Dental care issues for African immigrant families of preschoolers.(Report)

Introduction

According to the Surgeon General's report published by the U.S. Department of Health and Human Services (2000), dental caries is one of the most common chronic childhood diseases--5 times more common than asthma. The report indicates that the impact of oral disease on children is substantial and that more than 51 million school hours are lost each year to dental-related illness. The report shows further that "poor children suffer nearly 12 times more restricted-activity days than children from higher-income families" (p. 2). Furthermore, the report stresses that "pain and suffering due to untreated diseases can lead to problems in eating, speaking, and attending to learning" (p. 2).

Given the enormity of the adverse impact of dental-related illness on the health and schooling of children, it comes as no surprise that the American Academy of Pediatrics (2003), in its policy statement on improving the health of all children, calls for children to "begin to receive oral health risk assessments by 6 months of age by a qualified pediatrician or a qualified pediatric health care professional" (p. 1114). The policy also calls for close attention to important factors that impact families' oral health such as dietary practices, fluoride exposure, and utilization of dental services, among others.

Despite the considerable impact of dental-related illness on preschoolers' overall health and well-being, little research exists on the dental health of preschoolers in the oral health literature. Among the few publications that exist is the work of Du, Luo, Zeng, Alkhatib, and Bedi (2007). They conducted a cross-sectional survey on a representative sample of Chinese preschool children ages 3 to 5 years to determine the prevalence and severity of caries in primary dentition. The authors discovered that more than half (55%) of the preschoolers had caries, with 14% having rampant caries. On the frequency of tooth brushing, the authors learned that preschoolers from urban areas brushed their teeth more regularly and had a lower level of caries experience than those from rural areas. Such factors as place of abode, age, and mother's level of education, among others, were the most significant predictors of caries among the preschoolers. Also, the socioeconomic status of the preschoolers' families and dietary factors both influenced the occurrence and severity of caries.

With respect to parental perceptions of preschool children's oral health and its impact on the quality of life of children, Pahel, Rozier, and Slade (2007) found that the oral health-related quality of life of preschool-age children and their caregivers could be negatively affected by the preschoolers' dental disease and treatment experiences. According to the authors, children's quality of life is affected by parental perception of the children's general health and oral health. In particular, they discovered that the poorest quality of life was significantly associated with either fair or poor parental ratings of their child's general and oral health and with the presence of dental disease in the child.

Concerning the patronage of dental care by immigrants in different parts of the world, Lai and Hui (2007) as well as Edwards and Watt (1997) have shown, through their research, that there is low patronage by immigrants of dental care. For example, in their study of Gypsy travelers in East Hertfordshire, England, Edwards and Watt (1997) discovered that although their surveyed participants had no cultural barriers to dental care, they had a high level of unmet need, low dental registration, and very little use of preventive services due, in part, to the Gypsy travelers living in unauthorized and transit sites.

Lai and Hui's (2007) work on Chinese immigrants in Canada also showed low patronage of dental care services by the immigrants. Specifically, they saw that about 52% of the newly arrived immigrants did not use any dental care services. They discovered that longer periods of residence and strong social support, among other factors, increased the surveyed populations' likelihood of using dental services. Lai and Hui noted that in order to strengthen oral health promotion, it is important to consider the cultural characteristics and background of the immigrants.