Oral health … more education programmes needed in the Pacific. Image: PMC archive

Dental health expert says the links between poor oral health and non-communicable disease is a great threat to Pacific health.

Pacific Scoop:
Report – By Cassandra Mason

A New Zealand academic is calling for more oral health programmes in the Pacific after a Cook Islands dental project he founded revealed dangerously low levels of awareness about the links between gum disease and non-communicable illnesses.

Dr Jonathan Leichter says the relationship between oral health and systemic health poses a real threat to Pacific Island communities, which suffer from an existing prevalence of diabetes and cardiovascular disease.

Dr Leichter and fellow University of Otago dentistry academic Dr Colleen Murray founded the Cook Islands Dental Project seven years ago.

The idea arose from seeing the “state” of Rarotonga’s existing clinic while at a World Health Organisation oral health conference in the Cook Islands, Dr Leichter says.

The number of German and Scottish dental students volunteering their time “halfway around the world” in the islands also proved to be a catalyst.

“It didn’t make sense, we’re in New Zealand – we’re their Pacific brothers and sisters.”

Since then, the volunteer-based Cook Islands Dental Project has been providing free dental care and education to children, adults and health care providers on Rarotonga and outer islands.

Donated equipment
About $250,000 has been raised since the project began – with around half in cash and the rest in donated dentistry equipment.

The dental supplies are delivered from New Zealand to help build infrastructure and leave enough for local staff to carry on throughout the year.

Dr Leichter, Dr Murray and six dentistry students also spend a month each year on site in the project’s Cook Islands clinic working with local oral health workers and raising awareness about the perils of poor oral health.

“Islanders throughout the entire Pacific have a very high prevalence of dental disease, periodontal disease in specific, and most importantly, a very high prevalence of cardiovascular disease and diabetes,” Dr Leichter says.

“What does one have to do with the other? Well, everything. And that’s a big part of our educational programme.”

He says the link is well-documented in academic literature but not so recognised at a community level.

“If you have poorly-controlled dental disease you are putting yourself more at risk for being a poorly controlled diabetic.

Diabetes problem
“We know there is a bidirectional relationship and again, every other person has diabetes there.”

Untreated periodontal disease is also a well-recognised risk factor for heart disease, he says.

“We have a population that is cursed with diabetes, cursed with high blood pressure and cardiovascular disease and then the triple whammy is they have periodontal disease which is magnifying these potentially life-threatening diseases.”

A 2003 WHO World Oral Health report shows that Dr Leichter’s concerns are already universally acknowledged.

“Non-communicable chronic diseases, which continue to dominate in lower-middle and upper income countries, are becoming increasingly prevalent in many of the poorest developing countries.

“They create a double burden on top of the infectious diseases that continue to afflict
these countries.”

The report says oral diseases qualify as “major public health problems”.

Drawing attention
Dr Leichter says the project’s approach is designed not just to fix holes but to draw attention to these major public health problems.

The population must be aware that treatable conditions like gum disease can have significant impacts on systemic health, he says.

“It’s affecting every single person in the world but because the Pacific population, all of them, are at high risk for diabetes and cardiovascular disease it is much more important to get that message home to that population which is already in trouble.”

Another component of the project is what Leichter calls “guerrilla dentistry” – teaching people from the outer islands how to perform basic emergency dentistry.

“If you have a toothache in Puka Puka, it’s a five-day boat ride away.

“You’re not going to find a dentist setting up a quarter of a million dollar dental clinic there, it just wouldn’t work. So if we can train someone, give them some basic supplies to do basic emergency dental treatment, it’s an absolute godsend.”

While slightly unorthodox, Dr Leichter says the practice is sanctioned by the Cook Islands government.

More training
“We only have two hands and we can only be there for a month so how can we leverage what we do?

“One, by giving them supplies to carry on and two, by upscaling them and training new people to provide care where no one else lives.”

Dr Leichter says he would like to see more projects like the Cook Islands Dental Project being set up in the Pacific, as long as they are sustainable.

“A lot of dental volunteer missions are dental voyeurism. It’s dental pornography.

“People go, they have a holiday, they say ‘Look at the bad teeth, I’ll pull a tooth out, I’ll leave them some outdated supplies and I get to write off the trip.’

But it’s ongoing, sustainable projects supported by the local government and local health care suppliers that will help to make changes in the Pacific, he says.

Cook Islands Chief Dental Officer Danny Areai also says the relationship between gum disease and non-communicable disease is one of the biggest problems facing Pacific Island communities.

Changing lifestyles
Areai points to changing lifestyles for the high rates of dental disease.

“Diet has contributed dramatically.

“Studies in the Cook Islands done 30 or 40 years ago show the decay rate was much lower than it is now.”

He says increased access to imported foods, exposure to sugar and a lack of exercise have all contributed.

While awareness about the links is not as good as it should be, Areai says he hopes new evidence and the advocacy of dental workers will change this.

“We are now advocating to our people.

“And they need to take heed.”

Areai came on board with the Cook Islands Dental Project after working in Fiji and completing a masters degree at Otago University.

Mutual benefit
He now runs the clinic day to day.

In the last year, the project has gone “from strength to strength”, he says.

“It’s a two way thing. Students gain experience when they are here, and on the other hand, we get updated with new knowledge and we can improve the delivery of services to our people – there is a mutual benefit.”

Areai says an upcoming national oral health survey will hopefully shed light on problems whose explanations have mainly relied on anecdotal evidence up until now.

“The survey will give us a good platform to gauge the problems and decide which direction to go in,” he says.

Fiji has already completed a similar survey but is still waiting on the results.

One of the six dental students who volunteered this year, Sarah Davidson, says the month-long secondment drew her attention to differences between oral health in the Pacific and New Zealand, especially concerning periodontal disease.

“You do notice it in New Zealand but it was a lot more noticeable there. A lot of people were coming in with some degree of periodontal disease.

“You become aware of the inequalities in access and ability to seek dental treatment, there and everywhere in the world.”

Cassandra Mason is a Postgraduate Diploma in Communication Studies student journalist on the Asia-Pacific Journalism course at AUT University.