Refugee Child Oral Health with Dr. Elisha Riggs

Dr. Elisha Riggs, author of the concise review published in Oral Diseases (July 2016), spoke with Dr. Chiraz Guessaier about the review and its implications for oral health interventions for refugees. 

Highlights

This topic is of increasing importance as we witness the global movement of people fleeing their homes. Countries, services and healthcare professionals should be prepared to meet the needs of refugees as they work towards settling into a new country after a, sometimes, traumatic journey.

The latest evidence regarding supporting children and their families with respect to oral health needs includes:

1. Barriers in accessing oral care
Overall, parents want their children to be healthy; however, there are many unfamiliar services and items that preclude taking care of their oral health. As an example, traditionally, many refugees used a traditional and natural plant to take care of their teeth. This is both part of their cultural and sometimes, religious custom. Unfortunately, parents are unable to purchase fresh “Miswack” stems for their children to use or the powdered form of the plant for themselves. This impacts they way in which they care for their oral health. Furthermore, many people are not familiar with toothbrushes and toothpaste.

2. Influence of a new diet and dietary shifts
Several families have found a significant difference between the foods and diet they would normally eat in their own countries and those found in their new countries. The shift to more processed food and higher sugar in the diet has had an adverse impact. Because most refugee children have not had the luxury of having these types of foods, parents purchase the “treats” for their children. Additionally, at times, the cost of fresh food items compared to processed foods make these purchases more cost-effective for a newly settled family. In other situations, newly arrived refugee families may not be able to find or access the foods that they would normally eat in their own countries.

3. Barriers to service access
Families or individuals endure a long and challenging journey when settling into a new country and certain things take a higher priority over others. Language is a big barrier when trying to access services. Even with good health literacy in their own countries, navigation of health services in a new context can be very challenging. As such, they need to be supported during the settlement and beyond with information in their native tongue.

4. Dental care for children is required upon arrival
One of the issues in providing care for refugee children is the lack of good information about patients. It is difficult to identify this population and there is inconsistency in terms of the information that is obtained from families and patients. It is important to understand the family’s or individual’s migration history. There are multiples ways in which refugees may enter the country – resettlement programs, sponsorships, refugee status.

Interventions
• Prompt dental care on arrival can help recovery and settlement
• Trauma-informed care which takes into account that several patients may have survived previous traumatic experiences
• Provision of skilled and confident service
• Use of community health care workers who are trained to work in a health care setting, help refugees navigate the health system and share their cultural values
• Multidisciplinary workforce and coordinated services

Professional associations can be more proactive in helping to build capacity and confidence in their members to work with refugee populations. Focussed development training can be created to help clinicians understand what patients may be feeling and what they may have experienced. The importance of communication in one’s own language is crucial and it is important for staff and clinicians to know how to work with translators and interpreters. Additionally, resources printed in the native language of the patient are comforting and useful to patients.