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Hispanic Patients Challenge Many Dentists
An Expert Interview With Sarita Arteaga, DMD
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SAN FRANCISCO, California — Editor's note: The percentage of Hispanics in the United States has grown steadily in recent decades, but few dentists are Hispanic.
A presentation on serving this population was featured here at the American Dental Association (ADA) 2012 Annual Session.Medscape Medical News interviewed presenter Sarita Arteaga, DMD, associate professor of dentistry at the University of Connecticut in Hartford, to discuss issues related to this population.
Medscape: How did you get interested in the relationship between dentists and their Hispanic patients?
Dr. Arteaga: I am past president of the Hispanic Dental Association. One of the things we have as our mission is to improve the oral health of Hispanic patients. And many dentists ask about this.
Medscape: What do dentists need to know to work well with Hispanic patients?
Dr. Arteaga: Being able to educate the patient is really important. It is not just a matter of language; it is important to be able to understand the patient.
Medscape: What gets in the way of that understanding?
Dr. Arteaga: A lot of practitioners think that all Hispanics are immigrants who are not going to stay around, so they don't give them a full treatment plan; they just address their urgent issues. They do not think of them as needing a dental home. They may also think the patients are poor, even though in reality many Hispanics make a good living. With that will come the idea that these patients do not have dental insurance, so [the practitioners] will just give them the minimum treatment. That can be a huge detriment to oral health. Practitioners also may think Hispanics do not care about their teeth. For example, they might just do an extraction and not recommend an implant. They may think people who do not understand the language are not intelligent enough to understand other things, so they won't try to educate their patients or explain all the treatment options.
Medscape: Are there any real cultural differences that can affect oral health?
Dr. Arteaga: Some Hispanics arrive late for their appointment — they may stop to socialize on the way — so you might want to ask the patient to come early. Hispanics may prioritize oral health differently. They may feel that they are more knowledgeable than the dentist about oral health. They also may not bring the child to the dentist unless there is a problem. We did a survey in collaboration with Crest and Oral B, and found that two thirds of Hispanics actually thought they could brush cavities away.
Medscape: How can dentists surmount these misunderstandings?
Dr. Arteaga: It is important to educate yourself as much as you can about different cultures, and understand some of the myths.
Medscape: How can you best educate the Hispanic population?
Dr. Arteaga: A lot of Hispanics will look at their mail or media sources, so maybe you can use some of those.
Medscape: Would a brochure in Spanish be helpful?
Dr. Arteaga: A brochure might help. But language is only part of the issue. They are more likely to trust a newspaper or magazine that they already read, so you could show them articles about oral health in these media.
Medscape: Are immigrants from Latin America likely to have different attitudes about fluoridated water?
Dr. Arteaga: It depends on the country. In some places, like Mexico, in many towns they would not drink tap water; they might not be willing to drink it here either.
Medscape: In that case, should you recommend fluoride supplements?
Dr. Arteaga: You could. You would have to explain what it is. You could also offer topical fluoride in the office. But once again, you have to explain the benefits.
Medscape: If no one in the dental office speaks Spanish, what is the best way to communicate?
Dr. Arteaga: There are dental Spanish apps for Android and Apple products. Most Hispanic patients are very grateful if you even try.
Medscape: Do you recommend asking patients to bring their own interpreter?
Dr. Arteaga: There can be HIPAA [Health Insurance Portability and Accountability Act] complications with the patient providing a translator if they are underage. You have to get consent. In most states, you can do this by getting signatures on the appropriate forms.
In certain states, it's illegal for the patient's child to translate. An underage individual might be making decisions, and it is not clear if the patient is giving consent.
Medscape: Are dental schools preparing students to work with Hispanic people?
Dr. Arteaga: At the University of Connecticut dental school, we include cultural awareness as part of the curriculum. We have a whole course on treating diversity. We try to incorporate it as an externship so that the students learn it while they are out in the clinics. The didactic course is about 25 hours. We have standardized patients, who are like patient actors, and we give them sample cases.
Medscape: Are there advantages to working with Hispanic patients?
Dr. Arteaga: Many Hispanic families go together wherever they can. Sometimes dentists are surprised to see the whole family show up for one person's appointment. I sometimes tell dentists that this is an opportunity to recruit the whole family. The Hispanic population is growing and dentists should be aware that they are going to have an Hispanic person in their practice sooner or later.
Dr. Arteaga has disclosed no relevant financial relationships.
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