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Tue 18 Sep 2007 04:00 AM

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Teething problems

Dr Sultan Al-Mubarak is a consultant periodontist in practice at Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia. MED caught up with him to discuss dentist shortages, promoting prevention, and to hear why GDPs are a dying breed.

Dr Sultan Al-Mubarak is a consultant periodontist in practice at Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia. MED caught up with him to discuss dentist shortages, promoting prevention, and to hear why GDPs are a dying breed.

How would you describe the current state of dentistry in Saudi Arabia?

There is discrimination in dental treatment for special-needs patients. It is a neglected part of the health system worldwide.

Oral health in the Gulf is relatively new, and there are not enough dentists to meet the needs of the population. In Saudi Arabia, there is only one dentist for every 12,000 of the population, which is very insufficient. While new [dental] schools have opened, the cost of graduating as a dentist is relatively high. The population is growing dramatically and the need for dentists is increasing. The first dental school in the region wasn't established until the late 1970s/early 1980s and, during that time, most of the dentists were expatriates. Even now, there is still a gap between oral health and general health, and there is a continuous demand for dental professionals in the region.

Has this impacted on the standard of dentistry available regionally?

In any part of the world it is difficult to maintain an even standard. Dentistry is like any other industry; there are some practices that concentrate more on getting income than the quality of the work. Despite the increase in demand for dentistry across the region, there is also ignorance about the quality.

Dentists tend to develop a specialty and a sub-specialty. What we need to focus on is the need for general dentistry. In Saudi Arabia, there is a good number of sub-specialties, but we are losing a very important specialty which is the general dentist. AGD - advanced general dentistry - is nationally required. Specialties are needed but we also have to focus on the core structure, which is the AGD.

Saudi Arabiahas recently announced mandatory dental screening for preschool children. Is government-led enforcement a good step?

It's an excellent measure. There is also an excellent example in Sweden, where dental treatment is a must. If parents don't take their child to the dentist, the authorities visit them. There is a dental clinic in each school. Scandinavia is a very good example of where they are able to effectively maintain the integrity of the teeth and stop decay at an early age.
Do you believe Saudi can recreate that success?

Yes, if we can launch certain education campaigns in the media, in the newspaper and on the television, as well as opening smaller clinics. Sweden, for example, employs dental therapists; a specialty that is higher than a dental nurse but lower than a dentist. They perform extractions of baby teeth, polishing and cleaning. The cost of these clinics is low, but the benefit is very high. If we can open such clinics in the GCC, I think it will be a major breakthrough.

Dental treatment is typically very expensive. With certain preventive measures, such as periodic visits to the dentist, costs could be avoided by the Ministries of Health within each country. The lack of education in this region means the first thing that makes people go to the dentist is pain. We are trying to get adult people to come to the dentist at least once or twice a year. For kids, we are trying to get them to come quarterly. Unfortunately most parents send their kids to me when their teeth are decayed. We keep educating them but we need to do some public campaigns in order to increase the awareness.

Are other healthcare professionals supportive of your role, specifically the link between oral health and overall health?

Previously there had been a huge gap between dentists and physicians, although these two specialties are closely linked together. Now there is increased awareness that, for some diseases, you will see the first symptom in the patient's oral health and vice-versa. There is an increased tendency among physicians to ask their patients to go to the dentist for a general check-up. Here at Sultan Bin Abdulaziz Humanitarian City, we were one of the first hospitals in the Middle East to introduce a dental check-up as part of our standard general check-up for all in-patients.

You work closely with special-needs children. What are the challenges involved in working in this field?

There is discrimination in dental treatment for these patients. It is a neglected part of the health system worldwide, because the dentist has to spend a long time with the patient but the income is not high. These children grow up with dental decay and by the time they are 20, may have lost more than half of their teeth.

Very few dentists over the world are working in this field. Yet we believe that in Saudi Arabia there is as many as 750,000 children with special needs that require tailored dental treatment. We are also receiving patients from the other GCC countries. With these patients, it is very difficult to undertake dental exams, so we are doing what we call full mouth consultation while the patient is under anaesthesia. This has proved to be very cost effective, as well as allowing good preventive care.

Do you believe the FDI Congress will have a positive impact on regional dental professionals?

It will have a significant impact, and it should increase the continuing education of participating dentists within the region. With the internet, the world has become very small and you can obtain almost any information from your desk. I believe, however, there is a problem when dentists qualify and they don't travel to broaden their experience. Prevention should be the first issue to be tackled, as we are now stepping back towards that goal.

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