This document discusses the influence of culture on health and oral health. It makes three key points: 1) Culture plays an important role in shaping behaviors and practices related to nutrition, hygiene, child rearing, and healthcare that can significantly impact health and oral health outcomes. Both beneficial and harmful cultural influences exist. 2) Some common harmful cultural practices discussed include large joint families contributing to malnutrition, beliefs delaying medical care for children, and traditions increasing risk of infection. Food customs can also influence nutrient deficiencies. 3) The document calls for identifying and discouraging deleterious cultural practices through health education, with primary health workers and teachers playing a role in raising awareness of harmful impacts.

1. IJDA, 1(1), 200924
Dept. of Community Dentistry
Kamineni Institute of Dental Sciences, Abstract:
Narketpally.
Andhra Pradesh, India Culture plays an important role in human societies. Every culture
hasitsowncustomswhichmayhavesignificantinfluenceonhealth
and oral health. It is now fairly established that the cultural factors
are deeply involved in the whole way of life, like in the matters of
nutrition, immunization, personal hygiene, family planning, child
rearing, seeking early medical care, disposal of solid wastes and
human excreta etc. All cultural practices are not harmful. The
inclination to get into the habits of smoking, alcoholism, drug
addiction in the name of civilization among the younger
generation needs to be countered at the earliest,otherwise,it may
have a huge deleterious impact on the health status of the
generation to come. We have to identify the cultural factors that
are deleterious and discourage these practices through intensive
health education. The primary health workers and school teachers
can a play a vital role in creating the awareness on the adverse
effects of deleterious cultural practices among the general
population and students.
Key words: Culture, nuclear family, food habits, smoking,
pan-chewing, alcoholism, drug addiction.
Reader1
Proffessor & HOD2
Email for correspondence:
drchandrubr@yahoo.com
INTRODUCTION
Culture is defined as learned behavior which has
been socially aquired1
and in other words “it is the
shared and organized body of customs, skills, ideas
and values,transmitted socially from one generation
to other.2
Culture plays an important role in human
societies. It lays down norms of behavior and
provides mechanisms which secure for an individual,
his personal and social survival. 3
Culture includes
everything which one generation can tell, convey or
hand down to the next. Culture has three parts. It is
anexperiencethatislearned,sharedandtransmitted.
4
Acculturation refers to culture contact. There are
various ways by which the acculturation can occur,
like in the way of trade and commerce,
industrialization, propagation of religion, education
and conquest to name some. An Indian is said to be
the next best Englishman as the Britishers brought
their culture to India through conquest. 1
Cultural factors in health and disease have
engaged the attention of medical scientists and
sociologists. Everyculturehasitsowncustomswhich
may have significant influence on health and oral
health. The increased incidence of lung cancer
because smoking, cirrhosis because of alcoholism in
manydevelopedcountries,thesurgeintheincidence
of oral cancer in India due to pan chewing habits are
some classical examples to demonstrate the
influence of culture on health and oral health. It is
now fairly established that the cultural factors are
deeply involved in the whole way of life, like in the
mattersofnutrition,immunization,personalhygiene,
Article Info
Received: 9th July, 2009
Review Completed: 16th August, 2009
Accepted: 12th September, 2009
Available Online: 18th January, 2010
© NAD, 2009 - All rights reserved
Cultural factors in Health and Oral health
Chandra Shekar BR1
,Raja Babu P2
INDIAN JOURNAL OF DENTAL ADVANCEMENTS
Jour nal homepage: www.nacd.in
REVIEW

2. IJDA, 1(1), 2009 25
family planning, child rearing, seeking early medical
care,disposal of solid wastes and human excreta etc.
All cultural practices are not harmful. Every
human has the culturally ingrained habit of cleaning
or brushing the teeth early in the morning. The use
of soap for personal hygiene,oil massaging,exposure
of the new born to sunlight etc are some cultural
practices that needs to be encouraged. The
inclination to get into the habits of smoking,
alcoholism,drug addiction in the name of civilization
among the younger generation needs to be
countered at the earliest, otherwise, it may have a
huge deleterious impact on the health status of the
generation to come. Keeping in mind, the very
significant role, the culture plays on health and oral
health, this paper is an attempt to review the effects
of key cultural factors on health and oral health.
Role of family: Family is the primary unit in all
societies. It is a group of biologically related
individuals living under the same roof and eating
from the common kitchen. Family as a cultural unit
reflects the culture of the wider society of which it is
a part and determines the attitude and behavior of
its members. Joint family system is commonly seen
in Asia,Africa,the Far East and Middle East countries,
more so, in the rural areas than in urban places. The
presence of parents,grand parents,uncles,aunts,and
other near relatives plays a vital role in child rearing
as well as in shaping the attitude and behavior of the
child. Nuclear family systems seen predominantly in
most of the western countries and urban areas in
developing countries, place a greater burden on the
parents in bringing up the child due to the absence
of other members in the family. This problem is
magnified especially if both the parents are earning
members. The lack of parental attention in the
nuclear families and peer pressure may provoke the
childintodeleterioushabitslikesmoking,alcoholism,
drug addiction,dating etc at an early age (a common
practice seen in most developed countries). These
adverse cultural practices in turn increase the
incidence of oral cancers, venereal diseases and
mental illnesses.1
Beliefs in the family: The rural folk in a developing
country like India have many misconceptions related
to the family size and structure. Many believe that
children are god’s gifts,the number of children in the
family is determined by god,children are poor man’s
wealth, and the family is not complete without the
birth of a male child. These misconceptions may lead
to large families which has a significant impact on
the economic status and there by, on health as well
as oral health of an individual. The close birth
intervals here may result in maternal malnutrition,
nutritional anemia, low birth weight and increased
maternal and infant mortality rates.1
Sex and marriage: Sexual customs vary among
different religious and ethnic groups. Muslims have
religious restrictions on oro-genital sex and
intercourse during menstruation. Similarly,orthodox
Jewsareforbiddentohaveintercourseforsevendays
after menstruation ceases. This may have an
influence on oral health and family planning. 5
The
practices of polygamy (marrying of one man to
several women) and polyandry (marrying of one
woman to several men) seen in many tribal
communities of the country (Todas of Nilgiri hills,
Nayars of Malabar coast, the inhabitants of Jaunsar
Bhawar in Uttar Pradesh) attribute to the high rate of
venereal diseases and affect the oral health.1
United
States of America is termed as the genetic melting
pot due to excessive racial mixing. This may result in
high frequencies of jaw and tooth size discrepancies
leading to malocclusion. This may be the cause for
high rate of malocclusion in U S A compared to any
other primitive population lacking racial mixing.
Maternal and child health:Mother and child health
(MCH) is surrounded by a wide range of customs and
beliefs all over the world. The various customs in the
field of MCH have been classified as good, bad,
unimportant and uncertain. Prolonged breast
feeding, oil bath, massage and exposure to sun are
among the good customs. The avoidance of foods
such as papaya, milk, fish, meat, egg and leafy
vegetables among pregnant women in some parts
of the country, more so in Tamil Nadu and
Pondicherry, with the misconception that they may
induce heat in the body,which may have an adverse
influence on the fetus are amongst the bad customs.
Punching of ear and nose, application of oil or
turmeric on the anterior fontanel of the fetus are
Cultural factors in Health and Oral health Chandra Shekar & Raja Babu

3. IJDA, 1(1), 200926
some unimportant customs. The application of kajal
or black soot mixed with oil to the eyelids partly for
beautification and partly for warding off of the evil
eye are amongst the uncertain habits.1
Adverse practices in child rearing: The deliveries
conducted by untrained dais,who have very minimal
knowledge on asepsis and sterilization, and whom
the villagers trust more than the trained health care
workers in many rural areas of the country may
increase the incidence of maternal and infant
mortality. The child is not put into breast feeding in
the first three days after birth in some rural parts of
the country (Gwalior region of Madhya Pradesh) due
to the misconception that colostrum is harmful. Here
instead, the child is put on water. This may prevent
the transfer of maternal antibodies and there by
increase the risk for many opportunistic infections
in the infant. Adulteration of milk, delay in the start
of weaning foods are other misconceptions related
to child rearing that may result in protein energy
malnutrition and adversely affect the child’s health
and oral health. There are some beliefs that diarrhea
amongchildreniscommonduringteethinganddoes
not need to be taken care of. They also believe that
diarrhea will take off the heat from the body and
hence the child should not be fed milk and other
liquids. This result in dehydration.6
Food habits: Food habits are amongst the most
deeply entrenched habits in any culture having deep
psychological roots,religious influence and influence
of the local conditions in the form of climate and soil.
The family plays a vital role in shaping the food habits
and this runs in the families from generation to
generation.
Ariboflavinosis due to deficiency of riboflavin is
common among the population whose staple diet is
rice,seen predominantly in the eastern and southern
parts of the country. 7
Pellagra due to niacin
deficiency is more in the population (Telangana
region of Andhra Pradesh) whose staple diet is maize
or jowar. This occurs because of the amino acid
imbalance caused by excess leucine among jowar
and maize eaters. 8
The high concentration of
molybdenum in jowar facilitates retention of fluoride
in the body, and there by, may increase the severity
of fluorosis among the population whose staple diet
is jowar than in the population whose staple diet is
rice, especially in an endemic fluoride belt. 9 10
Vegetarianism is given a place of honor in Hindu
religion. Orthodox Hindus are pure vegetarians and
hence may not take any foods of animal origin
including the milk. This may result in Vitamin B12
deficiency leading to Moeller’s glossitis.11, 12, 13
Adulteration of milk, though is done with the
motive of economic gain, there are some disbeliefs
that if the pure milk is boiled,it may dry the secretion
in the donor animal. This results in over dilution of
the milk, there by reducing its nutritive value which
may result in protein energy malnutrition among the
consumers.1
Adverse cultural practice in the cooking and
preparation of foods such as discarding the cooking
water from cereals, which is commonly seen in the
rural areas of the country,reduces the nutritive value
of food.1
Religious restrictions in food habits: Hindus don’t
eat beef, thinking it is a sacred animal and Muslims
don’t eat pork,thinking it is a scavenging animal that
feeds on human excreta and garbage. These habits
are protective as they prevent the occurrence of
taeniasis caused by an adult form of Taenia Saginata
and cystecercosis which manifest as edematous oral
ulcers, gingival bleeding and lesions mimicking
mucocles.14, 15
Dietaryhabits:Tribalandprimitivepopulationshave
diet patterns which are coarse and fibrous in nature
andfreefromrefinedcarbohydrates. Thismayreduce
the risk for dental caries 16, 17, 18
and also facilitate
adequate stimulation of the jaws, jaw muscles and
teeth eruption which may reduce the risk for
malocclusion to some extent. The western diet on
the other hand consists of refined foods which
increasetheriskforcariesaswellasmalocclusiondue
to inadequate stimulation of jaw and jaw
musculature.19, 20, 21
Scandinavian food habits mainly
include variety of fishes, cheese etc which may offer
someanticariesbenefit. Similarly,theCaribbeanfood
habits in the form of local fruits and vegetables,
cassava (a starchy root) and great deal of fishes offer
them some protection against dental caries. 22
The
trona salt is used extensively as a preservative,
Cultural factors in Health and Oral health Chandra Shekar & Raja Babu

4. IJDA, 1(1), 2009 27
tenderizer, flavoring agent in food as well as for
medicinal purposes (in the treatment of dyspepsia)
by Africans. This salt contains high concentration of
fluoride (as high as 7900 PPM) and it may increase
the risk for dental fluorosis.23
Fasting is a frequent practice among orthodox
Hindus. Muslims do fast during the time of Ramzan.
Excessive fasting leads to gastritis, peptic ulcer,
malnutrition, nutritional anemia, and loss of weight,
which may have deleterious impact on health and
oral health.1
Men eat first and women last and poorly,in many
rural families. This leads to maternal malnutrition,
leading to high maternal and infant mortality rates.1
Excessive consumption of spicy food in the form
of green chilies is commonly seen in some regions
ofAndhraPradeshandNorthernKarnataka. Thismay
predispose to the occurrence of peptic ulcer,oral sub
mucous fibrosis and oral malignancies as well. 24
Personalhygiene:Majority of the people in the rural
areas use open fields for defecation. The villagers are
averse to the idea of latrines due to the misbelief that
the latrines are meant for city dwellers where they
lack open fields. They are often ignorant about the
ill effects of improper disposal of human excreta
which may result in water, food, soil contamination,
favor the breeding of mosquitoes and flies. Villagers
allowthesolidwastestoaccumulateanddecompose
in the vicinity of their houses. This also may result in
food and water contamination as well as favor the
breeding of flies and mosquitoes. The well water is
the major source of drinking water for a large
segment of the Indian population in rural areas along
with tanks and ponds to some extent. These sources
are notoriously subject to contamination due to
human activities like bathing,washing of clothes and
utensils. These are often the places where animals
also are given a bath and drink which contaminates
the water. Some rivers are considered to be holy.
People go on pilgrimage,carry samples of holy water
in bottles,preserve them for long duration and carry
them over long distances to be distributed among
the relatives and friends. This is also cause for
epidemics of cholera and gastroenteritis. The rural
houses are usually damp,ill- lighted and ill ventilated
with lack of separate kitchen, latrine, and proper
drainage. Animal keeping is common practice in the
villages. All these may increase the risk for most of
the communicable diseases among them. 1
ORAL HYGIENE PRACTICES
Hindu Brahmins and priests, especially in the
region of Varanasi (Uttar Pradesh, India) clean their
teeth using cherry wood for an hour,facing the rising
sun. This may promote oral health if it is done
appropriately. Orthodox Jains clean their teeth using
fingers and without using the brush. This may have
a negative impact on their oral health. Muslims offer
prayer in the form of namaz, five times in a day.
During each namaz, as part of the ritual, they use
miswack stick, tooth picks and do gum massaging.
This may promote the oral health.6, 24
Use of chewing twigs: The rural folk in Udupi region
of Karnataka use the twigs from mango or cashew
tree. Neem and Banyan twigs are commonly used in
the rural areas of Tamil Nadu, coconut twigs in the
rural areas of Kerala. Datun is used in North India. In
African countries,twigs from Salvaodora Persicca are
used for cleaning the teeth. The twigs offer
mechanical cleaning action and some twigs may
haveantimicrobialproperties. Thesalvadorapersicca
twig has high concentration of fluoride, which may
offer anticaries benefit. The use of chewing twigs can
be recommended in lower class people who can not
afford the brush and paste. These twigs have to be
properly used and the method should to be taught
tothem,otherwise,improperusemayleadtogingival
and periodontal trauma over a period of time.6, 24
Dentifrices: The rural people use brick, charcoal,
rangoli powder, mud, salt, ash etc for cleaning the
teeth. This may result in gingival recession, abrasion
and dentin sensitivity.6
PERSONAL HABITS:
Purdah system: Practiced among Muslims and high
caste Hindus has beneficial as well as detrimental
effects. The practice protects against the exposure
to harmful sunrays and there by prevents the
Cultural factors in Health and Oral health Chandra Shekar & Raja Babu

5. IJDA, 1(1), 200928
occurrence of Basal cell carcinoma. The lack of
exposure to sunlight may result in decreased
synthesis of vitamin D, leading to hypoplasia of the
teeth. There is evidence that the frequency of droplet
infections like tuberculosis and diphtheria to be
relatively high among people who practice purdah
system. 1, 24
Smoking and alcoholism: The habit of alcoholism in
prohibited among Muslims and high caste Hindus.
This may promote the oral health. The younger
generation and the population in the western world
consider the habits of smoking, alcoholism etc as a
reward,status symbol or something glamorous. This
may have an adverse consequence on the health as
well as oral health. 25, 26
The habits of smoking and
alcoholism, are culturally acceptable among some
tribal population. Here, males and females have
almost the equal frequency of these habits. The habit
of reverse smoking is highly prevalent among the
fishingcommunitiesinthedistrictsofSrikakulamand
Vishakhapatnam in Andhra Pradesh. This increases
the risk of palatal malignancies.24
Pan chewing as a custom: Offering pan having betel
leaf, slaked slime, areca nut, and catechu is a way of
welcoming the guests in North Indian states like
Rajasthan, Uttar Pradesh, Maharashtra and West
Bengal.6
Rejecting pan is taken as an insult. This may
encourage the people to get into the habit of
chewing pan, which is a proven risk factor for
periodontal diseases,27
oral sub mucous fibrosis28
and
oral malignancies29
.
Drug addiction: Hindu sadhus have the habit of
incorporating charas, bhang and ganja into the
cigarettes. This habit is spreading into the younger
generation in India and is a common practice in
western culture (U S A). The use of these, results in
physical and psychological dependence, which may
be deleterious to health and oral health.1, 30
Sedentary life style: Lack of physical exercises
among the upper class people is the main cause for
obesity,whichinturnpredisposethepersonformany
cardiovascular diseases, diabetes mellitus etc. These
diseases have deleterious impact on oral health.1
ColaandKhatchewing:Thesehabitsarewidelyseen
in African countries. The cola has tannin, Theo
bromine, and Caffeine. This may facilitate healing of
oral mucosal lesions where as Khat chewing causes
dry mouth, thirst, pain, buccal keratosis and clicking
in the temporomandibular joint region.24
Alum rinsing and fomentation: Alum rinsing done
with the belief that it may make the gingiva stronger
may have an adverse effect in the long run.
Fomentation for reducing the pain associated with a
decayed tooth may not worsen the pain at times,but
it may result in cellulitis.6
SOCIAL CLASS DIFFERENCES
The level of education, per capita income and
occupation determine the overall socio-economic
status of an individual. The lack of preventive
awareness and affordability for sophisticated dental
procedures may predispose the people in the lower
classesforhigherfrequencyoforaldiseases.31-35
Caste
system is more rigid in rural areas. The lower class
people are considered as untouchables and will not
beallowedtofetchwaterfromtheplacewhereupper
class people do. They will not be allowed to utilize
the health care services. Though, caste system has
diminished in the recent times,it is still seen in some
rural communities.1, 6, 24
TOOTH AND SOFT TISSUE MUTILATIONS
These may be in the form of tooth avulsion,
alteration in the shape of the crown by filing and
chipping,lacqueringandstainingofteeth,decorative
crowns and inlays, tattooing, facial scarring and
uvulectomy. They are practiced in the primitive
population in different parts of the world as a sign of
tribalidentification,signof bravery,marriageableage
in females, ceremonial sacrifice, ceremonial rebirth,
to ensure life after death, for esthetics and fashion,
differentiation of sexes etc. whatever may be the
reasons for these habits, they definitely will have
harmful effects on the oral tissues and hence have to
be discouraged.6, 24
Cultural factors in Health and Oral health Chandra Shekar & Raja Babu

6. IJDA, 1(1), 2009 29
CONCLUSION:
Health is a consequence of an individual’s
lifestyle as well as a factor in determining it. Every
one of us, have our own beliefs and practices
concerning health and disease irrespective of the
area of residence (whether residing in urban or rural
areas). Not all cultural practices are harmful. Some
ofthesepracticeslikeadequatenutrition,goodsleep,
regular physical exercise etc are based on centuries
of trial and error and have positive values.
Achievement of optimum health demands adoption
of healthy lifestyles.36
We have to identify the cultural
factors that are deleterious and beneficial. We, the
health professionals have to discourage the
unhealthy practices through intensive health
education and promote the adoption of healthy
practices. The primary health workers and school
teachers can a play a vital role in creating the
awareness on the adverse effects of deleterious
cultural practices among the general population and
students. The mass media in the form of radio,
television, newspapers, health exhibitions, role plays
etc go a long way in changing the attitude and
behavior of the people and this demands more
patience as well as persistence from the health care
workers,as the cultural practices are deep rooted and
requires a very long time to change or modify.
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