“Flossing widens the gaps between my teeth. Besides, these teeth aren’t even my own.”
Absolutely no one can convince my grandmother that flossing is important. Notorious in our family because all of her teeth are now implant crowns, she feels an increased disconnect with these “fake” teeth and doesn’t feel the need to take care of them. Many of her relatives in India confirm her beliefs by misguidedly advising against visiting the dentist and flossing regularly. For them, why should she waste time and money now that her teeth aren’t even “hers” anymore?
What is periodontal disease?
Periodontal disease, or gum disease, is a chronic infection of the tissues supporting the teeth, including periodontal ligaments and bone surrounding the teeth. A range of studies show that adults with South Asian origin have disproportionately high rates of diabetes and prediabetes, which are both powerful accelerators of periodontal disease. A similar relationship exists with periodontal disease and cardiovascular disease; bacteria from infected gums can enter the bloodstream, causing inflammation that promotes plaque buildup in blood vessels and increasing stroke and heart attack risk. With the right oral health practices and clinical monitoring, gum disease can be detected and maintained in its early stages. However, among South Asian immigrant populations, periodontal disease often goes undetected until it becomes severe.
This isn’t a coincidence. Beliefs like my grandmother’s are far from unique among South Asian immigrants; many arrive in the United States with deep cultural traditions but limited exposure to preventative dental practices. It can be hard to understand that your gums can suffer even if your teeth are fake, and that flossing may cause bleeding initially but is ultimately a prevention strategy. A psychology study performed at La Trobe University found that South Asians tend to underutilize dental services, choosing only to seek care when symptoms become severe, despite alarming statistics indicating that South Asians represent 64 percent of global periodontal disease cases.
As a dental assistant in Seattle, I see patients of South Asian descent almost every day who rarely report flossing at all, let alone regularly. I’ve also noticed that many South Asian patients react to diagnoses of periodontal disease with a reluctance to pursue treatment, often facing multiple barriers to care. One patient I worked with left the clinic without treatment despite a detailed explanation of his X-rays and periodontal disease diagnosis from the dentist. His concerns centered around the cost of the scaling and root planing treatment, questioning whether it was necessary if he was not experiencing pain. Since periodontal disease lacks obvious daily symptoms, it is easy for many patients to dismiss it as “fake” and forgo treatment.
Cultural understandings of oral hygiene in South Asia clash with Western preventative practices, leading to hesitation and confusion surrounding routine care. Language barriers also exacerbate the oral health literacy gap within this community. Despite being one of the fastest-growing immigrant groups in the U.S., South Asians routinely lack access to linguistically appropriate services. Although 92 percent of health care facilities include Hindi/Urdu as a language option on Video Remote Interpretation, as much as 45 to 50 percent of South Asians in the U.S. speak a language other than Hindi/Urdu and would need specialized interpretation services. Understanding periodontal disease is already a confusing concept for many patients; compounded with limited English, it becomes particularly challenging to understand the disease’s implications and how to prevent it from getting worse.
How can we help?
Data from community-based oral health interventions have demonstrated significant improvements in periodontal health when education and screening programs are culturally tailored and linguistically accessible. In 2017, the National Institutes of Health conducted the Sikh American Families Oral Health Promotion Program in gurdwaras (Sikh places of worship) across New York and New Jersey. Sikh educators explained the risk factors associated with oral health problems such as periodontal disease, higher cavity risk, and other factors like diabetes and predisposition to heart disease. They spoke in Punjabi, a language that many Sikh families speak at home, and used examples that related directly to what the families were experiencing: unfamiliarity with their new home, nostalgia for their childhood and where they grew up, and how to navigate something unknown.
Preventative dental programs like Sikh American Families Program offer a successful template for future interventions for immigrant communities. Meeting communities where they are could include expanding public health programs that offer free or low-cost periodontal screenings in cultural centers or places of worship. Since diabetes, cardiovascular health, and periodontal disease are intricately linked, medical departments focusing on diabetes and cardiovascular care should also refer at-risk patients to dental clinics for periodontal screenings. Expanding insurance coverage for preventative dental care, especially in states with large South Asian immigrant populations like New Jersey and California, would bring these communities much closer to accessing the fundamental health care they need.
What can you do?
Systemic change requires community action. Talking to relatives, neighbors, and friends about oral health can get them thinking about their own oral hygiene habits, and how cavities are not the only oral issue you can have. Proposing dental education events to local clinics and cultural organizations and supporting policies can help expand preventative dental coverage. By challenging the misconception that dental care is optional, we can educate about the connection between teeth, natural or implanted, and overall health. The ultimate goal is to bridge the gap in oral health literacy and attack the root of the periodontal disease problem in South Asians and other immigrant populations, especially given the U.S.’ current political climate. Expanded programs and frequent conversations will make it harder for people like my grandmother to avoid their dentists and chip away at the cultural beliefs that keep too many South Asians from seeking proper care. With time and better outreach, families like mine won’t need to debate whether flossing widens gaps; they’ll simply see it as a part of being healthy. But for now, I’ll keep nagging my grandmother.
Varsha Mantravadi is an undergraduate student.
