Traditions, Trends and the Tooth Fairy

Traditions, Trends and the
Tooth Fairy
Julie Maniate, DMD, FRCDC
Children’s Dental World
November 7, 2015
What is Culture?
 Culture is the patterns of ideas, customs and
behaviors shared by a particular people or
society.
 These patterns identify members as part of a
group and distinguish members from other
groups.
What is Culture?
 Culture may include all or a subset of the
following characteristics:
 ethnicity, language, religion and spiritual beliefs
 gender socio-economic class
 age
 sexual orientation
 geographic origin
 group history
 education
 upbringing
What is Culture?
 Culture is:
 dynamic and evolving
 learned and passed on through
generations
 shared among those who agree on the
way they name and understand reality
 often identified ‘symbolically’, through
language, dress, music and behaviours
 integrated into all aspects of an
individual’s life.
How Culture Affects Oral Health Beliefs
and Behaviors
CDA: “Poor oral health can affect a person's quality of life.
Oral pain, missing teeth or oral infections can influence
the way a person speaks, eats and socializes. These oral
health problems can reduce a person's quality of life by
affecting their physical, mental and social well-being.”
How Culture Affects Oral Health Beliefs
and Behaviors
Key: Developing good habits at an early age will
help children get a good start on a lifetime of
healthy teeth and gums.
How Culture Affects Oral Health Beliefs
and Behaviors
 AAPD: children with immigrant background
have three times higher caries rates than nonimmigrants
 Inverse relationship between socioeconomic
status and caries prevalence in studies of
children less that 6 years of age
 Cultural beliefs, values, and practices are often
implicated as causes of oral health disparities
How Culture Affects Oral Health Beliefs
and Behaviors
 Cultural bias may result in very different health-
related preferences and perceptions.
 Being aware of and negotiating such
differences are skills known as 'cultural
competence'.
Dental Health
Literacy
Cultural
Influences
Personal
Experience
Socioeconomic
Status
4 Domains that Shape Cultural Beliefs
and Practices Related to Oral Health
1. Help Seeking & Preventive Care
2. Oral Hygiene Practices
3. Beliefs About Teeth & Oral Cavity
4. Use of Folk Remedies
1. Help-Seeking & Preventive Care
 Cultural groups lack strong preventive
orientation
 Health care
 Oral health
 Emergency Care
 Advance interventions
1. Help-Seeking & Preventive Care
 American Academy of Pediatrics’ (AAP): “medical
home”
 American Academy of Pediatric Dentistry (AAPD):
“dental home”
2. Oral Hygiene Practices
 Understanding of gum
disease
 Understanding of
brushing teeth
 Understanding of
hygiene adjuncts and
services
2: Oral Hygiene Practices
a) Teeth: Brushing and Scrubbing
 Babylon and Egypt, 3500-3000 BC: brush made by fraying
the end of a twig.
 China, 1600BC: “chewing sticks” from aromatic tree twigs to
freshen breath.
 China, 15th century: invented first natural bristle toothbrush;
bristles from pigs' necks attached to a bone or bamboo
handle.
 Europe: used softer horsehairs (preferred) or used feathers.
2: Oral Hygiene Practices
a) Teeth: Brushing and Scrubbing
 England, 1780: William Addis; cattle bone handle and swine
bristles.
 1844: first 3-row natural bristle brush until Du Pont invented
nylon.
 1938 nylon bristles, and by 1950s softer nylon bristles
 1939, first electric toothbrush
 US was the Broxodent in 1960.
2: Oral Hygiene Practices
a) Teeth: Brushing and Scrubbing
 Africa: south Sahara, twig brushes; chew/scrub through day
 Cleans, medicinal, whitens, freshens breath
2: Oral Hygiene Practices
a) Teeth: Brushing and Scrubbing
 Arabian peninsula, India, Central and Southeast Asia:
miswak stick made from Salvador perisca tree
2. Oral Hygiene Practices
b) Toothpaste and Toothpowders
 Egypt, 5000BC : paste used before toothbrushes invented;
Ancient Greeks and Roman
 China & India, 500 BC: used toothpaste; keeping teeth and
gums clean, whitening teeth and freshening breath
2. Oral Hygiene Practices
b) Toothpaste and Toothpowders
 Ingredients: powder of ox hooves’, ashes and
burnt eggshells that was combined with
pumice
 Greeks & Romans—crushed bones and
oyster shells
 Romans—flavoring to help with bad
breath, powdered charcoal and bark
 China: ginseng, herbal mints and salt
 1800s—chalk, soap, betel nut, ground
charcoal
2. Oral Hygiene Practices
b) Toothpaste and Toothpowders
 Before 1850 tooth powder, 1850s toothpaste in jar, 1890
toothpaste in tube, 1914 fluoride introduced
 Toothpowders: chalk, powdered sugar, baking soda, borax,
charcoal, honey and peppermint oil.
2. Oral Hygiene Practices
c) Brushing Baby Teeth
 No need to brush,
they will eventually
fall out.
3. Beliefs About Teeth & the Oral Cavity
 Esthetic teeth vs.
“healthy” teeth and
gums
3. Beliefs About Teeth & the Oral Cavity
 China: smile practice, biting chopstick
3. Beliefs About Teeth & the Oral Cavity
3. Beliefs About Teeth & the Oral Cavity
 Japan: Tseuko-Yaeba
 Max canines capped
3. Beliefs About Teeth & the Oral Cavity
3. Beliefs About Teeth & the Oral Cavity
 Southeast Asia: fake braces
3. Beliefs About Teeth & the Oral Cavity:
Tooth Traditions
CANADA, U.S.A. AND BEYOND: (other English-speaking
countries)
•
Tooth fairy--help ease the trauma of losing baby teeth
3. Beliefs About Teeth & the Oral Cavity:
Tooth Traditions
SPAIN: (other Hispanic cultures, i.e. Mexico,
Peru, Chile, Argentina, and Colombia)
• Ratocinto Perez—(aka Raton Perez,
Perez Mouse, El Raton de Los Dientes,
• Argentina: stick teeth in a glass of
water before bed.
3. Beliefs About Teeth & the Oral Cavity
INDIA, CHINA, JAPAN, KOREA, AND VIETNAM
• Throw teeth
• Sometimes yell out a wish
3. Beliefs About Teeth & the Oral Cavity
SOUTH AFRICA:
• leave the tooth, get some money;
place into slippers
MONGOLIA:
• put the tooth into some fat and
feed it to a dog
• bury it by a tree
3. Beliefs About Teeth & the Oral Cavity
IRAQ, JORDAN, AND EGYPT:
•
Throw teeth to sky: It’s possible that the tossed teeth tradition
dates all the way back to the 13th century.
FRANCE:
•
“La Bonne Petite Souris” -- tiny mouse will take teeth left under
pillows, replacing them with either cash or sweets
3. Beliefs About Teeth & the Oral Cavity
 Tooth Fairy Index: 2015
 sixth annual TFI: average American child got $3.19 US/tooth
 down by 24% from the previous year's level
 $3.19/tooth--represents $64/mouth; vs $74 for year 2014
3. Beliefs About Teeth & the Oral Cavity
 Tooth Fairy Index (cont’d)
 32% said $1 left by the Tooth Fairy
 Nearly 20% said the Tooth Fairy left a $5 bill.
 5% said the Tooth Fairy left $20 or more under the pillow.
 Only 1 in 10 parents reported the Tooth Fairy forgot to
leave any money
3. Beliefs About Teeth & the Oral Cavity
 Tooth Fairy Index (cont’d)
 For the second year in a row, dads left nearly 30%
more than moms did: $3.63 vs. $2.87.
4. Use of Folk Remedies
 Use of traditional remedies and
cures vs. western medicine
 Use of herbs, healing methods
 Pain (e.g. oral) treated using
culturally-accepted remedies
4. Use of Folk Remedies
 India: Oil Pulling/Swishing
 Oil "swished” or "held” in the mouth
 Pulls out toxins, thus reducing inflammation
4. Use of Folk Remedies
4. Use of Folk Remedies
 Bali: Tooth Filing
 Hindu ceremony;
smoothing down
incisors and canines.
 Purpose to cut the
vice like gluttony,
arrogance, and bluff
which are owned by
every human being.
Additional Culturally-Related Oral health
Facts
 Primary Teeth: belief that treatment in children unnecessary
 “Teeth are going to fall out anyway”
Additional Culturally-Related Oral health
Facts
 Purpose of brushing understood in
most cultures
 Belief oral health is hereditary
 Making preventive care unimportant
 Belief pain in oral cavity early symptom
of oral cancer
 Study: 70% African-Americans
believe
Additional Culturally-Related Oral health
Facts
 Belief that fever and diarrhea common during
eruption of teeth for child
 Somalia: traditional healers treat infants for
diarrhea using various oral procedures
 Cutting into lower gums and extracting
canines
Additional Culturally-Related Oral health
Facts
 Some cultures believe gum disease is
related to the “hot/cold syndrome”
 China and other Asian countries
 tooth health believed to depend
upon condition of kidneys
 natural to lose one’s teeth as one
ages
Crucial Link Between Primary Care
Providers and Oral Health Care
 Dental decay can start once teeth erupt
 preventive oral health strategies
 Infants and children seen by primary care
providers (PCP) frequently during first two
years
 PCP limited training re. oral diseases
 E.g. “Cavity Free at Three” program in Colorado
 Preventive dental care need for high-risk
children
Summary
 Health care and oral health is a cultural
construct
 Cultural issues central to delivery oral
health care
Summary
 In order to link primary care providers and
children with oral health care needs, need to
consider cultural aspects of oral health
Conclusion
 Demonstrating awareness of a patient’s culture
can promote trust, better health care, lead to
higher rates of acceptance of diagnoses and
improve treatment adherence
References

Vargas CM, Crall JJ, Schneider DA. Sociodemographic distribution of pediatric dental caries: NHANES III, 1988-1994. J Am Dent Assoc 1998;129(9):1229-38.

American Academy of Pediatrics Committee on Pediatric Workforce. Culturally effective pediatric care: Education and training issues. Pediatrics 1999;103(1):167-70.

American Academy of Pediatrics. The medical home. Pediatrics 2002;110(1Pt1):184-6.

University of Minnesota, Center for Advanced Research on Language Acquisition. What is culture?

Nova Scotia Department of Health, Primary Health Care Section, 2005. A cultural competence guide for primary health care professionals in Nova Scotia.

Kodjo, C. Cultural competence in clinician communication. Paediatri Rev 2009;30(2):57-64. University of Washington Medical Centre. Communication Guide: All
Cultures. Culture Clue for Clinicians, 2011.

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

Henderson L, Millett C, Thorogood N: Perceptions of childhoodimmunization in a minority community: qualitative study. J Emerg Nurs 2008, 21(6):569-70.

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) 100104.

Mendoza FS: The health of Latino children in the United States. Future Child 1994, 4(43–72)

Mikhail BI: Hispanic mothers’ beliefs and practices regarding selected children’s health problems. West J Nurs Res 1994, 16(6):623-6388

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