Dentistry and immigrant children: the challenges they face

Dr. Amin at the American Dental Education Association conference last year.

A multidisciplinary study, Access to Healthcare for Immigrant Children in Canada, reviewed barriers for immigrants to access to healthcare from the lens of their children. Led by associate professor in the Faculty of Nursing at the University of Alberta, Dr. Bukola Salami, and including researchers from the Faculties of Education, Arts, and Medicine and Dentistry, the study invited Dr. Maryam Sharifzadeh-Amin, oral health researcher with the School of Dentistry to bring an oral health perspective.

Amin was an ideal choice for this collaboration. She is a qualitative researcher in the areas of access to care in immigrant populations and pediatric oral healthcare. She says, "My intention in collaborating on this study was to show dentists that our struggles are not unique to dentistry. We need to work together with other healthcare providers to resolve these issues."

While there is a lot of research on immigrants' access to care, few studies focus on access to care for the children of immigrants. The findings for this study show that many of the barriers, such as knowing what services are available, language barriers and the patient/provider relationship are common to all disciplines.

However, there are additional burdens specific to access to oral health care for children of immigrants.

"Cost is a bigger issue in dentistry."

The discussion surrounding dentistry as a private business is "a discussion for another time," Amin jokes. But treating patients in their early years of being in Canada — still struggling with upgrading credentials and finding jobs — is much harder when cost comes into play.

She explains, "One of our biggest tools as healthcare providers is advocating for prevention. Recommending that a patient come in for an annual checkup can prevent many more expensive procedures later on. Still, the patient has to be able to afford to pay out of pocket or have the right insurance. Patients see the cost and put off their visits."

Amin recommends to dentists, "While we may not be able to resolve the financial issue, but we can work on the other social determinants." Some of her recommendations include:

• Having more interpretation services available to recent immigrants.
• Making health care providers more aware of cultural differences.
• Increasing cultural competency of future oral healthcare providers.
• Using a model of patient-centred care.

"Children's teeth are important."

Another barrier is the lack of awareness that children's teeth are vital, even though they fall out naturally. "Many people don't understand the traumatic impact of losing primary teeth prematurely or the impact on permanent teeth when the oral cavity and environment isn't safe."

She continues, "Access to care in vulnerable populations is a passion of mine. The immigrant population specifically is at higher risk of developing dental and periodontal diseases."

"Multidisciplinary studies are crucial to dentistry."

This paper shows how multidisciplinary studies are critical, especially for dentistry and oral health researchers. Amin says, "Every time I receive an invitation from my colleagues in medicine, I'm very pleased to collaborate. I'm tired of seeing oral health addressed in a silo. Dentists know that the oral cavity is part of the body and when we talk about general health, we're also talking about oral health. Still, we need to share this with other professionals."

"I've heard it myself. Funders asking me, 'Can you tell me that teeth are more important than hearts?' No, I can't, obviously, but it doesn't mean that teeth are not important. It's a pity for oral health researchers because we have to spend a lot of space in our studies justifying why the study is important!"

Amin recommends that oral health researchers initiate this type of collaboration with colleagues from other disciplines such as medicine, nursing or even psychology. "They have the expertise we don't have. Working together and dealing with the issue as complex beyond the medical model would help us to resolve them."