Where There Is No Dentist 2012 ix
practice dentistry, because they are the only persons working in marginal
communities where dentists’ prices are too high for the people. The court
decided in favor of the technicians, and ordered the dentist to return the
technician’s tools and pay him for work lost.
In other countries dentists and community dental workers work in closer
harmony. In Guatemala, Ecuador, Papua New Guinea, and Mozambique,
dental technicians are now recognized by the Ministries of Health. In Papua
New Guinea and Ecuador, professional dentists train and supervise them
to provide dental care to school children. In Ecuador, they work mostly
as dentist assistants, bringing high quality services to more people while
decreasing costs. The ‘dental therapists’ in Papua New Guinea are trained
to extract, drill, and fill teeth, as well as to work on prevention of dental
problems in school children.
In Guatemala and Mozambique, dentists from the dental school have trained
village health promoters as dental workers who work with people of all ages.
Their training includes community dental health education, cleaning of teeth,
extractions, and drilling and filling. These health workers are provided with
the few basic instruments needed to provide these services.
In Project Piaxtla Mexico (with which I and the Hesperian Foundation have
worked for many years), visiting dentists have also helped train village
‘dentics’. They, in turn, now teach basic dental skills to the part-time village
health workers. These village dentics, some of whom have had only 3
to 6 years of primary school, now practice—and teach—a wider range of
dental skills than the average dentist. Their activities include dental health
campaigns with school children, community puppet shows about low-cost
dental self-care, cleaning of teeth, extractions, drilling and filling, and the
making of dentures (false teeth). Several of the dental workers can now do
root canal work—a special treatment to remove the central nerve in order to
save an infected tooth. One of the village dentics, remembering what he had
seen a dentist do, taught himself how to do root canals when his girlfriend
had an infected front tooth that he did not want to pull. (He had also learned
to check the tooth from time to time afterward to make sure this treatment
had been successful.)
We still have much to learn about dental health. Dentists need to learn from
the knowledge of the local people, as well as the people from the dentists.
We have learned that villagers with little formal education often can learn
skills with their hands—such as tooth extractions, puppetry, or surgery—
much faster than university students (who have never learned to use their
hands for much more than pushing pencils). We also have observed that
the best way to learn dentistry is not through school but through practice,
helping someone with more experience who is willing to teach.