‘We need to eradicate caries from the face of the Earth’
Miami, FL, USA: Executive Director of the FDI World Dental Federation Dr David Alexander said in an interview with Dental Tribune at the 87th General Session and Exhibit of the International Association of Dental Research (IADR), that for too long dentistry and dental policy makers have been counting numbers of decayed teeth, instead of focusing on real issues such as quality of life. He advocates for radical change in the attitude and language used by dentists, and for a bold move to eradicate caries from the planet.
What is FDI focusing on?
FDI’s vision is to lead the world to optimum oral health. We carry out this mission through health promotion, health policy, access to care, and continuing education. For health policy, we work through our Committees structure to generate policy statements that our national dental association members can take to their governments and use locally in their countries. In terms of health promotion, we have programs in 38 countries that are improving people’s oral health and their quality of life. For continuing education (CE), we have our FDI Annual World Dental Congress every year, where we have major continuing education programs with world-class speakers. Over 80 world-class speakers will give presentations in Singapore this September. We also have a regional CE program (FDI organizes at least one CE course on average every two weeks), where FDI focuses on taking education to those countries which normally don’t get quality education. The final piece is access to care through this work we do, where we are improving the safety and effectiveness of the care delivery system, enabling dentists to give care that is safe and effective.
How effective are your programs since needs are vastly different?
Currently there is not a good measuring and evaluation system in place, and that’s something that as Executive Director I will strive to have in all our programs. We have many global issues around caries. In developed countries people think it’s not an issue anymore, but it still is! There are communities that have an incredibly high burden of disease, as happens in less developed countries. We as the dental profession have a responsibility to do something, and in all communities.
We need to be bold and daring, to have the audacious goal of eradicating caries. Through our Global Caries Initiative we are looking at new ways to diagnose and classify the disease so we can pick it up at an earlier stage when prevention is possible. Most of our diagnostic systems identify when cavitation has occurred and all we can do is provide restorations. We need to get into the environmental stage; we need to reduce cariogenic foodstuffs in the diet and look at widespread use of fluoride toothpastes. Fluoride is the most effective preventive measure, and yet in many communities they have not something as simple as a toothbrush and fluoride toothpaste that you use twice a day to prevent disease. The cost savings alone would be great.
In many countries in Latin America toothpaste and toothbrushes are considered a cosmetic item and thus subject to taxes, which is expensive.
This is a classic case where FDI, FOLA (Latin American Regional Organisation of FDI), and the national dental associations need to take a strong stand of leadership. If we don’t take this leadership role, nobody else will. We have allowed this to be in the hands of public health ministries that haven’t taken the compelling stand of looking at the science. It’s unconscionable that something as effective and as clinically proven as fluoride should be taxed as a cosmetic.
On addressing caries in Latin America, we are working closely with the Pan American Health Organization, and in particularly with Dr. Saskia Estupiñán. FDI is the world leader for dentistry working with the World Health Organization and its divisions.
But (the tax issue) is a difficult proposition…
Let’s look at child development. A child who has a toothache cannot sleep at night, cannot concentrate in school, cannot eat properly. That child is not developing to be an economic-generating individual. What is the economic cost to a country of a child who doesn’t develop into a productive person? Taxation limits access to this most effective preventable agent for dental caries. This is not a cosmetic. Preventing dental caries is absolutely related to overall health, quality of life and development. Finance and Commerce Ministers who can’t see that are very short-sighted and are failing in the development of their countries.
This is the language that we need to use. As dentists, we have been our own worst enemies, counting numbers of decayed teeth in people, from DMFT scores to DMFS; we’ve missed the point. We count teeth, forgetting quality of life, and attainment and development of people. We argue that you can’t have general health without oral health. But who took oral health out of general health? When we put the mouth back in the body, and stop counting teeth and surfaces, and start talking child development and quality of life, then we’d be talking in a language that people can understand.
How do you bridge that problem? Dentists and physicians don’t have a good relation.
Unfortunately, both dentists and physicians are trained separately and differently in many countries. Physicians don’t value the oral cavity because they only see decaying teeth that “the dentist can fix”. They don’t see that patient with caries and periapical abscesses as having a disease, which through the effect of bacteria and inflammatory mediators will affect other body systems too. We know of the relationship between gum disease and preterm low-birth weight babies. Currently low birth-weight preterm babies cost the US health system an estimated USD$400,000. If that gum disease would have been treated it may have cost only USD$400. We need to be advocates to the medical profession, to help them understand these major issues of cost and quality of life impacted by preventable dental diseases. Every woman who’s planning to get pregnant, who becomes pregnant, should be counseled through the dental care system to reduce the risk of preterm low-birth weight babies. We know there’s an association between gum disease and diabetes. How much does it cost to treat and manage diabetes for the rest of a patient’s life? There’s an association between oral health and cardiovascular health. What does it cost to maintain a cardiovascular patient? We need to maintain a much greater dialogue with all members of the health profession, to bring about optimal oral health, which contributes to optimal general health.
Caries is preventable – we have known that for many years. As a big hairy audacious goal we will eradicate it. Caries falls right at the heart of the dental profession, no one else – its time to act.