Supporting the Oral Health of America’s Newest Residents

Immigration has long been an historical phenomenon in the United States. Since the mid-19th century to the turn of the 20th century, New York has been the prototypical immigrant city with Germans, Irish, Jews, and Italians dominating the influx of immigrants.¹

The COVID-19 pandemic also drew an inflow of asylum seekers to New York City. In 2023, more than 79,000 people flooded shelters and humanitarian relief centers in New York City, a 77% increase since 2022.² Following migration, immigrants often experience an increased risk for chronic disorders that include poor behavioral and mental health outcomes.³

The impact of migration on health is ­significant among immigrants and asylum seekers. Cheng and Lo⁴ investigated how im­migrant children in the US use health services. Using data from the 2021 National Survey of Children’s Health, involving 9,759 immigrant parents and children, they found that physician visits are negatively associated with child health, meaning healthier children are less likely to visit the physician, and dental visits are only positively associated with older children, who are more likely to visit a dental provider; however, younger children are not.

Aarabi et al⁵ examined the relationship between migration background and oral health-related quality of life (OHRQoL), determining that individuals with a migration background have lower OHRQoL compared to those without, with men being more affected than women. The findings highlight the need for culturally and socially sensitive measures to improve access to dental care and oral health information for migrants.

Additionally, oral health literacy plays an important port in maintaining dental health. Valdez et al⁶ found that migrants generally have lower oral health literacy compared to nonmigrants, leading to less frequent use of dental services and poorer oral health behaviors.

The development of oral health problems in immigrant and asylum-seeking children is influenced by various factors, such as cultural effects and health experiences from their home countries.⁷ Research has shown increased severity and prevalence of dental caries among asylum seekers and refugees than among the local population in each host country, regardless of sex, age, or country of origin.⁸ Moreover, oral health problems may worsen due to diet changes and increased sugar consumption when asylum seekers begin their journey.⁸

Outreach to Migrant Communities

In 2022, I was fortunate to be one of two dental hygienists who participated in the Bridging the Gap Associateship at New York University (NYU) College of Dentistry’s Department of Pediatric Dentistry, a Health Resources and Services Administration Title VII training grant to expand dental workforce with skills to treat individuals with special needs and disabilities (Figure 1, page 10). The associateship enabled me to participate in Bringing Smiles, a school-based dental outreach program that serves children with disabilities and those of low socioeconomic status within New York City public schools.

During my time as a Bridging the Gap and Bringing Smiles associate, I worked alongside dentists, dental hygiene students, and dental students from NYU at public schools throughout New York City. Many of the students are unhoused and/or asylum seekers from South American countries. Through the associateship, we provided prophylaxes and essential dental treatment that included dental restorations and extractions

I witnessed firsthand an exorbitant number of migrant children with excessive decay, dental infections, and an unparalleled level of plaque. Unfortunately, we found these children and their parents had low levels of oral health literacy. Toothbrushing and maintaining their oral health were the least of their concern when trying to fight for survival in their homeland. As my associateship concluded, the visitations to these New York City public schools continued with the goal of improving oral health literacy among children seeking asylum.

During the past year, I followed a similar path providing dental services to underserved and underprivileged populations throughout New York City via Smile New York Outreach, a corporation consisting of licensed dentists and other oral health professionals delivering dental care to children in their schools who may not otherwise have access. A team consisting of a licensed dentist, three dental assistants, and I would arrive at a public school registered under the New York City Department of Education. With only a minivan, we would unload compressors, ultrasonic scalers, mobile digital X-ray machines, chairs, tables, personal protective equipment, instruments, ultrasonic cleaners, and autoclaves to transform an auditorium or a classroom into a dental clinic (Figure 2).

On any given day, the team and I would see anywhere between 30 and 45 children. Collectively, we managed to service more than 65,000 children in New York during the 2023-2024 school year. I personally observed the level of rampant decay and infections throughout the mouths of children as young as 5. Licensed dentists on the team would refer these children to specialty dentists for restorative treatment and, unfortunately, parents often failed to follow-up with the referrals. By the next visit, the children were experiencing pain or developed an abscess and had difficulty relaying this information to dental staff due to language barriers. No importance was placed on brushing, flossing, or maintaining their oral health.

Improving the oral health of vulnerable children is essential. One approach uses an ecological model to advance oral health equity.⁹ School-based oral health programs are at the core of this model and they may provide the following:⁹

1. Improve oral health by increased healthcare access in disadvantaged and asylum-seeker communities
2. Support health and well-being
3. Develop skills-based health education to enhance the understanding of health-influencing factors among students, teachers, and parents

Research shows that oral health outcomes improve when immigrants receive care that is culturally sensitive.¹⁰ Because immigrant children are more prone to dental caries as well as facing increased challenges in accessing dental care than nonimmigrant children, oral health promotion strategies are key to addressing disparities.¹¹

My experience working with Bridging the Gap and Bringing Smiles has inspired me to continue caring for asylum seekers in order to improve their oral and overall health. I believe school-based dental programs integrated with cultural sensitivity can address the significant barriers to care faced by asylum seekers.

Whether delivering oral healthcare or teaching in a classroom, individuals need to be empathetic and culturally sensitive in order to improve the oral health and overall well-being of these children.

References

1. Foner N. Immigration history and the remaking of New York. In: Foner N, Rath J, Duyvendak JW, van Reekum R, eds. New York and Amsterdam: Immigration and the New Urban Landscape. New York: New York University Press; 2014:29-51.
2. Office of the Mayor of New York City. The Road Forward: A Blueprint to Address New York City’s Response to the Asylum Seeker Crisis. Available at: nyc.gov/assets/home/downloads/pdf/press-releases/2023/asylum-seeker-blueprint.pdf. Accessed July 1, 2024.
3. Fanfan D, Mulligan CJ, Groer M, et al. The intersection of social determinants of health, the microbiome, and health outcomes in immigrants: a scoping review. Am J Biol Anthropol. 2024;183:3-19.
4. Cheng TC, Lo CC. Factors in immigrant children’s use of physician and dentist visits, hospital care, and prescribed medication in the United States. Eur J Investig Health Psychol Educ. 2023;13:2251-2261.
5. Aarabi G, Walther C, Kretzler B, Zwar L, König HH, Hajek A. Association between migration and oral health-related quality of life: results from a nationally representative online survey. BMC Oral Health. 2022;22:309.
6. Valdez R, Spinler K, Kofahl C, et al. Oral health literacy in migrant and ethnic minority populations: a systematic review. J Immigr Minor Health. 2022;24:1061-1080.
7. Crespo E. The importance of oral health in immigrant and refugee children. Children. 2019;6:102.
8. Banihashem Rad SA, Esteves Oliveira M, Maklennan A, Castiglia P, Campus G. Higher prevalence of dental caries and periodontal problems among refugees: a scoping review. J Glob Health. 2023;13:04111.
9. Gargano L, Mason MK, Northridge ME. Advancing oral health equity through school-based oral health programs: an ecological model and review. Front Public Health. 2019;7:359.
10. Doucette H, Yang S, Spina M. The impact of culture on new Asian immigrants’ access to oral health care: a scoping review. Can J Dent Hyg. 2023;57:33-43.
11. Luo H, Wu B, Wu Y, Moss ME. Dental caries and preventive dental visits among children in the US: the impact of race/ethnicity and immigration. AJPM Focus. 2024;3:100230.

From Dimensions of Dental Hygiene. August/September 2024; 22(5):10,13