Following the American Psychological Association’s Guidelines
Hygiene is often something we consider when examining different cultures around the world. We often wonder what cleaning rituals different people have, and how they define the word, “cleanliness” themselves. Something we sometimes overlook, however, is dental hygiene when we are examining cleanliness. Specifically, we overlook how dental hygiene differs in care and cultural beliefs between two different groups. Take, for example, the people of Saudi Arabia, and the African American communities of the United States. Some of their oral hygiene practices are the same, due to poverty, or education. Others are different due to cultural and religious beliefs. Remarkably, despite these differences, the two cultures seem to follow a pattern: the young know more than the old and have better oral hygiene practices, while the elderly are undereducated and often run the risk of having poor oral hygiene, or even losing all of their teeth.
The African American communities are not entirely segregated to low income neighborhoods, but a vast majority of them live there for a variety of sociological factors. Many African America families are impoverished, placing them at the bottom of the healthcare system. Even middle-class African Americans often cannot afford proper dental visits for themselves or their families. Children have an easier time obtaining cheaper healthcare thanks to several programs in the United States; this allows many African American children to have healthy teeth and learn good oral and dental hygiene at a young age. They may carry these habits into their adult years depending on their surroundings, their upbringing, and the atmosphere in which they surround themselves, according to, “Differences in Self-Reported Oral Health Among Community-Dwelling Black, Hispanic, and White Elders.” Items for good dental healthcare, such as toothpaste and a toothbrush are relatively easy to purchase in the United States, and basic utilities are can be bought at a cost. Electric toothbrushes are more expensive.
Unfortunately, the relatively well kept healthcare system for disadvantage youth in the United States is still in its infancy. Elderly African Americans did not have a chance to reap its benefits when they were children; if their families were poor or disadvantaged they went without those things. Individuals were also less educated five decades ago, not understanding that poor oral and dental hygiene would lead to gum disease and tooth erosion. Eventually this can lead to a loss of one’s teeth entirely, which is something the elderly African American community faces now. Fortunately for them, the United States’ medical system has enforced Medicaid to provide dentures, or false teeth, to most of these individuals. However, even with this service, many elderly African Americans cannot afford high quality dentures, or are unable to afford dentures at all. Because they were not taught good dental hygiene as children, they are often left as adults to eat only foods that will not hurt their gums or aggravate sensitive teeth or cavities, according to, “Food Avoidance and Food Modification Practices of Older Rural Adults: Association With Oral Health Status and Implications for Service Provision .”
Cultural divides also surround oral and dental hygiene. In the United States, most African Americans want their children to have clean teeth and good oral hygiene. It is a sign of being clean and well kept. It may also be an inadvertent sign of good parenting if a child knows how to care for their teeth and has followed directions well. Poor oral hygiene is seen as a mark of destitution or, in contrast, poor parenting, as stated in, “Urban Education with an Attitude .” In adults, a stereotype among African Americans and poor oral hygiene has been paired with the use of drugs. Drugs such as Crack cocaine, and heroine are known to cause he erosion of gums, as well as tooth decay. They are perpetuated as popular throughout African American communities, and sometimes it is assumed if an individual has bad teeth, they are doing drugs. This stereotype may further compel African Americans to maintain good oral hygiene in order to divert these stereotypes.
Other cultural practices involve the use of gold teeth. Many musicians, often known as rap artists, as well as gang members, see gold caps on teeth as a symbol of status. They still attempt to maintain healthy teeth. However, they also adopt the façade that they literally have a mouth full of gold. This perpetuation is to express to amount of wealth the individual has accrued. When they smile, anybody they are talking to will see the gold tooth, or gold teeth, gleaming. While gold caps are still popular in the African American community, “Urban Education with an Attitude,” states that the gold tooth has evolved into the more popular “grill.” Grills are fitted caps that go across an entire row of teeth. They can be set with gold, silver, diamonds, or the jewel of the wearer’s choice. They have little to do with hygiene and are completely a cultural practice.
Oral hygiene may appear to be a universal practice; something that is the same no matter where a person is. That is not always the case. Oral care and hygiene in among Saudi Arabian people, for instance, is different from that of African Americans in the United States. The same healthcare is not offered in Saudi Arabia. Children in America are often afforded the opportunity to have free healthcare for a short time, which allows them to learn about oral hygiene. They carry this information into adulthood. Programs like this are not often available in Saudi Arabia for children or citizens of any other age. The only way to obtain education about hygiene is from one another or through one’s school. It puts the Saudi Arabian people at a severe disadvantage. Other things differentiate Saudi Arabians from African Americans concerning oral hygiene, as well. For example, many in the United States will have never heard of a tool called a miswak. According to Omar A. Bawazir’s, “Knowledge and Attitudes of Pharmacists Regarding Oral Healthcare and Oral Hygiene Products in Riyadh, Saudi Arabia,” a miswak is a twig made from a Salvadora persica, or Arak, tree. The twig is used for cleaning teeth and is a popular alternative to the toothbrush among Saudi Arabians .
The miswak is essentially a chewing stick, but is traditional in nature. Embedded in religion as well as culture throughout Saudi Arabia and surrounding countries, scientists have recently discovered how useful the tool can be. The miswak was conclusively found to remove more plaque than a toothbrush, based on the fact that it coule be run in between teeth and along the gumline. Miswak users also showed less chance of developing gingavitis . According to Saudi Arabian history, it has been used for centuries, and has other medicinal benefits. Studies performed by Elisha Riggs and her associates showed that men over the age of thirty were more inclined to use the miswake than men under the age of thirty. The study also showed that men were, overall, more likely to use the miswak than women. Women reportedly were more likely to use a traditional toothbrush to clean their teeth unless they were over the age of sixty . Individuals over fifty-fifty of either gender preferred to only use a miswak, or did not bother with oral hygiene at all.
Further studies showed that oral hygiene was not the first thing on the population’s mind in Saudi Arabia. According to, “Understanding Muslim Patients: Cross-Cultural Dental Hygiene Care,” it was found that 70% of Saudi Arabians who were inclined to use a toothbrush for oral hygiene cleaned their teeth on a daily basis, while 59% of miswak users cleaned their teeth each day . Moreover, studies continued to find that older generations of Saudi Arabians seemed to have poor oral hygiene because they were not properly educated on what constituted acceptable teeth-cleaning regimens. For example, 25% of the population polled forty-five years and older believed that chewing gum was an adequate alternative to brushing one’s teeth, or even using a miswak . Younger groups of Saudi Arabians, aged sixteen-years-old and younger had a higher tendency to brush their teeth every day, using what is today known as a traditional toothbrush . These discrepancies in oral hygiene showed that there were not only large differences between cultures in the United States and Saudi Arabia, but differences among the oral hygiene within sociological groups in Saudi Arabia itself.
The old-fashioned ideas behind oral hygiene in Saudi Arabia are not the fault of the people. It is partially the fault of distribution and education, and partially the fault of the culture. “Reflections on Cultural Diversity and Oral Health Promotion and Prevention,” states that in many cases, the proper oral hygiene tools are not made as readily available to people as they are in other countries . Even when materials such as toothbrushes, floss, picks, mouthwash, toothpaste, and other amenities are made available, the sales of these items fall short due to the widespread popularity of the miswak. S.L. Sirois and associates state in their article the reason for this is education; Saudi Arabia is primarily is Muslim society, who follow the teaching of the Prophet Mohammed . The Prophet’s writings endorse the miswak as the primary tool for teeth cleaning, a direction that Muslims have attempted to integrate into their everydat lives. Dentists in Dubai have demanded that Saudi Arabians have more frequent dental visits if they are in pain, or at least get regular check-ups in 2012 but there has yet to be a significant increase in service rendered.
Enamel erosion and tooth decay was also observed among Saudi Arabians, more significantly than in several other cultures. Researchers began likening the results to starving tribes in Africa. Eventually the results were attributed to the fact that Some Islamic rituals require the Muslim to fast . Religious differences should be respected, regaurdless of the situation, and it is important even for dentists to be culturally competent. However, dentists in the area felt it was necessary for people of the country to get proper nutrition in order to avoid tooth decay and enamel erosion. Most resisted, of course, for religious reasons. This difference, however, is still marked as one of the largest between Saudi Arabian culture and African American culture in the United States, as most African Americans are of Christian faith and do not fast.
Also unlike the African American culture in America, who now receives knowledge about oral hygiene very early in life, it was concluded that many Saudi Arabians learn about oral hygiene late in life. Therefore, they begin practicing it late in life. The age an individual begins practicing oral care, as well as their education level, was associated with whether the individual used a miswak or a toothbrush. Older, less educated individuals used the miswak, while those who began practicing oral care early used the toothbrush, and often used floss, making up for the plaque build-up the miswak helped fight. While, as previously mentioned, it is important to respect the religious and cultural values of different people around the world, the miswak was found to be a wholly ineffective tool when aiding in oral hygiene. It is obvious that Saudi Arabians need better oral hygiene education. Perhaps if it is suggested that the miswak be used with the toothbrush, the culture can be respected, and the people can receive the proper oral hygiene they deserve.
In sum, the African American community in the United States and the Saudi Arabian people has similarities and differences concerning oral hygiene. Both cultures have an undereducated elderly population at constant risk of losing their teeth to poor hygiene. Some African Americans may be able to procure dentures. Another similarity is that both cultures have an educated youth population who understand oral hygiene is important, though both groups could be educated more on this subject. Primary differences lie within the cultures themselves. African Americans have taken oral hygiene and turned it into a fad, exposing their teeth with gold caps, silver fillings, and diamond encrusted grills in an effort to show their status. In contrast, many Saudi Arabians are Muslim and, therefore, forego using a toothbrush. Instead, they use a miswak, as prescribed in the Prophet’s writings. Saudi Muslims are also prone to having weaker tooth enamel and experience tooth decay at a younger age due to the fasting required for religious ceremonies. While both parties appear to be trying, more oral hygiene is still needed in each culture if we are to ensure that they do not experience early tooth decay, cavities, or weak enamel.
References
Bawazir, O. A. (2014). Knowledge and Attitudes of Pharmacists Regarding Oral Healthcare and Oral Hygiene Products in Riyadh, Saudi Arabia. Journal of International Oral Health, 1-4.
Johnson, L., Finn, M. E., & Lewis, R. (2012). Urban Education with an Attitude. New York: SUNY Press.
Quanndt, S. A., Chen, H., Bell, R. A., Savoca, M. A., Anderson, A. M., Leng, X., et al. (2009). Food Avoidance and Food Modification Practices of Older Rural Adults: Association With Oral Health Status and Implications for Service Provision. The Gerontologist, 100-111.
Riggs, E., Gemert, C. v., Gussy, M., Waters, E., & Kilpatrick, N. (2012). Reflections on cultural diversity in oral health promotion and prevention. Global Health Promotion, 60-63.
Sirois, S., Darby, M., & Tolle, S. (2012). Understanding Muslim patients: cross-cultural dental hygiene care. International Journal of Oral Hygiene, 105-114.
Wu, B., Plassman, B. L., Liang, J., Remle, C. R., Bai, L., & Crout, R. J. (2011). Differences in Self-Reported Oral Health Among Community-Dwelling Black, Hispanic, and White Elders. Health Journal Quarterly, 267-288.
