The Provision of Dental Care in the Chinese Culture
CMST 440 International Communication
Eastern Washington University
Cultural beliefs and its effect in dental care
Culture identifies specific groups of people who have similar beliefs, values and common behavior patterns. People are not born with the inherited traits of a particular culture. Instead they learn about their culture through the interactions with others who are a part of the culture. Children learn their culture from parents, other family members, friends, and even from strangers in their surroundings. Each culture practices their own set of rules which provides the expectations people have of one another and of themselves. A culture gives people guidelines about how to act, what is important, and what should or should not be done. In health care settings, these guidelines and beliefs can promote or act as barriers to accessing health care services. Research on poor health outcomes generally examines limitations such as high cost, lack of insurance and availability of services, but often aspects of cultural ideas and practices are also suggested as additional limitations (International Dental Journal, 1993).
In Chinese culture, Traditional Chinese Medicine (TCM) is still widely practiced. According to the report from U.S. Department of Health and Human Services (2009), the TCM view of what causes illness and how to treat them is different from the Western practice of medicine. Chinese believe in the universe-human body relationship and practices holistic or naturalistic beliefs about health (Lustig & Koester, 2010, p. 286). Everything in the universe is made up of balance between opposing yet complementary forces such as, ying and yang, hot or cold, and positive or negative. Imbalances in these forces results in illness and increasing risk of disease. In order to restore the balance and prevent illness, TCM procedures such as herbal remedies and acupunctures may be used (U.S. Department of Health and Human Services, 2009).
The oral health perspective is based on the ideas of ying and yang theory. The Chinese believe that condition of the kidneys affect the health of their teeth. The kidneys determine the condition of the bone and the teeth are considered to be part of the bone. Therefore, teeth problems such as loose teeth are considered to be an expression of weakened kidneys and the imbalance between two opposite forces. Similarly, the gums are related to the stomach and gum inflammation is considered to be the result from issues in the stomach (Butani, Weintraub, & Barker, 2008, p. 26).
Chinese people believe that they are susceptible to dental diseases such as tooth decay or periodontal disease and it is normal to lose all their teeth as they age. Most of the older Chinese population believes that preventative dental treatment is not effective. Only four out of ten people reported that they will see a dentist only when they are in pain (Zhu, L., Peterson, P., & Wang, H., 2005). Instead, many of them resort to traditional therapies for dental problems. Kwan et al. (1999) found that the older Chinese population prefers traditional remedies over seeking a dental professional. Among the adult and elderly groups, gum bleeding was considered normal process of aging or due to an ‘imbalance of bodily fluids’. One man commented in the study that it is best to lose all teeth as ‘having teeth in old age would eat away children’s fortune, and would bring bad luck to the family’. Perhaps the man’s comment reflects the characteristics of the collectivistic Chinese society as they are more concerned about the interests of the group, in this case, his family. He would be worried about spending money on himself at the dentist to get his teeth taking care of when he can use it to support his family.
It is believed by elderly Chinese that teeth cleanings might be able to delay the tooth loss but they will eventually and inevitably lose their teeth. Therefore, regular checkups were unnecessary and waste of money. A study showed that participants from more rural areas having never seen a dentist during their lifetime (Zhu, L., Peterson, P., & Wang, H. 2005). Some women also believe that frequent child birth can cause tooth loss because the baby takes calcium away from mother. In contrast, teenagers are more acceptable with dental disease prevention, frequent tooth brushing and cutting back on a cariogenic diet which will help them to keep their teeth longer. When they have dental problems, they would go see a dentist to fix the problem rather than using traditional remedies (Kwan, S., & Holmes, M., 1999).
Some people reported that the cost of dental treatment is one of the reasons for avoiding visits to dental office. It is considered embarrassing if they can’t afford the treatment and they might ‘lose face’. Dental visits are perceived as a painful experience, both physically and financially, and it is better for them to avoid it all together. Even if they were not satisfied with the result of dental treatment such as getting fillings or dentures, they would rather not deal with the dentist again because it is embarrassing to go back and have it fixed. They also mentioned that they do not want to bother the dentist by going back to the office to address the issues of dissatisfaction because they feel that they are wasting the dentist’s time and would not want to be perceived as a problem patient (Kwan, S., & Holmes, M.,1999). In Chinese culture, the concept of face is especially important. Face is the public expression of the inner self that a person wants others to have of him or her (Lustig, M. W., & Koester, J. 2010. P.257). To maintain “face”, they act polite to others while expect others to reciprocate the same. Having confrontations with others, or putting someone on the spot or failing to give proper respect to a person can result in “loss of face”.
Low number of dental service providers and high cost of services also act as barriers in receiving dental treatment. Zhu et al. (2005) reported that the number of dental personnel is limited relative to the population size, so that the dentist to population ratio is 1:100,000. Dental treatment is offered on a fee-for-service basis and patients pay for the cost themselves. Due to the lack of competing dentists, the fees for preventive services are ten times higher than restorative services and twice more than tooth extraction.
Understanding of the culture and my reflection
Within my work place setting, I encounter patients with many different cultural backgrounds and work with other providers who have different cultures than my own. I work with a Chinese dentist who speaks both English and Chinese fluently. A large number of Chinese patients who cannot speak English very well come to our office because they feel more comfortable communicating in Chinese with the doctor about their oral health. Among the Chinese patients, many have not seen a dentist for several years because they were not able to communicate with English only speaking providers and felt reluctant to deal with them. Often times, these patients suffer from severe periodontal disease and severe dental decay. As a dental hygienist, my responsibility is to treat the dental diseases and provide oral health education to patients. As I was giving instructions to the Chinese patients, I had noticed that the patients would avoid eye contact and usually keep straight facial expressions without saying a word. This made me think that they were not pleased with my service. After studying the Chinese culture and through self-reflection, I have discovered that my conversation method might have been too direct for the patients whom come from a culture which would make them feel uncomfortable or “lose face”. Also, health care workers are seen as authority figures in Chinese culture so the patients would be reluctant to initiate interaction and ask questions. Therefore, the nonverbal communication should be closely observed so that a culturally appropriate treatment can be provided.
Another lesson I learned is that in Chinese culture, dental disease prevention is not widely practiced because they believe that they will lose their teeth in the future no matter what they do. Knowing this cultural difference helped me understand why some Chinese patients were against the treatment of periodontal disease. For some people, it is ineffective, costly and an unnecessary procedure. Since some patients have strong traditional health beliefs, I need to be patient and take a softer approach when giving oral health instructions. Also, it is important to be respectful of their naturalistic health care beliefs and to build a trusting relationship with the patients as their oral health care provider.
Above all, the most important lesson I learned from taking this course is the need to respect other cultures that are different from my own. As a health care provider, it is important for me to develop intercultural competence which will help me strengthen the ability to communicate competently and work with patients from other cultures.
International Dental Journal. (1993). Age and Culture: influence on oral health behavior. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8478130
U.S. Department of Health and Human Services. (2009). Traditional Chinese Medicine: An Introduction. Retrieved from http://nccam.nih.gov/sites/nccam.nih.gov/ files/D428.pdf
Lustig, M. W., & Koester, J. (2010). Intercultural competence: Interpersonal communication across cultures. Boston, MA: Allyn & Bacon.
Butani, Y., Weintraub, J. A., & Barker, J. C. (2008). Oral health-related cultural beliefs for four racial/ethnic groups: Assessment of the literature. BMC Oral Health, 8, 26.
Zhu, L., Peterson, P., & Wang, H. (2005). Oral health knowledge, attitudes and behavior of adult in China. International Dental Journal 55, 231-241. Retrieved from http://www.who.int/oral_health/publications/orh_IDJ_KAP_adults_china.pdf
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