited to: 1) chewing and biting; 2) appearance to others; 3) eating and enjoyment of same; 4) confidence; 5) smiling and laughing; 6) feeling comfortable; and 7) enjoyment of life. Strauss concluded that "knowledge of dental health beliefs and cultural values in older adults provides a dentist with insight into the motivational system of this population" (p. 88).

There is a paucity of studies on the efficacy of alternative oral health practices and dental products.
The use of alternative dental practices and products have increased considerably over the past few years, with more individuals using natural dental products (Jacobsen & Cohan, 1998).

According to these authors, alternative dental products can be classified into four categories:
  1. natural standard products - formulated from naturally derived components
  2. herbal products - herbal sources as the main ingredient
  3. homeopathic products - based on the medical system of homeopathy; and
  4. synthetic alternative products - made of synthesized compounds.
Despite the use of alternative dental products, there were very few research studies that addressed the efficacy of these products for oral health.

Few studies document common oral health practices among diverse cultural groups. Literature cites the use of natural remedies for pain such as cayenne, Achonite, Humphreys, and cloves or oil of cloves. Cayenne was also documented to be used as a remedy for sore throat and colds. Additionally there are anecdotal reports of using plants with antiseptic properties including anise and neem for cleaning the teeth.

Consumer and community partnerships are necessary to expand the research agenda in oral health.
There is a critical need for research to corroborate the efficacy of culturally and linguistically competent approaches in the delivery of oral health care services. The research agenda will require many partners such as: government, universities, consumers, advocacy, community and special interest groups, dental practitioners, health care organizations and professional associations. In order to effectively address the elimination of oral health disparities within racial and ethnic groups, the research agenda should be expanded to include the following.

Strategies

  • Advocate for the use of culturally competent and participatory action methodologies that include the active involvement of consumers in all aspects of the research process (e.g. design, sampling, instrumentation, data collection and analysis, and dissemination).
  • Assure that current and future researchers have the knowledge, skills and expertise to conduct research that uses culturally competent and participatory action methodologies.
  • Adapt or modify approaches to oral health screening and assessment that capture information on cultural perceptions, beliefs and practices of the populations served.
  • Increase the application of research into targeted oral health prevention methods.
  • Develop and implement a public education campaign to emphasize the correlation between good oral health practices and overall health and well being.

Research Areas

  • Assess the efficacy of indigenous oral health practices and alternative dental products used by culturally diverse populations.
  • Assess the natural remedies and practices employed by homeopaths, herbalists, spiritualists and natural healers for the management and maintenance of oral health.
  • Assess the efficacy of delivering oral health care that has been adapted to reflect the cultural context of communities and individuals served.

References

Davidson, P.L. & Andersen, R.M. (1997). Determinants of Dental Care Utilization for Diverse Ethnic and Age Groups. Adv Dent Res, 11 (2).

Davidson, P.L., Rams, T.E., & Anderson, R.M. (1997). Socio-Behavioral Determinants of Oral Hygiene Practices among USA Ethnic and Age Groups. Adv Dent Res, 11 (2).

Gregg, H. G., Stoller, E.P., Duncan, R.P., Earls, J.L., & Campbell, A.M. (2000). Dental self-care among dentate adults: contrasting problem-oriented dental attenders and regular dental attenders. Special Care in Dentistry, 20 (4).

Jacobson, P.L. & Cohan, R.P. (1998). Alternative Dental Products. Journal of the Canadian Dental Association, 26 (3).

Strauss, R.P. (1996). Culture, dental professionals and oral health values in multicultural societies: measuring cultural factors in geriatric oral health research and education. Gerodontology, 13 (2).

US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000.

Additional Resource

For more information on community-participation in oral health education, see: Watson, M.R., Horowitz, A.M., Garcia, I. & Canto, M.T. (2001). Journal of Public Health Dentistry, 61 (1)

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