History and observation and common sense have shown that the more we can sustain a dental program and build trust with individuals (and the community), we have a greater chance to move beyond emergency care to restoring teeth and restoring dignity in the individual.

Many rural/remote communities have experienced episodic dental visits in the past, building an expectation that you only go to the “dentist” when you have toothache. This is also a symptom of limited resources and personnel.

Clinicians can provide effective preventive care to children and adults following the principles of minimal intervention, and the atraumatic treatment approach pioneered by Dr Graham Craig in remote New South Wales, Australia, in the 1980s. This approach was the foundation for the development of the Atraumatic Restorative Treatment (ART) program, part of the World Health Organisation’s Basic Package of Oral Care (BPOC).

We can be guided by evidence based approaches – for example fissure sealing in children, fluoride treatments where regularity of visits can be assured, and caries arrestment – and we can learn from experienced clinicians who have focussed their efforts on restoring dignity through sound clinical care.

Instruction on good oral hygiene, diet, habits are important.

However we must be aware of the limitations of our ability to change behaviours and social norms, no matter how often we explain the correct brushing technique to someone!!

Have a look here for some ideas on approaches to appropriate treatments in high risk communities, and here for more information and resources.


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First world problem.... flight departure delayed while engineers fix the plane’s blocked toilet.... the day after World Toilet Day.
Update...toilet not fixable, replacement aircraft organised. First world solution.

World Toilet Day 2019. TT in 2007, the beginning of matching dental programs in Nepal with improved access to clean water and toilets. Still the work continues.

TT celebrates 20 years of working with Bishnu, project manager in Nepal. The first few years our dental programs, then adding sanitation with PP/HH, then adding earthquake reconstruction. We salute this hard working, passionate and compassionate local champion. Many thanks Bishnu Ji, dherai dherai dhanyabad mero sathi. Namaskar! ...