Oral health in the South-

East Asia Region

Presented by-vishu midha

• The WHO South East Asia Region has 11
Member States: Bangladesh, Bhutan,
Democratic People's Republic of Korea, India,
Indonesia, Maldives, Myanmar, Nepal, Sri
Lanka, Thailand, Timor-Leste.
Korea
Bangladesh
 Bhutan

T
India
Indonesia
Maldives
Myanmar
Nepal
Sri lanka
Thailand
Timor-Leste
Oral health in the South-
East Asia Region
• Oral diseases such as dental caries, periodontal
diseases, tooth loss and oral cancer have
emerged as a major public health problem in
the Member countries of the South-East Asia
(SEA) Region of WHO.
• In view of the prevalence of risk factors and
inadequate access to and affordability of
preventive and curative oral health services
oral diseases have a growing impact on the
health and wellbeing of people in the Region
and in particular on vulnerable and
marginalized groups of population.
India
• There are differences in the caries status among different
populations.

• The plausible explanation for such discrepancy can be inequality in

economic conditions and resources, effective fluoridation policy,
efficiency of healthcare system, availability and consumption of
refined sugars, standard of oral health awareness among public,
dietary and oral hygiene lifestyles, as well as motivational status of
parents and children.
 Epidemilogical survey
• 1939

• 1940
Dental caries in indian
children below 5yrs
Year investigator Place Number Age yr PP Mean
DMFT

1987 Virjee Bangalore U 673 4-5 66.3% 2.9

Shankar
Aradhya

1987 Virjee Karnataka R 394 4-5 58.4% 2.3

Shankar
Aradhya

1992 Sarkar & West bengal 40 1 0.0 -

chaudhary 40 3 13.2
50 4 25.5

1996 Sethi & tandon Udupi 404 3-5 65.5 -

karnatka
1997 Goyal et al CHD U 135 1 1.5 .04
128 2 12 .3
120 3 23 .3
111 4 32 .3
124 5 48 1.5

1999 Kuriakose trivandrum 600 <5 57 2.28(mean)

Joseph E 3.18(low)
1.95(high
income)

2000 Sharma et al CHD 139 16-18m 2.88 0.12

34-36m 13.6 0.76

2001 Gautam et al NCR-delhi 524 <5 35.12 1.18

Benley george (2012) Kerala 5688 5yr 41.5% 0.67

Sarumathi T et al (2013) chennai 537 3yr 63.4% 1.81

4yr 57.8% 2.39
5yr 72.0% 2.83
Anshul sachdeva (2014) Haryana 576 <5yr 33.85%

Patel snehal et al (2014) Western 300 <5yr 32% 2.57

maharashtra

Deepak K (2014) Udupi 825 3-5yr 64.2% 3.74

Karnataka

Mittal M (2014) Gurgaon 619 5yr 68.5%

Mythri hallape et al (2015) Tumkur city 316 3-4yr 42.14 1.12

4-5yr 48.05 1.56

Darshana bennedi (2015) mysore 500 3-6yr 64% 3.20

Devanand gupta et al (2015) Moradabad R 1500 3-5yr 45.1%

 Prevalence of dental
caries in 5-6yrs children
of different region of
india
Northern region
Year ` investigator Place Number PP Mean
dmft
1941 Shourie Delhi 69 50.8% 2.83

1947 shourie Ajmer U 178 50% 2.1

1953 Thaper Moga 70 47.7%

1967 chowdhary Lucknow U 107 52.3%

1968 Gill and prasad Lucknow 138 44% 1.1

R
1977 Tewari & CHD (U) 65 70.6% 2.6
Chawla
1982 Damle et al Haryana R 123 74% 3.3

1983 Chopra et al Punjab U 141 61.1% 1.72

1985 Tewari et al Srinagar U 192 75% 2.9
Srinagar R 201 2.8

1985 Tewari et al HP U 227 53% 2.0

HP R 185 55% 2.35

1987 Mehta K. UP-Dehradun U 54.7 2.1

Kavita et al Meerut U 57.4 1.9
Lucknow U 89 4.4
Banaras U 53 1.3

1989 Thaper et al Jaipur 68.6 2.1

1993 Chawla et al CHD - - 2.26

1993 Chawla et al Delhi U 382 34.1 1.14

Jalandhar U - 46.8 1.5
Jalandhar R 151 39.7 1.0
Abohar U 145 27.6 0.6
Abohar R 150 24.7 0.6
1998 Norboo et al Leh U 62 74.6 4.3
Leh R 72 63.9 2.3
Kargil U 63 70.7 2.9
Kargil R 71 63.4 2.2

1999 Tewari S. Rohtak

5yrs Haryana 113 36.3 0.87
6yrs 157 38.2 0.91
2000 Chawla et al CHD (U) 131 60.3 2.7

2001 Gautam Delhi(U) 2366 35.12 1.18

R et al
2002-03 Pankaj G et al Delhi(R) 113 29.9 1.1

2002 A goyal CHD 459 79.74 4.0

2012 Arora et al Greater noida 1031 30.06 1.68

2012 Ramandeep k et al Chandigarh 579 48.3 1.8

2012 Hind P bhatia Ghaziabad 500 45.4 1.68

2014 Mittal M Gurgaon 619 68.5
2015 Hansa kundu Northern region 634 43.34
Eastern region
1965 Dutta A CALCUTTA 79 67.1 2.96 -

1985 Tewari et Bihar U 212 54 1.5

al Bihar R 99 35 1.10

1986 Sahoo et al Orissa U 170 58.82 2.52 3.96

Orissa R 160 57.5 2.66 4.94

1988 Sharma et Meghalaya 180 88.33 6.36 16.26

al Manipur 199 88.44 5.53 13.58
Nagaland 198 90.40 6.40 14.10

1994 Mandal et West bengal U 124 52.42 1.86 3.84

al West bengal R 20 48.33 1.48 3.01
Orissa 116 56.03 2.36 5.28
2001 Mandel West bengal 2067 52.4
KR Orissa 56
Sikkim 61.8
2012 Joyson Chidambaram 544 63.83
moses
2015 Shantanu Baksa district, 155 30
K et al Assam
Western region
1960 Sehgal Mumbai 69 39.36 5.9

1962 Antia Mumbai 504 6.64

1985 Tewari et al Mumbai R 220 89 5.30

1985 Tewari & Mandal Indore U 147 52.4 2.3

2002-03 Abhay k et al Bhandara 322 78.8 4.2

2002-03 Madhuri S et al Nashik 208 39.6 1.6

2002-03 Vaishali S et al Ahmednagar 316 51.7 2.1

2002-03 Rahul B et al Amravati 285 56.3 2.1

2002-03 Rawalani et al Wardha 406 38.1 1.4

2012 Shingare Uran , 107 78.5

maharashta
2015 Javid Y patel Surat 18 55.55
Southern region
1942 Shourie Day & Tamil nadu 53 55 1.5
Sedwick

1980 Nagaraja Udupi - - 4.1

Rao karnataka

1999 Menon & WHO Dharwad 300 31 0.78

indushekhar 1987 Karnataka 488 24.6 0.6

1999 Rao et al WHO Karnataka 771 67.1 1.29

1987

1999 Gopinath et al WHO Tamil nadu 232 61.2 0.32

1987

2000 Retnakumari WHO Varkala (R) 119 67.2 2.067

1987

2000 Goel P. WHO Puttur 203 59.6 1.87

Sequeira S.P 1987 (karnataka) 116(M) 62.06 2.93
Peter S. 87(F) 59.3 3.13
2001 Sogi G Dental caries Davangere
Bhaskar D.J index 1938 5yr 936 2.85
6yr 1071 3.40
2005 Mahesh KP et Chennai 600 80 3.94
al
2005 Hedge PP et al Belgaum 400 59.60 2.41

2006 Mahejabeen Dharwad 1500 54.1 2.70

2013 Sarumathi et Chennai 527 5yr-72 2.83

al 6yr-74.1 3.11
.
2014 Karunakaran Namakkal 850 65.9 2.89
et al
2015 Mythri hallapa Tumkur city 316 57.32 2.68

2015 Syeda nikhat Davangere 1140 45.08 0.25

(Karnataka)
2015 Darshana Mysore 500 64 3.20
bennedi
 Prevalence of dental
caries in 12yrs children
of different region of
india
Northern region
year investigators place No. Point Prevalence Mean Dmft/
DMFT
1941 Table =2
shourie Delhi (U) 95 54.8 5.7

1957 Chaudhary et al lucknow 368 32.0 1.15

1968 Gill et al lucknow 99 43.3 0.8

(U)

1977 Tewari et al chandigarh 216 78.2 3.4

1982 Damle et al haryana 152 89.5 3.2

1983 Gauba et al Ludhiana 173 86.1 3.9

1983 Chopra et al Punjab (u) 2555 67.2 1.3

1989 thapar et al Rajasthan (r) 31.4 0.5

1993 Chawla et al chandigarh ---- 1.2

1993 Hari praksh et al New delhi 87.0 -

1998 Norboo et al Leh 74 43.2 0.87

Kargil 69 29.0 0.68

1999 Isingh A.A et al Haryana 233 33.1 0.79

faridabad

2002 Chawla et al chandigarh 223 87 3.03

2002-03 Pankaj et al Delhi U 243 47.7 1.2

2009 Grewal et al Nainital 722 77.7 1.97

2011 Grewal et al Delhi 520 52.3 0.53

2012 Ramandeep K Chandigarh 534 30.5 0.5

2012 Hind P bhatia Ghaziabad 500 60.8 2.3

2013 Vaibhav munjhal et Ludhiana 1250 81.36 2.74

al

2013 Fotedar shailee et al Shimla 497 32.6 0.62

2014 Mittal M Gurgaon 384 37.5 -

2014 Grewal et al Ferozpur 674 67.94

2015 Hansa kundu Northern region - 48.11

Eastern region
1965 dutta Calcutta (U) 116 74.1 2.4

Table 3

1985 Mishra & shee Orissa ------ 61.1 ------

1985 Tewari et al Orissa(U) 159 63.1 2.1

Orissa(R)

1986 Sahoo et al Orissa(u) 63.8 2.1

Orissa (R) 67.9 2.0

2015 Sahoo et al Vidarbha 3960 65.70 2.2

Western region
1960 sehgel ---- Mumbai 144 89.8 5.6
Table=4

1962 anita ------ Mumbai 506 ---- 4.21

1993 Damle & Who nagpur 83.3 4.1

ghonmode (1983)

1994 Damle & Who Mumbai 367 80.0 3.8

patel (1983)

1998 Rodrigues & Who Mumbai 358 63.4 1.23

damle (1997)

1998 Rodrigues & Who Maharashtra 256 55.5 1.08

damle (1997) (bhiwandi)
2002-03 Madhuri s et al nashik 210 49.8 1.7

2002-03 Vaushali B et al ahmednagar 316 39.9 1.1

2002-03 Rahul B et al amravati 298 42.0 1.1

2002-03 Rawalani sm et al waradha 416 59.3 1.8

2012 PV kotecha Vadodra - HF-39.53 -

LF-48.21
2014 Malvannia et al Vadodra 1539 17.15 0.26
2015 Javid Y patel Surat 54 74.04
Southern region
1942 Shourie Day & Tamil nadu 53 55 1.5
Sedwick

1980 Nagaraja Udupi - - 4.1

Rao karnataka

1999 Menon & WHO Dharwad 300 31 0.78

indushekhar 1987 Karnataka 488 24.6 0.6

1999 Rao et al WHO Karnataka 771 67.1 1.29

1987

1999 Gopinath et al WHO Tamil nadu 232 61.2 0.32

1987

2000 Retnakumari WHO Varkala (R) 119 67.2 2.067

1987

2000 Goel P. WHO Puttur 203 59.6 1.87

Sequeira S.P 1987 (karnataka) 116(M) 62.06 2.93
Peter S. 87(F) 59.3 3.13
2002 Kulkarini Belgaum 2005 45.12 1.18
Deshpande 11-15
2005 Mahesh KP et Chennai 600 80 3.94
al
2005 Hedge PP et al Belgaum 400 59.60 2.41

2012 Benley george kerala 5688 36.09 0.58

2013 Sukhabogi JR Nalgonda 426 42.6 0.67

et al
2014 Dulas das West bengal 1764 28.06 -

2015 Arthi Tamil nadu 974 61.4 2.03

veerasamy
2015 Syeda nikhat Davangere 1140 45.08 0.57
(karnataka)
2015 Hansa kundu Southern 39.27
region
 Prevalence of dental
caries in 15yr children of
different region of india
Northern region
Year Investigator Place Total no. Prevalence Mean DMFT

1941 Shourie K.L Delhi 19 52.7 1.20

1957 Chowdhury Lucknow 107 32.7 --

et al
1968 Gill et al Lucknow 23 62 1.1

1977 Tewari & Chandigarh 82 86.6 4.7

chawla
1982 Moller index Naraingarh 230 77.2 2.4

1983 Moller index Ludhiana 101 88.1 5

1985 Tewari et al Chandigarh 217 51.1 1.38

1985 Tewari et al Himachal 178 50 1.2

pradesh
1985 Tewari et al Harayana 229 50 1.35

1987 Mehta, Lucknow 202 42.6 1

Kavita
1987 Mehta, kavita Lucknow 112 20.5 0.4
et al

1995 Chopra et al Jalandhar 150 42 .9

1998 Norboo et al Leh 70 60 1.01
1999 Singh et al Harayana 207 42.5 1.29
2000 Chawla et al Chandigarh 155 56 1.12
2001 Gautam et al Delhi 2397 23.95 0.53
2002 Pankaj g et al Delhi 105 50.5 1.5
2012 Goyal A CHD 437 87% 3.82
2012 Hind P bhatia Ghaziabad 500 48.2 1.06
2013 Vaibhav Ludhiana 1250 86.16 4.21
munjhal

2013 Fotedar Shimla 514 42.2 1.06

shailee et al

2015 Hansa kundu Northern 62.02

region
Eastern region
Year Investigator Place Total no. Prevalence Mean DMFT

1985 Tiwari et al Bihar 160 42.5 1.2

1986 Sahoo et al Orissa 175 62.3 2.0

1988 Sharma et al Meghalaya 183 60.1 2.1

1994 Mandal et al Calcutta 119 21.0 0.35

2001 Mandal et al West bengal 2067 21

Orissa 15.2
Sikkim 18.3

2015 Sahoo et al Vidarbha 3960(6-16yr) 65.70

Western region
Year Investigato Place Total no. Prevalence Mean DMFT
r
1960 Sehgal Mumbai 96 86.4 7
1985 Damle et al Mumbai 202 96 4.7
1985 Tewari et al Indore 162 68 2.8
1993 Damle et al Nagpur 82.6 4
1984 Damle et al Mumbai 78 3.6
1998 Rodrigues & Mumbai 334 70.4 1.99
damle
2002-03 Abhay K et Bhandara 244 86 4.7
al
2002-03 Madhuri S Nashik 207 63.8 2.3
et al
2002-03 Vaishali et al Ahmednagar 318 44.1 1.2
2002-03 Rahul B et Amrawati 287 61.3 1.9
al
2002-03 Rawalani Wardha 417 71.5 2.8
SM et al
Southern region
Year Investagator Place Total no. Prevalence Mean DMFT
1942 Shourie K.L Tamil nadu 42 57 2
1994 Mandal et al West 119 21 .35
bengal
1987 Gupta et al hyderabad 85 34.12 0.96
1999 Menon & dharwad 106 55.7 1.09
indushekhar

2002 Kulkarini Belgaum 2005 45.12 1.18

Deshpande
2012 Benley Kerala 5688 40.6 0.65
george
2013 Sukhabogi JR Nalgonda 485 48.6 1.07
et al
2015 Arthi Tamil nadu 974 61.4 2.03
veerasamy
2015 Hansa kundu Southern 39.27
region
 Prevalence of dental
caries in 32-35yr old of
different regions of india
Northern region
Year Investigator Place Total no. Prevalence Total DMFT
1982 Damle et al Haryana 667 61 1.70
1985 Tewari et al Chandigarh 156 81.4 4.38
1985 Chopra et al Jalandhar 144 34.72 1.08
1995 Chopra et al Delhi 388 24.5 0.5
2002-03 Pankaj G et al Delhi 123 78 3.9

2007 Binod K Delhi 452 82.4

Patro

2012 Mohit bansal Baddi (HP) 69 - 2.18

2014 Grewal et al Ferozpur 674 67.94

Eastern region
Year Investigator Place Total no. Prevalence Total DMFT

1985 Sharma et al Meghalaya 196 54.6 1.18

1995 Tewari et al Bihar 149 69.1 1.75

2001 Mandal KR West bengal 2067 19.4

Orissa 24.3
Sikkim 29.9
Western region
Year Investigator Place Total no. Prevalence Total DMFT

1953 Barreto et al Mumbai 331 - 1.50

1967 Mangi & jalili Madhya 331 - 4.10

pradesh

1985 Tewari & Indore 66 70 3.80

mandal

2002-03 Abhay K et al Bhandara 391 88.3 4.9

2002-03 Madhuri S et Nashik 288 77.8 4.1

al

2002-03 Vaishali B et Ahmednagar 316 63.2 2.8

al

2002-03 Ragul B et al Amrawati 308 78 3.1

2002-03 Rawalani SM Wardha 413 83.2 5.2

et al

2012 P.V Kotecha Vadodra 1123 39.53

2012 Ami M maru Kachchh 189 87.8

district,gujarat
Southern region
Year Investigator Place Total no. Prevalence Mean DMFT

1942 Shourie Tamil nadu 42 57 2.0

1987 Gupta et al Davangere 98 42.86 1.07

1999 Menon & Dharwad 106 55.7 1.09

indushekhar

1999 Menon & Calicut - 45.65 0.91

indushekhar
 Prevalence of baby
bottle tooth decay or
nursing caries in india
Author,(year) Place Total no. Prevalence(%) Mean dmft/dmfs
Virjee Bangalore 673 66.3 2.9
shanker(1987)

Sarkar & West bengal 40 25.5 -

Chowdary(1992)
 •Prevalence of early
childhood caries in india
Author,(year) Place Total no. Prevalence(%) Mean
dmft/dmfs

Sethi & Tandon(1996) Udupi 404 65.5 -

Goyal et al(1997) Chandigarh 154 19.4 0.4

Kuriokose (1999) Kerala 600 57 2.28

Babu et al(2003) Kerala 530 12 1.83

Tyagi (2008) Chennai 813 19.2 -

Priyadarshini et al(2011) Bangalore 566 37.3 1.90

prashanth et al(2012) Bangalore 1500 27.5 0.854

Shilpi et al(2012) Bangalore 717 40 1.89

Subramanium et al (2013) Bangalore 1500 27.5 0.8

Gaidhane et al, (2013) Wardha 330 33.48 -

Shrutha et al(2013) Kanpur 2000 48 2.03

Kuriakose (2015) Trivandrum 1329 54 2.3

Shah et al(2015) Srinagar 466 39.9 1.80

Stephen et al (2015) Salem 2771 16 0.2

Kaikure et al (2015) Bylakuppe, 500 92.2 6.15

Awasthi sreedharan(2016) Kannur 500 56.3

dist.,kerala
Dental Caries Scenario Among 5, 12 and 15-Year-old
Children in India- A Retrospective Analysis

Hansa Kundu et al,2015

 Objectives
• Dental caries is the most prevalent dental disease and
children are one of the most affected groups. Thus, the
present study was conducted to assess the average dental
caries prevalence across different WHO index age groups
(5, 12 & 15 years) for the past fifteen years.
 Materials and Methods
• Literature search was performed electronically in various search
engines like google scholar, PubMed, Copernicus, etc.
• Articles from the past 15 years reporting on dental caries prevalence
and experience in India were searched and this online searching
strategy collected and listed 781 articles. After evaluating abstracts,
only 30 articles fulfilled the inclusion and exclusion criteria & were
finally selected for complete review and data collection.
• Five articles which were hand searched were also included. Pooled
estimates were calculated for different index age groups and different
regions (Northern and Southern) separately with a confidence
interval of 95% both for prevalence and experience of dental caries.
 Results
• The pooled prevalence of dental caries was found to be
highest in 15 year olds followed by 5 and 12 years
(62.02%, 48.11% & 43.34% respectively).
• Weighted mean was also found to be highest for 15
years, followed by 5 and 12 years (2.56±6.508,
2.49±7.78, 1.48±3.292 respectively).
• Pooled prevalence and weighted mean for the Northern
India region was found to be more in all the index age
groups as compared to the Southern India region.
 Conclusion
• More than 40% of the children in India have
shown dental caries in both primary and
permanent teeth in the past 15 years. Also,
Northern region was found to be more affected
by dental caries than Southern region.
• High prevalence in 15 years could be attributed to the high intake of
sweets, poor oral hygiene, and general negligence of oral health in this
age group.
• High caries experience among 5-year-old could be attributed to the
factors such as a diet higher in sugars and/or the inability of a young child
to properly brush teeth on their own.
• Besides this, lack of preventive measures in India could be another reason
which increases the peril.
• The low caries experience was witnessed in 12 year age group when
compared to 5 year age group. This can be ascribed to the fact that WHO
index does not record incipient caries, but puts down only when the
caries involves dentin, resulting in slight underestimation of caries in 12
year groups
• The present systematic review revealed that Northern area was
found to have more prevalence of dental caries as compared to
the Southern region in all the index age groups. The likely
cause behind this could be attributed to the changing lifestyle
and eating habits of population in Northern India
• All the studies conducted in all the regions (Northern,
Southern, Eastern and west) of India were considered in the
recapitulation, but very few studies were conducted among the
index age groups of Eastern and west region of India;
therefore, weighted prevalence could not be calculated for
these two regions.
 NATIONAL ORAL HEALTH
CARE PROGRAMME
• National Oral Health Care Programme’ has been launched as “Pilot Project” in five
States (Delhi, Punjab, Maharashtra, Kerala and Northeastern States) to implement.
• The goals were to reduce the prevalence and incidence of dental caries, periodontal
diseases, oral cancer, clefts and fluorosis with oral health education to schools, health
workers, training of workforce and awareness of people.
• school health programs, medical officers and paramedical staff are trained to diagnose
dental diseases and referral, diet counseling, oral hygiene to be implemented.
• The other strategies that are proposed are cleft lip and palate, national fluorosis
prevention and control, trauma care facility and tobacco control . These definitely are
the examples of enhancement of oral health care.
• Oral health should be one of the essential agenda on the national health policy of India
which is the second largest population in world around with 1210.2 million, i.e., sharing
17.5% of whole world population. There is an actual need of current oral health policy
to be integrated within national health policy.
 Oral health strategies
• • Oral health education
• Use of mass communication
• Multipurpose health workers
• • One dentist for a population of 30,000
• Oral health education of school children
• One dentist for 50,000 school children
• Utilization of the mass media
• Oral health set up
Assessment of quality of
oral care system in india
 Oral health strategies to reduce
prevalence of dental caries
• According to National Oral Health Policy of India, oral health education of
school children will have far-reaching benefits.
• One dentist to be appointed for a population of 50,000 school children.

• Regular oral health promotional activities, i.e., health education, regular

dental check- up, demonstration of brushing and rinsing technique and
preventive and interceptive treatment can be undertaken at school level.
• Knowledge of oral health can be included in school textbooks.

• The availability, affordability, and quality of fluoride toothpaste remain a

major problem in many developing countries ,so complete knowledge about
prevention of dental caries by use of flourides should be implemented
• Preventive measures such as pit and fissure sealants programs should be
introduced.
 Conclusion
• Dentistry faces serious problems regarding accessibility of its
services to all in India. The major missing link is the absence of a
primary health care approach. At present, in rural India one dentist is
serving 2.5 lakhs of people whereas; the overall ratio of dentists to
population in India is 1: 10,000.

• Due to significant geographic imbalance in the distribution of dental

colleges, a great variation in the dentist to population ratio in the
rural and the urban areas is seen.

• Reports suggest that there are about more than one million
unqualified dental health-care providers, or 'quacks', in India.They
have long been blamed for misdiagnosing and mistreating.
 Recommendations
• 1. Emphasis on prevention to reduce the quantum of treatment
requirements by improving and increasing the public dental
healthcare system which will include health education, counseling,
and health promotion. Prevention is always cheaper, less time
consuming than treatment & does not require skilled labor.
• 2. Increase the employment of dentists in public sector.

• 3. There are only 11,000 sanctioned Govt. jobs in India. The irony is
only 5,500 jobs are filled on date and the remaining are lying vacant.
To begin with, remaining vacancies should be filled by the concerned
authorities.
• 4. Increase public awareness by dental health camps and use of mass
media.
• 5. Control the dentists: population ratio by -

• a) all academic dental institutions must meet quality standards established by

the Dental council of India.
• b). Encouraging dentists to establish practice in rural areas.

• c). Govt. should further reduce import duty to make dental treatment affordable
by more number of individuals.
• Health education programs utilizing cartoons characters in various Medias such
as Television, Internet, and Radio will be highly effective in communicating the
oral health messages to children and thereby creating a long ‐lasting impact in
them
• The efficacy of future treatments are difficult to predict, however the demand for
dentistry is likely to increase. Thus, the future of dentistry is bright.
Korea
 Oral health status in
Korea
• The number of practising dentists has increased with the
rapid economic growth.
• The community water fluoridation programme began as
a pilot in Jinhae and Chungjoo in 1981 but increased
dramatically to cover 12.7% of the national population in
2000.
• However, the anti-fluoridation movement has grown
since 1998, which resulted in the discontinuance of the
programme in some areas, decreasing it to 5.8% in 2006.
• Conversely, the central government adopted a public fissure sealant
programme as a nationwide policy to promote and maintain the oral health
of children..
• Since 2002, 200,000 children in rural and underprivileged urban areas have
undergone a fissure sealant programme every year.
• In the market, fluoridated toothpaste became generally available over the
counter in retail stores.
• The use of fluoride-containing toothpaste has increased dramatically since
the late 1990s.
• In 1997, 74.5% of adult workers used fluoridated toothpaste. The use of
fluoridated toothpaste increased to 97.4% and 99.3% in 2000 and 2004,
respectively.
Year Investigator Age group Total no. Prevalence dmft/DMFT
1991 Kim et al. 5-15 3348 3.0
2000 NATIONAL 8yrs 2397 53(caries free)
ORAL 12yrs 26
HEALTH
SURVEYS

2003 Bo –hyoung 6-59months 470 56.5 1.8

jin

2005 Leon C Goe 5-15yrs 854 32.7 1.2

2006 NATIONAL 8yrs 2650 69.5(caries free)

ORAL 12yrs 39(caries free)
HEALTH
SURVEYS

2012 Kim YS >18yr 11466 27 0.7

2013 Cho HJ et al 6yr 469 20.2 0.8
8yr 22.3 0.9
11yr 23.2 1.1
2015 Min ji kin 5yr 314 - 0.7
• The decline in dental caries among Korean children
aged 8 and 12 years from 2000 to 2012 focusing
SiC Index and DMFT

• Kim et al. BMC Oral Health (2016)

 Aim
• The aim of this study was to analyse the
prevalence and severity of dental caries among
Korean children aged 8 and 12 years over a
period of 12 years by determining the number of
decayed, missing, and filled teeth (DMFT) and
the Significant Caries index (SiC index).
 Methods
• Stratified cluster-sampled data from the National Oral
Health Survey conducted from 2000 to 2012 were
analysed.
• In 2000, 2006, and 2012, a total of 2397, 2650, and 9601
children aged 8 and 12 years were examined,
respectively.
• The children’s oral health status, including the number of
DMFT and fissures sealed teeth, was examined and
recorded. The SiC index was calculated according to the
child’s residential district.
Results
• a free fissure sealant programme that was
implemented by the government from 2002 to 2009
was conducted for almost 200,000 primary school
children every year by public health centres.
• Fissure sealant has been covered for children by
national health insurance since 2009. The scope of
oral health in public health care has expanded since
2005. Facilities for tooth-brushing drills in primary
schools were installed beginning in 2011
 2000 2006 2012
Population (thousand 47,008 48,297 50,004
persons)

Practicing dentists 14,410 18,515 21,888

(persons )

Population drinking 12.7 5.8 6.4

flouridated water

Population received 340 6254

public fissure sealant
program aged 12 yr
 Conclusions
• a remarkable decline in dental caries for 8- and
12-year-old children was observed during the 12-
year study period.
• Public oral health programmes using fluoride
and fissure sealants and the common use of
fluoridated toothpaste may have contributed to
the improved oral health of 8- and 12-year-old
Korean children.
Bangladesh
• Bangladesh is one of the poorest countries in Asia, with roughly 150 million people
living on land 60 percent smaller than Japan and 30 percent of the population living in
poverty.

• Vulnerable to natural disasters such as cyclones, floods and earthquakes, Bangladesh

is also susceptible to the effects of climate change.

• In the 2000s, the country had firm economic growth averaging six percent each year,
and attention has been drawn to the country as both a destination for investment and
as a market because of its scale of population, and ample, inexpensive labor force.

• To assist the government of Bangladesh in attaining its objective of becoming a

middle-income country by 2021, JICA has provided assistance to achieve sustainable
economic growth and poverty alleviation.

• To overcome the vulnerabilities of society, JICA is providing assistance in areas such

as basic education, health care, rural development, governance and disaster
management.
• There is no national-level information about
the distribution of oral diseases in Bangladesh.
• Only 1591 dental health technologists are
available in the country and no primary oral
health workers or oral hygienists.
• There is need to develop a curriculum for
primary oral health care workers and oral
hygienists.
Age group % affected DMFT Year source

8-11 years n.a 1.5 1978-91 Von Palenstein helderman et al.

Prevalance & severity of periodontal
diseases and dental caries in Bangladesh
International dental journal (1996)
15-19yrs n.a 1.6 1978-91 Von Palenstein helderman et al.
Prevalance & severity of periodontal
diseases and dental caries in Bangladesh
International dental journal (1996)
20-34yrs n.a 1.0 1978-91 Von Palenstein helderman et al.
Prevalance & severity of periodontal
diseases and dental caries in Bangladesh
International dental journal (1996)

35-44yrs n.a 1.4 1978-91 Von Palenstein helderman et al.

Prevalance & severity of periodontal
diseases and dental caries in Bangladesh
International dental journal (1996)

12yrs n.a 1.5 1981 Leous P et al.

Oral health situation analysis in
bangladesh in 1981.Geneva,WHO,1982
12yrs n.a 1.4 1984 Tcherynlch P. Oral health in Bangladesh in
1978-1984. Geneva , WHO, 1985
12yrs 46.4 1.0 2000 Ullah MS.An epidemiological oral health study
on 12yr old bangladeshi school children 2001

12yrs n.a 0.97 2008 Oral health of 12-year-old Bangladeshi

children.
Mohammad Shafi Ullaha, Jolanta
Aleksejunienea & Harald M. Eriksena

8-12yrs n.a 1.05 2009 A Survey on Oral Health Condition in Primary

School Children
Fakir MM , Alam KMU , Mamun FA , Sarker N

>18yrs 58.1 1.6 2009 Prevalence of dental caries among adults in a

rural community of Bangladesh

<5yrs 44.34 1.1 2010 Prevalence of dental caries in the primary

dentition among under five children
SS Rahman, CH Rasul, MA Kashem, SS
Biswas

5-15yrs 69.6% - 2012 Oral hygiene practice among the primary

school children in selected rural areas of
Bangladesh.AFM Sarwar et al
 Conclusion
• After evaluating the results from various studies
in bangladesh the conclusion is due to ignorance
,illiteracy ,food habits, inadequate pratice of oral
hygiene are the major contributing factors for
dental caries in bangladesh.
• Less dentist to population ratio

• Also, the treatment is non affordable and not

evenly available in all parts of country.
Model Project for an Improvement on Oral
Health Care in Rural Area in Bangladesh
• Objective:

• To enhance knowledge and awareness of oral health care

among rural residents, especially targeting primary school
pupils in the target area as a typical rural community in
Bangladesh, aiming to establish model activities to improve
oral health condition in the rural areas.
• Through the project, Knowledge and Experiences on oral
health care and management are mastered by Bangladesh
dentists and school teachers. It induces their activities on
newly and self-supporting oral health care for school pupils
and the public.
 Expected Outcome
• 1) Short Expert Training in Japan- The Bangladeshi dentist will acquire methods of
oral health care instruction for rural people- Instructional materials such as posters
and photos will be prepared .

• 2) Primary schools in the target area- The school teachers and pupils understand
the oral health care and acquire a proper knowledge and practice of oral health
care.

• 3) Local dentists- The local dentists will understand the instruction methods of oral
hygiene and how to give effective instruction, especially in the remote areas in
Bangladesh.

• 4) Administration officials- The importance of preventive dentistry and oral

hygiene care will be shared among the relevant officials, and that an introduction
of school dental check-up will be considered and proposed in the target area as a
model case.
Indonesia
• In Indonesia oral health is included in the general health plan and health promotion programme.

• Children under five, pregnant women, children of school going age the elderly are given priority.

• There is a need to strengthen the involvement of communities, NGO's, professional organizations

and the private sector to enhance cross-sectoral collaboration as well as laws and regulations for
the prevention of oral diseases and promotion of oral health.

• This could be achieved among others through multisectoral action involving government, industry
and media to limit the promotion and advertising of foods and beverages that are harmful to oral
health. The dental health referral system will be continuously assessed to improve its efficiency.

• There is a need to establish an oral health information system, strengthen dental health education
and promote community participation..
 The Trend Analysis of the Availability
of Dental Caries and Dental Health
Personnel in Indonesia

• Niniek Lely Pratiwi

• Humanities Center for Health Policy and Community

Empowerment, National Institute of Health Research and
Development, Ministry of Health, Jakarta, Indonesia,2013
• AIM-This study aims to provide an overview
trend of dental caries and dental health
personnel in Indonesia.

• METHODS-: Data was analyzed from National

report on basic health research, RISKESDAS,
2007 and 2013 and the descriptive analysis was
made according to the type of data.
 RESULTS
• The results of the basic health research of
community (Riskesdas) for the year 2013 showed
that there was an increase in the prevalence of
active caries in Indonesian population compared
to the year 2007, from 43.4%(2007) to 53.2% (2013).
• Almost all provinces had an increase the
prevalence of active caries from 2007 to 2013,
• The highest increase was found in the province of
South Sulawesi (29.1%) and Lampung (23.6%),
 CONCLUSION
• The high prevalence of active caries requires promotion
of the importance of prevention of dental caries.
• Use of toothpaste containing fluoride among different
age groups must be implemented.
• Lack of dental health workers in health centers requires
an increase in community development by establishing
a cadre of health in order to perform promotion of
food consumption behavior with a high fiber content of
fruits, vegetables, and calcium so that it becomes a
necessity of society
Myanmar
• Social dentistry needs to be strengthened in Myanmar -
commencing from dental education, which is still
clinically and individually oriented.
• There are an insufficient number of public health
dentists to plan and implement community oral health
programmes.
• The oral health workforce, 545 dental professionals in
the public sector are assisted by 4800 basic health
workers trained in primary oral health care to cover a
population of 57 million population.
• The emphasis of the national oral health strategy in Myanmar is
on:
• (i) strengthening primary oral health care services for rural and
remote communities (the focus is on health promotion and
education, disease prevention, and provision of basic and
emergency oral health care);
• (ii) the fluoride project (including prevention of dental fluorosis
in endemic areas and promotion of affordable fluoride
toothpaste)
• (iii) delivery of quality routine oral health care services by
hospitals, urban health centres and school health teams.
 Age % DMFT Year Myanmar Source
Group affec
ted Per Cent Affected; DMFT; Different Age groups

12 n.a. 0.988 1999 1) Ogawa H, Soe P, Myint B, Sein K, Kyaing MM, Maw
KK, Oo HM, Muraii M, Miyazaki H. A pilot study of
dental caries status in relation to knowledge, attitutes and
practices in oral health in Myanmar. Asia Pac J Public
Health.2003;15(2):111-117
15-19 86 n.a. 1991 2) Moller, I.J. Oral health in Myanmar-Assignment
Report 1991 Regional Office for the South-East Asia
(SEARO), WHO
35-44 n.a. 4.38 1999 1) Ogawa H, Soe P, Myint B, Sein K, Kyaing MM, Maw
KK, Oo HM, Muraii M, Miyazaki H. A pilot study of
dental caries status in relation to knowledge, attitutes and
practices in oral health in Myanmar. Asia Pac J Public
Health.2003;15(2):111-117
65-74 n.a. 12.84 1999

35-44 12.81 2003 A Pilot Study of Dental Caries Status in relation to

Knowledge, Attitudes and Practices in Oral Health in
Myanmar.H Ogawa et al.2003
DMFT 12 Year Source
years
2.1 1991 1) Moller , I.J. Oral health in Myanmar – Assignment Report
Caries trends; dmft and DMFT; Different Age Groups
1991. Regional Office for the south –East Asia(SEARO),
WHO.
1.1 1993 2) Phantumvanti & Songpaisan. Assignment Report
SEA/DH, November 1994, SEARO
0.98 1999 3) Ogawa H, Soe P, Myint B, Sein K, Kyaing MM, Maw
KK, Oo HM, Murai M, Miyazaki H. A pilot study of dental
caries status in relation to knowledge, attitudes and practices
in oral health in myanmar. Asia Pac J Public Health. 2003;
15(2):111-117
0.2 2011 Oral health status and behaviours of children in Myanmar -
a pilot study in four villages in rural areas.
Chu CH1, Chau AM, Wong ZS, Hui BS, Lo EC.

1.71 2013 Aung Zaw Zaw Phyo, Natkamol Chansatitporn and Kulaya
Narksawat Faculty of Public Health, Mahidol University,
Bangkok, Thailand ,2013. ORAL HEALTH STATUS AND
ORAL HYGIENE HABITS AMONG CHILDREN AGED
12-13 YEARS IN YANGON, MYANMAR
 ORAL HEALTH STATUS AND ORAL HYGIENE HABITS AMONG
CHILDREN AGED 12-13 YEARS IN YANGON, MYANMAR

A cross sectional study was conducted among children aged 12-13 years in Yongon, Myanmar to

assess the oral health status and oral hygiene habits. The study involved 220 students were from

two high schools, one urban and the other rural. We conducted an oral health examination

following WHO criteria and used a self-administrated questionnaire

• Aung Zaw Zaw Phyo, Natkamol Chansatitporn and Kulaya Narksawat Faculty of
Public Health, Mahidol University, Bangkok, Thailand ,2013
 Materials and methods
• The study involved 220 students were from two high schools, one urban and the

other rural.

• Conducted an oral health examination following WHO criteria and used a self-

administrated questionnaire
 result
The prevalence rate of dental caries among the
study population was 53.2%.

The mean number of decayed, missing and filled

teeth (DMFT) was 1.7±2.1 teeth per person
 Conclusion
• The DMFT status in myanmar has recently been
getting worse compare to the results of previous
study .
• Although the current DMFT status is still lower
than global standard, the no. of DMFT has been
increasing gradually.
• This may be attributed to ready access to highly
cariogenic food stuffs which were only available in
developed countries in the past.
Nepal
• There is no dental council to regulate the education and planning for oral
health workforce development in Nepal nor there is a specific budget
allocated for oral health care and research.
• The oral health workforce is inequitably distributed as dentists are reluctant
to work in rural areas. Intersectoral coordination is rather weak and there is no
monitoring and evaluation system in place.
• The Government of Nepal has formulated a National Strategic Plan for Oral
Health. The document was developed by the National Oral Health Task Force
and its committees.
• The priority national-level strategies to improve oral health for the nation
include strengthening oral health education, prioritizing oral health promotion
approaches (such as fluoridation), prevention of common oral diseases and
conditions, incorporation of quality assurance mechanisms and development
of infrastructure for oral health at all levels.
Age group % affected DMFT YEAR Source

5-6yrs 67 3.3 1999-2000 Yee R et al

Gains in oral health and improved quality
of life of 5-6 yr old nepali school
children: Int Dent J 2006;56:196-202

35-44yrs 81 4.3 1995 Monitoring dental caries in adults aged

35-44yrs 1996. Oral Health Programme,
WHO, Geneva, 1996
DMFT 12 years Year Source

0.5-2.1 1984-86 WHO/ORH/J2/569/1985/Tewari

1.2 1994 Nithila A et al.

WHO Global oral data bank,1986-96:an overview of oral
health surveys at 12 years of age.Bull world health
organ.1998;76:237-244

0.8 2002 Yee R et al

Gains in oral health and improved quality of life of 12-13
yr old nepali school children:Int Dent J 2006;56:196-202

0.5 2004 Yee R et al

Gains in oral health and improved quality of life of 12-13
yr old nepali school children:Int Dent J 2006;56:196-202
Year /place Investigator Age Total no. Prevalence dmft/DMFT
2008/kathma Subedi b 5-6YR 313 69 3.79
ndu 12-13YR 325 53.23 1.6

2011/chitwan Prasal dixit et 5yr 131 52(5-6yr) 1.59

dist al 6yr 41(7-8yr) 0.31
7yr 0.52
8yr 0.84

2012/eastern TK Bhagat 5-15yr 666 1.82

nepal 0.37(DMFT)

2012/cental Kakuhiro 3-5yr 829 45.3 1.68

nepal(kathm fukai 6-10yr 18.8 0.32
andu) 11-13yr 30.5 0.56
14-16yr 34.8 0.80

2013/Kathma Khana S 12-15yr 252 58.3 1.2

ndu Acharya

2014/pokhera Karki s 6-12yr 142 66.90(dmft) 6-7yr-4.78

valley 29.57(DMFT) 8-9yr-3.59
10-12yr-1.20

2015/nawalpa Thapa p 5-6yrrs 1000 64.4% 4.4

rasi 12-13yrs 42.2% 2.3
 conclusion
• Nepal is currently facing an oral healthcare crisis.

• Fifty-eight percent of children and 69 percent of adults in the

country suffer from bacterial tooth decay.
• A national Oral Health Care Plan was drafted in 2004, but is
being implemented at a glacial speed. And thousands of Nepalis
in rural villages have no access to basic care such as fillings or
even fluorinated toothpaste and water.
• Meanwhile, intense superstition surrounds dental care, including
the belief that tooth extraction can cause blindness. In
Kathmandu, people nail coins to a tooth god shrine to heal their
mouth pain.
Sri lanka
 Sri Lanka
• there is no oral health policy in place in the country.

• General health promotion (through health promoting schools,

etc.), prevention of oral diseases (through addressing common
risk factors) and making basic oral health services accessible to
communities through primary health care approaches are the
priority strategies of this community centred national programme.
• The oral health workforce is concentrated in cities, and in
particular in tertiary care centres.
• The dental auxiliary personnel in Sri Lanka consist of dental
therapist who are based in schools and provide oral health care to
school children.
 Caries trends;DMFT;different
age groups
DMFT 12 yrs Year Source

1.9 1983-84 National oral health survey, sri lanka, ministry of health NOV
1985

1.4 1994-95 National oral health survey, sri lanka 1994-95, ministry of
health

DMFT 35-44 Year Source

9.2 1983-84 National oral health survey, sri lanka 1994-95, ministry of
health
10.1 1994-95 National oral health survey, sri lanka, ministry of health NOV
1985
Age % affected dmft/DMFT Year Source

6yrs 76.4 4.1 1994-95 Oral health survey, Sri Lanka 1994-
95, Ministry of Health

12yrs 53.2 1.4 1994-95 Oral health survey, Sri Lanka 1994-
95, Ministry of Health

15yrs 69.7 2.5 1994-95 Oral health survey, Sri Lanka ,1994-
95, Ministry of Health

35-44yrs 91.2 10.1 1994-95 Oral health survey, Sri Lanka 1994-
95, Ministry of Health

55-74yrs 64.5 22.5 1994-95 Oral health survey, Sri Lanka 1994-
95, Ministry of Health
year/place investigator Age Total no. prevalence dmft/DMFT

2002/veddha dasanayake 2-5yr 39 2.7

5-17yr 0.9

2008/regama Priyantha J 36-60mths 285 47.7 1.81

2012/Gampha dist Priyantha j 2-5yr 410 1.41

2014/colombo Perera I 15yr 1218 41.44 1.2

 Oral health programme
• Oral health promotion for socially disadvantaged, culturally diverse
preschool children in the Colombo Municipal
• Conducting a Preventive Dental Clinic for toddlers and children aged 1
year to 10 years in the Dental Institute, Colombo.
• Oral health promotion for pregnant mothers in the Colombo.

• Conducting oral health promotion programmes for diverse population

groups in different settings such as schools, child development
centres, occupational settings, Homes for elders, social events on
health and oral health promotion, Health camps etc.in Colombo.
• Capacity building of preschool teachers and health workers for oral
health promotion among high risk groups in Colombo area.
Thailand
 Thailand
• Thailand has developed oral health goals to be
achieved by the year 2020.

• They envisage improvement in the oral health status

of people (including social dimension) and
strengthening of the oral health delivery system.

• The Dental Health Division, Ministry of Public Health

(MoPH), Thailand conducts regular national oral health
surveys (NOHS) every five years.
• In addition to documenting the current oral health situation these
surveys measure the progress made in the achievement of specific
national oral health targets which include, among others
• (i) less than 50% prevalence of dental caries among 3-year-old children;

• (ii) retention of all permanent first molars in 100% of 12-year-old

children;
• (iii) prevalence of gingivitis in teenagers not exceeding 60%, and (iv)
having at least 20 functional teeth in 80% of the elderly.
• The sixth NOHS conducted in 2007 revealed that the prevalence of
dental caries in 3-year-old children was 61.4% and among 5- year-olds it
was 80.6%.
• NOHS programme includes health education and prophylaxis for pregnant women, oral
screening and provision of the first toothbrush for children aged 9-12 months and teeth
brushing programme in kindergartens.
• In schools pit and fissure sealant is provided for first grade students.

• Oral screenings and teeth-brushing drills are conducted and the consumption of sugary
snacks and carbonated drink is controlled.
• The oral health programme for the elderly focuses on the promotion of self care and
delivery of services aimed at prevention of tooth loss. Dental prostheses are provided for
senior citizen with edentulous arches.
• Within the consumer protection and environmental control scheme, standards have been
set for oral care products such as toothbrushes, fluoride concentration in toothpaste (1000
ppm) and in drinking water (0.7 mg/L).
• Moreover, a fluorosis mitigation programme is being developed in areas where there is
excess of fluoride in drinking water. Dentists are also encouraged to actively contribute to
towards control of tobacco consumption, including smoking cessation efforts.
Caries control
in
thailand
Bhutan
• Health care services in Bhutan are free for its citizens.

• However, the considerable challenges remain in the area of oral

health.
• The number of dental surgeons in the country is very low creating a
huge gap in the provision of qualified oral health services.
• Dental surgeons should be involved in the planning and
implementation of oral health programmes. There is a need to
ensure that oral health is closely linked to overall health care, and
follow the principles of public health.
• This requires formulation of an oral health policy which will be an
integral part of the National Health Policy.
Age group % affected DMFT YEAR Source

12yrs n.a 1.4 1985 WHO/ORH/J2/532/1985/Singh

12yrs 61 1.6 1985 Urban -Tewari A. et al.

Risk markers for oral diseases-dental
caries,Vol 1

12yrs 56 1.4 1985 Rural –Tewari A. et al.

Risk markers for oral diseases-dental
caries,Vol 1

15-19yrs 73 2.5 1985 Urban -Tewari A. et al.

Risk markers for oral diseases-dental
caries,Vol 1

15-19yrs 76 2.6 1985 Rural –Tewari A. et al.

Risk markers for oral diseases-dental
caries,Vol 1
12yrs 48 1.24 2009 Urban
Oral health and associated factors in 12
year-old children in Thimphu, Bhutan
 Current programmes
• Strengthening of school oral health programme in Tanzania
through health promotion’
• Building capacity for delivering preventive services to
disadvantaged community schools
• School-based programmes for the prevention of dental
diseases in Madagascar in Ndola, Zambia’.
• Oral health promotion and prevention for public pre-school
children in Cambodia’
• Simply Modified Atraumatic Restorative Treatment (SMART)
program for the oral health of Lao children’
Maldives
• There is no oral health policy in place in the Maldives .

• The dental services provided in the country are mostly

curative and the rural population is largely unattended to
regard to basic oral health care because dental surgeons
are concentrated in the capital.

• The total number of dentists in maldives are 32

• The availability of emergency oral health care is limited

and also not free. Primary health care workers are present
in most islands and are attached to health posts/health
centres.
• In term of oral cancer, Maldives and Sri Lanka ranks the two
highest in Asia while Papua New Guinea ranks the highest in
the world.
• There is high prevalence of dental caries and periodontal disease
in the Maldives.
• The focus of the oral health programme should be on oral health
promotion, prevention and provision of emergency care to the
entire population.
• The population of Maldives in 2014 was projected to be
341,848. The last census in 2006 recorded atotal population of
298,968 (Census, 2006)
Age % affected DMFT YEAR SOURCE
group

12yrs 70 2.1 1984 Tewari A. et al. Distribution of Dental Caries in India

and South East Asia. In Risk markers for oral
diseases, Vol I. Dental Caries. Ed. Johnson N.W.,
Cambridge University Press, 1991.

15-19yrs 87 4.9 1984

30-34yrs 62 3.5 1984

35-44yrs 61 2.2 1984

 conclusion
• Despite the achievements in the health sector, it is a daunting challenge for Maldives to
sustain accessibility of health services equitably throughout the country.

• The delivery of services is hampered by the geographical nature of the country with
numerous islands scattered throughout and often the means of transport is by sea which can
be affected by unfavourable weather.

• In terms of cost effectiveness and sustainability, it is not favourable to have hospitals or

health centers in each island as the population in some islands reach up to a few hundred
only.

• Moreover, due to the limited and unreliable public transport system, people in many islands
are unable to travel or have to pay high amounts to the private transport services to reach
appropriate health care.

• Considering these factors, health care services provision in Maldives is a costly undertaking.

• A systematically organized public transportation system is a necessary pre-requisite for the

full utilization of the four tier health care delivery system.

• A sustainable marine transport network will increase accessibility and mobility of the people
and is expected to increase economic regeneration at all levels through revitalization of the
urban setting and land use.
Timor-Leste
 Timor-Leste
• Oral diseases remain a significant problem in Timor Leste. There is a
high prevalence of dental caries and periodontal diseases.
• Treatment interventions alone will not reduce the burden of oral
diseases in the country. As treatment of oral diseases is beyond the
capacity of the existing oral health workforce and the budget of the
Ministry of Health the current response focuses on oral health
promotion, prevention of oral diseases, and provision of emergency care
throughout the country.
• The oral health strategy of Timor Leste is to provide sustainable and
affordable oral health services.
• The priorities include cost-effective prevention, oral health promotion
and interventions through primary health care approaches.
• The strategic framework for the National Oral Health Programme
specifies the following strategies
• : (i) oral health protection

• (ii) promotion and prevention

• (iii) integration of oral health into general health

• (iv) support for service delivery

• (v) personal dental care

• (vi) research (vii) human resource development (viii) institutional

approach (ix) strategic alliances, and (x) monitoring and evaluation.
• a survey conducted in 2007 by the Timor Leste
government (Ministry of Finance) found that
just less than 50% of Timorese lived below the
national poverty line with $0.88 per-capita per-
day (TL survey of living standard 2007).
Poverty has declined by 9 % point between
2007-2009, and life expectancy increased from
62 years in 2002 to 65 years in 2009
• Despite these improvements, the oral health sector remains a
significant problem in Timor Leste. The factors that influence the oral
health status of East Timorese have been chronic issues for years.
• They include limited access to oral health information, alteration in
socio-economic conditions and recent changes in eating habits as
people are now more likely to consume refined foods than traditional
foods.
• All of these factors have contributed to an increase the prevalence of
dental caries. In addition, factors such as smoking, betel quid chewing,
the lack of health education and poor access to dentists have played an
important role in increasing dental caries and periodontal disease
among children and adults (Timor Leste National Oral Health Strategy,
2004).
• The Report noted that dental caries was highly prevalent in the deciduous teeth of
children aged 6 – 8 years old.
• It was reported only just over half (57.7%) of the 6-8-years-old children brushed
yesterday. The same was also reported in those aged 12-17 years old.
• There were an increased proportion of children aged 12 – 17 years old who brushed
their teeth yesterday (93.3%).
• The prevalence of dental caries in this group of children was 66.7% (Timor Leste
National Oral Health Survey, 2002). However, the mean dmft for each child in this
age group was 3.4 and this mostly accounted by untreated decayed tooth.
• Furthermore, dental caries was also highly prevalent amongst adults (90.4%) and
the mean number of DMFT in adults was 5.3 teeth. About two-third of adults
population had experienced toothache and there were approximately twenty five
per cent of this group had avoided eating very often or sometimes in the last year
(Timor Leste National Oral Health Survey, 2002).
• Periodontal disease is also high amongst East Timorese.

• Gingivitis was found in both children and adults. Many adults who
suffered from a severe type of gingivitis may lose their teeth.
• Smoking and betel quid chewing played an important role in
worsening gingivitis in adults where most of them showed signs of
gingival bleeding or accumulation of dental calculus.
• The prevalence of periodontal disease was high in adults aged 45
years old and above. Approximately 76.6% of male adults were
smokers while betel quid chewing was practiced by 38.3% of men and
57.7% of women (National Oral Health Survey, 2002). Betel quid
chewing is a significant risk factor for oral cancer (Timor Leste
National Oral Health Survey, 2002).
 Statistics
• At present there are forty six dental nurses and seven dentists in East Timor
with an average of one dentist per 214,286 people.
• According to health officials at Ministry of Health in Timor Leste, there are
currently 30 dental students studying dentistry in East Java, Indonesia.
However, these students need another five to six years to complete their
studies.
• In East Timor almost all of the oral health professionals are employed by the
government to work in government dental clinics that are located in one main
hospital, five referral hospitals, and 15 health centres around the country. The
dentists are all working in the national and referral hospitals, while the dental
nurses are located in each health centre with limited dental materials and
equipment.
• About 60% per cent of the Timor Leste people are farmers and live in remote
areas.
• In conclusion, health issues in East Timor are strongly influenced
by factors such as poverty, illiteracy, economic difficulties,
political conflicts, and war.
• Specifically, oral health problems are affected by factors such as
poor preventable oral health programs, limited access to oral
health information, alteration in socio-economic conditions, the
recent change in eating patterns, and the limited number of
dental workforce.
• Most people in East Timor are affected by periodontal disease
and tooth decay. Poor patterns of utilizing dental service and lack
of oral hygiene practices resulted in increasing the prevalence of
dental caries as well as periodontal disease.
• Oral disease can be largely prevented through
strategic dental public health programs and
changes in personal oral health behaviours.
• There is a need to carry out epidemiological
studies in dental health in order to contribute
accurate data which needed to develop
appropriate strategic program to combat oral
disease in Timor Leste.
 Conclusion
• Oral diseases such as dental caries, periodontal
diseases, tooth loss and oral cancer have
emerged as a major public health problem in
the Member countries of the South-East Asia
(SEA) Region of WHO.
• There is an urgent need to formulate a
common oral health policy feasible for SEARO
region
• The three pillars essential for oral health
programs are

1. Oral health education

2. Primary prevention

3. Secondary prevention
THANK
YOU