What I learned about teeth in the past 7 years

Posted in: Blog, by Bridge2Aid Team, on 10th October 2013 | 0 comments

By Mark Topley

blog3-1The following post was originally written in 2011, and has been updated. 2 years on, I remain as convinced and passionately committed as ever that the overriding priority for oral health in developing countries is not simply providing equipment or more dentists, but giving safe, sustainable access to basic pain relief and simple oral health education. Here’s why:

On a balmy summer’s evening in 2003, in return for a curry, I made the mistake of driving Ian Wilson to speak about Oral Health in Developing Countries – an evening that changed my direction in life completely.

On that night I was blown away as I learned about the impact of oral pain on the quality of life for people living in developing nations.  The extent of the problem was huge.

Today I find myself the chief executive of a dental charity.  Over the past 7+ years since Jo and I moved to Tanzania, I have tried to learn a bit about teeth and specifically how oral pain impacts people living in countries like Tanzania.

Over the coming weeks, interspersed with other ramblings, I plan to blog about this.  Don’t expect academic papers or in depth clinical discussion. This will be my honest perspectives based on the last few years of living and working in this wonderful country.


For those of you who are new to this, here’s the deal:

Most countries in the world don’t have enough dentists.

The problem is, people living in them  suffer the same levels of tooth decay and pain as we do in the west.  Tanzania for example, has about 440 dentally trained personnel – dentists, therapists, assistant dental officers etc, – mostly located in the cities, caring  for a population of 40 million people.

But at least 75% of people live a long way from the cities. The vast majority of them won’t have any access to a dentist who can help them when they have dental pain. And most of them will experience pain in any given year.

So it’s not about teeth – it’s about people in pain, and what we can do about it?

How about just increasing the number of dentists – that would work?

Or would it?

Even if we could bring about an instant increase in the numbers of trained dentists – the economy couldn’t support them.

Dentistry is an expensive part of healthcare to implement – equipment costs a lot of money, and is hard to maintain. What is more, most of what dentists use in the UK is superfluous to meet far more basic needs. In countries like Tanzania, there isn’t enough money available to fund health care, let alone graduate level dentistry in the small towns, villages and hamlets where most people live.

Getting dentists to live where most of the problems exist is also nigh on impossible. Dental graduates simply expect a certain standard of living. You can imagine the congratulatory letter from the Ministry of Health –

‘Congratulations on gaining your BDS! After many years of school and 5 years of dental school, your assignment is to work in a remote district town with sporadic running water, frequent power cuts, no tarmac roads, no good schools for your children, and no restaurants or places to hang out with your friends. Oh, and you’re the only dentist for 400,000 people.’

So although more dentists are needed, focusing on that alone won’t address the problem. It’s going to take many years for economies to grow to the point of sustaining this level of provision.

In the meantime people suffer.

My opinion, based on what I’ve seen and learned in East Africa, is that in this generation at least, for places like the one where I live, what is needed is not simply more dentists – but instead to train the army of healthcare professionals already present in rural areas to help people in pain.

Someone who has got toothache and has been in pain for months – or even years – simply wants to know;

Can you get me out of pain?


How did I get into pain in the first place?

That’s why our Bridge2Aid Dental Training Programme (served largely by our DVP volunteers) is built around answering these two questions – training local health workers in emergency dentistry to relieve pain in their communities, and educating rural populations about the causes of tooth decay. By training those health workersalready deployed by the government to provide a simple, safe emergency dental service, the impact on the prevalence of pain is very high.

I also believe that we should keep building capacity.  Let’s keep training dentists! But we must be pragmatic – the pace of development is slow, and it will take many years before economies and infrastructures in this part of the world have grown to the point where the oral health care system can put a dentist within reach of every remote community.

And let’s keep it simple. Expensive dental equipment will break down and become unusable. I have lost count of the number of District Hospitals I have visited that have redundant and decaying equipment bought at great cost. Why not equip dentally qualified personnel with something more basic and appropriate to the level of treatment they will pragmatically be providing?

Waiting to implement a developed world model  in places where it is not yet appropriate isn’t good enough. People are in pain, we need to do something about it – now.

– Mark

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