Mao Her still remembers a story about her uncle who went to see a dentist because of a toothache and came home confused because he had a whole new tooth.
She told her uncle that the dentist had whittled his decayed tooth down and put in a new crown. He was shocked, saying the dentist never went over the procedure with him. He said he would never go back to the dentist again.
"I explained it to him, but the damage had been done," she said. "He was very upset for a long time."
Her, who will complete her dental residency at the end of this month, plans to work in Huron for two years and then return to Fresno. She will then become one of four Hmong dentists in the city of Fresno.
She says her uncle's story is not unique.
Dentists say a combination of language barriers, cultural attitudes and other factors have created a chronic problem -- tooth loss -- in the Hmong community.
Blong Xiong, program manager for the Center for New Americans, said Hmong people, who come from agrarian societies in Laos, do not give their teeth a high priority because they didn't have basic tools like toothbrushes and they had no access to dentists in their homeland.
"We're tying to break centuries of perceptions," said Xiong.
At the Center for New Americans in Fresno the hope is that the Dental Project, a three-year plan that began last year, will turn the tide on centuries of poor dental health through an outreach effort to Hmong, as well as dental health care professionals.
Xiong said the need to educate Hmong is important now because their diet, once mostly vegetarian in Laos, is filled now with sugars, leading to a higher incidence of tooth decay.
Two dentists who serve primarily Hmong clienteles said in a survey that out of the 4,000 Hmong they see, only 20% to 25% of those patients follow up in a year while 70% to 75% of their non-Hmong patients follow up.
They also found that most of the Hmong children they see between the ages of 1 1/2 to 5 are showing severe incidents of tooth decay, and by the ages of 6 to 12 they are treating children with gum diseases.
Volunteers for the project have conducted a variety of education programs since January.
They've put on demonstrations for Hmong children at four Fresno schools, showing them how to brush and floss and encouraging them to visit a dentist twice a year. They created a video for adults and children to educate them on preventive care. Zoua Vang, a reporter at KSEE 24, narrated the information in Hmong.
The video has been made available to seven schools in the Clovis and Fresno school districts.
Two mobile dental vans, one run by the Healthy Smiles Mobile Dental Foundation and the other by Fresno County, show the video. The vans are equipped like dental offices and visit schools to treat children.
The center also has organized three workshops for dental-health-care professionals. About 200 people attended their presentation in March at the Hmong Health Conference at California State University, Fresno.
They were given a course on cultural differences that can act as barriers between doctors and patients. For example, they learned to address men instead of women because the culture is male-dominated and to recognize the important role of shamans, who treat spiritual and physical ailments in the community.
Most dentists said their Hmong clienteles are small, but they are now more sensitive to Hmong patients' concerns. Dr. Emilio Garcia decided after attending a seminar at the Fresno Madera Dental Society last winter that he will ask patients whether they see a shaman to understand their ideas regarding treatments.
Xiong said that it's too early to tell whether the program is having an impact, but he can tell that people are being reached.
"When they see the video they'll say things like 'I didn't know that,' " he said. "You can tell that it's very helpful to them."
The reporter can be reached at email@example.com or 441-6632. GRAPHIC: PHOTOS BY RICHARD DARBY -- THE FRESNO BEE ABOVE: Dentist Lynn Timple prepares to do a crown for Yer Lee in a mobile dental van Tuesday in front of Lowell Elementary School in Fresno. BELOW: From the left, Bee Yang, 6, Yer Yang, 8, and Scott Sisoutham, 10, watch video cartoons and color as they wait their turns in the mobile dental van.