Vietnamese Oral Health Beliefs and Practices: Impact on the Utilization of Western Preventive Oral Health Care

Introduction

In the Vietnamese culture, health is seen as a state of physical and spiritual harmony, with the body requiring balance to remain in good health.¹ To achieve health and balance, two essences, such as “hot” and “cold”, must harmonize with one another; while illness on the other hand, is considered to be an imbalance between two essences.^1-3 Vietnamese medicine evolved from traditional Chinese medicine (TCM),^1-3 and is based on a modified version of the Chinese philosophy of yin and yang, referred to as âm and dương.² It is through an imbalance in âm and dương that the traditional form of Vietnamese medicine emerged and is used to explain and address health issues.² The Vietnamese use a health care system comprised of either “Southern medicine” (thuoc nam) or “Northern medicine” (thuoc bac) In order to treat an imbalance.^2,3 Vietnamese people more commonly employ Chinese herbal medicine and folk medicine from the Southern medicine system, using local herbs for treatment.^2,3 Northern medicine relies on medicines from Hong Kong and Taiwan and is used by fewer individuals.^2,4,5

The Vietnamese belief system of health and illness, also guides their approach in addressing and identifying oral health problems and influences treatment choices, i.e., the use of traditional Vietnamese practices to treat oral health problems rather than Western oral health care services.^1,3,6-8 Procedures such as preventive oral examinations and diagnostic x-rays, commonly used in Western oral health care, are not sought out by the Vietnamese. Traditional Vietnamese health practices are either used concurrently or prior to seeking Western health care services. Additionally, the Vietnamese will typically seek Western health care only when experiencing severe pain.^1-3,7-9

The infrequent use of Western preventive oral health care services by the Vietnamese, resulting from deeply ingrained oral health beliefs and traditional Vietnamese health practices, was the predominant theme in the literature.^1,2,9-12 It is a common belief within the Asian cultures that an “internal fire” exists in the human body resulting from stress, lack of sleep, or an unhealthy diet that includes an excess of “hot foods” (fried and spicy foods) and a lack of “cold foods” (fruits and vegetables).¹³ Vietnamese cultural beliefs also attribute this “internal fire” with causing oral health problems.¹³ Remedies and methods used in the Asian culture to resolve and prevent oral health issues include the avoidance of fried or spicy food, the consumption of herbal teas, and rinsing the mouth with cold boiled water. Salt water rinsing is also commonly used and believed to prevent dental caries and stress management is believed to be an effective measure in preventing gingival disease.¹³

Kwan and Holmes conducted a qualitative study investigating the oral health beliefs of the Chinese population residing in West Yorkshire, United Kingdom, and reported that participants believed bleeding “gums” were considered to be a normal condition or due to an “imbalance of the body.”¹⁴ These participants also believed the process of tooth loss would be painful, but not preventable since oral health diseases are considered to be inevitable in old age.¹⁴ In fact, these participants did not believe that dental diseases of any kind were preventable. The adolescent group in this study held the belief that it was “natural for people to lose all their teeth as they get old” and that dental disease, primarily dental caries, was an inevitable “part of life.”¹⁴ However, in contrast to the adult and elderly group, the adolescent group preferred oral health treatment from a Western health care provider and did not believe traditional Asian health practices could help remedy oral health problems.¹⁴ Kwan and Holmes‘ findings regarding oral health beliefs in this Chinese population were similar to those reported in Vietnamese populations discussed in the literature. ^5,6,15-17

In a study regarding traditional oral health care practices of Vietnamese-speaking parents (n=24) of children in Sydney, Australia, it was reported that while still in Vietnam, participants brushed their teeth with palm fruit husks or with their fingers and used salt to clean their teeth.⁹ These same Vietnamese parents who used traditional oral health care practices did not seek preventive oral health screenings, diagnostic testing, or treatments and would wait until symptoms progressed before seeking oral health care services.^2,8,10,11 This use of traditional oral health care practices and approach to oral health care services by parents was also passed onto their children.⁹

The oral health beliefs and practices identified in Vietnamese and Chinese cultures, are parallel to the choices made by Asians when considering general health care options and utilization patterns for general health services.² In a study designed to assess the patterns of health care service use by Chinese immigrants (n=75), 45.3% of the participants used Western health care services or traditional clinics in the United States (US).¹¹ Thirty-two percent of the study participants stated that they travelled home to China or Taiwan for health care needs, 21.3% used US clinics as a primary source for health care needs, while 45.3% used both Western and traditional Asian clinics within the US.¹¹ Self-treatment and home remedies were practiced by 94.6% of the immigrants with 20% never using health care services at all.¹¹ The Chinese immigrants who indicated that they did not seek Western health services for care, also believed Western medicine could not cure their illnesses; most of the participants relied on self-care or traditional alternative health resources to treat their health problems.¹¹ The purpose of this study was to explore Vietnamese oral health beliefs and practices and their impact on the use of Western preventive oral health care services.^2,3,6