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Background: Oral health disparities related to socioeconomic status have been well described in the U.S., but oral health among refugee groups has not been well characterized. This article examines oral health among Somali refugees in Massachusetts., Methods: Eighty-three (83) participants were purposively selected for an in-depth, open-ended interview related to oral health., Results: Older individuals associated use of the stick brush with the Islamic practice of cleansing before prayer. When unable to find stick brushes in the U.S., many adopted the Western toothbrush. Parents expressed concern that their children had adopted U.S. practices of brushing with a toothbrush only once or twice a day., Conclusions/implications: Somali oral health practices have changed following arrival to the U.S., but the underlying model for oral health care remains rooted in Islam. By acknowledging the value of traditional practices, dentists may communicate the value of Western preventive and restorative dentistry, and recommend approaches to integrating the two.

Objectives: We assessed the impact of health literacy and acculturation on oral health status of Somali refugees in Massachusetts., Methods: Between December 2009 and June 2011, we surveyed 439 adult Somalis who had lived in the United States 10 years or less. Assessments included oral examinations with decayed, missing, and filled teeth (DMFT) counts and measurement of spoken English and health literacy. We tested associations with generalized linear regression models., Results: Participants had means of 1.4 decayed, 2.8 missing, and 1.3 filled teeth. Among participants who had been in the United States 0 to 4 years, lower health literacy scores correlated with lower DMFT (rate ratio [RR] = 0.78; P = .016). Among participants who had been in the country 5 to 10 years, lower literacy scores correlated with higher DMFT (RR = 1.37; P = .012). Literacy was not significantly associated with decayed teeth. Lower literacy scores correlated marginally with lower risk of periodontal disease (odds ratio = 0.22; P = .047)., Conclusions: Worsening oral health of Somali refugees over time may be linked to less access to preventive care and less utilization of beneficial oral hygiene practices.