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Oral Healthcare Challenges for Older Punjabi-Speaking Immigrants*

  • Michael I. MacEntee (a1), Sabrina T. Wong (a2), André Smith (a3), B. Lynn Beattie (a4), Mario Brondani (a1), S. Ross Bryant (a1), Peter Graf (a5) and Shimae Soheilipour (a6)...


This study explored how older Punjabi-speaking South-Asian immigrants (four focus groups; 33 participants) in Surrey, British Columbia, perceive oral health and related problems. Content analysis revealed two umbrella themes: (a) interpretations of mouth conditions and (b) challenges to oral health. The umbrella themes had four sub-themes: damage caused by heat (wai), disturbances caused by caries, coping with dentures, and quality of life. Three challenges were considered: home remedies, Western dentistry, and difficulties accessing dentists. Participants explained oral diseases in terms of a systemic infection (resha), and preferred to decrease imbalances of wai in the mouth with home remedies from India. We conclude that older Punjabi-speaking immigrants interpret oral health and disease in the context of both Western and Ayurvedic traditions, and that they manage dental problems with a mix of traditional remedies supplemented, if possible, by elective oral health care in India, and by emergency dental care in Canada.

Cette étude a exploré comment les immigrants âgés d’origine sud-asiatique, parlant le pendjabi (quatre groupes de discussion; 33 participants) de Surrey en Colombie-Britannique, perçoivent leur santé buccale et les problèmes connexes. L’analyse a relevé deux thèmes généraux: les interprétations de la condition bucco-dentaire et les défis de santé bucco-dentaire. Le thème des interprétations avait quatre sous-thèmes: les dommages causés par le wai, les perturbations causé par la carie, l’adaptation aux prothèses dentaires, et qualité de vie; alors que le thème des défis considérés: remèdes à domicile, dentisterie occidentale; et difficultés d’accès aux dentistes. Les participants ont expliqué les maladies bucco-dentaires en termes d’une infection systémique (resha) et ont dit préféré les remèdes faits maison pour diminuer les écarts de chaleur (wai) dans la bouche. Nous concluons que les immigrants âgés d’origine sud-asiatique parlant le pendjabi interprète la santé et les maladies bucco-dentaires dans un contexte mixte de traditions occidentales et Ayurvédique, et gèrent leur santé buccale au moyen de remèdes traditionnels faits maison, complémentés au besoin par des soins d’urgence dispensés au Canada.


Corresponding author

La correspondance et les demandes de tirés-à-part doivent être adressées à: / Correspondence and requests for offprints should be sent to: Michael I. MacEntee, LDS(I), FRCD(C), Ph.D. Department of Oral Health Sciences University of British Columbia 2199 Wesbrook Mall Vancouver, BC V6R 2X3 (


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This study was supported by funding from the Canadian Institutes for Health Research (Operating Grant # FRN-77375). We are grateful to Kathy Hornby for her contribution to the research proposal and the library searches.



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Boeije, H. (2002). A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality & Quantity, 36(4), 391409.
Bonikowska, A., Green, D. A., & Riddell, W. C. (2008). Literacy and the labour market: Cognitive skills and immigrant earnings. International adult literacy survey. Ottawa: Statistics Canada. Catalogue number 89-552-M No. 020. Retrieved 17 July 2013 from
Brar, B. S., Norman, R. G., & Dasanayake, A. P. (2012). Involvement of Ayurvedic practitioners in oral health care in the United States. Journal of the American Dental Association, 143(10), 11201126.
Brondani, M. A., Bryant, S. R., & MacEntee, M. I. (2007). Elders assessment of an evolving model of oral health. Gerodontology, 24(4), 189195.
City of Surrey. (2009). City of Surrey: Citizenship and immigration fact sheet. Surrey, British Columbia: City of Surrey. Retrieved 17 July 2013 from
Gerritsen, A. E., Allen, P. F., Witter, D. J., Bronkhorst, E. M., & Creugers, N. H. J. (2010). Tooth loss and oral health-related quality of life: A systematic review and meta-analysis. Health and Quality of Life Outcomes, 8(126), 111.
Gurm, B. K., Stephen, J., MacKenzie, G., Doll, R., Barroetavena, M. C., & Cadell, S. (2008). Understanding Canadian Punjabi-speaking South Asian women’s experience of breast cancer: A qualitative study. International Journal of Nursing Studies, 45(2), 266276.
Hartzell, J. F., & Zysk, K. G. (1995). Health, science, and the spirit: Veda and Ayurveda in the Western world. Journal of Alternative and Complementary Medicine, 1(3), 297301.
Health Canada. (2010). Report on the findings of the oral health component of the Canadian Health Measures Survey 2007–2009 (Table 25). Ottawa: Author. Retrieved 17 July 2013 from
Hilton, B. A., Grewal, S., Popatia, N., Bottorff, J. L., Johnson, J. L., Clarke, H., et al. (2001). The desi ways: Traditional health practices of South Asian women in Canada. Health Care for Women International, 22(6), 553567.
Hufford, D. (2002). CAM and cultural diversity: Ethics and epistemology converge. In Callahan, D. (Ed.), The role of complementary and alternative medicine: Accommodating pluralism (pp. 1535). Washington, DC.: Georgetown University Press.
Kay, E. J., Shaikh, I., & Bhopal, R. S. (1990). Dental knowledge, beliefs, attitudes and behaviour of the Asian community in Glasgow. Health Bulletin, 48(2), 7380.
Koehn, S., Spencer, C., & Hwang, E. (2010). Promises, promises: Cultural and legal dimensions of sponsorship for immigrant seniors. In Durst, D. & MacLean, M. (Eds.), Diversity and aging among immigrant seniors in Canada: Changing faces and greying temples. Calgary, AB: Detselig.
Krause, I-B. (1994). Numbers and meaning: A dialogue in cross-cultural psychiatry. Journal of the Royal Society of Medicine, 87(5), 278282.
Kwan, S. Y., & Williams, S. A. (1999). Dental beliefs, knowledge and behaviour of Chinese people in the United Kingdom. Community Dental Health, 16(1), 3339.
Lincoln, Y. S., & Guba, E. G. (2003). Paradigmatic controversies, contradictions, and emerging confluences. In Denzin, N. K. & Lincoln, Y. S. (Eds.), The landscape of qualitative research: Theories and issues (pp. 253291). Thousand Oaks, CA: Sage.
MacEntee, M. I. (2006). An existential model of oral health from evolving views on health, function and disability. Community Dental Health, 23(1), 514.
MacEntee, M. I., Hole, R., & Stolar, E. (1997). The significance of the mouth in old age. Social Science and Medicine, 45(9), 14491458.
MacEntee, M. I., Marińo, R., Wong, S., Kiyak, A., Minichiello, V., Chi, I., et al. (2012). Discussions on oral health care among elderly Chinese immigrants in Melbourne and Vancouver. Gerodontology, 29(2), 822832.
MacEntee, M. I., Wyatt, C. C. L., Kiyak, H. A., Hujoel, P. P., Persson, R. E., Persson, G. R., et al. (2002). Response to direct and indirect recruitment for a randomized dental clinical trial in a multicultural population of elders. Community Dentistry and Oral Epidemiology, 30(5), 377381.
Mackenzie, E. R., Taylor, L., Bloom, B. S., Hufford, D. J., & Johnson, J. C. (2003). Ethnic minority use of complementary and alternative medicine (CAM): A national probability survey of CAM utilizers. Alternative Therapies in Health and Medicine, 9(4), 5056.
Malenfant, E. C., Lebel, A., & Martel, L. (2010). Projections of the diversity of the Canadian population 2006 to 2031. Ottawa, ON: Statistics Canada. Catalogue no. 91-551-X. Retrieved 17 July 2013 from
Marshall, E., Wong, S. T., Levesque, J. F., & Haggerty, J. L. (2010). Perceptions of unmet health care needs: What do Punjabi and Chinese-speaking immigrants think? BMC Health Services Research, 10(46). Retrieved 17 July 2013 from
Maxwell, J. A. (2013). Qualitative research design: An interactive approach (3rd ed.) (pp. 107120), Thousand Oaks, CA: Sage.
Newbold, K. B., & Patel, A. (2006). Use of dental services by immigrant Canadians. Journal of the Canadian Dental Association, 72(3), 143.
Newton, J. T., Khan, F. A., Bhavnani, V., Pitt, J., Gelbier, S., & Gibbons, D. E. (2000). Self assessed oral health status of ethnic minority residents of South London. Community Dentistry Oral Epidemiology, 28(6), 424434.
Ng, E., & Omariba, D. W. R. (2010). Health literacy and immigrants in Canada: Determinants and effects on health outcomes. Ottawa, ON: Health Analysis Division, Statistics Canada. Retrieved 17 July 2013 from
Ng, E., Wilkins, R., Gendron, F., & Berthelot, J.-M. (2005). Dynamics of immigrants’ health in Canada: Evidence from the National Population Health Survey: Healthy today, healthy tomorrow? Findings from the National Population Health Survey. Ottawa, ON: Statistics Canada. Catalogue no. 82-618; 2:111.
Omariba, D. W., & Ng, E. (2011). Immigration, generation and self-rated health in Canada: On the role of health literacy. Canadian Journal of Public Health. Revue Canadienne de Santé Publique, 102(4), 281285.
Patton, M. Q. (2001). Qualitative research and evaluation methods. Thousand Oaks, CA: Sage.
Roth, M., & Kobayashi, K. M. (2008). The use of complementary and alternative medicine among Chinese Canadians: Results from a national survey. Journal of Immigrant and Minority Health, 10(6), 517528.
Sandhu, D. S., & Heinrich, M. (2005). The use of health foods, spices and other botanicals in the Sikh community in London. Phytotherapy Research, 19(7), 633642.
Saper, R. B., Phillips, R. S., Sehgal, A., Khouri, N., Davis, R. B., Paquin, J., et al. (2008). Lead, mercury, and arsenic in US- and Indian-manufactured Ayurvedic medicines sold via the Internet. Journal of the American Medical Association, 300(8), 915923.
Scott, B. J., Leung, K. C., McMillan, A. S., Davis, D. M., & Fiske, J. (2001). A transcultural perspective on the emotional effect of tooth loss in complete denture wearers. International Journal of Prosthodontists, 14(5), 461465.
Shariati, B., MacEntee, M. I., & Yazdizadeh, M. (2013). The economics of dentistry: A neglected concern. Community Dentistry Oral Epidemiology, 41(5), 385–94.
Statistics Canada. (2007a). Surrey, British Columbia (Code 5915004) (table). 2006 community profiles: 2006 census. Ottawa, ON: Author. Catalogue no. 92-591-XWE. Released 13 March 2007. Retrieved 17 July 2013 from
Statistics Canada. (2007b). The South Asian community in Canada. Ottawa, ON: Author. Retrieved 17 July 2013 from
Statistics Canada. (2012). Surrey, British Columbia (Code 5915004) and British Columbia (Code 59) (table). Census profile: 2011 census. Ottawa, ON: Author. Catalogue no. 98-316-XWE. Released 24 October 2012. Retrieved 17 July 2013 from
Suinn, R. M. (2010). Reviewing acculturation and Asian Americans: How acculturation affects health, adjustment, school achievement, and counselling. Asian American Journal of Psychology, 1(1), 517.
Thorne, S. (2000). Data analysis in qualitative research. Evidence-Based Nursing, 3(3), 6870.
Thorne, S., Kirkham, S. R., & O’Flynn-Magee, K. (2004). The analytic challenge in interpretive description. International Journal of Qualitative Methods, 3(1). Article retrieved 16 March 2014 from∼iiqm/backissues/3_1/pdf/thorneetal.pdf.
Turcotte, M., & Schellenberg, G. (2007). A portrait of seniors in Canada 2006. Ottawa, ON: Statistics Canada. Catalog no. 89-519-XIE. Retrieved 17 July 2013 from
Wallace, B., & MacEntee, M. I. (2012). Access to dental care for low-income adults: Perceptions of affordability, availability and acceptability. Journal of Community Health, 37, 3239.
Waxler-Morrison, N. A., Anderson, J., & Richardson, E. (Eds.) (2005). Cross-cultural caring: A handbook for health professionals in Western Canada. Vancouver, BC: UBC Press.
Wong, S. T., Yoo, G. J., & Stewart, A. L. (2006). The changing meanings of family support among Chinese and Korean immigrant elderly. Journals of Gerontology Series B, Psychological Sciences Social Sciences, 61, S4S9.
Yao, C. S., & MacEntee, M. I. (2014). Inequity in Oral Health Care for Elderly Canadians: Part 3. Reducing barriers to oral care. Journal of the Canadian Dental Association. 80:e11



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