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Over the past several years our community has seen a huge increase in treating Karen people, mostly refugees from Burma. They are a very difficult population to treat. Very heavy, tenacious calculus and stain and most adult patients have moderate to severe periodontal disease. Wondering if any other RDHs have seen this population of people and how they approach treatment?



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4 Answers

I am a DHY student in Columbus, OH and we see many,many Burmese patients at our clinic! I agree with your statement that the majority of them have heavy stain and calculus. I had a 35 year old female patient who, once the mandibular anteriors were scaled, her teeth became very mobile to the point where I’m not sure if she can keep them much longer! I was the first cleaning she ever had. It would be interesting to research their culture to find out what about it causes their disinterest in their oral health.

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I have come across my fair share of people from other countries that had severe periodontal disease, heavy tenuous calculus and stain. I found that once everything was explained to the patient about the importance of needing a SRP followed up by regular maintenance appointments most were receptive to treatment. And because they wanted to keep their teeth they were compliant with homecare and regular dental visits. while language was sometimes a barrier it would take a little longer to explain but once they understood, it was ok and they would set up their appointments to start their treatments.

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There is a cultural custom of chewing on betel nut. Betel nut lends to a natural high for the person but also tends to add to the formation of heavy, tenacious calculus as well as heavy, heavy stain. Sometimes it can take four or more visits to remove the calculus and stain.
On the up side though, betel leaf and nut also have an anti caries effect so frequently we do not see these patients having much calculus.
The best treatment for these people would be to bring them in for a gross debridement (even though we do not do this procedure too often today unless we are trying to obtain probing depths). Use the ultrasonic and remove that outer layer and break up the matrix. Sometimes if you make a slurry of a paste of lab pumice with water or hydrogen peroxide and rub it on the areas it too will loosen the calculus a little for you. Then send the patient home with good home care instructions and a “tartar control” paste and have them return in a week for a follow up and continue this way until the calculus is removed. Always finish though with a finishing Gracey please.
Hope that this has been of some help.

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I worked in a perio office in Honolulu. Many of our patients had calculus that practically laughed at us when we tried to remove it. The ultrasonic with a good pink tip, very sharp instruments, files and a lot of patience is what worked for me and my patients.

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