Oral health as perceived by Karen people living with tooth loss and non-communicable: a case study of Doi Luang, Chiang Rai, Thailand

Background: Oral health examination, as part of a comprehensive healthcheck-up, is free of charge for people living with non-communicable diseases (NCDs)in Thailand as there’s a strong connection between diabetes and periodontitis. However,the use of this service among hill tribe population has been low. Objective: Theobjectives of this study were to explore 1) how Karen adults and older adults livingwith NCDs define oral health, and 2) how Karen culture influenced their oral healthrelated issues. Methods: The researchers selected Norpagor subdistrict as our studysetting because it was the catchment area for primary care of Doi Luang Hospital, wherethe first author of this study was responsible for delivering the oral health services. Theresearchers selected Karen people because they were the largest hill tribe in Thailandand studies regarding oral health of Karen elders in Northern Thailand is still scarce.The researchers recruited all Karen people of Norpagor who had NCDs and fit ourselection criteria such as 1) being 40 years old or over and 2) not being the end-of-lifepatient. First, the researchers performed a brief oral health examination using a criterionpromoted by the Dental Bureau, Ministry of Health based on number of remainingteeth. Also, the researchers measured the participants’ chewing performance using acolor-changeable chewing gum to see the mixing ability. Second, the researchersselected 12 participants who did not pass either the number of teeth or chewing abilitycriteria for a semi-structured face-to-face interview by translator. A dental assistant whospoke Karen language was present at all interviews to aid with any translation needed.Interviews were recorded and transcribed verbatim. Both authors employed aninductive thematic content analysis and end the fieldwork findings analysis when itreaches data consensus. Results: Twenty-seven people (69%) had more than 20 teethand passed the chewing test. Eleven people (28%) neither had adequate number of teethor chewing performance. Interestingly, one person (3%) passed the chewing gum testeven with fewer than 20 teeth/4 occluding posterior teeth. Three common themesemerged from the interviews: 1) Good oral health was defined as having no pain, beingable to enjoy food varieties, and being able to eat socially, but interestingly there wasno concern about nutritional status); 2) Tooth loss is part of life but not necessarily partof general health; 3) Oral health problems are “bearable” and “could be manageable bymyself”. Conclusion: The findings may help dental professionals to better understandthe perceived needs by the patients. The use of dental services may be promotedaccording to what Karen people find meaningful. Also, oral health examination mayinclude testing of oral function such as chewing ability, which may not necessarilycorelate with the number of remaining teeth.