Sunday, April 22, 2007

Life among the toothless

Dentistry is a problem in Taiwan:

Poor oral hygiene is a serious problem among Taiwan elementary school students, with around 60 percent of them reporting having cavities in a recent survey, a Taipei city councilwoman said Wednesday.

Councilwoman Lee Yen-hsiu of the opposition Kuomintang cited the results of a survey on 300 students at six Taipei elementary schools as indicating that 61 percent of the students have cavities, with nearly 30 percent of these students having at least three cavities and 12 percent having at least five cavities.

Lee pointed out that most parents, schools and children in Taiwan have not attached importance to dental care, leading to a high ratio of tooth decay among schoolchildren -- a ratio she claimed as the second highest in Asia, behind only that of the Philippines.

The ratio of Taiwan schoolchildren with cavities is three times that of schoolchildren in Hong Kong and Singapore, Lee added.

She noted that more than 40 percent of Taiwan parents will only take their children to see a dentist when they complain about toothache and that children have not formed the good habit of brushing their teeth regularly.

Good dentistry only put in an appearance here in the last three decades or so; orthodontics is even more recent. Many families don't consider spending the money on teeth worth the cost, especially in working class areas. I have even heard well educated people with jobs in international companies say that they didn't teach their toddlers to brush because baby teeth will fall out anyway....there is a perception that funky teeth are cute. Many times I had people tell me that a canine that has strayed far up and out in the gum is an attractive feature, and not just their owners, either. I've experimented with telling students that they ought to think about dentistry if they want to get a serious job with a foreign firm, but I dropped the campaign since I've had no effect on anyone.

Traditional medical practices and folk beliefs underlie much of this. It is an article of faith here that tooth loss is inevitable with aging, and even desirable, as this article on Chinese in the UK notes:
Prompter question: Is losing teeth a serious matter?
Apart from the elderly groups, everyone thought that losing teeth was a serious matter as it would affect appearance, and ability to eat and speak. The process of tooth loss was considered to be unpleasant and painful; having no teeth could be very inconvenient and eating with dentures might lead to indigestion. Some believed that having a full set of teeth was a sign of honesty and decency, as there is a Chinese saying that `if you lie, you will lose a molar' (male adult, aged 47 years).

However, one man from the adult group identified teeth with problems and perceived tooth loss as an opportunity to avoid pain, `no teeth, no more toothache' (a 49-year-old take-away owner). The majority of elderly people held a cultural belief that it was best to lose all teeth as `having teeth in old age would eat away children's fortune, bringing bad luck to the family'.

A baby born with teeth was seen as a sign of bad luck (female adult and female elderly groups), indicating either that the infant has been cursed by devils or that it was retribution for something evil that the family had done.
Two other comments were of interest, both of which I have heard here but didn't really get when I heard them:
Regular check-ups were not generally considered important among adults and the elderly. They were costly and unnecessary. Prolonged bleeding was also considered a problem because people might be giving up vital energy, qi, which would weaken the body. The prospect of bleeding, therefore, might have deterred some Chinese from going to the dentist (adult and elderly groups).

The concept of a `blood tooth', a belief found in some elderly members, may be another deterrent. This belief stemmed from their childhood, when a dentist refused to extract a particular tooth which was diagnosed as a `blood tooth'. If the patient had this tooth out, s/he would bleed to death. Certain times of day were not considered suitable for dental treatment, such as soon after eating, otherwise non-stop bleeding might result. `The most suitable time for an extraction will be nine o'clock in the morning before food' (elderly female group).
If many elderly hold such beliefs, what are the prospects for transmission, since so many grandparents are caring for children here?

Another reason for avoiding dentistry, not mentioned here, is the competence of dentists, especially small local ones. My father in law distrusted hospitals but trusted his local dentist, who pulled teeth he might otherwise have kept had he gone to a competent and ethical practitioner. I've heard many similar tales. We take our kids to the dentists at the teaching hospital, and have encountered no trouble. Except the deadly cost of braces.....


Jonathan Benda said...

In the past five years, I've seen more and more kids--and more and more adults--getting braces. Quite a few of my college students are getting them, too. I guess it's becoming more of a concern among younger people nowadays.

"We take our kids to the dentists at the teaching hospital, and have encountered no trouble. Except the deadly cost of braces....."

Ha--you should try getting braces in the States. You practically have to take out a second mortgage to pay for 'em...

Anonymous said...

Finally, a topic I can really sink my teeth into! *cough* Sorry bout that.

I got 2 wisdom teeth pulled out a couple of weeks ago. It took 1 hour and cost me 150NT. In the States that would have cost around $400.

Anonymous said...

It took 1 hour and cost me 150NT

Wow that's cheap. Actually I think getting wisdom teeth out is more than $400. In California, you have to be an oral surgeon to take out wisdom teeth. I think 400 are closer to what a person with insurance will pay.

Btw, how many people reading this blog actually goes to a dentist every 6 months? giggles

Anonymous said...

Yeah, if they're impacted it takes a lot of time. Luckily it was only the top ones which, if already protruding, aren't too much of a hassle.

400 w/ insurance? That's really expensive.

Since Taiwan's dental care coverage is so good (for the time being), I'm heading every 6 months for sure.