“If the cost of dental treatment is exactly the same as the cost of a car, Chinese patients would buy a car instead of getting their teeth fixed. But Western patients would definitely choose to save their tooth, even if it meant a huge debt,” said Manhui Liu.
Manhui Liu, a dentist at Malden Dental Associates in Malden, Massachusetts, drew analogies to show the difference between Chinese and Western patients.
Liu, who has practiced dentistry for 25 years in both China and the United States, says Chinese patients are very different from Westerners in both oral health habits and attitudes. In China, a large number of people brush their teeth but rarely gargle or floss, Liu says. “Protecting teeth with simple brushing and flossing is not enough,” Liu said. “It is very important to clean your teeth regularly. Some middle-aged people also need deep cleanings to prevent gum decay.”
Xiaolei Wang, a 26-year-old Chinese graduate student, has been living with her American roommate Sarah Vennochi for two years. Both have a daily routine in cleaning and protecting the teeth. “I brush my teeth two or three times a day and floss once every two days,” Wang said.
Meanwhile, Vennochi, a graduate student at Tufts University, has a more robust schedule. “I use an electric toothbrush and brush my teeth 2-3 minutes a day. After brushing for about 3 to 4 minutes, I floss each spot. Then I swish my mouth around with mouthwash for 30 seconds.”
Wang and Vennochi embody the differences between Chinese and Westerners in terms of oral health.
Vennochi says she started seeing a dentist at the age of three and currently goes for a teeth cleaning every six months. On the other hand, Wang said, “In China, very few dentists and parents recommend patients to have teeth cleaning, as they thought that cleaning teeth would cause damage to the teeth and gums themselves.”
“I don't know why the Chinese have such a misunderstanding about teeth cleaning,” said Joshua Lee, a Korean-American dentist at Malden Dental Associates who has worked in Boston's Chinatown and Malden and seen countless Chinese patients.
“Westerners have a good understanding of dental disease prevention, so they actively seek dental examination and care,” he said. “But the Chinese only seek care when a symptom such as periodontitis and gum erosion occurs.”
Generally, Chinese patients may go to the dentist for a painful tooth after suffering it for a while, and then just wait to have the bad tooth removed. Lee explained.
Liu agrees, but warns that it's not always that simple. “For example, some patients may need major dental work such as root canals, crowns and dentures. These treatments usually cost a lot,” Liu said. These costs may put dental hygiene out of reach for some Chinese patients. “Some patients may either be cost-conscious or drop out of treatment.
Liu believes there are three factors that underlie the difference between Chinese and Western patients: cultural differences, education levels and values. From 1949 to 1990, living standards and education were very poor in China, and a large number could not go to college because of the cultural revolution. This meant that, for decades, Chinese people not only lacked the basic knowledge of oral care but also the money to afford such care, Liu said.
For decades, good oral health was only available to those in the highest echelons of Chinese society. According to Marcia Ye, author of a study on Chinese attitudes toward oral health, “advanced interventions to save a bad tooth, such as root canals and crowns, may be common in the US and other Western countries, but it is often the privilege of only rich people in China.”
There is also something cultural about it. There is a widespread belief that treatment for primary teeth is unnecessary and that many more conservative Chinese consider Western medicine invasive and in some cases used too extensively, according to a review of oral health for the Chinese and three other ethnic groups that published in 2008.
These resources with Liu. “Years ago, I was working in China, although parents often used a traditional treatment for themselves, they were less likely to use it for their child. Most parents brought their children to the dentist or pediatrician only in response to pain.”
Cultural and educational differences have a direct impact on values and don't seem to be going away anytime soon. Liu still sees hesitation from Chinese patients at her dental practice. “Today, although many Chinese customers came to see the dentist and could afford the cost of treatment, they still often questioned the treatment plan and its value.”
