The Fine ART of Dental Care

by Natalia Cieslik

Kabul, Afghanistan--His mouth wide open, eyes fixed to the ceiling, Said is lying on the table in the chemistry classroom in his high school, almost motionless. Only sometimes, when the dentist pushes her instruments really hard into the cavity, his toes twitch a bit. “It didn’t hurt,” the 15-year-old says afterwards, putting on a brave face. “I am not afraid of the dentist.”

15 year old Said gets two fillings without drilling. Atraumatic Restorative Treatment (ART) is easy to learn and affordable. PHOTO: NATALIA CIESLIK

 Before the IMC dentists came to his school, Said had been to the dentist only once. That is more than most of his classmates still queuing for their turn. Today, about 70 of them are to be examined, and half will be treated by IMC dentists. The others have to come back another day. Dr. Haroon Sirat, the master trainer, figures that about 80 percent will have cavities that need filling. 

For a few hours a day the chemistry room becomes a mass dentistry practice until all students at Said’s high school in downtown Kabul have had their turn. Sixteen IMC-trained dentists, two in a team, are examining and treating Said and his classmates. But there is no fear-inducing, shrieking sound of the drill. This silent form of filling cavities is called atraumatic restorative treatment (ART). Dentists remove decayed tooth tissue by using only simple manual instruments. Then they fill the cavity with a special material that chemically sticks to the tooth. The fillings will last six to eight years.

The ART technique is relatively easy to learn and not very expensive. “It is a good solution for us,” says Dr. Haroon Sirat. Dr. Farida Ghawsi, who just finished filling two of Said’s molars, agrees. ““This is a poor country and there has never been a focus on dental health,” he says.“The traditional Afghan way of dealing with a bad tooth is removing it. Because of the treatment IMC provides, these children will have more teeth in their mouth when they are older.” 

Proud owners of a new toothbrush and toothpaste. Dental health education is part of the IMC dental program in Kabul. PHOTO: NATALIA CIESLIK

The country has about 500 dentists serving a population of 30 million. Most Afghans never see a dentist. They rely on barbers and traditional healers to extract the tooth when in pain. With funding form Caroline Hudson Firestone, IMC began the ART program in September 2006 in Kabul province. Since the start of the program, IMC has trained 39 health professionals in ART and selected 20 of them (four master trainers and 16 operators) to treat children between 6 and 16 years in Kabul province. In the first three months, the project examined almost 2,000 children, many of them orphans. 1208 were treated and 1711 restorations were done. Some children had teeth so bad, they couldn’t be helped by ART, and had to be referred to a dental clinic for more complicated procedures.

Dental care education is the second leg of the program. At Qalaee Mussa mosque in Kabul, about 100 children and their mothers have come to listen to the IMC educator. A little boy is asked to demonstrate how he brushes his teeth. At first hesitant, he moves the brush from left to right. “False,” Dr. Haroon Noori says. “You must go up and down, not sideways – and at least once a day.” Every child gets a new brush, toothpaste, and a leaflet that illustrates how to do it right.

Brushing teeth is a duty, Dr. Haroon says. “God, the Almighty, has created us as perfect and beautiful people. We cannot neglect our body. If one of your teeth is broken or you have a cavity, go to the dentist. Or you will be sorry.”