TONGA DENTAL HEALTH PROJECT 1998 REPORT

Transcription

1 TONGA DENTAL HEALTH PROJECT 1998 REPORT REPORT ON A VISIT TO TONGA IN SEPTEMBER 1998 According to the early explorers, Pacific Islanders had wonderful teeth two hundred years ago. Until recent times the Tongan people consumed relatively small amounts of sugar (Tonga 13 kg. per capita - nearby Fiji 42 kg. in 1973) and could boast lower DMFT rates than most developed Western countries. For instance, in New Zealand the DMF index in 1973 was 6.0, whereas on the islands of Tonga to the north in 1966 it was only 0.7. However, anecdotal evidence from recent visits indicated that this is no longer the case. A Rotary / St. John of God Hospital Dental Health Project work party (the 3 rd. such work party) visited Tonga in September 1998 with two main aims: 1. To do a survey of dental decay in six, nine and twelve year old children 2. To film an Infection Control training video, specifically for Tongan conditions. DMF SURVEY The survey was intended to give an accurate picture of the state of caries in children in 1998 and also to compare these results with the Tongan National Oral health Survey done in Our survey was performed according to current guidelines (the criteria set out in the WHO Oral Health Surveys Basic Methods 4 th. Edition 1997), and involved 548 school children in ten different geographic locations. Seven locations were on the main island of Tongatapu and three on Vava'u. Although the Kingdom of Tonga consists of more than 150 islands, the two islands surveyed contain about 85% of the Tongan population. RESULTS A comparison of the results in 1986 and 1998 are shown. Age Group Number of Children DMFT (Permanent teeth) Dmft (Deciduous teeth) Caries Free % 6 y.o N/A 7.7% 9 y.o y.o

2 As can be seen in Table 1 dmft (decayed, missing, filled in Deciduous teeth) in six year olds has more than doubled from 2.7 to 6.5 and DMFT (decayed missing, filled in Permanent teeth) in twelve year olds has trebled from 1.0 to 3.1. This compares with a WHO goal for the year 2000 of a DMFT index of less then 3.0 for 12 year olds, and the current world weighted average in 1996 of 2.2. The number of twelve year olds that are caries free, has decreased from 75% in 1986 to 22.5% in Nine year olds have fallen from 76.6% to 30%. However, if deciduous teeth are included, only 10.3% of nine year olds are now decay free The situation is worse in six year olds, where only 7.7% are caries free (and 30% have ten or more teeth affected by decay.) The WHO goal for the year 2000 is that 50% of six year-olds be caries free. DISCUSSION It is obvious that there has been a deterioration in the oral health of Tongan children over the last twelve years. Moreover, because the 1986 survey used sharp sickle probes (Oral Health Surveys Basic Methods 2 nd.. Edition WHO 1977), the deterioration is even greater than it appears. The blunt, ball-ended probes that we used should detect less caries than sharp probes. To introduce a ball ended CPI probe and detect a "soft wall or floor" (4 th. edition 1997,p. 41) will now require more obvious cavitation than in previous years. A comparison of the D component of the DMFT index will need to take into account the change in criteria for detecting caries, as an improvement in the DMFT may in fact be due to the change in methodology. Despite the high caries rate in six year olds, there was little evidence of dental treatment in 223 children. We found only 18 fillings and 79 missing teeth due to extractions. Similarly in 253 twelve year olds 77.5% had evidence of caries but only 30% had any signs of treatment, as shown by 59 extractions and 97 fillings. In the total DMF of 3.1, the D = 2.5, M = 0,23, and F = This is quite different to countries with a well developed delivery of dental services, where the highest component is typically the F portion. There is a growing need for dental treatment in Tonga and an urgent need for preventive strategies. The deterioration in dental health is yet to impact on the public or political conscious, partly because it is largely to the deciduous teeth, which are of course eventually lost, and young Tongans tend not to complain.

3 One suspects that it will not be perceived as a problem until caries affects the anterior teeth of older children and adults, and spoils that famous Tongan smile. Currently, although 77% of twelve year olds have evidence of caries, only 20% have caries in their anterior teeth. A comparison of the DMFT rates of twelve year olds in the Western Pacific Region as obtained from the WHO Global Data Base indicates that Tonga has gone from a very low category in 1986, to the "moderate" category in The increase in caries points to the need for some form of prevention to arrest this trend. Existing and future dental manpower is highly unlikely to ever be able to meet treatment needs. SURVEY CONCLUSION A comparison of dental surveys in 1986 and 1998 has shown a marked deterioration in the oral health of Tongan children. Decay rates have more than doubled, and whereas the majority of children were once caries free, now less than 25% are. Existing manpower (six dentists, five therapists) cannot meet the growing needs of over 100,000 people spread over 150 islands. Currently no effective preventive measures are being used in Tonga to improve the situation. However the first stage in any caries preventive program is realising the extent of the problem. Unfortunately, the days of Tonga being able to boast a DMFT in 12 year olds of 1.0 have gone. INFECTION CONTROL TRAINING VIDEO The second part of last September's visit was the filming in the Vaiola Hospital Dental Clinic of an Infection Control training video in Tongan and in English. This Infection Control video is aimed at consolidating the improvements made in this area on previous visits. There are now three autoclaves and an ultrasonic cleaner in the sterilising room serving the needs of the 8 chair clinic at the main Vaiola hospital in Nuku'alofa. This is the same hospital where 19% of the blood donors tested positive for Hepatitis B in a W.H.O. survey, so the transmission of blood borne viruses there is a real concern. The video has been specifically tailored to the local conditions and is intended to create a safer workplace using work practices that are sustainable in Tonga, given their limited financial resources. The video is in both English and Tongan language versions but could easily have

4 voiceovers done in other languages at little extra cost. This excellent video, which was filmed, scripted and edited by the staff at RMIT University in Melbourne, Australia, runs for 12 minutes, and copies are available from the Ballarat West Rotary Club on application. Topics covered include patient evaluation, barrier protection, cleaning of instruments, sterilisation and disinfection techniques, and the storing and disposal of hazardous waste. FOOTNOTE Much of the dental equipment at the Vaiola hospital in the capital, Nuku'alofa, still needs to be upgraded. Clean water kits, handpieces and two new dental chairs (donated by the Adec dental equipment company), and three autoclaves are to be installed at the Vava'u hospital (above) in the northern island region of Tonga on the next visit in September This party will also include an Oral-Maxillofacial surgeon, dental nurse, two dentists and a dental equipment repair technician. Rod McLean, infection control expert from RMIT University will also be part of this team and will introduce the Infection Control video to the staff at Vaiola Hospital and explain how it can best be put to use. Dr. David Goldsmith 11, Lyons Street North Ballarat 3350 Australia Fax dgold@netconnect.com.au May 1999 ACKNOWLEDGMENTS Grateful thanks go to the following for supporting the project;

5 All the friendly staff at the Vaiola and Vava'u Hospitals. Survey team; Dr. Ekke Martini B.D.Sc.(Melb.)-(who also interpreted the survey results) Dr. Scott Sherwell B.D.Sc. (Adel.) Dr. David Goldsmith. B.D.S (Durham), L.D.S.,R.C.S.(Eng.) Recorders; Dr.Tevita Vao.(dentist) Ms Nenase Latu (dental nurse) from Tonga Ms. Klaarke Halatanu De Jong (Dutch dental hygienist) Petra Willburger, Dagmar Baumgarten (final year dental students, Koln University) RMIT University, Melbourne. Infection Control Video team; Rod McLean (Health & Clinical Science & Nursing Faculty) - script / director Kara Burns (Scientific Photography, RMIT) - filming Iain McKay (Visual Communications dept. RMIT) - editing Dental equipment technician; Chris Kettle; Dental Alternatives Pty., Melbourne. St. John of God Hospital, Drummond Street, Ballarat, 3350, Australia Dr. Moi Tapealava, CDO,Vaiola Hospital Dental Clinic, Nuku'alofa, Tonga, Dr. Sililo Tomiki, CDO, Prince Wellington Ngu Hospital, Neiafu, Vava'u, Tonga. Rotary Club of Ballarat West, P.O.Box 92, Ballarat 3353, Australia Nuku'Alofa Rotary Club, Tonga.