[by Alexis Alexander; courtesy photos]
After a long day at school Mateo, an elementary student, arrives home, excited to tell his Abuelita about his day.
“¡Abuelita, I went to el dentista today,” Mateo said.
“How great! ¿Como te fue Mateo?” his grandmother asked.
Mateo gushes about his first screening visit at school, explaining how a ‘señorita’ took photos of his teeth with a camera.
Mateo’s story is captured in “Smiles Por Vida: A Spanglish Children’s Dental Book” written by Amber Lovatos and Maxine Cordova. While Mateo is a fictional character, his story is rooted in reality. Growing up in a low-income Latinx household, Lovatos, a first-generation Mexican-American, had no access to dental care. Lovatos wrote Mateo’s story to show his first-ever dentist visit being at a free school dental screening because, for many Latinx children, this is the reality.
Today, Lovatos, a Texas-based author and public health dental hygienist, serves low-income and uninsured Latinx and Hispanic children, just like Mateo and her younger self.
Like many others in her community, Lovatos grew up using home remedies to treat cavities. She would mix cloves and water into a paste to medicate her damaged enamel. When Lovatos’ mother noticed her daughter’s teeth growing crooked, she decided to seek help from her ‘communidad.’ This led to Lovatos’ being taken to Mexico, to have her maxillary canine teeth removed for $20.
According to the National Survey of Children’s Health, Hispanic children are likelier to have never seen a dentist than any other ethnic group. In children aged 2 to 11 years, Hispanic children were found to have tooth decay and untreated dental issues at significantly higher rates than their white counterparts.
Latinx and Hispanic children lack access to care for a myriad of reasons, but all reasons relate to one another. These barriers include socioeconomic status, health literacy, educational attainment, insurance, language barriers, and cultural beliefs. From lack of time and income to cultural beliefs, one factor these issues all have in common is the lack of dental oral health education. How can one protect and prevent dental disease, when they have no idea where to even start?
“Misinformation is so perpetuated in our community and there’s nobody to educate us,” Lovatos said. “It’s a lack of having providers that look like us, who speak like us, who know our community background and would know what following questions to ask, who would know what things might impact our decision making and what misconceptions we have in our community. Not having a lot of Latin people in this profession to educate our people makes it hard for us.”
The complexities in the reasons that Hispanic and Latino children face disparities are clear and studies suggest the most effective way of reducing the racial/ethnic gaps in children’s dental health is to provide extensive and all-inclusive population-based interventions.
Lovatos has seen a vast amount of oral disease in children due to a lack of prevention and a lack of understanding and or education.
A CDC study found 33 percent of Mexican American children ages 2 to 5 years old, had cavities in their primary teeth compared with 18 percent of non-Hispanic White children.
“I’ve had patients as adults who grew up low-income, U.S. citizens would have qualified for things like Medicaid/medical, yet their parents never applied because of fear,” Lovatos said. “They grew up not having access to care, likely not having education, having a lot of dental problems that then go on into adulthood. In Texas, we don’t have programs for adults. At 18 do they stop being low-income? Do they stop having needs?”
Lack of dental/oral health education continues to be a pattern amongst the parents of Hispanic and Latinx children who suffer from these disparities.
Acculturation is described as a shift in attitudes, behaviors, and identity to acclimate from one culture to another. As individuals practice acculturation, their health conditions may improve or worsen depending on the health area of interest. The new environment they are attempting to adapt to can change their diet, physical activity, and other common health-related behaviors. In a BMC Public Health study, Hispanic and Latinx children who lived in high-acculturation households were considerably less likely to experience dental caries than those in low-acculturation households.
Elaine Musselman, SF State Professor specializing in pediatrics and dental/oral health, found that the knowledge of oral health of parents, with children aged 3 to 5 years old, relates directly to the practices and health in their child’s dental care, especially the care of baby teeth.
“Children with cavities in their baby teeth have a higher likelihood of cavities in their permanent teeth,” Musselman said. “We really look at how their knowledge translates into practice, so we have an idea of where do we start, what are the needs in order to improve the oral health of children?”
Musselman’s works with the Head Start program in San Francisco with an area of focus primarily on improving children’s overall oral health in whatever way a specific low-income community needs through education.
“Not all communities have the same needs, the same ways that will work and be successful at increasing their oral health awareness and then their practices,” Musselman said. “We really want to involve specific communities to see what they need, what is the messaging that they need, how can we best support those neighborhoods, not go in and try to fix a problem.”
Valentina Leonett, a Venezuelan dentist practicing in Sioux City, Iowa, sees lack of information and language barriers as one of the central issues in the Latinx community and their access to dental care. Leonett is a part of 20 percent of Latinos living in Sioux City. Patients often come to her from a few cities away, just to get care from someone who they can understand.
In a 2005 John Hopkins University study, researchers found social norms amongst parents, such as the beliefs of the mother and her social network, were related to the age her children first visited the dentist.
“In the areas, I’ve been in, patients have been very thankful to have a Spanish-speaking provider because it’s very uncommon,” Leonett said.