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increased marketing potential. The betel nut’s carcinogens are
enhanced in gutka as a result of the addition of tobacco and
25, 26, 27 All products containing betel nut are harmful to the
oral cavity and consequences of their use should be recognized
and discouraged by dental professionals.
Oral Health Disparities
Racial/ethnic disparities in health and health care have been well
documented, revealing that emerging majority groups suffer disproportionate rates of many conditions and diseases, including
those affecting the oral cavity.
17, 28 The Surgeon General’s report
on oral health, released in 2000, discussed the “silent epidemic”
of oral diseases affecting our most vulnerable citizens—the poor,
the elderly, and many members of certain racial/ethnic groups.
The reasons for these disparities are multifactorial, and include
the variations in patients’ health values, beliefs, preferences, and
behaviors which are often culturally determined.
Developing cultural competence among health-care providers is a strategy to help address disparities and reduce organizational, structural, and clinical barriers to care. Increasing
the racial/ethnic diversity among the workforce can help to address organizational barriers, as diversity in the workforce has
been well correlated with the delivery of quality care to diverse
28 Appropriate interpreter services and culturally
and linguistically suitable education materials assist in addressing structural barriers. The oral health-care providers’ understanding of socioculturally based health beliefs, practices, and
values that may be different from the mainstream care system
can ultimately reduce clinical barriers as providers work with
patients to provide care within their cultural parameters.
Problems with multifactorial causes often require multifactorial approaches for resolution. Increasing cultural competence
in all dental-care delivery systems is one approach that can have
a large impact on reducing oral health disparities.
Well-trained oral health providers should not only be experts in
clinical skills, but also be able to identify, provoke, accept, and
respect patient’s cultural beliefs and practices. More and more,
professional dental care is being provided in multicultural environments. By understanding, valuing, and incorporating the
cultural differences of diverse populations into the processes of
care, dental providers can support a health-care system that responds appropriately to, and serves the unique needs of diverse
groups—even if their cultural beliefs, values, and practices may
be different from those of the mainstream dominant culture.
Maintaining an open mind about cultural variances can go far
in maintaining patient rapport and trust in the dental services
environment to provide the best care possible for all patients.
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Sherri M. Lukes, RDH, MS, FAADH - A dental hygienist for 35 years Sherri Lukes
holds advanced degrees in education. She is associate professor emerita, Southern Illinois
University, where she taught oral pathology, public health and multicultural dental
hygiene. Research was concentrated in migrant oral health, pathology and public health
issues, resulting in multiple peer reviewed publications. She serves on the Penn Well
continuing education advisory committee and the peer review board for Dimensions of
Dental Hygiene. She is an approved speaker of and holds a pathology fellowship in the
American Academy of Dental Hygiene and is immediate past president of the Illinois
Dental Hygienists’ Association. Honors include Community Service, Research, and
Teacher of the Year awards while at SIU, IFLOSS Coalition/Illinois Department of Public
Health Oral Health Champion Award and the Sunstar/RDH Award of Distinction.
Sherri M. Lukes, RDH, MS, FAADH is a member of the Penn Well continuing dental