By Michele Rankin
Dental caries, periodontal, pulpties disease, periapical disease and facial infection affect most people in Timor-Leste. The nutritional status of children and adults in Timor-Leste remains significantly below acceptable world standards and poor nutrition is a leading risk factor for oral ill-health.
There is now an increased prevalence of dental caries and periodontal disease among children and adults. Recent changes in eating habits means that people are now more likely to consume refined foods rather than traditional foods. Poor oral hygiene, the lack of fluoride, smoking, betel quid chewing, and limited access to dental practitioners and restorative dental materials have also contributed to this increase. Most oral health workers are employed by the government and work in hospitals and health centres spread across the districts. With only 7 dentists and 40 dental nurses in Timor-Leste, the treatment of dental problems is beyond the capacity of the existing dental health workforce.
Good oral health is essential to good overall health as well as to the prevention of oral disease and unnecessary suffering. In August 2016, the Balibó Dental Clinic was opened with the goal to provide a cost-effective and needs-based health system that specifically addresses the oral health issues of children and other vulnerable groups. The Clinic is staffed by local dental assistants Sidonia and Felix, and is visited periodically by volunteer Australian dentists.
I have been fortunate to assist Felix and Sidonia to increase their knowledge and experience, thus building the skill capital of the Clinic. The visiting Australian Dentists have also been very supportive in training our local assistants to develop their clinical skills, sterility techniques and how to maintain equipment. Felix and Sidonia are now able to apply silver fluoride, perform cleans, fissures seals, fillings and simple extractions. Almost three and a half thousand patients have been treated since the Clinic’s inception.
Dental caries is a serious problem. On average decayed, missing or filled teeth are due to dental caries. It is however preventable. Because there is a lack of preventive oriented treatment, a prevention and health education program is necessary. Good oral health habits, attitudes, and behaviour are best established during childhood. Therefore, schools are a central setting for health education programs directed at controlling the increasing burden of oral diseases and promoting oral health.
My most rewarding work with Felix and Sidonia has been to create an equitable, cost effective and sustainable primary oral education and prevention service. Under our Saude Nihan Program (Healthy Teeth Program), we visit schools within the district with an emphasis on the most remote communities. The children are instructed about good foods and bad foods, how to brush teeth, when to brush teeth and to visit the dentist twice a year. Initial dental examinations are then conducted so clinic referrals can be identified. All children receive a tooth brush and fluoride toothpaste.
We also collaborate with the school community and health outposts to identify priority patients with critical oral health needs within the community. In 2019, we put in place a process to provide transport to and from the clinic, not only for the school children but for the community at large. This process has been proven to be extremely effective in treating high risk children and people in the community who need urgent treatment . Since the program started there have been 34 school visited, 2,954 children examined, 177 priority cases treated, and 346 silver fluoride treatment applied out in the field by both dentists and dental assistants.
I believe the success of the Dental Program is attributed to the collective participation of all groups involved. It began with a request to Balibó House Trust from the Balibó community for a dental clinic. Consultations with the Ministry of Health, the Chefe de Suco, the Sub-district Administrator, community members and the local district health service then followed. Working collaboratively throughout the development of the Balibó Dental Clinic Dental Program has resulted in a good business model that is consistent with the Ministry of Health’s objective to ensure the availability, accessibility and affordability of oral health services to all people.
Michele Rankin began working with the staff of the Balibo 5 Community Learning Centre in 2016 and 2017 as an Institutional Development Mentor and returned in 2019 to continue this work. You can support the Balibo community by becoming a regular donor to this project or making a one-off donation.