Preventative dental care such as annual check-ups, regular scaling, and daily tooth brushing has not been practised by many Low German people in Latin America. Fathers often remove loose teeth for children and if children experience dental pain (especially if they still have their baby teeth), the tooth is usually extracted by a lay dental worker.
As with other medical concerns, accessing qualified dental practitioners is usually only done if/when lay dental workers have not been able to mend the situation. Many Low German families in Latin America do not have the financial ability to utilize qualified staff and/or the families live prohibitively far from appropriate dental clinics.
“We didn’t all have toothbrushes – there were 16 of us.”
“I saw one (toothbrush) and asked my mother for one. She bought the cheapest one. I had it for many years. I didn’t know what to do with it.”
“I wanted to clean teeth, so I would clean them on a Kleenex.”
“When you were grown up you would get a toothbrush – but we never had toothpaste.”
Oral hygiene practice and dental treatment in Ontario
Low German communities continue to have limited oral hygiene practices in Ontario. Dental care professionals who work with the Low German population consistently describe the obstacles these communities face in accessing appropriate dental treatment as complex challenges that include cultural differences, language and literacy barriers, (ongoing) migration between Mexico and Canada, poverty and immigration issues. Dental care practitioners are often limited in their ability to address these various barriers and to therefore see improved oral health in the communities.
“It is too far for me to go and drive to take all the children to the dentist.”
“We don’t have coverage, so we don’t go.”
Low German women generally state that all their children have toothbrushes and toothpaste. Some children reportedly brush at least once a day and a few have access to regular cleanings. However, most parents in Ontario still only take their children to the dentist when the children are in pain and eligible for Children in Need of Treatment (CINOT). Some newcomer Low German families return to Latin America for Christmas, Easter or Pentecost holidays and will address dental needs such as dentures, crowns, and sometimes even root canals during those visits. Others will request that dental practitioners extract problematic teeth in Ontario if they are unable to afford the required dental procedures and/or cannot wait until the next visit to Latin America. This request is often surprising to dental practitioners if they are unaware of how prohibitive the financial costs of alternative dental care can be. Additionally, some Low German adults believe that the benefit of dentures (no more dental pain) makes them a preferable alternative to maintaining one’s own oral health.
“I learned about toothbrushes and toothpaste when I first came to Canada from the Christmas baskets.”
“We went to the dentist only when we had a lot of pain. Mostly teeth were extracted. I was terrified of going to the dentist and today it still scares me to think of going.”
“If I had dental coverage, I would go more often and not drive to Mexico for dental work.”
“I have never been to a dentist in Canada, neither has my husband, we go to Mexico.”
Low German families in Ontario are beginning to access preventative dental care for their children when barriers to dental services are addressed (dentist provides this care for large families at a reduced cost, community based dental clinics are easily accessed in rural areas, community workers liaison with families and dental services, Ontario Healthy Smiles programs are available, access to Children in Need Of Treatment, etc.).
“My daughter is three, should I take her to the dentist? I didn’t know baby teeth were important.”
“I can’t pay to get my teeth fixed. Can I call you?”
“If I could pay $50 for a cleaning, I would go.”
Nutrition and diet in relation to oral health
Low German people experience significant differences in diet and eating habits between Latin America and Canada. Many Low German people are not aware of how food habits affect oral health. Because oral health is not emphasized in their Latin American context, and because foods eaten there contain much less sugar, Low German people tend to be uncertain about why they seem to have more dental troubles in Canada even though they are engaging in more personal care (daily brushing) than they previously did in Latin America.
Foods in Latin America are often simple and unprocessed, with minimal sugar content, whereas in Canada there is a much greater variety of a food available. This includes nutritious and healthy food, but also pop, candy and chips. Packaged snacks were special treats in Latin America due to limited incomes. Typically, the only daily sugar intake would have been jam for breakfast with candies and pop shared on special occasions. Like many immigrant groups, Low German people eat more highly processed and sweetened foods in Canada compared to their Latin American diets. This is in part perpetuated by their feeling pressure to buy packaged snacks for their children’s lunches to help them fit in. Low German mothers often describe wanting to provide their children with signs of affluence such as pop and sweetened milk. A practice that has become common in Ontario is to add strawberry or chocolate syrup (or other sweeteners) to milk. Some parents are coming to realize that providing packaged snacks and sweet drinks are not healthy habits.
“My husband never went to the dentist or had a toothbrush in Mexico – it was only here that his teeth became bad.”
“In Mexico we shared a pop on Sundays.”
“We didn’t eat sugar except in jam for breakfast or in baking on Sundays. We drank water and didn’t eat snacks. We just ate our meals.”
“Our children eat so many snacks here; they are not hungry for food.”
“I don’t want to buy those snacks because they have no taste and they are expensive, but my children want it.”
“Here I add chocolate to their milk because I never had that.”
“They won’t drink the milk here unless it is pink (strawberry syrup added).”
“I used to give my children a lot of pop, but now I stopped. I found out that I didn’t feel so good when I drank pop and my children were cranky and angry. Now I am encouraging them to drink more water.”
Feeding babies
Many Low German women breast feed but then use sweetened milk in bottles when the children are weaned. Bottle-fed babies will often be introduced to sweetened milk at 4-6 months of age. Mothers often seem convinced that children will not drink milk unless it is sweetened, even if they have heard that it is not healthy for their baby’s teeth.
“I add sugar to get them to drink milk at night.”
“I just add a little (strawberry) syrup to give it colour.”
“When I learned at the Wednesday program that pink milk in bottles hurt their teeth, I stopped.”
*All above quotes were compiled by The Smiling Project, a Low German dental assessment delivered by a service provider collaborative.