Smile at risk

23 million Nepalis live in villages but vast majority of dentists are in urban areas

Related story

Smile

For a country battling high maternal and child mortality, investing in oral health has not been a government priority. This disinterest is understandable as very few oral diseases are life threatening. Yet, they cannot be ignored because almost everyone suffers from oro-dental problem at least once in a lifetime and the ensuing pain is one of the worst known to humans. It is an integral part of general health as well as a major element for self-esteem.

About 23 million Nepalis live in villages but an overwhelming majority of dentists work in urban areas. For example, an estimated dentist-population ratio in Kathmandu is 1:9,000 while only two dentists work in the entire far-western region. This is partly because dental care services they offer such as dental restoration, rehabilitation, surgery or realignment of teeth requires sophisticated and expensive infrastructure (e.g. dental chair, equipment, materials and laboratory). Power shortages add to the cost of running the dental unit through alternative sources. Besides, private sector is the major provider of dental care services, thereby making the services affordable and accessible only to a small proportion of population.

Contrary to popular belief, good dental health is actually possible with little expenditure. Most dental diseases can be prevented with correct lifestyle. Proper oral hygiene is the best care one can provide at home and prevents dental caries and gum diseases. Most other oral diseases or conditions can be prevented through measures such as avoiding tobacco products and alcohol and consuming healthy diet, factors that also prevent other non-communicable diseases. Moreover, early management of oral disease is less expensive.

Although preventive dentistry must be the chief strategy of dental public health, a strong base of primary oral health is absent. Dental surgeons form the major dental workforce and largely concentrate on providing curative and specialized services. Other categories of dentistry personnel such as dental hygienists are yet to assert themselves in the public sector.

Children in rural areas and in public schools are reported to have worse oral health compared to their urban and private school counterparts. While community dentistry programs in dental colleges try to offer oral health programs in different communities and schools, oral healthcare services for the rural population and the poor has largely been ignored. On the other hand, factors promoting oral diseases (and other diseases) such as refined sugar and sweet products wrapped in attractive packaging appear to easily find their way to rural markets. Consuming these sugary delights without correct oral healthcare measures has a disastrous consequence, particularly in children.

Damage to natural teeth is irreversible and untreated dental caries is not just painful, it affects children's weight, growth and quality of life. Without access to dental care provider, it eventually results in tooth decay and tooth loss. This means that a significant proportion of the Nepali population may have at least one missing permanent teeth by the time they are 25 years old.

Adult women in South Asia are found to have worse dental health (e.g. more caries, unhealthy gums, early loss of teeth, more missing teeth) compared to adult men due to genetic, hormonal and cultural reasons. For example, a traditional practice that still exists in many communities is to avoid brushing while pregnant. Due to changes in certain hormone levels during pregnancy, inflammation of the gums is common which can be neutralized through good oral hygiene. On the other hand, poor oral hygiene will lead to poor periodontal health (health of structures supporting the teeth e.g. gums), which also results in tooth loss. In pregnant women, periodontal disease is found to be associated with low birth weight and pre-term babies.

Nepal government has well-established maternal and child health (MCH) programs at the community level. However, an oral health component is missing. Incorporating primary oral health in these programs would be an effective strategy to educate communities on dental care. MCH workers must be trained adequately on maternal and child oral health until there are adequate resources for public dental care services in rural areas. Oral hygiene counseling for pregnant women and caretakers of children by MCH workers is a necessary, powerful and cost-effective way to improve oral healthcare practices in community households.

The isolation of oral health from general public health programs so far may be due to its popular perception as being expensive, specialized and unnecessary. The risk of dental caries among the rural and poor population may have been low three decades ago. Today, consumption of refined sugar without proper dental care is inviting a caries epidemic. The consequence is that generations of children and young adults are with missing teeth. Treatment is going to be very costly. Prevention is not.

The author is a dentist

mahat.agya@gmail.com