Providing Dental Care to Burmese Populations

I too am familiar with this ethnic group—Fort Wayne, Indiana, is home to more than 10,000 refugees and immigrants from Burma, making it one of the largest Burmese communities in the United States. Arizona, California, Iowa, Minnesota, New Jersey, New York, and Texas are also home to significant populations of Burmese refugees. The Southeast Asian country of Burma was renamed Myanmar after a civil war in 1989, although many English-speaking countries still refer to it as Burma. It is home to hundreds of different ethnic groups, including the Karen, who are indigenous to the Thailand-Burma border region. The Karen are one of the largest ethnic populations in Burma.¹ Many dialects are spoken in Burma, making it difficult to create oral health education materials in a language that most immigrants will understand. The main dialect of Karen is Sgaw Karen. Public health professionals at the Rochester General Health System in Rochester, New York, have created an oral health brochure written in Sgaw Karen that is available here. Rochester General provides health information in more than 40 languages, including information about health services for many refugee groups.² Patients with language barriers may also experience low oral health literacy. This results in difficulty understanding written information, scheduling appointments, grasping the risks and benefits of procedures, and following up on treatment plans. To effectively communicate with patients who have low oral health literacy, use plain language, pictures, or drawings. Limit the amount of information given at once. Repeating instructions is helpful. The use of a medical interpreter may also be appropriate. Trained interpreters allow for timely information exchange that is both accurate and culturally sensitive. A significant oral health issue affecting the Karen population is betel nut quid chewing. Betel quids are parcels of areca nuts and tobacco wrapped in a lime-coated betel leaf. Chewing betel quids stimulates the central nervous system and is similar to the use of tobacco or caffeine. Oral manifestations of betel quid use include reddish brown discoloration of teeth and gums, ulcers, periodontal diseases, oral cancers, and oral submucous fibrosis. The teeth can also become worn from the chronic friction produced in chewing the quid and exposure to the chemicals contained therein. Behavior modification techniques are useful as quid chewing is highly addictive. The reddish-brown/black stain caused by betel nut chewing is difficult to remove. Over time, the stain can become intrinsic. Some Karen individuals see the betel quid stain as attractive, so clinicians should always ask if they would like it removed. Arecoline is the active ingredient in betel nut and inhibits the growth of periodontal fibroblasts. Therefore, betel quid chewing may exacerbate pre-existing periodontal diseases and cause quid users to experience greater periodontal attachment loss and increased calculus formation than nonusers.3 The oral health of betel nut users should be monitored for both periodontal disease and oral cancer. The United Nations estimates that 120,000 Burmese refugees remain in camps along the Thai-Myanmar border, with many hoping to resettle in the US. There is an ongoing need for health promotion and education to these populations. Social workers and other aid workers assisting in the resettlement of these refugees may be able to provide you with additional support.

References

1. EthnoMed. Karen Cultural Profile. Available at: ethnomed.org/culture/ karen/karen-cultural-profile. Accessed September 2, 2015.
2. Rochester General. Refugee Healthcare. Available at: rochestergeneral.org/ centers-and-services/refugee-healthcare. Accessed September 2, 2015.
3. Trivedy CR, Craig G, Warnakulasuriya S. The oral health consequences of chewing areca nut. Addict Biol. 2002;7:115–125.