Shades of Decay

1
Shades of Decay

• The Meanings of Tooth Discoloration to Latino
  Immigrants

Erin E. Masterson, BA Kristin S. Hoeft, MPH
Judith C. Barker, PhD Center to Address
Disparities in Childrens Oral Health University
of California San Francisco (Supported by NIDCR
grant U54 DE 14251)
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Dental Discoloration

• A broad range of dental discolorations can exist
  in deciduous dentition (Sapir Refuat 2005 Hapeh
  Vehashinayim 22(2)24-36 Sulieman 2005 Dent
  Update 32463-71 Welbury 1997 Paediatric
  Dentistry)
• Range of colors in the clinical literature
• White/opaque through black
• Wide variety of causes for discoloration (many
  ways to categorize one way is by
  extrinsic/intrinsic causes)
• Extrinsic- medicaments, oral hygiene, food,
  beverages, smoking, etc.
• Intrinsic- medicaments, genetics, trauma,
  fluorosis, dental caries
• Discerning the causes and clinical significance
  of dental discoloration in children is an
  extraordinarily complex issue

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Significance of Tooth Discoloration

• Relatively little research has been done on
  parental perceptions of the significance of tooth
  discoloration
• Mostly concerning dental esthetics and
  perceptions of fluorosis in children (Lalumandier
  1998 JADA 1291000-1006 Shulman 2004 JADA
  135595-604)
• Dissatisfaction among parents, dentists and
  children with severe levels of dental fluorosis
  in children
• Parents are concerned about the color of
  childrens teeth (even when not caused by
  fluorosis)

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Study Objective

• To investigate urban Latino immigrant caregivers
  understandings of and behaviors surrounding tooth
  discoloration, predominantly in children aged 1-5
  years
• To link observed dental discolorations and
  care-seeking behaviors

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Methodology

• Convenience sample
• Primary caregiver of Mexican descent with at
  least one child aged 5 years or less
• Lived in a primarily low-income Latino
  neighborhood in an urban center in northern
  California
• Recruited from preschools, community
  organizations, community festivals, dental
  clinics, and referred from other participants
• Data was collected by open-ended interviews (most
  in Spanish) and ethnographic observations
• Interviews were recorded, translated and
  transcribed
• Two researchers independently read, coded and
  analyzed the transcripts using NVivo Software
  Package

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Study Sample Description
Caregiver Demographics (N38)
Children Demographics (N92)
At least 61 reported to have had caries
experience At least 18 reported to have had
discoloration
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Shades of Decay

• Parents discussed a limited range of colors to
  describe tooth discoloration
• 5 categories White, Beige, Yellow, Brown, Black

The three-year-old, my nephew, has black (negro)
teeth. I once told him that they even looked
green (verde). Yes! with insistent tone He
once came here and I brushed his teeth really
well, poor child. He even cried. His teeth
still looked black (negro). His teeth looked
black to the bone (a su huesito, negro).
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Discoloration and Spanish Terms

• A significant association was found between use
  of darker shades of discoloration and Spanish
  terms describing more severe conditions and
  possible decay

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Structural Integrity of the Tooth

• Descriptions of structural damage to the tooth
  was also used to describe severely discolored
  teeth and was always associated with decay or
  caries
• Phrases such as Get smaller, fragile,
  crumbling, falling apart, breaking, etc.

I dont know if thats what made her teeth get
so fragile (fragiles) and what made them go brown
(café), not yellow (amarillo), but brown (café).
Im telling you, her teeth would fall apart
(deshacer) on the inside I have seen many
children who have rotten (podridos) teeth. You
can see that their teeth at the front have
crumbled (malcomido). Ive seen that. Like I
said, her teeth started to break (romper) because
of the juice. I dont know what that is
called The teeth were not completely decayed
(picado), they were just yellowish (amarillento),
as if they were crumbling (malcomiendo) -not
black (negro) or anything. They decided to take
all his teeth out.
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Attributed Causes of Discoloration
(N34), Respondents could offer more than one
cause therefore percentages do not total 100.
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Discoloration and Care-Seeking
Indicates that 2 of the 3 cases described a
specific structural problem in addition to the
discoloration
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Discussion

• Only one study could be found in the literature
  that describes how rural Latino child caregivers
  respond to various stains or dental
  discoloration in children (Horton Barker Comm
  Dent Hlth in press)
• The present study serves as an expansion of this
  topic with a comparable urban population
• Caregivers describe a wide range of colors and
  generally associate discoloration with a level of
  tooth disintegration

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Conclusion

• Need conclusion or straight into implications???
• Spanish terminology used to describe tooth
  discoloration and its possible association with
  decay is broad and complex (worth repeating???)

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Study Implications

• Dental practitioners need to know, not just the
  terms, but the meanings of these terms to Latino
  patients so that clear communication may lead to
  development of appropriate caregiver responses to
  dental discoloration and decay
• More education is needed about early warning
  signs of tooth decay
• Black and structurally damaged teeth prompt
  dental visits
• Less severe discoloration might not prompt a
  dental visit (highly dependent on income/access
  to services)

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Support and Thanks

• Supported by NIDCR grant U54 DE 14251 and the
• Center to Address Disparities in Childrens
  Oral Health
• (CAN DO Center) at the University of
  California at
• San Francisco
• Thank you to the caregivers, community
  organizations and others that participated in
  this study
• Research Team
• Judith C. Barker, PhD (PI)
• Sarah Horton, PhD
• Kristin Hoeft, MPH
• Erin Masterson, BA
• Jane A. Weintraub, DDS, MPH
• The CAN DO Center