Culture plays an important role in human societies by laying down norms of behavior and providing mechanisms for personal and social survival. It is learned and shared among members of a society. Culture consists of both material aspects like housing and dress as well as non-material aspects like beliefs and values. Key concepts include ethnocentrism, cultural relativism, enculturation, and acculturation, which is how cultures change through contact with other cultures.

1. CULTURE AND
HEALTH
DR. RADHIKA MITRA
II YEAR POST-GRADUATE STUDENT
BATCH: 2017-2020
1

2. CULTURE AND
HEALTH
DR. RADHIKA MITRA
II YEAR POST-GRADUATE STUDENT
BATCH: 2017-2020
2

3. CONTENTS
■ Introduction
■ Definition
■ Functional Aspect of Society
■ Concepts related to culture
■ Characteristics of culture
■ Cultural factors in Health and Disease
■ Public Health Significance
■ Conclusion
■ References
3

4. INTRODUCTION
■ Culture is defined as learned behaviour which has
been socially acquired and in other words “it is the
shared and organized body of customs, skills, ideas
and values, transmitted socially from one generation
to other.
■ Culture plays an important role in human societies.
It lays down norms of behaviour and provides
mechanisms which secure for an individual, his
personal and social survival.
4

5. INTRODUCTION
■ Culture has three parts. It is an experience that is
learned, shared and transmitted. The Branch of
Anthropology that concerns with the study of social
institutions and the social and cultural aspects of
human life is known as Social Cultural Anthropology
■ The main aim of social cultural Anthropology is to
understand and appreciate the diversity in human
behaviour, and ultimately to develop a science of
human behaviour. This is attained through the
comparison of different people throughout the world.
5

6. DEFINITIONS OF CULTURE
■ According to M. J Herskovites "culture is the man-made
part of environment"
■ Ruth Benedict "culture is not the content of social life,
but it is an order and organisation of social life".
■ Bronislaw Kaspar Malinowski "culture comprises of
inherited artifacts, goods, technical process, ideas, habits
and values".
■ The first Anthropological definition of culture was given
by Edward Burnet Tylor(1871). “Culture is that complex
whole which includes knowledge, beliefs, art, morals, law,
customs and any other capabilities and habits acquired by
man as a member of the society”.
6
Source: Nanda , Warms RL. Cultural Anthropology. 9th ed. Thomson Wadsworth;
2007.p. 2-114.

7. Functional aspect of society
CULTURESOCIAL NORMS
Folkways
Mores
Taboo
CUSTOM AND
HABITS
ETIQUETTES
AND
CONVENTIONS
SOCIAL VALUE
7
Source: Peter S. Essentials of Preventive and Community Dentistry, 3rd
edition. New Delhi; Arya Publishing House.2006. p.231-269

8. Functional aspect of society
■ The day to day teaching and learning constitutes
an important functional aspect of society.
Social Norms
■ Every society specifies certain rules of conduct to
be followed by its members in certain situations.
These specified rules of conduct are technically
known as social norms.
8
Source: Peter S. Essentials of Preventive and Community Dentistry,
3rd edition. New Delhi; Arya Publishing House.2006. p.231-269

9. Functional aspect of society
■ Folkways: They refer to customary ways of
behavior.
■ Mores: Mores are socially acceptable ways of
behavior that involve moral standards.
■ Taboos: A taboo is a strong social prohibition against
words, objects, actions or discussions that are
considered undesirable or offensive by a group,
culture, society or community.
9
Source: Peter S. Essentials of Preventive and Community Dentistry,
3rd edition. New Delhi; Arya Publishing House.2006. p.231-269

10. Functional aspect of society
Customs and Habits
■ Custom is a broad term embracing all the norms
classified as folkways and mores.
■ It refers primarily to practices that have been repeated
by a number of generations, practices that tend to be
followed simply because they have been followed in
the past.
■ Customs have a traditional, automatic, mass
character.
■ On the other hand, a Habit is a purely personal affair,
not entailing any obligation
10

11. Functional aspect of society
Etiquettes and Conventions
■ Etiquettes are concerned with choice of the proper
form for doing something in relation to other people.
■ Convention is merely an agreed upon procedure. Set
of agreed, accepted norms, criteria often taking the
form of custom.
Social Values
■ Values refer to those standards of judgment by which
things and actions are evaluated as good or bad,
moral or immoral, beautiful or ugly.
11
Source: Peter S. Essentials of Preventive and Community Dentistry, 3rd edition. New
Delhi; Arya Publishing House.2006. p.231-269

12. CONCEPTS RELATED TO
CULTURE
■ Material and non-material culture
■ Ethnocentrism and Cultural Relativism
■ Emic and Etic Culture
■ Culture Trait and Culture Complex
■ Enculturation
■ Acculturation
■ Culture Shock
■ Culture lag
12
Source: Nanda , Warms RL. Cultural
Anthropology. 9th ed. Thomson Wadsworth;
2007.p. 2-114.

13. Material and Non-material Culture
■ Culture comprises both material and non-material
aspects. Those aspects of culture which are visible
are called material culture. According to Malinowski
material culture is the physical aspects of culture. It
includes house, household articles, vehicles, dress,
ornaments, road, weapons, means of transport etc.
■ The aspects of culture which are not visible are non-
material culture. These include knowledge, beliefs,
values, religion, social organisation, philosophy,
ideas, etc. They can be understood only through close
interactions with the people.
13

14. Material and Non-material Culture
14

15. Ethnocentrism and Cultural
Relativism
■ Ethnocentrism is an attitude of judging other
cultures based on the norms and values present in
one's own culture.
■ Most people grow up thinking that their culture is
‘the way of life’ and that of others is strange and
meaningless.
■ It is mainly because we consider our own culture to
judge other cultures. This attitude is called
ethnocentrism.
15
Source: Nanda , Warms RL. Cultural Anthropology. 9th ed. Thomson Wadsworth;
2007.p. 2-114.

16. ■ Opposite to ethnocentrism is the attitude of cultural
relativism (Some use the term 'ethno relativism').
■ It is based on the idea that each culture must be
understood in its own standards.
■ The beliefs and values of a culture should not be
used to judge other cultures. The idea of cultural
relativism holds the view that no culture is inferior or
superior. One is not better than others.
■ Each culture contains its own unique pattern of
behaviour.
16

17. Emic and Etic Culture
■ What people think about their own culture is emic.
■ What an outsider thinks about a culture other than
his own is etic.
■ The term emic refers to what insiders do and grasp
about their own culture. It includes people's view of
reality and their explanation of why they do and the
way they do. At the same time, an etic view could
look to other explanations in an objective way
without being coloured by the emic view.
17
Source: Nanda , Warms RL. Cultural Anthropology. 9th ed. Thomson Wadsworth; 2007.p.
2-114.

18. Culture Trait and Culture Complex
■ The smallest and indivisible unit of a culture is called
'culture trait'. It is the smallest functional unit of a
culture.
■ Cultural trait can be material or non-material.
■ Material traits include house, radio, mobile phone,
watch, television, furniture, dress and ornaments
■ Non-material traits include beliefs, values, knowledge,
concepts, symbols, gestures, world views, customs,
traditions, handshake, greetings, touching of feet,
blessings, prinkling of water on idols, walking barefoot
etc.
18
Source: Nanda , Warms RL. Cultural Anthropology. 9th ed. Thomson
Wadsworth; 2007.p. 2-114.

19. ■ Large number of cultural traits that combine to form a
meaningful segment of culture is called a culture
complex.
■ A cultural trait will be meaningless, if it is separated from
the culture complex. For example, a chalk, as a cultural
trait, is important only if it is a part of classroom
education. When it is separated from classroom and put in
an agricultural situation, it will be meaningless.
■ If kitchen is considered as a culture complex, then the
items like stove, utensil, mixer grinder, cooker, fridge,
knife, glass, plate, the knowledge of making and
preserving food are all culture traits.
19

20. Enculturation
■ Enculturation refers to the process by which one
learns the way of life and behaviour of one's own
culture. It will help the person to become an active
participant of that culture. An individual can
participate in the society, only if he/ she learns the
norms and values that exist in the society.
■ A child learns toilet training, the way of addressing
relatives (kinship terms), the way to behave with
elders in the family, the beliefs and practices of his/
her culture by imitating and observing.
20

21. Acculturation
■ Acculturation refers to the changes that occur in
one's culture due to continuous contact with other
culture. It occurs when one culture dominates over
other culture(s).
■ It may happen intentionally or accidentally. For
instance, Indian culture has undergone changes due
to continuous contact with western culture.
■ Similarly tribal cultures in India and elsewhere also
witness widespread changes due to the contact with
non - tribal cultures.
21
Source: Nanda , Warms RL. Cultural Anthropology. 9th ed. Thomson Wadsworth;
2007.p. 2-114.

22. ■ Separation occurs when individuals reject the
dominant or host culture in favor of preserving their
culture of origin. Separation is often facilitated by
immigration to ethnic enclaves.
■ Assimilation occurs when individuals adopt the
cultural norms of a dominant or host culture, over
their original culture. Sometimes it is forced by
governments.
■ Integration occurs when individuals are able to adopt
the cultural norms of the dominant or host culture
while maintaining their culture of origin. Integration
leads to, and is often synonymous with biculturalism.
■ Marginalization occurs when individuals reject both
their culture of origin and the dominant host culture.
22

23. ■ There are various forms of acculturation like
deculturation and transculturation.
■ Deculturation is the process by which a culture
loses its cultural identity due to contact with other
cultures. Many tribal cultures are losing their identity
under domination of external cultures.
■ Transculturation is the process of exchange of
cultural traits among different cultures. Indian culture
adopting English language and the European culture
adopting Ayurveda are examples of transculturation.
23
Source: Nanda , Warms RL. Cultural Anthropology. 9th ed. Thomson Wadsworth;
2007.p. 2-114.

24. Culture Shock
■ The whole set of feeling towards an unfamiliar
situation can be called as culture shock. Culture
shock is the psychological or social
maladjustment, experienced when people
encounter a strange cultural situation for the first
time. It is a frightening feeling of alienation. It
may result in adjustment problems.
24
Source: Nanda , Warms RL. Cultural
Anthropology. 9th ed. Thomson Wadsworth;
2007.p. 2-114.

25. Culture Lag
■ According to W.F. Ogburn, compared to non-
material aspects of culture including beliefs,
values, morals, etc. material culture changes more
rapidly. In other words, the non-material part
always lags behind the material part. The gap
between the rate of changes in the material and
the non-material culture is referred to as 'culture
lag'.
25
Source: Nanda , Warms RL. Cultural Anthropology. 9th ed. Thomson
Wadsworth; 2007.p. 2-114.

26. CHARACTERISTICS OF
CULTURE
■ All cultures have at least five characteristics in
common:
■ Culture is learned
■ Culture is based on symbols
■ Culture is shared
■ Culture is patterned or integrated
■ Culture is usually adaptive
26
Source: Nanda , Warms RL. Cultural Anthropology. 9th ed. Thomson Wadsworth;
2007.p. 2-114.

27. CULTURE IS LEARNED
■ All we do, say, or believe is learned.
Cultural learning, also called cultural transmission,
is the way a group of people within a society
or culture tend to learn and pass on information.
■ Learning styles are greatly influenced by how
a culture socializes with its children and young
people
■ Enculturation: Learning the ways of a culture
27
Source: Nanda , Warms RL. Cultural Anthropology. 9th ed.
Thomson Wadsworth; 2007.p. 2-114.

28. CULTURE IS ACQUIRED
THROUGH SYMBOLS
■ Symbols are the basis of culture. A symbol is an
object, word, or action that stands for something with
no natural relationship that is culturally defined.
■ Everything one does throughout their life is based
and organized through cultural symbolism.
Symbolism is when something represents abstract
ideas or concepts.
The Rosetta stone has several different
languages carved into it28
Source: Nanda , Warms RL. Cultural
Anthropology. 9th ed. Thomson Wadsworth;
2007.p. 2-114.

29. SYMBOLISM AND
CULTURE
■ Symbols are the root of all culture
■ Symbols mean different things to different people,
which is why it is impossible to hypothesize how a
specific culture will symbolize something.
■ Some symbols are gained from experience, while
others are gained from culture. One of the most
common cultural symbols is language. For example,
the letters of an alphabet symbolize the sounds of a
specific spoken language.
29

30. CULTURE IS SHARED
■ Culture is shared by the social
interaction may take in many
forms to transmit the beliefs,
values and expectation of the
human society. The exchange
of social ideas may provide
understanding and learning
the human culture and
tradition.
■ Groups may be as small as 50.
They may comprise nation of
millions or there may be
subcultures in a culture
30
Source: Nanda , Warms RL. Cultural Anthropology. 9th ed. Thomson
Wadsworth; 2007.p. 2-114.

31. SHARED BEHAVIOR AND
SUBCULTURES
■ The Amish are a true subculture.
Amish seem similar to dominant
culture (farm in Indiana).
■ All farming is by horsepower
There are no machines, no cars.
■ Other features: have own
(German) schools, communes,
Anabaptist religion. The Amish
have persisted through the
generations since the 17th century.
31
Source: Nanda , Warms RL. Cultural Anthropology. 9th ed. Thomson
Wadsworth; 2007.p. 2-114.

32. CULTURE IS
PATTERNED/INTEGRATED
■ A "culture pattern" is a set of related traits and
characteristics that describe a particular group of
people.
■ Culture is integrated. This is called Holism, or
the various parts of a culture being
interconnected. All aspects of culture are related
to one another and to truly understand a culture,
one must learn about all of its parts.
32
Source: Nanda , Warms RL. Cultural Anthropology. 9th ed.
Thomson Wadsworth; 2007.p. 2-114.

33. CULTURE IS
ADAPTIVE
■ Culture is adaptive. Culture continually
renews itself. It is even said that nothing is much
more predictable than death, change, and culture
change. Humans have a way of inventing things
when he is in very much need of it. If he finds that
the method he uses is no longer obtaining his desired
results, he then turns to a new strategy which may
give to him the results he so desires.
■ Cultures can become maladaptive during rapid
change.
33
Source: Nanda , Warms RL. Cultural Anthropology. 9th ed. Thomson Wadsworth;
2007.p. 2-114.

34. CULTURAL FACTORS IN
HEALTH AND DISEASE
■ All people, whether rural or urban, have their own
beliefs and practices concerning health and disease.
It is now widely recognized that cultural factors are
deeply involved in all the affairs of man, including
health and sickness.
■ A brief account of the cultural factors relating to
health and sickness as observed are concept of cure,
environmental sanitation, food habits, mother-child
healthcare, personal hygiene, sex and marriage.
34

35. Concept Of Etiology And Cure
■ Broadly, the causes of disease, as
understood by the majority of rural
people, fall into two groups:
(a) supernatural and
(b) physical.
a) Supernatural Causes
• Wrath of gods and goddesses:
There are good many people
(even among educated) who
believe that certain diseases
are due wrath of some god or
goddess.
35

36. Concept Of Etiology And Cure
• Breach of taboo: Venereal diseases are believed by
some to be due to illicit sexual intercourse with a
woman of low caste, or a woman during
menstruation.
• Past sins: Leprosy and tuberculosis
• Evil eye: Children are considered to be most
susceptible to the effect of evil eyes. In order to ward
off the effects of the evil eye, charms and amulets are
prescribed and incantations recited by the exorcist.
36

37. Concept Of Etiology And Cure
• Spirit of ghost intrusion: Hysteria and epilepsy
are regarded due to spirit or ghost intrusion into
the body. The services of an exorcist are sought to
drive away the evil spirit or ghost.
37

38. Concept Of Etiology And Cure
b) Physical Causes
• Effects of Weather: Exposure to heat during summer
is responsible for an attack of loo (heat stroke). The
folk remedies consist of application of oil and ghee
on the soles of feet and administration of mango-
phool (prepared by keeping unripe mangoes under
hot ashes for a few minutes and extracting the pulp
in cold water) with a pinch of salt
38

39. Concept Of Etiology And Cure
b) Physical Causes
• Water: Impure water is associated with diseases.
• Impure blood: Skin diseases, viz. boils and
scabies are considered to be due to impure blood.
Eating neem leaves and flowers is considered to
purify blood.
39

40. Environmental Sanitation
• Disposal of human excreta:
➢ Open field defecation.
➢ No idea of latrines among villagers.
➢ Latrines are meant for city dwellers, where there
are no fields for defecation.
➢ Faeces are infectious, pollutes water and soil and
promotes fly breeding.
➢ Problem of excreta disposal is bound up with
numerous beliefs and habits based on ignorance
40

41. Environmental Sanitation
• Disposal of wastes:
➢ Not aware that mosquitoes breed in collections of
waste water.
➢ The solid waste is invariably thrown in front of the
houses where it is permitted to accumulate and
decompose. Periodically it is removed to the fields
and used as fertilizer.
➢ The animal dung (cow dung) is allowed to
accumulate. It is used sometimes as manure and often
times pressed into cakes, sun-dried and used as fuel.
41

42. Environmental Sanitation
• Water Supply:
➢ Ponds & Tanks → Common use for
washing, bathing, drinking
➢ Some rivers are considered "holy".
➢ Epidemics of cholera, gastroenteritis
have occurred due to these cultural
practices.
42

43. Environmental Sanitation
• Housing:
➢ Rural houses are same all over the country. Usually
kuccha and damp, ill-lighted and ill-ventilated.
➢ For reasons of security, no windows are provided, and
if at all one is provided, it is merely a small hole.
➢ Absence of a separate kitchen, latrine, bathroom and
drainage are characteristic features of an average rural
house.
➢ Animal keeping is very common in villages.
Infrequently, human beings and animals live under
one roof.
43

44. Food Habits
■ Influenced by local conditions (e.g. soil, climate),
religious customs and beliefs.
■ Vegetarianism is given a place of honour in Hindu
society. 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 pernicious anaemia, Moeller’s
glossitis.
44
Source: Chandra Shekar BR, Raja Babu
P. Cultural factors in Health and Oral
health. IJDA 2009 1(1):24-30

45. Food Habits
■ 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.
45
Source: Chandra Shekar BR, Raja Babu P.
Cultural factors in Health and Oral health.
IJDA 2009 1(1):24-30

46. Food Habits
■ 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.
46
Source: Chandra Shekar BR, Raja Babu P. Cultural factors in Health and Oral
health. IJDA 2009 1(1):24-30

47. Food Habits
■ The family plays a vital role in shaping the food habits and
this runs in the families from generation to generation.
■ Ariboflavinosis- deficiency of riboflavin- population
whose staple diet is rice, seen predominantly in the eastern
and southern parts of the country.
■ Pellagra- niacin deficiency is more in the population
Telangana whose staple diet is maize or jowar.
■ The high concentration of molybdenum in jowar- retention
of fluoride in the body- may increase the severity of
fluorosis among the population whose staple diet is jowar
than in the population whose staple diet is rice
47
Source: Chandra Shekar BR, Raja Babu P. Cultural factors in Health and Oral
health. IJDA 2009 1(1):24-30

48. Food Habits
■ 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.
48

49. Food Habits
■ Eating and drinking from common utensils is considered as
a sign of brotherhood among Muslims.
■ 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.
■ Some people do not eat unless they have taken a bath.
■ Excessive consumption of spicy food in the form of green
chilies is commonly seen in some regions of Andhra
Pradesh and Northern Karnataka. This may predispose to
the occurrence of peptic ulcer, oral sub mucous fibrosis
and oral malignancies
49

50. Mother 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.
■ Good: Prolonged breast feeding, oil bath, massage and
exposure to sun
50

51. Mother and Child Health
■ Bad:
➢ Avoidance of foods among pregnant women with the
misconception that they may induce heat in the body,
which may have an adverse influence on the foetus.
➢ In rural areas, most deliveries are conducted by the
traditional untrained dai or birth attendant.
➢ In some rural parts of the country -no breast feed during
the first 3 days of birth because of the belief that
colostrum might be harmful; instead the child is put on
water, and sugar solution.
➢ There are some beliefs that diarrhea among children is
common during teething and does not need to be taken
care of.
51
Source: Basavaraj P, et al. Assessing influence of culture on oral health- A
review. Journal of Pearldent. 2014;5(2):1-8

52. Mother and Child Health
■ Unimportant: There are certain customs which are
unimportant, viz, punching the ear and nose, application
of oil or a paste of turmeric on the anterior fontanelle.
■ Uncertain: The practice applying kajal or black soot
mixed with oil to the eyelids partly for beautification and
partly for warding off the effects of "evil eye". Often-
times, this custom has been blamed for transmitting
trachoma and other eye infections.
52

53. Personal hygiene
■ Indians have an immense sense of personal cleanliness
1. Oral hygiene:
Many people in the countryside use twigs and neem tree as a
tooth brush; some use ashes; and some charcoal.
The rural folk in Udupi region of Karnataka use the twigs
from mango or cashew tree. Neem and Banyan twigs - rural
areas of Tamil Nadu, coconut twigs- rural areas of Kerala.
Datun-North India. In African countries, twigs from
Salvaodora Persicca are used.
The twigs offer mechanical cleaning action and some twigs
may have antimicrobial properties.
53

54. ■ 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.
■ 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. It may have a negative impact on oral health
■ Fluoridated toothpaste are prohibited in some religions as it
may contain beef tallow.( Staufenbiel et al, 2015)
54

55. 2. Bathing:
■ Bathing naked is a taboo.
■ Apart from normal baths of which Indians are very fond,
there are baths fixed on special occasions:
- Women after menstruation must have a purifying
bath;
- After childbirth, there may be 2-3 ceremonial baths,
the time for which is fixed upon the advice of the priest.
The practice of an oil bath is a good Indian custom.
Womenfolk in the countryside use a paste consisting of gram,
mustard oil and turmeric powder and rub it on the body before
a bath.
55

56. Personal hygiene
3. Sleep:
People in villages often sleep on the
ground for reasons of poverty, and
they are exposed to insect bites.
4. Wearing shoes:
The transmission of hookworm
disease is associated with bare feet.
Many villagers in South India do
not wear shoes.
56

57. Personal Habits
1. 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 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.
■ Frequency of droplet infections like tuberculosis and
diphtheria- high among people who practice purdah
system.
57
Source: Chandra Shekar
BR, Raja Babu P. Cultural
factors in Health and Oral
health. IJDA 2009
1(1):24-30

58. Personal Habits
2. 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.
■ The habit of reverse smoking is highly prevalent among
the fishing communities in the districts of Srikakulam and
Vishakhapatnam in Andhra Pradesh. This increases the
risk of palatal malignancies.
58

59. Personal Habits
3. 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.
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, oral sub mucous fibrosis
and oral malignancies.
59
Source: Basavaraj P, et al. Assessing
influence of culture on oral health- A review.
Journal of Pearldent. 2014;5(2):1-8

60. Personal Habits
4. Drug addiction:
■ Alcoholic drinks are tabooed by Muslims and high caste
Hindus.
■ Ganja, bhang and charas are frequently consumed by
sadhus; these habits are now spreading into the general
population, especially the younger generation.
■ The use of these, results in physical and psychological
dependence, which may be deleterious to health and oral
health.
60
Source: Basavaraj P, et al. Assessing
influence of culture on oral health- A
review. Journal of Pearldent.
2014;5(2):1-8

61. Personal Habits
5. Cola and Khat chewing: widely seen in African countries.
■ Cola- tannin, theo bromine, and caffeine. This may facilitate
healing of oral mucosal lesions.
■ Khat chewing causes dry mouth, thirst, pain, buccal
keratosis, dental staining and clicking in the
temporomandibular joint region.
6. Alum rinsing and fomentation: Alum rinsing done with the
belief- gingiva stronger- adverse effect in the long run.
■ Fomentation- reducing pain associated with tooth decay-
may not worsen the pain- cellulitis.
61

62. Sex and Marriage
■ Sexual customs vary among different religious and
ethnic groups.
■ For certain religious groups menstruation is the time
of uncleanliness when women are forbidden to pray
or have intercourse.
■ Muslims have religious restrictions on oro-genital
sex and intercourse during menstruation.
■ Similarly, orthodox Jews are forbidden to have
intercourse for seven days after menstruation ceases.
This may have an influence on family planning.
62

63. Sex and Marriage
■ 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.
63

64. Consanguineous Marriage
■ It is a deeply rooted social trend. In clinical genetics- it is
defined as a union between two individuals who are
related as second cousins or closer with the inbreeding
co-efficient equal or higher than 0.0156
■ The inbreeding coefficient- a measure of the proportion
of loci at which the offspring of a consanguineous union
is expected to inherit identical gene copies from both
parents.
■ In some communities- highest coefficients are reached
with unions between double first cousins- practiced in
Arabs and uncle-niece marriages in South India.
64
Source: Hamamy H. Consanguineous
Marriages. J Community Genet 2012;3:185-92

65. TOOTH MUTILATIONS AND
SOFT TISSUE MUTILATIONS
■ The practice of deliberate mutilation of the
human dentition is known to have existed since
prehistoric times in an ethnically and
geographically diverse range of peoples.
65
Source: Chandra Shekar BR, Raja Babu P.
Cultural factors in Health and Oral health.
IJDA 2009 1(1):24-30

66. TOOTH MUTILATIONS AND
SOFT TISSUE MUTILATIONS
■ These practices include:
• Tooth evulsion (non therapeutic extraction of tooth)
• Alterations in the shape of the tooth crown by filling
and chipping
• Decorative crowns and inlays
• Lacquering and staining of teeth
• Tattooing
• Uvulectomy, Facial scarring.
66

67. TOOTH MUTILATIONS AND
SOFT TISSUE MUTILATIONS
■ These practices are performed for reasons like:
• To ensure a life after death
• As a sign of marriageable age in females
• Ceremonial sacrifice, ceremonial rebirth
• To facilitate sexual activity
• To mark the transition from childhood to manhood or
women-hood.
• Tribal identification
• As a sign of bravery / punishment
67
Source: Chandra Shekar BR,
Raja Babu P. Cultural factors
in Health and Oral health.
IJDA 2009 1(1):24-30

68. Tooth Chiseling
■ Tooth chiseling has in fact been banned by the
Indonesian government; however the Mentawai tribe
have refused to stop the practice.
■ The women of this tribe chisel their teeth to make them
look beautiful.
■ They make it more narrow and pointy because they
believe that it makes them look attractive. They also
believe that if they do so, their husbands won’t leave
them for someone else.
68
Source: Shameema, Panchmal GS, et al.
Culture and Oral Health- A Review. Journal Of
Applied Dental and Medical Sciences 2016;
2(4):72-9.

69. Lacquering and dyeing of
teeth
■ These practices are related to concepts of beauty and sexual
appeal, maturity or to prevent dental decay.
■ Staining of teeth is accomplished by chewing the leaves or
bark of specific plant species.
■ Unusual method of staining teeth - the use of insect derived
cochineal in central America and the use of resin from an
insect-infested peepul tree in Gujarat region of India
■ The practice of blackening the teeth was reported among
the Jivaro Indian people of Northern Peru and Ecuador
which was carried out to prevent dental caries.
69
Source: Shameema, Panchmal GS, et al. Culture and Oral Health- A Review.
Journal Of Applied Dental and Medical Sciences 2016; 2(4):72-9.

70. Dental inlays and crowns
■ The use of dental inlays and crown for adornment
purpose is a form of non-therapeutic tooth mutilation.
■ In general these practices are usually carried out for
purposes of beautification to signify wealth or to signify
some event
■ India- The teeth of important people such as Maharaja’s
were reportedly inlayed with glass or pearls.
■ Roman civilization were familiar with dental restoration
of gold.
■ Among Muslims, the presence of a gold crown on a front
tooth is used to signify that the wearer had visited Mecca
70

71. Tattooing
■ It is a practice more popular in many nontropical areas of
the world largely confined to countries in the region of
North Africa and the Middle East.
■ Tattooing of the lip and gingiva is occasionally seen.
■ According to Gazi the gingiva may be tattooed when
females reach puberty or when they become married.
This custom may be practiced by men to relieve the pain
associated with diseased gums.
71

72. Oral and Perioral
Piercing
■ Tongue piercing was practiced in a ritual form by the
ancient Aztecs, Mayas of Central America and the Haida,
Kwakiutul, and Tlinglit tribes of the American Northwest.
■ The tongue was pierced to draw blood to propitiate the
gods, and to create an altered state of consciousness so
that the priest or shaman could communicate with the
gods.
■ Common in south eastern Asian countries.( to impress
the god)
■ Tongue piercing can result in hypotensive collapse and
also other complication such as life threatening infection,
airway problems, damaged teeth or mucosal surfaces
72

73. Oral and Perioral Piercing
■ Lip piercing
The piercing of the lips for the insertion of objects into them
is very widely practiced throughout the world, however only
two tribes pierce the lips with a ring; the Dogon tribe Of
Mali, and the Nuba of Ethiopia. Among the Dogon the
piercing of the lip has religious significance.
The Makololo tribe of Malawi wear lip plates.
73
Source: Shameema, Panchmal GS, et al.
Culture and Oral Health- A Review.
Journal Of Applied Dental and Medical
Sciences 2016; 2(4):72-9.

74. Uvulectomy
■ The traditional practice of Uvulectomy is widespread in
Africa. Also occurring in Chad, Niger, Nigeria, Morocco,
Tanzania, Kenya, Mali, Ethiopia and Sudan, as well as the
Arabian Peninsula.
■ Uvulectomy was most frequently performed at 2-4 months
of age. It was performed by a traditional healer, or barber,
often with unsterilized instruments.
■ Commonly performed to treat or prevent vomiting,
Respiratory tract symptoms, i.e., coughing and throat pain
■ Other reasons- influence of grandparents, religious beliefs,
failure of modern medicine to treat some chronic diseases
74
Source: Shameema, Panchmal GS, et al. Culture and Oral Health- A Review.
Journal Of Applied Dental and Medical Sciences 2016; 2(4):72-9.

75. Enamel tattoo
■ Choumps are a rare type of tooth tattoo made in gold and
are placed on the tooth enamel, mainly on the labial
surfaces of the maxillary anterior teeth.
■ Prevalent among certain tribes of western Uttar Pradesh
and Rajasthan, India, specially the Gujjar Tribes, and also
some Jaduvanshi Thakurs & Jaat Tribes.
■ Carried out after the eruption of maxillary permanent
incisors. tooth enamel of the labial surface of upper
central incisors are engraved with circular patterns using a
hand drill and are later filled with gold.
75
Source: Shameema, Panchmal GS, et al. Culture
and Oral Health- A Review. Journal Of Applied
Dental and Medical Sciences 2016; 2(4):72-9.

76. Skin Mutilation
■ A tribe in New Guinea- Chambri tribe, given men
crocodile scars to honour their ancestors.
■ Boys as young as 11 years risks their life to take part in
this tradition.
■ Slits are made in their skin then clay and tree oil are
inserted into the cuts. This maintains their raised shape
and gives them scales like a crocodile.
■ The only pain relief provided to them during the process
is by chewing leaves with healing properties to numb the
pain.
76

77. 77

78. CULTURAL COMPETENCY
■ The long-range goal of teaching cross-cultural
communication to the health professional is for the
clinician to become culturally competent and proficient-
that is, understand the patient from his or her point of
view and from that group’s point of view, be mindful of
the factors that influence a health encounter, and
understand the varying magnitude of the factors.
■ In general, topics addressed in coursework on cultural
competence must address global issues of health and
disease, as well as introspection into our own attitudes.
78

79. CULTURAL COMPETENCY
■ Health sensitizers and case reports are used to highlight
specific interpersonal behaviors, and to illustrate cultural
competence.
■ Trigger tapes may serve to demonstrate positive
(desirable) and negative (undesirable) behaviors that are
used to underscore relevant topics, as well as modeling.
Discussion among students is encouraged using the
clinical encounters viewed on the tapes.
■ Use of videotapes, case studies, and role-playing
situations, in addition to didactic material related to
communication and epidemiology, is helpful.
79

80. PUBLIC HEALTH SIGNIFICANCE
■ Culture forms an integral part of our lives. It plays
a very important role in maintenance of oral health
as well. Various beliefs and customs, food practices
and social practices have influenced oral health.
■ Once attuned to the cultural beliefs of the patient,
the healthcare professional can become a more
effective healthcare provider and a more positive
health advocate
80

81. PUBLIC HEALTH SIGNIFICANCE
■ 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.
81

82. CONCLUSION
■ Culture is an important sector of social and human
development, which contributes to identity-building and
self-esteem, fosters economic growth and social
cohesion, and helps to promote political participation and
ownership.
■ More than any other discipline in the university,
anthropology has developed the tools, models, and
sensitivities to analyze culture and to provide bridges of
understanding between individuals of different cultures.
82

83. CONCLUSION
■ Cultural Anthropology raises awareness of the meaning,
value, and importance of culture; this is a profoundly
important thing in a world of unprecedented contact
among people of different cultures.
■ By understanding that Culture is not simply a reflection
of human biology and analyze and understand culture
itself, we could discover ways to improve humanity’s lot.
■ Understanding that culture is flexible and variable gives
us hope for a better future.
83

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2. Peter S. Essentials of Preventive and Community
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3. Hiremath SS. Text book of Preventive and Community
Dentistry. 1st edition. New Delhi; Elsevier 2007: p.119-
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4. Harris NO, Godoy FG, Nathe CN. 8th ed. Culture and
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5. Nanda , Warms RL. Cultural Anthropology. 9th ed.
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85. REFERENCES
6. Chandra Shekar BR, Raja Babu P. Cultural factors in Health
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7. Shameema, Panchmal GS, et al. Culture and Oral Health- A
Review. Journal Of Applied Dental and Medical Sciences
2016; 2(4):72-9.
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10. Scully C, Wilson NHF. Culturally sensitive oral healthcare.
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86. REFERENCES
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