“If the cost of dental treatment is exactly the same as the cost of a car, Chinese patients would buy a car instead of fixing their teeth. But Western patients would definitely choose to save their tooth, even if it meant a huge debt,” said Manhui Liu.

Manhui Liu, a dentist at Malden Dental Associates in Malden, Mass., drew analogies to show the difference between Chinese and Western patients.

Liu, who has practiced dentistry for 25 years in both China and United States, says that Chinese patients are very different from Westerners in both oral health habits and attitudes. In China, a great number of people brush their teeth but rarely gargle or, floss, Liu says. “Protecting teeth by simply brushing and flossing are not enough,” said Liu. “It’s really important to do teeth cleaning regularly as well. Some middle-aged people also need to do the deep-teeth cleaning to prevent gum from erosion.”

Xiaolei Wang, a 26-year-old Chinese graduate student, has lived with her American roommate Sarah Vennochi for two years. Both of them have daily routines in teeth cleaning and protection. “I brush my teeth two or three times a day and floss once every two days,” said Wang.

Meanwhile, Vennochi, a graduate student at Tufts University, has a more robust schedule. “I use an electric toothbrush and brush my teeth 2-3 minutes a day. After brushing about 3 to 4 min, I floss every site. Then I swish my mouth with mouthwash for 30 seconds.”

Wang and Vennochi embody the differences between Chinese and Westerners when it comes to oral health.

Vennochi says she started seeing a dentist at the age of three and, currently goes in for teeth cleaning every six months. On the other hand, Wang said,“In China, very few dentists and parents recommend patients do teeth cleaning since they considered teeth cleaning would cause damage to teeth itself and gum.”

“I don’t know why Chinese people have such a big misunderstanding about teeth cleaning,” said Joshua Lee, a Korean-American dentist at Malden Dental Associates who has worked in Boston’s Chinatown and Malden and seen countless Chinese patients.

“Westerners have a fine notion of teeth disease prevention, so they seek dental examination and care actively,” he said. “But Chinese people seek care only when a symptom occurs such as periodontitis and gum erosion.”

Generally, Chinese patients might go to the dentist for a painful tooth after suffering with it for a while, and then simply expect to have the bad tooth extracted. Lee explained.

Liu agrees but cautions that it is not always that simple. “For instance, some patients may need major dental work such as root canals, crowns, and dentures. Those treatments usually cost a lot,” said Liu. Those costs may place dental hygiene out of reach for some Chinese patients. “Some patients may either doubt the cost or even give up treatment.”

Liu believes there are three factors that underscore the difference between Chinese and Western patients: cultural differences, education levels, and values. From 1949 to 1990, the living standards and education were very poor in China and a great number couldn’t go to college due to the cultural revolution. This meant that, for decades, Chinese people not only lacked the basic knowledge of oral health care but also the money to afford that care, Liu said.

For decades, fine oral health was only available to those at the highest rungs of Chinese society. According to Marcia Ye, author of a study on Chinese attitudes towards oral health, “advanced interventions to save a bad tooth, such as root canals and crowns, may be common in the U.S. and other Western countries, but are the often privilege of only wealthy people in China.”

There is something cultural to it, too. There is a widespread belief that treatment for primary teeth is not essential, and that many more conservative-minded Chinese consider Western medicine aggressive and in some instances used too extensively, according to a review of oral health for Chinese and three other ethnic groups published in 2008.

That resources with Liu. “Back to the years, I worked in China, although parents would frequently use a traditional remedy for themselves, they are less likely to use it for their child. Most parents only brought children to the dentist or pediatrician in response to pain.”

Cultural and educational difference have a direct impact on values and they don’t seem to be going away anytime soon. Liu still sees hesitance from Chinese patients in her dental practice. “Nowadays, even though many Chinese clients would come and see the dentist, and could afford the cost of treatment, they still frequently questioned the treatment plan and its value.”