12 Oh Canada!
Summer Issue - 2017
Focus: Cultural Awareness: Working with First Nations or Ethnic Populations
Dental Hygiene
Focus:
Fire Flaring Up:
Intercultural Dental Hygiene Practice
by Maggie Wen, MSc, RDH pracwelltoday@gmail.com
One sunny afternoon, a new client arrived at our practice
in Vancouver, BC. She was a pleasant Asian lady in her
early sixties and this was her first time seeing a dental
hygienist in Canada. She sat down in my chair and
immediately told me that my gums hurt and they bleed
when I brush. I think my fire levels are up.
WaitWhat fire was she talking about?
Fortunately, I grew up in a family that believed in traditional
Chinese medicine (TCM) and I also practiced dental
hygiene in Singapore, so this was not the first time that
clients had described their symptoms to me in those words.
According to TCM, the human body is believed to have
a harmonious and intricate relationship with nature.1 The
body is made of five essential elements: metal, wood,
water, fire, and earth.2 A person is healthy when all the
body elements are in balance, and a person falls sick when
any of the five elements is out of balance.2
Cultural Awareness: Working with
First Nations or Ethnic Populations
TCM also asserts that many food and herbal products
provide either hot or cold energy.2 Food with hot energy
is believed to increase ones fire levels. Overconsumption
of hot energy will lead to a condition known as shang huo,
or fire flaring up.1 Its typical signs include sore throat,
blisters on the lips, toothaches, and gum bleeding.2 It is
believed that an imbalance of fire levels can be resolved
by consuming products with cold energy. Some examples
of hot products include tropical fruits, spicy or deep-fried
foods, and alcohol. Cold foods include orange peels,
watermelon, green tea, green vegetables, honey,
and green beans.
With this knowledge in mind, I asked my client if she was
doing anything to bring down the fire levels. However, I
was in for a small surprise. She told me she was using an
oral spray she brought from China, and it contained Niu
Huang. What is that?
A quick online search showed that Niu Huang are cattle
gallstones, considered to be a source of cold energy. They
are widely used in TCM to alleviate fire, which can manifest
itself as redness, pain, and swelling.3 Niu Huang is available
in pills, gels, and oral sprays and can be purchased
over-the-counter in many East Asian countries (Figure 1).
In published literature, Niu Huang has been shown to
have anti-inflammatory effects in animal trials, but large
double-blind human trials have yet to be conducted.3
When communicating with clients of different cultures,
the first step to building rapport is always acknowledging
their existing beliefs and practices.4 A clinician can then
determine whether these practices are beneficial, neutral or
harmful to the clients health and provide treatment options
accordingly (Figure 2).
14 Oh Canada! Summer Issue - 2017

Focus: Cultural Awareness: Working with First Nations or Ethnic Populations

>>>> Dental Hygiene Focus
Fire Flaring Up...contd

Acknowledge

Beneficial Mutual Harmful

Continue Keep the Modify practice;

with the practice along receive clinical
practice with clinical treatment
treatment

Figure 1. Examples of over-the-counter products containing Niu Figure 2. Assessment of culturally based oral hygiene practices
Huang and other herbal supplements believed to reduce fire (adapted from: Darby ML, Walsh M. Dental Hygiene Theory
levels in the human body. Photo credit: Maggie Wen and Practice.4)

Upon examining my client intraorally, I found extensive References

heavy supra- and subgingival calculus, pockets over 6 mm, 1. Unschuld PU. Traditional Chinese medicine: some
historical and epistemological reflections. Soc Sci Med.
and bleeding on probing. Therefore, I offered to remove
1987;24(12):10231029.
the calculus to physically remove the toxins and relieve fire
toxicity that was irritating her gums. I also recommended 2. Chan E, Tan M, Xin J, Sudarsanam S, Johnson DE.
Interactions between traditional Chinese medicines and
over-the-counter oral rinses to keep the fire levels down. Western therapeutics. Curr Opin Drug Discov Devel.
Meanwhile, she could keep using the Niu Huang spray since 2010;13(1):5065.
it was neither harmful nor beneficial to her oral health. The 3. Li T, Yang Z, Cai H-J, et al. Effects of in vitro cultivated
client felt happy and relieved that I understood her problems Calculus Bovis compound on pulmonary lesions in
and has returned for her recall visits ever since! rabbits with schistosomiasis. World J Gastroenterol.
2010;16(6):74954. doi:10.3748/wjg.v16.i6.749.
According to the 2011 census, 20% of Canadians are born 4. Darby ML, Walsh MM. Dental hygiene: Theory and
outside of Canada and 6.8 million Canadians identified a practice. 4th ed. St. Louis, MO: Saunders/Elsevier; 2015.
non-official language as their mother tongue.5 This number 5. Statistics Canada. 2011 census profile [Internet] [cited 2017
is expected to increase in the years to come. Therefore, May 29]. Available from: www12.statcan.gc.ca/census-
effectively integrating a clients socio-ethno-cultural recensement/2011/dp-pd/prof/index.cfm?Lang=E.
background into the dental hygiene process of care has
become more critical than ever. Aside from learning and
being mindful about the oral health practices of other
cultures, Ive always found the phrase CARE 4 (comfort,
acceptance, responsiveness, empathy) to be a great
reminder of our roles and responsibilities as health care
providers in our everchanging communities.
Or perhaps an ancient Chinese
proverb best summarizes it all:
a good communicator needs
eyes, ears, undivided attention,
and a true heart.