Bureau of Health Professions
Division of Scholarships and
Loan Repayment
Dental Initiative
Topic of Interest #4
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:
- natural standard products - formulated from naturally derived
components
- herbal products - herbal sources as the main ingredient
- homeopathic products - based on the medical system of homeopathy;
and
- 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)
