Hispanic people represent 15 percent of the total number of dentin hypersensitivity sufferers in the United States.1 However, many Hispanic people may not seek treatment for this or other potential oral health conditions due to a language barrier or a lack of convenient access to care. In fact, only 8.5 percent of Hispanics suffering from dentin hypersensitivity treat their pain with a desensitizing toothpaste, compared with 22 percent of total sufferers.2 Dental hygienists play a significant role in identifying and managing dentin hypersensitivity, as well as educating patients about an easy-to-obtain and effective treatment for their pain.
What the growing Hispanic population means for hygienists
The Hispanic population in the United States grew by a dramatic 58 percent between 1990 and 2000, according to the U.S. Census Bureau.3 By 2020, it is predicted that Hispanics will make up 16 percent of the total population.4 This growth pattern has prompted dental professionals to address the specific needs of these patients, especially regarding access to treatment and effective communication.
Dietary habits may have specific implications for Hispanic oral health, especially for those who have immigrated to the United States. Dentin hypersensitivity is one of several conditions that may affect Hispanic people, which is partly due to dietary habits. Communicating with patients about tooth pain related to sensitivity can go a long way toward managing this often under-reported condition.
The word “Hispanic” describes a large but diverse population that shares Spanish as a native language. Latino often is used interchangeably with the word Hispanic in American English; however, Latino technically refers to people of Latin American descent, while Hispanic denotes a broader population group. The category includes Spanish-speaking people living in the United States who have ancestry from Mexico, Spain, Puerto Rico, Cuba, Central and South America, and other Spanish-speaking regions. Despite their diverse heritage, data shows that Hispanic people often face common challenges related to cultural, language, and legal barriers in accessing health care, including oral health treatment.5 And data from the United States Department of Health has shown that Hispanics have some of the lowest usage rates of dental care, and are at high risk for being uninsured.6
Once in a dentist’s chair, language and cultural barriers also may prevent Hispanic people from obtaining adequate care. Hispanic people may have a general apprehension of the health care system and care providers, which may prevent them from communicating openly. Past experiences with the dental care system and cultural values also may impact a patient’s decision about complying with a suggested treatment regimen.7
Dentin hypersensitivity sufferers, especially, may refrain from visiting their dental professional or alerting them to their sensitivity. Data shows that 42 percent of both Hispanic and non-Hispanic patients in the United States do not inform dental professionals of tooth sensitivity8 and often are not aware that their pain may be relieved with an easy-to-obtain, at-home treatment.
Dentin hypersensitivity - a common problem
Up to 20 percent of the total United States population suffers from dentin hypersensitivity, which is defined as a short, sharp pain arising from exposed dentin, in response to stimuli.9 Intensity of the pain can vary from day to day and person to person; however, it often is triggered by foods and beverages. Both sweet and sour, or acidic foods and beverages are among the common triggers. One explanation for this may be that frequent consumption of acidic foods can contribute to erosion of the dental enamel,10 which may bring about rapid loss of the smear layer and opening of the dentinal tubules, potentially leading to dentin hypersensitivity.11 A review of the shopping and eating habits of Hispanic people shows that both acidic and sweet foods are largely prevalent in their diets.12,13 As such, Hispanic people may have a greater potential for suffering from dentin hypersensitivity.
If dentin hypersensitivity is suspected, a clinical examination may be required to rule out other conditions. Once dentin hypersensitivity is diagnosed, dental professionals should begin with the most conservative approach to treatment. In many cases, a dentifrice containing 5 percent potassium nitrate, such as Sensodyne® (GlaxoSmithKline Consumer Healthcare), is all that is required for relief.
Dental professionals can feel comfortable advising patients to brush with a 5 percent potassium nitrate toothpaste twice daily, and should advise patients to continue using the toothpaste for long-term relief. Professionals also should carefully ensure that treatment instructions are communicated effectively. In some cases, help from an interpreter or caregiver may be necessary to help patients understand the information. Educational materials that are written in Spanish also may be of assistance. Dental professionals can access materials that can be customized and used for patient education at www.dental-professional.com.
Hygienists can make a difference
Dental hygienists can play an important role in identifying and managing dentin hypersensitivity in all patients. This is especially important among Hispanic patients, as data shows Hispanic people have less opportunity for access to dental care and may have a greater potential for suffering from the condition. They also may not proactively inform their dental professional of their pain, because they fear a more serious condition.
Dental hygienists can help alleviate dentin hyper-sensitivity by asking specific questions at each patient visit, and by advising patients to use an anti-sensitivity toothpaste that contains 5 percent potassium nitrate, such as Sensodyne. Patients will be relieved to know their pain can be eased with an easily accessible and effective treatment.
Kathy Alvarez, RDH, currently is an associate professor in the dental hygiene department at Cypress College in Cypress, Calif., and adjunct faculty in the Department of Dental Hygiene at West Los Angeles College. Kathy is past president of the Hispanic Dental Association, the American Dental Hygienists’ Association, the California Dental Hygienists’ Association and the South Bay Dental Hygienists’ Society.
1,2 WSI Incidence Study 2001
2 U.S. Census Bureau, Current Population Survey. March 2000
3Aldrich L, Variyam J. Acculturation erodes the diet quality of U.S. Hispanics. FoodReview. 23(1); 2000: 51-55.
4 Crall. Imrpoving the oral health of Hispanic populations: challenges and opportunities. Compendium. 2002; 23(12): 5-8.
5 Healthy People 2010 Objectives. US Dept. of Health and Human Services, Office of Disease Prevention and Health Promotion. Available at http://web.health/gov/healthypeople. (accessed March 2, 2005).
6 Cruz. Barriers that affect achieving and maintaining oral health among Hispanics. Compendium. 2002: 23(12).
7 GlaxoSmithKline: Data on file
8 Holland, G.R., Narhi, M.N., Addy, M., et al. Guidelines for the design and conduct of clinical trials on dentine hypersensitivity. J Clin Periodontal 1997, 24:808-813.
9 Shipley S, Taylor K, Mitchell W. Identifying causes of dental erosion. General Dentistry 53(1); 2005: 73-75.
10 Addy M. Dentine hypersensitivity: new perspectives on an old problem. Int Dent J. 52; 2002: 367-375.
11 Mathews, R. Hispanic food preferences continue to diversify. Grocery Marketing. 57(11); 1991: 12-18.
12 Jones D., Darling M. Ethnic Foodways in Minnesota: handbook of food and wellness across cultures. University of Minnesota Press. 1996. Available at: http://www.agricola.umn.edu/foodways/ (accessed March 2, 2005).
Questions to ask ...
... in two languages
Many patients avoid certain foods or beverages to prevent the pain of dentin hypersensitivity and may not be aware that the pain is treatable. Dental professionals can help identify and treat patients who are suffering from dentin hypersensitivity by engaging them in a dialogue at each visit. In some cases, a language barrier may prevent effective communication between both parties, so it is important to ask specific questions related to a patient’s pain.
The following questions can be asked when inquiring about dentin hypersensitivity:
1 Do you avoid any specific foods or beverages that cause tooth sensitivity or pain?
2 Do you experience discomfort from cold or hot foods or beverages such as ice cream or coffee?
3 Do you experience discomfort from sweet foods or beverages or desserts?
4 Do you experience discomfort from foods or beverages that are acidic, such as tomato products or fruit juices?
The same questions in Spanish are included below:
1 ¿Evita usted ciertas comidas o bebidas específicas que le producen malestar o dolor en los dientes?
2 ¿Le causan molestias las comidas o bebidas frías o calientes, como el helado o el café?
3 ¿Le causan molestias las comidas, las bebidas o los postres dulces?
4 ¿Le causan molestias las comidas o bebidas ácidas, como los productos derivados del tomate o los jugos de fruta?