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Introduction

Introduction. The Boston Center for Refugee Health & Human Rights Program for Refugee Oral Health. One Boston Medical Center Place Dowling 7 Boston, MA 02118 617.414.4226 www.bcrhhr.org. Program for Refugee Oral Health Objectives:

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Introduction

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  1. Introduction The Boston Center for Refugee Health & Human Rights Program for Refugee Oral Health One Boston Medical Center Place Dowling 7 Boston, MA 02118 617.414.4226 www.bcrhhr.org

  2. Program for Refugee Oral Health • Objectives: • To support BCRHHR and Center for Refugee health in the provision of comprehensive and culturally sensitive health care by identifying and addressing patients oral health needs • To improve the oral health status of BCRHHR clients and their access to quality dental care • To provide oral hygiene education and supplies to BCRHHR clients • To identify oral health issues and eliminate barriers to access dental care particular to BCRHHR’s clients Program for Refugee Health Objectives

  3. PROGRAM OVERVIEW • Referral Sources: - Primary Care - Ob/Gyn - Mental Health - Social Work Our patients are linked to BCRHHR and receive other services at the center • Referral Sites: - Boston Area Community Health Centers - Boston University Goldman School of Dental Medicine Patient Care Clinic - Boston Medical Center Emergency Dental Care - Oral Surgery Most of our patients have no dental insurance, Mass Health, or seek free care for dental services

  4. ORAL HEALTH SERVICES • Interview office - Non dental office setting • Dental Screenings using a penlight and disposable mirror • Referral • First appointment scheduling • Patient Education (using visual aids) - Oral hygiene - Issues found at screening - Upcoming dental exam and possible treatments - Possible need for multiple appointments • Toothbrush, toothpaste and floss provided to clients • Feedback to PCP and case workers involved with each patient to facilitate follow up • Case management and follow up as needed

  5. SCREENING INFORMATION • Demographic and contact information • Need for interpreter assistance • Significant medical history • Significant trauma history • Dentition and number of teeth • Decay experience (Untreated Cavities/Restorations) • Periodontal/Gingival Index • Oral Hygiene • Oral pathology • Previous dental care Based on the above, treatment urgency is determined by screener

  6. SCREENING CONSIDERATIONS • Welcoming and non-traumatizing environment • Before screening, an informal conversation must be conducted, including patient’s background and possible torture experience • Physical and psychological symptoms must be considered • Avoid situations that may evoke torture memories • Secure patient’s trust and confidence • Respect the individual • Inform carefully about examination

  7. SCREENING CONSIDERATIONS • Examinations may cause acute emotional reactions or profound withdrawal • The typical dental exam may evoke a memory of physical or psychological torture to the head, face, mouth or teeth • A bright overhead light can awaken a memory of forced sleep deprivation or interrogation • Questions about dental history and oral facial scars may elicit profound fear of being reported to government authorities • Findings consistent with torture history must be documented; applicants for asylum may need thisinformation to support their case

  8. PATIENT DEMOGRAPHICS • 358 patients screened from February 2002 to January 2009 • Age Range: 7 to 79 years old • 43% Male 55% Female • Our patients are native from 57 countries • Our patients speak 38 languages • 25% of our patients speak English. 62% have limited English Proficiency and 12.5% needed interpreting assistance

  9. LEGAL STATUS IN U.S.

  10. ORAL HEALTH PERCEPTION

  11. LAST VISIT TO THE DENTIST

  12. RITUALS AND CUSTOMS • SUDAN: Symbolic passage into manhood for male youths is the ritualistic extraction of lower central and lateral incisors • AFRICA: - Enamel opacities from Fluoride or Non-Fluoride are sources of pride - Teeth stand for power. Their loss, for loss of power - A lost tooth is buried so it does not get into the hands of the enemy who could use it to inflict harm • SOMALIA: Primary teeth are believed to cause digestive disorders in children; lower canines are extracted to cure the illness • ETHIOPIANS/ERITREANS: Uvula is excised as it is believed to put infants at risk for suffocation

  13. RITUALS AND CUSTOMS • TYPICAL WAYS TO ALLEVIATE PAIN FROM TOOTHACHE • Battery acid • Gasoline • MSG • Pure Perfume • Tobacco • Lemon Juice Chewing sticks: timeless natural toothbrushes for oral cleansing., Wu CD, Darout IA, Skaug N., Dept. of Periodontics, College of Dentistry, University Of Illinois at Chicago, 60612-7212, USA

  14. ORAL HEALTH PRIOR TO MIGRATION • Cultural perception of oral health and its importance • No link between oral health and overall health • Lack of knowledge of prevention and oral hygiene practices No access to fluoridated water, fluoridated toothpaste, toothbrush or floss • Torture or trauma to teeth, mouth or face • Limited or no access to dental care. In some cultures, dental care provided by traditional healers

  15. BARRIERS TO DENTAL CARE IN THE U.S. • Dietary Changes • Low socio-economic status • Limited eligibility for dental insurance • Limited insurance coverage –when eligible • Lack of knowledge of healthcare system • Language • Transportation

  16. COMMON ORAL HEALTH FINDINGS • Untreated Decay • Periodontal Disease • Fair/Poor Oral Hygiene • Torture/Trauma Sequelae • Infection due to advanced decay or periodontal conditions • Pain

  17. MISSING LOWER ANTERIORS

  18. SCREENING FINDINGS Pain Untreated Decay Trauma History Toothbrush Use In Country of Origin

  19. ANTERIOR TEETH LOST DUE TO TRAUMA

  20. TREATMENT URGENCY

  21. LESSONS LEARNED • It is important to include dental screenings in the health • management of Refugees and Torture Survivors • This population is at high risk of suffering from complications due to untreated dental problems or undetected oral cancer • Due to barriers like language or transportation, they are likely to • discontinue treatment once emergency is resolved. • - These barriers must be considered when choosing a referral • site • - Follow up is required when referring these patients for • treatment.

  22. CONTACT INFORMATION:Ana Zea, DDS(617) 414-1158azea@bu.eduBoston University Goldman School of Dental MedicineDivision of Health Policy & Health Services ResearchAdapted From: “Oral Health Issues of Survivors of Torture” by Harpreet Singh, RDH, MS

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