A dental school is not the right answer
by J.K.M. Richmond, D.D.S.
Stabroek News
April 14, 2004
The level of dental need in Guyana is high. Dentists are few so we must have more of them. There is no argument against the logic of this. It is the next step that is open to question. In the past we have gone the low-cost way by getting scholarships for the candidates. Now it is proposed to take the high-cost highway of establishing our own dental school. That such a school will provide a continuing stream of practitioners is a blessing of doubtful merit for a cash-poor country.
It is proposed that the academic part of the training will be in the Medical School at UG, the clinical at the CBJ Dental Centre
While medical and dental training have areas of overlap, dentistry is a quite separate discipline. We shared classes with the medics in physiology, pathology, histology, embryology, pharmacology, psychiatry (yes!), public health and jurisprudence. Gross anatomy we did by ourselves, hands-on, a facility which UG Med is yet unable to provide. Separately we did biochemistry and neuroanatomy and labs in histology, bacteriology and physiology. Of course, there were the purely dental fields: dental anatomy, dental materials, operative dentistry, oral surgery, periodontia, prostodontia, pedo-dontia, orthodontia, and endodontia.
The decision to have more dentists by either route implies a commitment to provide each new dentist with the hardware needed to practise-at least a chair and unit, a not inconsiderable undertaking.
The CBJ Centre at which the clinical training and, perhaps practice, is to take place has ten units, four of which do not work. The remaining six are shared by five dentists and four dentexes. Patients are often sent from Government facilities for dental x-rays. Most of the clinics do not have x-ray machines and CBJ, which has two, is frequently without film. Dentistry is a prodigious user of supplies and, for whatever reasons, Government facilities are often so starved that even simple procedures cannot be carried out. I recall loaning anaesthetic.
Assuming the training has been done and the hardware and consumables are in place what should we expect of them?
A study done in New York City several years ago is helpful in understanding the problem. The dentist-patient ratio there was in the vicinity of 3000: 1. For the purpose of the study it was assumed that no new defect would arise, none get worse and every dentist would work eight hours a day. Statistics projected that it would take 25 years to catch up with the accumulated defects.
In Guyana the ratio is about 20 000: 1 and statistics will not restrain the progress of defects.
The pool of need will be continually refilled. So we should expect no appreciable change in the level of need even if a wealthy government could provide the wherewithal for twice, thrice or more times the present number of dentists.
That is not to say that Government should not provide and provision new dentists to the full extent of its ability: it should always be apparent that a government has concern for its people. However it must look elsewhere for a solution.
This will lie in Public Health measures that have for their objective attending to the defects of the very young so that at adulthood their needs will be at a manageable level. This offers the best hope. The first requirement is continuing and intense oral health education, secondly, it has been shown for over 50 years that environmental fluoride greatly reduces the incidence of dental decay. The vehicle best suited for its delivery in our country is cooking salt. Its introduction was mandated by Minister Teixeira in 1997, but during my stint as Chairman of the Dental Council I found that the authorities, for varying reasons, were not monitoring the import.
The third prong addresses such caries as may arise in the earliest ages. The FDI (International Dental Federa-tion), a WHO affiliate, has urged the use of ART (Atraumatic Restorative Therapy). This can be done even in remote areas by community members.
It does not require a high level of training and only simple hand instruments to clean the emergent cavities and fill them with a special material. Neither of the last two measures has roused the enthusiasm of our dental administrators: they offer no ribbons for cutting, no trumpets for blowing, no Deanships, no Professorships. They merely do the job.