An insight into Pacific region oral health

The Annual General Meeting of the Australian Institute of Dental Assistants (SA) Inc, provided an opportunity for Past (Founding) President Jan Shepherd, to introduce the Executive and members to the work of Rotary International, and its support to health programs, such as “Dental Care to Share from Australia”. Jan voiced a commitment to the program, and an intention to promote fund-raising in her role as President of the Rotary Club of Prospect Sunrise. The program Dental Care to Share from Australia (DCS) is a program for volunteer dentists and health professionals who are contributing to the improvement of oral health in countries with limited resources. They have been assisted by local South Australian Rotary Clubs in providing resources, such as training manuals, and more recently, providing instruction and training for a dental technician from Papua New Guinea (PNG). This training will enable the technician to repair the dental equipment sent by Rotary International to PNG. Notice of the Program is communicated to the dental professional groups in the South Pacific region either directly or through the respective Ministries of Health, for projects to be identified within the scope of the program. Projects are implemented as the necessary sponsorship and support become available, with project sponsors given recognition and provided with a comprehensive report at the conclusion of the program. Health issues Life expectancy for some of these nations is little more than 50 years of age. This is a high mortality rate in today’s society... much less than the accepted three score and ten for western cultures. Children in Pacific nations with poor economic structure suffer the highest rate of loss of dentition (extraction of teeth). To improve the quality of life for children and adult populations of poor Pacific nations, it becomes a moral responsibility for neighbouring countries to provide assistance in establishing the infrastructure on which local communities can build and develop health care systems. Pacific nations have a distinctive local culture – to offer betel nuts to guests, similar to the western culture of offering visitors a drink as part of normal hospitality. Local custom also is to mix the betel nut with slake lime for the flavour and narcotic effects this offers, the result of which then has a ‘heating’ effect on the mouth tissues from the irritant behaviour of the chemical mix! This can lead to oral cancer, shown below. Dental Care to Share from Australia have commenced a 3 Phase Program to assist Pacific nations in the provision of basic dental health care for communities. 3 Phase Program Dental Care to Share from Australia plan to implement a Three Phase Program for change. Phase 1 - Education Prevention is always better than cure - therefore the School Dental Program needs to be re-established in schools as the first stage. Dental professionals from South Australia visited the Solomon Islands to promote oral health, through the program. The team gave talks on dental subjects of relevance to the region, distributed dental materials and textbooks, and surveyed the dental health of school children. The education for adults was given by medical nurses and nurse educators, and covered all aspects of health for family benefit. Education and simple dental treatment at an early age will provide fundamental dental health for residents in countries with little or no resources. Introductory Dental Health Manuals for education have been produced and these are currently in use and being evaluated as to their efficacy. There is now a need to provide a further 1,000 manuals in this region. Flash cards have been produced, to reinforce the dental health message for older primary school children. There is no availability of toothbrushes or toothpaste so alternative materials and substances are used as cleaning agents for teeth, such as sugar cane, guava sticks, coconut, husks of betel nuts (below). Phase 2 - Train Local Health Workers The second stage of the program was to educate and train local health workers in simple and inexpensive dental procedures (pictured right). It was essential that these procedures be able to be administered in village structures, without the conveniences of public health facilities. Currently there are 15 dental chairs to treat the entire Solomon Islands population of 450,000 – for a comparison, the South Australian Dental Service (public provider of dental services) has 1200 chairs to service a population of 2 million! There are 3 new chairs in a new special clinic forming the basis of the School Dental Service – however, the situation for outreach areas (islands) is serious. The introduction of a new filling technique, and the training of village health care workers in the delivery of this simple treatment was intended to help more teeth be saved. The technique, specifically designed for under-developed countries, uses inexpensive restorative material which can be placed without the use of costly equipment. This technique has been used in African/Asian nations for the past 10 years with sound results: between 60% – 80% retention rate This procedure known as ART (A-traumatic Restorative Technique) is being taught to local student therapists in areas where there are limited resources such as water/electricity. Illumination to perform this simple dentistry is by a caver’s light worn around the head. Six locals have been trained by DCS dental professionals in the ART technique, and these people then train village workers. Basically, this technique involves removing soft caries (decay) to a layer of tooth structure (dentine) that is able to regenerate or re-mineralise soft tooth structure. This is all a manual (hands on) application. Pressure cookers are used to sterilise the basic hand instruments. Work practices that for us now are routine, such as the wearing of gloves for all procedures is still a long way off for these people... the gloves are so few (and we rely on the generosity of glove manufacturers to supply these) that health care workers are instructed on using one glove only, so that the consumption of gloves is lengthened! WHO (World Health Organisation) and a manufacturing company in Japan have pledged their support to supply the dental materials used in the atraumatic restorative technique, however we need to train more health care workers to deliver the treatment. Phase 3 - Long Term Strategies The third phase of the program had to be long term strategies. Rice is the stable diet for islanders, and a process of fluoridating rice can provide long term effects, as proven in the fluoride studies conducted in Australia. Other vehicles to deliver fluoride, such as milk, salt and toothpaste are not readily available in developing tropical countries, however a program of using sugar as the fluoride vehicle was successfully tested in Finland, and recently trialled in Indonesia. WHO supported the trial, however expressed concerns that the use of sugar as the fluoride vehicle may send the wrong health message. The trials of fluoridating various foods settled on rice. Some communities in the Pacific region prefer processed or white rice after it has been processed, eg. husks removed, washed etc. Fluoride is now being added at the final stage of processing. Rice is not the major food source for inhabitants of the Pacific region, but does form part of their normal diets. By flouridating rice at the final stage of processing, the long term benefits will be measurable over time, as rice is the constant stable food for the young and old of poorer nations. The eating of rice as part of normal diet will ensure that small and constant amounts of fluoride are absorbed into the body, strengthening and protecting tooth and bone structures. A simple solution that will have long term effects on all age groups! Support strategies DCS are able to intervene and get access to dental equipment heading for salvage from the public dental service and the private sector, and this equipment must then be tested and repaired before sending overseas. The cost of this testing and maintenance is borne by DCS. In 2004 a dental technician from PNG was sponsored and hosted by a local Rotary Club for a period of three months, to be trained in the maintenance of dental units and dental handpieces. DCS relies on the support of Rotary Clubs in Australia who have kindly assisted DCS by providing dental equipment for Papua New Guinea and printing the first issue of manuals that went to Solomon Islands. The manuals were trialled by health care workers and have been evaluated as being an essential component of the program. More of these manuals are to be printed by another Rotary Club, and these are to be sent to the Solomon Islands. Programs such as DCS have a far-reaching effect on PNG and smaller Pacific nations. For example, PNG Government are aware of the introduction of 40 dental chairs into their health service, and have now sent 6 dental undergraduates to Fiji for training. Further to this, the PNG Government is now looking to establish a Training School for dental assistants. DCS relies on the support that it receives from Rotary Clubs and from fund-raising efforts, donations, etc, to progress and expand this program. Following her presentation, Ms Shepherd was presented with a cheque from the Australian Institute of Dental Assistants (SA) Inc, (AIDA) to support the work of Rotary International in the printing of further training manuals for DCS.