Verbal communication nuances can be especially challenging when working with diverse cultures. A report from the US
Census Bureau revealed that 21% of the US population age five
and over speak a language other than English in the home.
Those who speak the same language often have difficulty communicating; one can imagine how difficult it must be to communicate with those whose first language is not English. Four of
the 15 National CLAS Standards address communication and
language assistance to assure equity in communication needs of
11 Effective use of interpreters is essential in health
messaging; trained interpreters are always preferred over ad
hoc, untrained interpreters such as children and other family
members. Interpreters should be able to interpret smoothly,
be fluent in both English as well as the patient’s language, understand confidentiality issues, possess knowledge of medical/
dental terminology in both languages, and understand both the
mainstream American as well as the patient’s culture.
1, 17, 19
Different word meanings, relaying information about a
health problem, and comfort with discussions between the
health-care provider and patient can also vary greatly among
cultures. Some may not want to know a negative diagnosis or
prognosis and may make decisions concerning treatment only
after consulting with family members or cultural leaders (
6 Health-care providers must make certain to avoid
jargon and technical terms, selecting words that will be understandable for the patient for complete comprehension.
provider should also seek to guard against stereotyping and the
patient perception of being “talked down to”.
Nonverbal and verbal communication skills are equally
important in health-care settings. Facial expressions, gestures,
physical touch, proximity, eye contact, personal appearance,
emotional expressiveness, and many other non-verbal cues can
be relayed and perceived in a variety of ways. Smiling can show
pleasure but also be a sign of embarrassment or emotional pain.
A “thumbs up” gesture in the US denotes something positive,
but in other countries and cultures it can be the equivalent of
giving someone “the finger.” The same is true with the two-finger “peace” or “victory” gesture.
Physical touch is accepted and encouraged in many Hispanic cultures, but considered offensive in some Asian and
Middle Eastern cultures, especially touching a person’s head,
which is certainly problematic for the dental provider. Some
cultures enjoy close proximity during communication, where
others may not. Dentistry tends to be invasive of the patient’s
personal space, requiring providers to be sensitive to comfort
levels. Eye contact or lack thereof can be perceived differently in varying cultures; lack of eye contact can be perceived
as portraying dishonesty or that the person is hiding something
by Westerners, whereas direct eye contact can be perceived as
disrespectful among Asian, Latin American, and American
Indian cultures. When experiencing pain, patient reactions
can range from highly expressive to stoic which can be learned
6, 15, 20
Oral Practices of Diverse Cultures
Diverse populations engage in a variety of health practices that
may be used alone or in conjunction with Western medicine. A
comprehensive description of alternative therapies used by the
designated US racial and ethnic groups is beyond the scope of
this course; however, the use of home remedies, folk healers, and
other alternative therapies is demonstrated among the diverse
populations and spans a vast array of practices and treatments
both for general and oral health. Pertaining to oral practices,
the literature is lacking in respect to specific oral practices for
each US racial/ethnic designation,
21 however, some practices
have a dominant presence in the literature, possibly due to their
unusual nature, when compared to mainstream practices.
Knowledge of alternative oral cleaning devices used by various
cultures is valuable for dental providers when dealing with clients of diverse cultures. The miswak, or chewstick, is a common
alternative oral cleaning device used by cultures in many parts of
the world as well as diverse groups in the United States.
12, 15, 22, 23 A
pencil-sized stick from the Salvadora persica tree or “toothbrush
tree,” the miswak is used to remove plaque and has actually been
shown to have antibacterial properties.
23 Multiple social media
sites discuss the use of the miswak, including a video of an interview about its use by a Chicago dentist.
24 As with any oral hygiene
device, proper technique is required to guard against tooth abrasion, gingival recession and other trauma.
Alternative therapies for gum health are many and can be culturally derived. Polish Americans may use yarrow tea for “
pyorrhea” and Native Americans may grind lichens to rub on inflamed
gums. Other cultures have used bayberry tea for gingivitis. Additional home remedies from a wide variety of cultures often contain
herbs and other substances such as bloodroot, clove oil, garlic, soy,
lemon balm, Echinacea, fennel, licorice root, grapeseed extract,
eucalyptus, and ginger. Some Irish may prefer to brush with Ivory
soap or table salt instead of toothpaste and the rationale for such
practices is sometimes elusive.
It has long been recognized that tobacco use has detrimental effects on the oral cavity; however, dental providers may
not be aware of additional harmful oral habits practiced by
diverse cultures. The use of betel nut and betel nut combination
products are common in Asian cultures and like tobacco can be
addictive and damaging to the oral cavity.A nut from the Areca
catechu palm tree, betel nut is often chewed or combined with
other products, wrapped in a leaf from the betel tree, and held
in the buccal vestibule. The primary attraction for using betel
nut is its psychostimulating effects. Consequences for the oral
cavity include tooth attrition and staining, periodontal disease,
submucous fibrosis, and oral cancer.
15, 25, 26 Paan is a betel nut
quid, it may contain other ingredients such as perfumes and
spices, and is sometimes used as a palate cleanser and breath
26, 27 Additional uses for the betel nut are as an appetite stimulant, a flatus reliever, a dentifrice, a diuretic, and
25 Gutka is a combination of betel nut, tobacco,
catechu, lime ,and flavorings, and is sold in small packets for