It all started back in 1990 when in Romania there were appalling newspaper reports about the abandoned children after the fall of the dictator there. I went off armed with a suitcase of drugs to a village called Tatari north of Bucharest and set about restoring an orphanage of 400 totally abandoned children. This expanded into more visits, some dental-orientated ones, a container of new beds, and other support taken via my lorries. This is now a leading model, self-sufficient with equipment for a cottage industry making wooden toys to sell in Romania.
I am sure we have all witnessed the serious decay rates in some young children who have been allowed free access to some form of sugar solution, whether this be sweetened feeds as a baby or the sugar comforter placed in the mouth of the infant to subdue a tendency to cry. The result is total erosion of the primary teeth and subsequent early loss and further on a serious rate of decay of the first molars.
To address this issue and improve the DMF rates in the world's children is a real challenge when the diet pattern is a high frequency of sugar consumption.
To this end, I was determined to visit such communities and try and introduce some simple oral health messages:
- Cut the frequency of consumption of sugary drinks and foods such as biscuits
- Impress on the children the importance of applying fluoride-containing toothpaste to cleaning the tooth surfaces of their mouth at the most critical moment using a very small measure of toothpaste
- Refraining from actually rinsing out their mouth to leave their teeth acceptably clean before they went to sleep at night.
Research shows that getting a group of children to adopt this routine can reduce the rates of dental decay by a good 30% without the active intervention of applying dentistry. Decay will arrest giving the mouth the chance to slow down the damage.
How do we get over this message? Gathering an assembly of children and demonstrating a bass technique of tooth cleaning, coupled with a spiel on diet restraint, followed by a very quick dental exam. Then counting the DMF rates and show the worst cases to their teacher. Then recruit them into the repeat game for the message to change the diet and tooth cleaning routine for the children.
There is a marked difference in some countries. Countries such as Zimbabwe where there is a high rate of breastfeeding of infants showed a marked lower rate of DMF incidence. In comparison, in a country such as Pakistan where drinks such as Coco-Cola and lemonade as a drink are quite common, and indulgent grandparents who care for young children showed a markedly higher rate of dental decay and incidence of dental decay. Other countries such as Nepal are somewhere in between.
I managed to do these IOH sessions at a rate of about 5 schools and colleges a day often with an audience numbering over a thousand at a time. Purchasing toothbrushes and toothpaste at a rate of around 30p complete from the wholesalers, it was possible to target those with a high decay rate.
This was repeated in the same schools about twice a year for two or three years and the DMF rates certainly improved markedly. Hopefully, their school teachers carry on the message and incorporate the message in their lessons. Obviously, a step up is supervised tooth cleaning sessions as part of the daily routine for the children but time was limited to set this up.
One area that struck me was one hospital was geared to offer cleft lip and palate surgery repair using visiting plastic surgeons from many parts of the world and so funded by 'smile train'. Here the operation is charged up at around $250 a case, but did not include any pre-operation assessment of oral health or any IOH to either the patient or the family. This seemed to be a total disaster as we know that a high standard of oral care is an essential contribution to the longer-term success of the surgery and the final cosmetic result.
I raised this issue with the international medical advisory committee of 'smile train' which is based in USA and has reps in many countries where 'smile train' operate.
I managed to get a direct telephone dialogue with the management of 'smile train' with also the support from a number of bodies here in the UK such as the Royal College of Surgeons with the support of Professor Bedi, who was very supportive and someone who carries great weight in his international reputation. Some progress was made and acknowledgment of the importance of assessing oral health as part of the care of cleft lip and palate patients. The most important message is that dental disease is totally preventable and just needs the simple message to be given and reinforced as part of the child's education on how to look after themselves. A high sugar diet is a factor in the early development of type 2 diabetes and coronary heart disease.
The history of this mission started in 1998 with a visit to an abandoned orphanage in Tatari in Romania. This was a dreadful site with 400 cot-bound children hardly fed with little care who needed some serious aid. Over a series of visits, we restored their conditions, installed music and TV to stimulate them, looked after their oral health, and introduced a wooden toy factory to provide an income as these were sold in the Country.
Then the war in the Balkans stimulated an aid convoy phase with over 15 convoys to Serbia and Republicka Srpska, moving over 400 tons of aid via my lorries. Having to obtain an HGV licence, which was unusual for a dentist, especially when parking a 40-ton lorry outside the practice! I learnt how to obtain UN certification and the special medical permits from New York to allow passage across into Serbia with medicines and supplies to an isolated community, again taking dental equipment to try and deal with the zugboljia (toothache) requests in the refugee camps visited.
After the Balkans came the issues of the conflict between parts of Kashmir. I had a friend who has a house in Kashmir in the Bhimber district of Kashmir and so made a number of visits there, installing a dental surgery and treating patients there in another hospital in Gurjarat. Again, going around many local schools and military establishments delivering an IOH message and distributing toothpaste and brushes (which only cost 30p for brush and paste complete)
I made a number of visits to many schools in Kashmir where either they had no toilets, water or had suffered earthquake damage. These were delivered and now the schools with earthquake damage have been rebuilt. I also helped and visited a school site in Harare Zimbabwe where we managed to build and establish a new primary school for over 80 children. We have a support network here in the UK as the school is expanding and caters to children who cannot afford to attend school. While in Zimbabwe we distributed via a lorry large amounts of food parcels to give to those villages that were exceptionally poor.
I always made the point that I come here as a Christian to a Muslim Country as an act of helping humanity... no bias toward any one group of religion.
The future beckons to return to Kashmir to build another new school and return to Zimbabwe to see that new school expand, install more water wells and new toilets for the children, and of course pursue the IOH lectures to try and reduce the caries level and suffering of all those child dental patients. Just where opportunity and God directs my efforts.
Hattie Roberts OH 2014-2021 enjoys summer work experience in Hull More...