Cheen Loo says it was her mouthful of fillings — acquired without the aid of local anesthesia, no less — that landed her in dental school. She wanted to help others, especially children and teenagers, to avoid her fate. In her role as professor and chair of pediatric dentistry at Tufts University School of Dentistry, Loo preaches the importance of preventive care early, beginning no later than a young person’s first birthday.
This emphasis on so-called baby teeth goes against some cultural assumptions, including those of many Asian immigrant parents who bring their children to dental school, located in Boston’s Chinatown. Approximately 40% of pediatric clinic patients identify as Asian; Loo says the majority of them are of Chinese descent.
“For a typical family in China, you can’t see a dentist until you have a problem, until you have a toothache or you fall and break a tooth,” says Loo. . The result is that children often arrive at Tufts around the age of 5 – most likely a pediatrician referred them after a pre-kindergarten exam – with significant dental disease, which may be so extensive that it requires travel. in the operating room. While 11% of pediatric dental patients require treatment under general anesthesia, Asian or Asian American children make up about a third of them.
Growing up in Malaysia, where her parents had emigrated from mainland China, Loo didn’t visit the dentist until she was in school, where a small van transported children to a public health dentist. “I remember doing quite a few fillings, without a local,” she recalls. She went to high school in Australia and the dentist taught her the importance of prevention. “It helped me realize that I could be a dentist and help someone else avoid my situation.”
clumps now spoke to Loo about providing dental care to the children of Asian immigrants.
clumps now: What is special about the care of these first-generation patients?
Cheen Loo: Most parents want the best for their child, but lack the health literacy to be able to provide what is needed when it comes to prevention. There will be a lot of cavities, and the parents don’t know about it. Or they say, “I thought it was normal. You just dropped the baby teeth. They think of it as when they were growing up themselves. Even as adults, they may not visit the dentist regularly. And many parents have other worries: they have two jobs or have other priorities to take care of their family.
What other financial or lifestyle factors play a role here?
If families are eligible for standard MassHealth (Medicaid), children’s dental care is covered. It’s more that the parents have to take a few hours or half a day off, and sometimes the journey to come, which is difficult.
Due to the high financial burden of childcare in Boston, many parents send their children back to China to be cared for by their extended family until they are of school age. We see quite a few patients who come to see us after returning to the United States. It’s difficult because they haven’t had any preventative treatment, checkups or cleanings in China.
What are the implications of skipping preventive care?
Decay on primary teeth progresses much faster than decay on adult teeth, so we can’t wait too long for this to be treated. Often, by the time children arrive, we have to treat them under general anesthesia at Tufts Medical Center. We have had one or two occasions when children were on the waiting list for our services at the hospital, but had to come for emergency treatment because the cavity became so pervasive that it caused a big abscess and an infection that could potentially be fatal. . In a more recent case, we had to remove most of the child’s teeth. Such cases occur because parents do not know that they have to bring their child no later than his first birthday for his first dental appointment.
What are some of the ways your department has reached out to immigrant parents during the pandemic?
It’s a little harder now because of COVID to do outreach events. We work with pediatric residents at Tufts Medical Center and pediatric nursing students at Northeastern University to provide interprofessional education in preventive treatment, tooth decay, dental trauma and dental emergencies. We also reach out to parents who come for pediatrician appointments.
When school-aged children come for an appointment, we will ask parents if they have other children at home and recommend that they make an appointment. Sometimes, if parents have younger children, they will say, “They’re not going to sit in the chair. They won’t behave. We will explain to them that it is very common for a 2 year old not to be able to sit up, but they will be seated with a parent, and we will check everything and go over what needs to be done at home. And the instructions are more for the parent, what he should do to take care of the child’s teeth.