Table 1 Perception and belief of oral health among Karen ethnic group

Folk knowledge of teeth

Two sets of teeth: low perceived value of baby teeth compared with adult teeth. Baby teeth are susceptible to tooth decay regardless of oral hygiene practices and regular dental visit

Folk knowledge and perceptions about Dental caries

Identification of dental caries was based on pain rather than on external appearance such as black staining

Tooth worms as a main cause of dental caries

Sweet foods and drinks strengthen the worms, which creates holes/cavities in tooth

Folk knowledge and perceptions about Gingivitis

Identified as gum bleeding

Caused by brushing teeth too fast, for a long time, or too hard, or irritation from chewing betel quid

Inadequate knowledge about cause of gingivitis

Not consider as a problem unless they see large amount of bleeding

Sweet food consumption as a risk factor for dental problems

Knowledgeable about relationship between consumption of sweet foods or drinks and dental caries

Recent increase of sweet foods or drinks availability as the main cause of high prevalence of dental caries among children

Oral hygiene practices

Gargling with drinking water and using toothpicks after meals to remove leftover foods were common practices

Toothbrush and salt were commonly used for brushing teeth

Toothbrushing while taking a bath in the evening was sufficient, regardless of having dinner after toothbrushing

Purpose of toothbrushing was for cleanliness and did not worry about health risk of not brushing their teeth twice a day and before going to bed

Inadequate knowledge of mouthwash and dental floss, only available in town areas, therefore not accessible by most participants

Poor awareness regarding seeking dental care

Poor awareness of preventive dental care services at the dental clinic of Thasongyang hospital

Consider seeking dental care as lower priority than seeking general health care due to ability to deal with dental problems by themselves

Reliance on self-care for oral health problems from the annual visit of mobile dental clinics to their villages

Ability to self-treat dental illness

Lack of or insufficient oral hygiene tools and oral health care facility in the past lead to reliance on self-care for their oral health problems

For dental pain, wait to resolve dental pain on its own or brush more frequently and limit consumption of sweet foods or take analgesics or take traditional remedies. If pain was not resolved, they visited to dental clinic

For gum bleeding, rinse their mouths with normal water, warm water, or salt water

For tooth mobility, avoid discomfort or pain while eating by chewing food on the other side of the mouth or eating soft diet

Decision to seek professional dental care was based on the poor outcome of the self-care rather than on their awareness of the need for dental treatment

Seeking professional dental care

Due to suffering severe dental pain that interfere with work-related activities or their daily life

For children with dental pain,

parents let them to wait until the hospital team to visit their school or

wait for mobile dental clinics or

parents sent their children to school hoped that the teachers would take the children to the hospital

Parents have little extra time to accompany with their children due to busy lifestyle of parents or guardians

Fear of dental care procedures

Fear of dental procedures and equipment and fear or tooth removal lead to self-care of oral health problems

Unpleasant experiences of dental visit cause vicious circle of lack of timely care-seeking behavior and dental fear