Vietnam, capitol Hanoi, is a Southeast Asian country bordered by Cambodia, China, Laos and Malaysia with the Vietnamese dong as the national currency. The national language is Vietnamese with few confident English speakers despite learning it in school, but due to the history of one thousand years of Chinese occupation and French colonization in the late 19th to the early 20th century, minority languages spoken include both French and Chinese (Lonely planet, 2019).
Japanese invasion and control of Hanoi in 1940 caused resistance and saw the formation of the communism – anti-colonialists established under Ho Chi Minh, who resisted and destabilized the French and Japanese forces. In 1945, Ho Chi Minh declared the independence of Vietnam, however this was soon followed by strife between the Communist North and Anti-communist South, resulting in the taking over of the South in 1975. The reunification of Vietnam occurred in 1976, with Saigon being changed to Ho Chi Minh City, and it is currently governed as a communist state through a one-party system (Cultural Atlas, 2019).
Vietnam is officially declared an atheist state with tight control being kept over the organization of religious groups by the Vietnamese government, therefore it is illegal for foreigners to perform religious services without government approval. Around 20 percent of the population identify with registered religions including Buddhist, Catholic and Christian. It is estimated that many people practice folk religions such as Buddhism, Confucianism and Taoism, and may consider their traditional worship as a ‘philosophy’ or way of life rather than a religion (Cultural Atlas, 2019).
Modesty is considered a key part of the culture (Cultural Atlas, 2019) as well as the custom of ‘saving face’. These indicate a person’s reputation, influence, dignity and honor. Thus, while travelling in Vietnam, one should avoid public displays that could compromise reputation and avoid loud arguments, making a scene, berating others for mistakes or pointing out anything that would cause locals to feel shamed (Vietnam National Administration of Tourism, 2019).
Greetings and respect for the elders is considered important in Vietnam. When greeting, one should address them by their title and first name, shaking hands (sometimes using 2 hands) and bowing their heads or lowering the gaze of the younger person to indicate respect. It is important to note that it is uncommon for women to shake hands with men (or each other), so one should wait for the woman to extend her hand first (Cultural Atlas, 2019).
I believe good oral health is reflected by a healthy and pain free mouth, that does not limit an individual’s capacity to bite, chew, smile and speak (Naseem et al., 2017). Oral health entails more than just having healthy teeth; it is vital for good general health and well-being of both the biological and psychosocial sides, and does not diminish our quality of life. This implies being free of chronic orofacial pain, oral and pharyngeal cancer, oral tissue lesions, birth defects and other diseases or disorders that affect the craniofacial complex (WHO, 2019) and may affect our psychological and social well-being.
Good oral hygiene practices involve using a combination of effective home care and dental visiting habits to attain good oral health. This includes:
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- Brushing for two minutes twice a day, using either a manual or electric tooth brush and a fluoride toothpaste, and making sure to use the correct technique (modified bass);
- Spitting out the toothpaste and not rinsing afterwards to allow the fluoride to take effect;
- Replacing the toothbrush every 3 months;
- Flossing at least once a day after brushing or using other interdental cleaning products;
- Rinsing with a fluoride mouthwash or chewing sugar free gum with xylitol after meals and snacks;
- Wearing a mouth guard when engaging in contact sports;
- Having regular check-ups to detect and treat early signs of oral disease (FDI World Dental Federation, 2019).
It is both the dentist’s and the patient’s responsibility to ensure that good oral hygiene habits are being practiced and used effectively. Thus, what I value the most about patients is how rewarding it is to see them walk away with better oral health and often more confidence. Every day we meet different people from all walks of life and are given different situations to work with, but the appreciation for the work we do for the patient never changes and so does the sense that you’ve made a positive change for someone’s health. This not only makes being a dentist a really rewarding career, but also makes it very interesting and dynamic as you’re always discovering new things and you never stop learning throughout your career.
Health beliefs in Vietnam are often based on the balance of yin and yang (opposing forces), where an imbalance of these forces is believed to lead to disease (Duong Nguyen, 1985). Vietnamese people may also view good oral health to be of a lower standard and is often given lower priority than what has been discussed above. Studies have shown that the prevalence of caries amongst adults is high and overall, patients were more likely to have a reduced dentition, with low number of filled teeth but relatively high numbers of decayed or missing teeth (impacting mainly molars). At age 20, subjects had an average of 14 sound teeth, decreasing gradually until 6 at the age of 80 (Nguyen et al., 2010).
However, despite the large number of oral diseases reported in Vietnam, more than half of these patients do not use health faculties, with most patients choosing to self-medicate or have no treatment. Thus, delay or no treatment is highly prevalent despite the significant social and psychological impact the oral diseases may be causing the patients. Some of the barriers that may have contributes to this include education level, perceived importance of oral health, perceived benefits of visits and availability of care (Dao et al., 2015).
Where dental care is pursued, it is usually for symptomatic reasons instead of preventative purposes (Dao et al., 2015) with many patients not believing in the need for surgical and invasive techniques, except for as a last resort (Duong Nguyen, 1985). Therefore, for the vast majority of patients, relief from pain is what they value most about visiting the dental clinic, with extraction being the most common treatment for caries (Nguyen et al., 2010).
The current oral health status of the population in Vietnam was explored in a recent study. Findings state that the DMFT scores in subjects over 45 ranged from 6.09 to 11.66 and there were higher numbers of missing teeth compared to filled teeth with the mean number of missing teeth increased from 1 in each jaw at age 20, to 8 at age 80. Absent anterior teeth are considered to impact more on oral function than absent molar teeth, thus, using the concept of a shortened dental arch, the focus of most practices is to preserve anteriors and premolars to preserve adequate oral function (Nguyen et al., 2010).
Analyzing the statistics above, I believe the majority of patients we’ll see in Vietnam, regardless of the setting, will be for symptomatic reasons, including caries and periodontal issues, and rarely for preventative purposes. The focus of dental hospital will be on emergency procedures, whereas the primary school and private practices may be more concentrated towards preventative and aesthetic measures such as placement of fissure sealants and orthodontics.
However, currently in Vietnam there are insufficient dental resources and active dentist with nearly half of the nation’s rural districts having no dentists at all. The majority of the nation’s wealth and clinics tend to be concentrated in urban centers and even then, the ratio of dentists to the total population can range from 1:178 500 to 1:13 400. Incentives such as scholarships and stipends have been given to the number of practitioners in rural areas, but conditions make rural areas unappealing (Vu, 2013). Nationwide water fluoridation has been proven effective in preventing dental caries however 70% of the rural population do not benefit from it (Peterson et al., 2012).
In conclusion, the lack of oral health policies precludes not only proper intervention, but also the designing and implementation of health promotion and disease prevention activities (Kandelman et al., 2012). The World Health Organization has stated that a major reason for the lack of success of many oral health programs is that they operate in isolation, separate from the general health care structure. It is therefore important that any oral health promotion strategy is integrated into a national health promotion strategy. For future programs to be executed effectively, more effort needs to be spent from all areas (i.e., the government, communities, health centers, families) to make oral health a higher priority. Regional or district level programs can be created to better suit local needs, and each population should be investigated separately prior to program creation, with a trial period included before implementation on a larger scale.