For Some Immigrant Parents, a New Way to Think About Baby Teeth

Tufts’ pediatric dentists emphasize the importance of early dental care

Cheen Loo says it was her mouthful of fillings—acquired without benefit of local anesthesia, no less—that steered her toward dental school. She wanted to help others, especially children and teens, avoid her fate. In her role as professor and chair of pediatric dentistry at Tufts University School of Dental Medicine, Loo preaches the importance of early preventive care, starting no later than a youngster’s first birthday.

That emphasis on so-called baby teeth runs counter to some cultural assumptions, including those held by many of the Asian-immigrant parents who bring their kids to the dental school, located in Boston’s Chinatown. Approximately 40% of the pediatric clinic’s patients identify as Asian; Loo says the majority of these are of Chinese descent.

“For a typical family in China, you don’t get to see a dentist until you have a problem—until you have a toothache or you fall and then break a tooth,” says Loo. The result is that children often arrive at Tufts at about age 5—most likely, a pediatrician has referred them after a pre-kindergarten checkup—with significant dental disease, which can be so extensive it requires a trip to the operating room. While 11% of pediatric dental patients require treatment under general anesthesia, Asian or Asian American children account for about one-third of those.

Growing up in Malaysia, where her parents had emigrated from mainland China, Loo did not visit the dentist until she was in school, where a little van would ferry children to a public health dentist. “I remember getting quite a few fillings, without a local,” she recalls. She attended high school in Australia, and the dentist there taught her the importance of prevention. “It helped me realize I could be a dentist and help someone else avoid my situation.”

Tufts Now talked to Loo about the providing dental care for children of Asian immigrants.

Tufts Now: What is a distinguishing feature of treating these first-generation patients?

Cheen Loo: Most parents want what’s best for their child, but they do not have the health literacy to be able to provide what is needed in terms of prevention. There will be a lot of cavities, and the parents have not been aware. Or they say, “I thought this was normal. You just let the baby teeth fall out.” They are thinking of it as when they were growing up themselves. Even as adults, they may not be going to the dentist on a regular basis. And a lot of the parents have other things they’re worrying about—they’re working two jobs or have other priorities to balance in taking care of their family.

What other financial or lifestyle factors play a role here?

If families qualify for standard MassHealth (Medicaid), children’s dental treatment is covered. It’s more that parents have to take a few hours or half a day off from work, and sometimes the commute to come in, that is challenging.

Because of the high financial burden of child care in Boston, a lot of parents send their infants back to China to have extended family take care of them until they are school age. We see quite a few patients who come to us after they return to the United States. It is challenging because they haven’t had any preventive treatment, checkups, or cleanings in China.

What are the implications of skipping preventive care?

Decay on the primary teeth progresses a lot faster than decay on adult teeth, so we can’t wait too long to get that treated. A lot of times, by the time the children come in, we need to treat them under general anesthesia at Tufts Medical Center. We’ve had one or two occasions where children were on the wait list for our services at the hospital but had to come in for emergency treatment because the decay got so invasive that it caused a large abscess and infection that could potentially be life-threatening. In one case, more recently, we had to take out most of the child’s teeth. Cases like that happen because parents are not aware that they need to bring their child in at the latest at their first birthday for their first dental appointment.

What are some of the ways your department has been doing outreach to immigrant parents during the pandemic?

It’s a little bit harder now because of COVID to do outreach events. We work with the pediatrics residents at Tufts Medical Center and pediatric nurse practitioner students at Northeastern University to provide interprofessional education about preventive treatment, tooth decay, dental trauma, and dental emergencies. We also reach out to parents coming in for pediatrician appointments. 

When school-age children come for an appointment, we’ll ask the parents if they have other children at home and recommend they set up an appointment. Sometimes if the parents have younger children, they will l say, “They’re not going to sit still in the chair. They’re not going to behave.” We’ll explain to them that it’s very common for a 2-year-old not to be able to sit, but they will be sitting with a parent, and we are just checking everything and going over what needs to be done at home. And the instructions are more for the parent, what they have to do to take care of the child’s teeth.

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