Meeting Oral Health Needs

It is quite common to hear those who have participated in a volunteer project describe it as one of the most rewarding experiences of their lives. There is certainly a considerable sense of personal satisfaction and accomplishment that comes with using your unique skills to help others—and doing so under less than ideal circumstances. Many returning volunteers feel that they have gained much more than they have given because they have attained a greater understanding of different cultures and regions of the world. In sharing their knowledge and ability, they have been able to alleviate suffering caused by dental disorders and they have made new friends in the process.

From a strictly professional standpoint, short-term humanitarian dental service projects usually have one or two objectives. One is to meet the urgent emergency oral-health needs of a specific group of people—such as a village, a congregation at a site of worship, or a group of local children or orphans. Another objective is to provide education about dental health to similar groups of people. Rarely are there long-term objectives, and this in itself is an issue that is being given more focus.

Laudable as the short-term objectives might be, it is important for the organizers of all humanitarian dental projects to consider how lasting the benefits of their activities could be. This often gives rise to the idea that instead of performing only tooth extractions and providing basic dental health education it would be better to move beyond that emergency-care phase to something more permanent—such as providing simple restorations or establishing oral hygiene or other prevention-focused programs. Little consideration is given to evidence that supports the longer-term benefits of dental education alone. A concentration on the prevention of disease requires a multifaceted approach made up of an analysis of why there is so much disease (usually caries because of poor nutrition that is typically fed by easy access to refined sugars, poor hygiene conditions, and a lack of fluoride) as well as a survey of available resources (including personnel such as community health workers and dentists; availability of fluoridated salt, toothbrushes, and floss; alternative preventive methods) that would go into the development of an appropriate program to reach the target group.

In 2002, the WHO, through the CCOHC Planning and Future Scenarios, along with Dutch oral health care professionals, prepared a booklet titled Basic Package of Oral Care, which presents a simple approach to the issue of oral health. Three basic components, which in different formats should guide the development of primary oral health care services, are described: oral urgent treatment, affordable fluoridated toothpaste, and atraumatic restorative treatment. The principles of the suggested approach are summarized next, and readers can consult the original document and consider how they might work toward developing that approach during their next humanitarian assignment.

Oral Urgent Treatment

Oral urgent treatment is the relief of pain and oral infection and referral of complicated cases. The most common cause of pain or infection of oral origin is untreated dental caries. In its simplest form, oral urgent care means the provision of some form of analgesic. In its more complex form, it is the first stage of care.

On humanitarian missions, the most common treatment of choice is tooth extraction. The principle is for dental professionals on a humanitarian mission to provide a level of care that is practical for the specific community by using an approach that provides care to a large group of people—ideally all those who need it (also referred to as a population approach). Volunteers should also use a method that can be sustained over a long period of time. This may mean that consideration should be given to returning again and again to the same site to continue the service that has been started. Repeated visits are the only way to affect long-term change in a community. In the context of sustainability, the ongoing benefits of becoming involved in the training of local people to provide some level of oral health care must be considered as well.

Affordable Fluoride Toothpaste

It is important for volunteers to realize that there are different ways of doing things other than the way they are done in the United States. Adequate exposure to fluoride has been proven to be effective in preventing caries by inhibiting the demineralization of sound enamel and enhancing the remineralization of enamel damaged by acid. Fluoride is available through a number of delivery systems. Local and/or regional conditions as well as cultural preferences can influence which delivery system is the best for a given population. There two types of fluoridation are water and salt, each with its own advantages. Water fluoridation, which is extensively practiced in such countries as Australia, Brazil, Canada, Ireland, and the United States, potentially reaches the entire population and provides benefits without the need for any action on the part of individuals. Salt fluoridation is currently available in some European countries, such as France, Germany, and Switzerland, as well as in the Caribbean region (including the Dominican Republic and Jamaica) and in the Central American countries of Costa Rica and Panama. Salt fluoridation is extremely cost- effective and easily sustainable in low-income countries that do not have centralized piped water systems. Other fluoride delivery systems include fluoride toothpaste and fluoride varnish, both of which are effective alternatives.

Atraumatic Restorative Treatment

Atraumatic restorative treatment is a simple form of restorative care that has been much discussed in the dental literature and should be given careful consideration from the outset of any program. In essence, this technique uses hand instruments to excavate caries. A glass ionomer material is used for the restoration. Significant evidence supports the efficacy of this technique in underserved areas.

With these three basic elements and simple sustainable approaches, volunteers in any humanitarian project can provide a community with a manageable primary oral health care package. While the basic package of oral health care is not an end in itself—for much more is needed in many poor communities if better oral health is to be achieved for everyone—it provides a solid foundation on which to bring more long-term changes to the determinants of oral health in communities. It also can provide local credibility for oral health care professionals working in disadvantaged communities. This credibility is needed so volunteers can build training programs for local community workers who can take charge of aspects of the program that will ensure its long-term survival.