Letter to JADA

7/26/2011

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I praise Dr. Michael Glick’s remarks in the May 2011 Editorial: Justifying changes in the clinical practice (JADA 2011; 142[5]: 478-479).  In my capacity as a dental student, education is progressively becoming less traditional.  Education is a faculty responsibility, but today, and more than ever, education and learning are largely a student responsibility.  Dental education curriculum and training ought to support the development of analytical skills, the ability to critique research and translate research into clinical application and implications.  These are valuable skills.  And as Dr. Glick alluded to, these skills if learned can dictate successful changes in our practice and for our patients.  

The students at the Indiana University School of Dentistry are advocating for the first student outreach clinic.  We have proposed clinical policies, procedures and protocols based on evidence-based research.  Moreover, we expect to implement evidence-based methodologies in caries detection, treatment and monitoring of caries disease progression.  I applaud the ADA Center for Evidenced Based Dentistry (http://ebd.ada.org).  The ADA EBD provided a gamut of online tools and resources available to us to aid in evidence-based treatment and disease management.   Research is underutilized and lost as quickly as it is emerging.  So, I urge my colleagues to evaluate their dental education and methods of practices.  Understand the research and evidence behind our practices.  Evidence-based practice is a testament to the accountability and commitment to our patients and the dental community.    

Access the article online from the Journal of the American Dental Association: http://jada.ada.org/content/142/5/478.full.pdf+html
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Dentistry in Cambodia

2/23/2011

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Between the years of 1974-1979 Cambodia remained under the rule of the Khmer Rouge Regime, a social group that aimed to reduce the country to an agricultural society, led by notorious dictator Pol Pot. The regime was responsible for over nearly 2 million lives in what later became known as the Cambodian Genocide. During this time, education was abolished, currency, public transportation, and postal service system. With the annihilation of nearly all institutions, medicine and dentistry were abolished. 

Following the tragedy, it was reported that only two out of the six qualified dentists were able to provide dental care. The dental school in Cambodia recommenced in 1985, and it began its journey on the road to recovery. In 1990, it was reported there were 34 qualified and trained dentists (Durward 1991). There are a large number of traditional dentists, trained by apprenticeship, that are not recognized by the school. It has been reported that there may be over 300 traditional dentists by apprenticeship practicing still today and providing care to a large number of dental care to the population (Durward 1991).   

The country conducted its first ever and most recent National Oral Health Survey in 1991. In 1991, the National Oral Health Survey reported a high mean decay, missing, total (DMT) score of 3.2 in the Phnom Penh, the capital city of Cambodia. The survey also revealed that about 6.4% of six year old children were caries free, and the World Health Organization showed 50% were caries free (and this may be true in provincial areas). 

Following this survey, the Cambodian National Plan for Oral Health Plan 1992-2000 aimed to address four areas: (1) Oral health (2) Oral health promotion and prevention (3) Care delivery system and (4) Manpower training. Moreover, the design and implementation of health preventive and promotion programs were born as an outcome of the survey results. 

Tooth brushing and nutrition programs were implemented into primary school curriculum and a fluoride rinse program was implemented. In 1991 the Oral Health Preventive School Program sought to address needs and objectives in these four areas in primary schools (Teng 2004). Today, about 95 primary schools throughout Phnom Penh participate in the Oral Health Preventive School Program (OHPSP). OHPSP has four components: (1) Daily tooth brushing (2) Weekly fluoride mouth rinsing (3) Oral health education and (4) Oral health competition. One study revealed that with good cooperation, informed knowledge, attitudes and practice about oral health and hygiene correlated with a reduction in caries prevalence among children in primary schools (Teng 2004). 

In addition, the National Plan for Oral Health recommended the training of the dental nurse to provide dental services to rural communities. It is estimated that 80% of the population live in rural areas where access and availability to dental care are barriers. In an article titled “Dental nurse training in Cambodia—a new approach” it was reported there were 12 trained dental nurses, and it was projected there be 130 trained dental nurses by mid-1997.   This would bring the dental-nurse to population ratio to 1:60,000 (Mallow 1991).  The World Dental Federation reports that low income countries like Cambodia see a dentist to population ratio of 1:119,000.   This is alarming.  The disparities in access and utilization to oral health in rural communities has become a country's call for help.  It has become an issue or need that I hope to learn more about and find out how I can help be the change. 

References
1.       Barmes, D.E. (1971) Khmer Republic-Report on Dental Health. Geneva: World Health Organization.
2.       Durward, C.S., Hobdell, M. (1991) Cambodian National Oral Health Survey 1991. In: Durward CS, Todd RV, So PK, ed. Cambodian National Oral Health Survey 1990-1991. Phnom Penh, Cambodia.
3.       Durward, C.S. and Todd, R.V. (1991): Rebuilding the ruins: dental service and manpower in Cambodia. International Dental Journal. 41, 305-308.
4.       Durward, C.S. & Todd R.V. (1993) The Cambodian National Oral Health Plan 1992-2000. International Dental Journal. 43:219-222.
5.       FDI World Dental Federation. Facts and figures. Available at: “wwww.fdiworlddental.org/resources/3_0facts.html.” Accessed 9 Feb 2011.
6.       Mallow, PK (1997) Dental nurse training in Cambodia--a new approach. International Dental Journal. 47(3), 148-56.
7.       Pack, A. (1998) Dental services and needs in developing countries. International Dental Journal. 48(1), 239-247.
8.       Shidara, E., McGlothlin, J.D., Kobayashi, S. (227) A vicious cycle in the oral health status of schoolchildren in primary school in rural Cambodia. Int J Dent Hygiene. 5:165-173.
9.    Teng, O. et al. (2004) Oral health status among 12-year old children in primary schools participating in an oral health preventive school program in Phnom Penh City, Cambodia, 2002. Southeast Asian Journal Trop Med Public Health. 35(2) 458-462.
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