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by Murray Dickson
The world has witnessed breathtaking changes since I wrote the first edition of Where There Is No Dentist in 1983. I sometimes feel that if a person had gone to sleep then and woke up 32 years later, they would have a difficult time understanding many of the things we take for granted today. Unfortunately, however, they would also find much remains the same, especially the unequal relations among people. Since you can look into a person’s mouth and understand a lot about their income, nutrition, and general health and well-being, the inequality among people is not only a moral or ethical problem, but a dental problem as well.
As noted in the book’s introduction, dental care remains beyond the financial reach of too many people in all parts of the world — developed, underdeveloped and overdeveloped. While many more poorer countries have picked up on the World Health Association’s primary health care strategy and initiated training and support of front line dental therapists, it is not sufficient to reach the majority of those in need. Governments that are finally getting around to improving health insurance or extending health care to geographically or economically marginalized communities still treat dental care as an afterthought, as the last benefit to arrive.
Another change that has occurred, and not for the better, is the spread of diabetes into communities where it had never been a problem or maybe only a minor one. While classified as a Non-Communicable Disease (NCD) because it is not spread by germs, it is however spread by changes in diet and behaviors around the world. While sugary drinks such as Coca Cola were a problem for oral health before, now their spread threatens not just teeth but the heart, liver, indeed the entire body. The same is true of processed foods of many varieties: healthy diets have been replaced by factory foods and junk foods which contain too much sugar and not enough nutrition.
In Istanbul in 2013, the International Dental Federation noted that “36 million people die every year from NCDs, and 86% of the premature deaths occur in developing countries.” They issued a call for dentists to not only advocate for and promote oral health, but to commit themselves to take more responsibility in contributing to the improvement of the general health, quality of life, and well-being of their patients and the public at large. That kind of broad understanding of health and commitment to working for social justice is exactly what I hope people find in Where There Is No Dentist.
I am very happy that Hesperian is printing a new edition of Where There is no Dentist. But even more satisfying is knowing that the book continues to be used to train, empower, and motivate collaboration with new generations of dental health promoters and therapists. As a dentist, I always felt good about relieving a person’s pain and/or infection but the number of people who needed help was always more than I could ever hope to treat. Only through extending primary care, and making oral health a part of that care, can we ever hope to really make progress. And today that means promoting people’s rights to a healthy diet, a dignified life, and access to health care.