How Can Children’s Dental Health in Cambodia Be Improved?

Within Cambodia, there is a growing body of evidence pointing to the severity of dental problems (in particular, cavities) among children. One Cambodian National Oral Health Survey found that among children as young as six, there was a 97% prevalence of decayed, missing, or filled permanent teeth. As stated in a 2019 study published in BMC Oral Health, these numbers place Cambodia as among the most affected in the world in terms of dental cavities. What is causing the problem, how do cavities impact oral health, and what can be done to overcome them?

The Reasons for High Cavity Rates in Cambodia

The study above revealed that one of the biggest causes of cavities in Cambodia is a lack of awareness of the role that dental hygiene can play in prevention. Among those surveyed, one third did not believe that tooth decay was preventable and only one in 10 listed fluoride toothpaste as a means for prevention. There were also differences from area to area. For instance, those in Ratanakiri seemed to have a poor understanding of what causes cavities. There were also differences in nutrition, with children in Phnom Penh consuming twice the amount of sugary drinks as children in other regions and those in Kratie and Ratanakiri eating one packaged snack more every day than those in Phnom Penh. Additional reasons for cavities include a lack of daily tooth cleaning and breastfeeding past the age of two years.

Few Visits to the Dentist

Another study published in the European Archives of Paediatric Dentistry shows that children in Cambodia are not visiting the dentist as often as they should be. For instance, a large percentage of children had not visited a dentist in the previous year, meaning that an early stop could not be put to cavities. Low rates of dental visits mean that other problems cannot be spotted — including a lack of space for teeth to grow. Children may require braces or devices called palatal expanders to widen the upper jaw, so that teeth have enough space to grow through the gum and so that the bottom and upper teeth fit together better. A failure to rely on pre-orthodontics can result in problems with bite and tooth distance, resulting in crowding of teeth and ensuing cavities.

Why is Prevention so Important?

Failing to prevent cavities and treat them at an early stage can result in big problems for a child’s oral health. Big cavities can result in tooth loss, which can affect a child’s ability to eat, as well as their self-esteem. Tooth loss can also cause pain (including headaches and neck and shoulder pain) if various teeth are lost from one side of the mouth. Moreover, plaque buildup between teeth and the gumline can cause teeth to become loose and cause periodontal disease. The latter, in turn, can lead to bone loss and eventually, the loss of many or all teeth.

Health Awareness Programs

Because the prevalence of cavities is so high in children in Cambodia, urgent action should be taken to reduce the burden of disease. Some help is available through NGOs such as CHOICE Cambodia, founded and run by expats. CHOICE Cambodia set up a clinic at its rural base in Kandal province’s Kompong Svay commune, where those in need can have treatment for free. Across Cambodia, however, more education is required, especially in rural areas where false beliefs such as the ‘tooth worm’ being the cause of toothache, can be replaced with evidence-based approaches that prioritize prevention and regular dental checkups.  

Public Health Interventions

Government interventions need to put into place, especially those focusing on pregnant women, preschool children, and school-aged children. The Ministry of Health has suggested specific steps to be taken, including: providing access to the WHO Basic Package of Oral Care, including Oral Urgent Treatment; providing fluoride access to children (including toothpaste); the implementation of ‘healthy schools’ policies to teach children about preventive oral health care; focusing on prevention from birth by targeting mothers and children for education and topical fluoride applications. 

Cambodian children have an unacceptably high rate of cavities. The latter is owing to a variety of causes – including lack of preventive care and sugar-rich diets. Fixing the problem requires a multifaceted approach that includes the provision of care and fluoride products to children, and education for both parents and school age children regarding the causes of tooth decay and the importance of prevention.

(Submitted)