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The Zambia Six-Year Molar Focus School
Teethsavers Teaching and Treating
Introduction
The Six-Year-Molar Focus oral health project was initiated by Jack Rudd, DDS, FAGD in Chipata, Zambia, in 2002. Its focus is on preserving the functioning of the First Permanent Molars through oral health education (plaque control), sealing caries prone pits and fissures, and restoring cavitied molar teeth. The sealants and restorations are performed using the Atraumatic Restorative Treatment (ART) approach.
The teaching and treatments are carried out by high school graduates with a twelve-year certificate who also have undergone theoretical and clinical training at the Six-Year Molar Focus School that has been approved by the Ministries of Education and Health of Zambia. The graduates after completing the one year course receive a certificate "Community Oral Health Educator (COHE) and Atraumatic Restorative Treatment (ART) Technologist" registered by Medical Council of Zambia, the same as an MD or DDS.
The school's curriculum and practical are a one year course. A number of graduates are contracted to work within the Project, while others look for work in the public and private sector.
Different from the conventional oral care system, which relies on patients coming to the dental clinic, the Six-Year Molar Project takes oral care to the community. Graduate operators, dental assistants and staff travel to villages and primary schools, and stay until the target group has been educated on how best to preserve the dentition and its morbidity has been treated. Thereafter, the oral health team moves to the next primary school, its base for the villages in the catchment of the school.
The use of the ART approach allows sealants and restorations to be made outside the dental clinic. This is made possible because, with ART, neither electrically driven equipment nor running water or normal dental equipment is required. The remarkable efficiency of the system lies in its simplicity: the child patient lies on a wooden bench with their head in the operator's lap. An assistant using a wooden table and stool provides the hand instruments and materials in a virtually painless procedure by modern four-handed dentistry. This is accomplished by hand-mixing high-viscosity glass-ionomer and using a pressure cooker over an open fire for sterilization. This light-weight movable dental office is easily transported to the next primary school in a small lorry.
By September 2007 all 159 primary schools in Chipata District, some difficult to access, that were accessible by lorry, had been visited and the project moved on to the nearby situated Katete District. Plans were made to evaluate the outcomes of the oral care treatments provided by these operators and their dental assistants in Chipata District.
Results
Field work with teams of 12 to 18, using a rented truck, often camping overnight in 629 days from June 2002 to July 2008 by dental therapist, graduate operators, student practical, dental assistants and 27 volunteers from five different countries; three dentists, six non dental and 18 dental students, staying two weeks to three months.
The total children taught oral hygiene with a toothbrush and screened 122,243
Total children treated 41,143
Total ART sealants and ART restorations 42,656
Total periodontal treatment 13,855
Total procedures 59,680
Total “Teach a Few to Teach Many” (estimated) older children taught,
parents, guardians and school teachers 204,517
The total children taught oral hygiene with a toothbrush and screened 122,243
Total children treated 41,143
Total ART sealants and ART restorations 42,656
Total periodontal treatment 13,855
Total procedures 59,680
Total “Teach a Few to Teach Many” (estimated) older children taught,
parents, guardians and school teachers 204,517
Estimated average cost per child, taught, screened and treated US$1.45 about one-third to one-half the cost to extract a permanent molar in a government dental clinic. This cost included salaries, transport, food, toothbrushes, all supplies, everything.
The three months government schools are closed two Teethsavers go to each village to teach and screen and bring those needing treatment with their parent, to the team base government school for treatment.
REINFORCEMENT OF ORAL HYGIENE IS OUR MOST IMPORTANT RESPONSIBILITY AND SECOND THE IMPLEMENTATION OF FLUORIDE.
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