Why Cavities Matter

Last week, I talked about poor oral hygiene, an underemphasized issue that severely impacts the wellbeing of children globally. In particular, cavities are a common childhood problem which, without treatment, can lower a child’s quality of life. The extreme pain caused by cavities can hinder learning, in addition to causing problems eating, chewing, smiling and communicating. Cavities have also been known to impact self-esteem, as the damaged physical appearance resulting from poor oral hygiene can cause self-consciousness.

Photo Credit: CARF Brazil

Despite the negative impacts of cavities, preventative oral health programs and services are rarely employed. In developing nations, dental services are mainly found in urban health centers, making it difficult for rural populations to access the care. The shortage of qualified oral health practitioners also limits the number of individuals that are able to afford treatment. While in developed nations, there is generally 1 doctor for every 2,000 people, developing regions such as the African continent only have 1 doctor for every 150,000 individuals. As a result, dental care is often relegated to treatment and pain alleviation, rather than actual preventative care.

However, in recent years, countries have begun to design and implement programs that would emphasize prevention along with treatment. In the past 20 years, industrialized nations have seen a reduction in the number of cavities found. Interventions such as oral hygiene curriculum, fluoride toothpaste, nutrition education, subsidized dental care and tap water with fluoride have managed to lower cavity rates. Unfortunately, not all interventions would be viable in developing regions.

South America in particular struggles with high rates of early childhood cavities. And while several countries in South America have attempted to institute some form of tap water fluoridation, the method has proven to be largely ineffective. Without a unified water system, large portions of the population get left out the intervention scheme. Instead, countries are experimenting with salt and milk fluoridation.  Because salt is much more accessible for rural populations, salt fluoridation is considered a more feasible option for reduction of dental cavities. Jamaica, for example, found an 87% reduction in cavities for 6-year olds after the introduction of fluoridated salt. While Jamaica is a unique case due to the fact that there was a single salt provider for the entire island, it still demonstrates the potential efficacy of the program. Fluoride milk programs are another alternative, currently in place in parts of Chile and Peru. While less cost effective than salt fluoridation programs, they demonstrate strong results. In Chile, the milk fluoridation program was able to reach 90% of the population and increased the percentage of cavity-free children from 22% to 48%. This program is able to piggyback on existing social service programs, but there are still problems with creating standard formulas and ensuring correct dosages.

In addition to these large scale interventions, local NGOs have provided various services for smaller communities. In Bolivia, an organization named Smiles Forever takes a unique approach to oral health by training homeless young women as dental hygienists. By training women in an in-demand profession, Smiles Forever is able to create self-sustaining clinics and also provide individuals with the skills they need to break out of poverty. Smiles Forever also has school programs that teach children about oral health and provide fluoride varnishes, drops or tablets.

Fluoride treatments have become increasingly common among local organizations, seen as a more long-term preventative solution. Visiting schools and orphanages, nonprofits attempt to educate children on proper oral hygiene, and provide the fluoride treatments as a supplementary measure. The Sangre de Cristo Health Care Project, for example, has several components including a dental hygiene education program for elementary schools. Located in Guatemala, this program provides children in 15 schools with toothbrushes and toothpaste, in addition to fluoride treatments. At the beginning of the school year, volunteers from the clinic train teachers to administer a fluoride solution to children weekly, helping prevent caries.

Addressing oral health has not always been a health care priority for developing nations. The WHO found that for some countries, the cost of dental caries in children alone would exceed the entire health care budget for children. As a result, dental care has always emphasized treatment rather than prevention. However, the use of fluoride treatments and increasing education for oral health issues may be able to reduce the number of children struggling with dental cavities.


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