Cheen Loo says it was her bite of fillings—received without the benefit of local anesthesia, no less—that led her to dental school. She wanted to help others, especially children and teenagers, avoid her fate. In her role as professor and chair of pediatric dentistry at Tufts University School of Dentistry, Loo preaches the importance of early preventive care, starting no later than a youngster’s first birthday.
This 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 children to the dental school, located in Boston’s Chinatown. About 40% of the pediatric clinic’s 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 fall and then break a tooth,” says Loo. The result is that children often arrive at Tufts around age 5—most likely referred by a pediatrician after a pre-kindergarten screening—with significant dental disease, which may be so extensive as to require a trip to the surgery. . While 11% of pediatric dental patients require treatment under general anesthesia, Asian or Asian American children make up about one-third of them.
Growing up in Malaysia, where her parents had immigrated from mainland China, Loo didn’t see a dentist until she was at school, where a small van took the children to a public health dentist. “I remember getting quite a few fills, no local,” he recalls. She attended high school in Australia and the dentist there taught her the importance of prevention. “It helped me realize that I could become a dentist and help someone else avoid my situation.”
Tufts now spoke with Loo about providing dental care to Asian immigrant children.
Tufts now: What is the hallmark of treating these first-generation patients?
Cheen Loo: Most parents want what is best for their child, but lack the health literacy to be able to provide what is needed in terms of prevention. There will be many cavities, and the parents don’t know it. Or they say, “I thought this was normal. You just let the baby teeth fall out.” They think about it like when they were growing up themselves. Even as adults, they may not go to the dentist on a regular basis. And many of the parents have other things to worry about — working two jobs or having other priorities to balance caring for their family.
What other economic or lifestyle factors come into play 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 work, and sometimes commuting to come in, is a challenge.
Because of the high financial burden of childcare in Boston, many parents send their infants back to China to be cared for by extended family until they reach school age. We see a number of patients who come to us after returning to the United States. It is challenging because they have not undergone preventive treatment, examinations or cleanings in China.
What are the consequences of skipping preventive care?
Decay in primary teeth progresses much faster than decay in adult teeth, so we can’t wait too long to treat it. Many times, until children come in, we have to treat them under general anesthesia at Tufts Medical Center. We’ve had one or two cases where children were on the waiting list for our services at the hospital, but had to come in for emergency care because the tooth decay became so invasive that it caused a large abscess and infection that could be life-threatening. In one case, more recently, we had to extract most of the child’s teeth. Such cases occur because parents do not know that they should bring their child no later than their first birthday for their first dental appointment.
What are some of the ways your department has informed immigrant parents during the pandemic?
It’s a little more difficult now because of COVID to have outreach events. We work with pediatric residents at Tufts Medical Center and pediatric nursing students at Northeastern University to provide interprofessional education in preventive care, caries, dental trauma, and dental emergencies. We also address parents who come for an appointment with a pediatrician.
When school-aged children come for an appointment, we will ask the parents if they have other children at home and suggest that they make an appointment. Sometimes, if parents have younger children, they will say, “They won’t 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 to not be able to sit, but he’ll be sitting with a parent, and we’re just checking everything and going over what needs to be done at home. And the instructions are more for the parent, what to do to take care of the child’s teeth.
