viii Where There Is No Dentist 2012
While dental disease is decreasing in richer countries, it is on the increase
in most poor countries. One reason for this is that people are eating fewer
traditional (unrefined) foods and more pre-packaged commercial foods, often
sweetened with refined sugar.
Even as the need for dental care is growing, there are still far too few
dentists in poor countries. Most of those few work only in the cities, where
they serve mostly those who can afford their expensive services.
People in many countries cannot afford to pay for costly professional dental
care. Even in rich countries, persons who do not have dental insurance often
do not get the attention they need—or go into debt to get it.
Two things can greatly reduce the cost of adequate dental care: popular
education about dental health, and the training of primary health workers
as dental health promoters. In addition, numbers of community
dental technicians can be trained—in 2 to 3 months plus a period of
apprenticeship—to care for up to 90% of the people who have problems of
pain and infection.
Dentists’ training usually includes complicated oral surgery, root canal
work, orthodontics (straightening teeth), and other complex skills. Yet most
dentists rarely do more than pull, drill, and fill teeth—skills that require a
fraction of the training they have received. The simpler, more common
dental problems should be the work of community dental technicians who
are on the front lines (the villages), with secondary help from dentists for
more difficult problems.
Would this reduce quality of service? Not necessarily. Studies have shown
that dental technicians often can treat problems as well as or better than
professional dentists. In Boston (U.S.A.), for example, a study showed many
of the basic treatments commonly given by dentists to be done just as well,
and often better, by dental technicians with much shorter training.
Fortunately, in some countries skilled dental technicians have managed to
become the major providers of the most needed dental services. In India,
there are still ‘street-corner’ dental technicians with footpedal drills, who drill
and fill teeth at remarkably low cost.
In Honduras, dental technicians (who learn largely from each other,
starting as helpers) have formed their own union. Their political strength
was tested when, in the town of Trujillo, a dentist tried to put a technician
out of business. The local technician had removed an infected root left
mistakenly by the dentist. The technician had commented on the dentist’s
carelessness, and the dentist heard about it. The dentist sent a policeman
who shut down the technician’s office and took away his tools. However,
the dental technicians’ union took this to court. They argued their rights to