Brushing up - Nepali Times

Since having her first phase of crown treatment and dental fillings eight months ago, Chapagaun resident Ani Desar is yet to return to the dentist for a follow up appointment.

"I'll probably wait until it starts hurting again," says the 18-year-old. Desar may lack awareness of prevention, but she is luckier than most rural Nepalis who have no dental care at all.

There are now 500 dentists in Nepal, but nearly 80 per cent of them practise inside Kathmandu's Ring Road. Almost all decay is left untreated, causing tooth loss, speech problems and facial disfigurement. Even in the cities, a root canal can cost Rs 5,000, so most Nepalis would rather suffer in silence.

"Awareness of oral hygiene in rural Nepal is low because that is the last priority when people are just trying to survive from day to day," says dental surgeon Anjana Maharjan at Patan Hospital. Indeed, there is so much emphasis on nutrition and diet that oral hygiene is not even in the government's own health priority.

"We've neglected a well-functioning set of teeth where food is first processed," says Lonim Prasai Dixit at the People's Dental College and Hospital in Kathmandu.

Over the years, she has been advocating and lobbying for dental health education at local and international levels.
During her first partnership in 2007 with CCS Italy, an INGO working on child health and nutrition to deliver dental care packages at Kavre, she was thrilled to discover a strong psychological link between frequent teeth brushing and preventing malnutrition.

"Brushing programs in schools can actually increase the intake of mid day meals because they serve as a reminder for food consumption," says Lonim, who is also the Secretary General of the Nepal Dental Association. She has also recently developed a manual for training teachers on oral health.

Interestingly, basic brushing equipment doesn't cost much, the traditional neem twig as toothbrush and salt fluoride as toothpaste are readily available in nature.

"Most people will come only when pain strikes. What they are unaware of is that prevention is better and cheaper than cure,"says Mani Tara Shakya of Oral Dental Care Home.

Even in Kathmandu where cosmetic dentistry is catching on fast, people are neglecting function for aesthetics. "It's like buying a Rolls Royce and having no maintenance," says Sushil Koirala, the President of Vedic Institute of Smile Aesthetics, "proper hygiene and regular dental checkups should be the long term investments."

There is help at hand. Charities, schools and hospitals are starting to organise mobile dental camps. Sudin Shakya, a dentist at the Omkar Polyclinic is planning to organise trips to underprivileged school every 15 days to promote dental education and treatment.

Schools are the best places to nurture lifelong habits among the young, and when students relay oral health messages to their families, a multiplying effect is achieved.

As Nepal already has a national school health and nutrition policy, it would be easy to build oral hygiene into this existing framework.

PICS: KONG YEN LIN

CHECK UPS: A dental screening being performed in a village. Basic curative treatments like extractions and fillings would be carried out for free.

HEIGHTENING AWARENESS: Children from the Timal-besi area in Kavre learning proper brushing techniques in the first school-based oral health services initiated by the Community Dentistry department of People's Medical College and Hospital.

SCREENING: A child being checked for dental caries. One of the most prevalent childhood diseases in Nepal, caries are left untreated almost all the time in rural villages.

POPULAR BELIEF: Cultural myths can be a stumbling block in reforming oral health policies in Nepal. A superstition among Kathmandu dwellers has it that nailing coins on the Washya Dyo or Danteshwori devi shrine would alleviate toothaches.

RELAYING THE MESSAGE: Teachers in the Timal-besi area were taught how to brush their teeth correctly so that they can educate students. Preventive measures and habits inculcated early can prevent up to 54 per cent of dental diseases.