Preventing Dental Caries in Jamaicans of All Ages

Preventing Dental Caries in Jamaicans of All Ages

Sarah Et
set@uci.edu
Public Health 2, Summer Session 2 2014
Dr. Runnerstorm

Preventing Dental Caries in Jamaicans of All Ages

Step 1 and 2: Information, Preliminary Issues, and Present Situation

Dental Caries, more commonly known as tooth decay or cavities, is very prevalent in
children in every country around the globe.1 However, it is more common in developing
countries where clean water and doctors are not easy to access. It is even more common in poor
communities with a lower social economic status where they may not be able to afford dental
care. Therefore, it is hard for the children to keep their teeth clean and get proper care for any
dental caries, which then worsened over the years and the children grew into adulthood. These
untreated caries can affect a childs performance in everyday tasks, including sleeping and eating.
As the child grows older the child may also suffer from mental issues on appearance, and health
issues that may include difficulties in pregnancy and even premature birth. Public health
investigations following 124 pregnant or postpartum mothers have found a link between dental
caries in expecting mothers and preterm or low birth weight babies (pg 136). The Jamaican
government acknowledged that in order to help the health of their people, there must be
something done with the growing number of dental caries within the country.
In the 1980s, Jamaicas case of dental caries in children and adults were beyond what
experts could have predicted. Dr. Rosalie Warpeha, a dentist, researcher, and Marist missionary
sister (APHA) surveyed the children of Jamaica and found how prevalent dental caries were.
Her research stated that almost every child in Jamaica, on average, had about 6.7 decayed,
missing, or filled teeth (pg. 135). Even more shockingly, by the age of 12, fewer than three in
every one hundred children were free of caries (pg. 135) She then paired up with the Pan
American Health Organization in order to seek a solution.
Step 3: Finalize Issue Identification
The issue is simply tooth decay. It is the poor hygiene of the mouth. What Dr. Rosalie
Warpeha and the PAHO were fighting against was the many cases of tooth decay caused by the
bacteria that attached on to the teeth. Their question was: how to stop the bacteria causing dental
caries?
Step 4: Analysis
Prevention of dental caries can be done many ways. First being promoting correct dental
hygiene and providing the public with the essential tools to care for their teeth. This would
include: a toothbrush, toothpaste, mouthwash, and dental floss. Once each person has received
the tools, they may then begin proper dental care. If able, the government can even provide the
people with fluoride enriched toothpaste in order to kill off the bacteria. However, not all of the
public may know proper hygiene care. The country must then have extensive media that is able
to reach out to even the most rural of communities to teach the people how to correctly take care
of their teeth. This involves many posters and signs, in addition to man power of the people
going out and giving instructions to those who cannot read. This would be the most costly and
time consuming alternative possible. There is the issue of getting the people who will voluntarily
go out through the rural parts of Jamaica and teach the public. The PAHO cannot pay for people
to go out either. This is a very costly alternative; to provide the products it may cost around four
dollars per person. When factoring in the cost of media to keep the people informed and to
persuade them that this will do. Raising money for this task will be time consuming and
therefore, the treatment will not be given to the people until the money can be raised.
A second alternative would be treating the water with fluoride and distributing it, this is a
process called water fluoridation. Fluoride works by repairing the teeth through remineralization,
at the same time improving the chemical structure of the new enamel it rebuilds, and fighting off
the bacteria causing plaque that causes the dental caries. It is a very simple chemical that has

Preventing Dental Caries in Jamaicans of All Ages

benefits to human health. By treating the water with fluoride, every time a person would drink
clean water, they will be also treating their teeth with the fluoride in the water, therefore reducing
dental caries over time. However, this method is only efficient if the water supply is constantly
regulated and distributed through a clean and preferably piped water system to a majority of the
population. In 1980s Jamaica, many of the houses outside of the capital and big cities did not
have a water system. Most of those living out of the city collected rainwater to drink. The cost of
water fluoridation may cost up to ninety cents per person per year, depending on the size of the
community (pg. 137). This is less expensive than the first alternative, but more costly than what
was done. Though more costly, if possible, this route would have proven more efficiently if
everything was done correctly.
Last way, would be the way that was taken, salt fluoridation. This process would include
introducing the ion to salt, so when the salt is consumed, it will then help reduce dental caries.
This process was estimated to be six cents per person per year, therefore being the cheapest
option. During a study in Colombia done by the PAHO during the 1960 to 1970s comparing the
effects of salt fluoridation and water fluoridation, salt fluoridation reduced dental caries by 50%
while water fluoridation reduced dental caries by 60%. Therefore when done correctly, water
fluoridation would be more effective but more costly. In Jamaica where the salt distribution was
increasingly further than clean water, it proved to be more efficient.
Step 5: Recommendation
The route that was taken by the Jamaican government, Dr. Warpeha, and the PAHO was
the correct route. Though it was less efficient than water fluoridation, the results were astounding.
Since there was only one salt company in Jamaica, it was easy to have salt fluoridation. The
government was able to get word out to the public about what was happening to the salt they
were going to consume, and easily convinced them that this was good, therefore people were
reassured that the salt would not harm then and continued to buy salt.
Step 6: Future
In my opinion, I believed the PAHO handled this well. Salt proved to be more efficient to
get the fluoride out to every home than water. This way many more children were prevented
from having dental caries. The cost was low, it was effective, and there were many benefits from
it, I believe that any other way would not have produced such great results as these. It was smart
to compare Jamaica to Colombia when the process started since both countries were developing
and had similar problems. Colombia proves that water was more effective but only depending on
the environmental factors. Therefore, Dr. Warpeha was able to learn from what happened at
Colombia and apply it to Jamaica.
Resources
Donahue, G. J., Waddell, N., Plough, A. L., del Aguila, M. A., Garland, T. E. (2005). The
ABCDs of treating the most prevalent childhood disease [Abstract]. American Journal of
Public Health. 95(8), 1322-1324.
Jones, S., Burt, B. A., Petersen, P. E., Lennon, M. A. (2005). The effective use of Fluorides in
public health. SciFLO Public Health, 83(9). http://dx.doi.org/10.1590/S004296862005000900012
Levine, R. (2007). Case studies in global health: Millions saved. Sudburry, MA: Jones &
Bartlett Learning.

Preventing Dental Caries in Jamaicans of All Ages

N/E. (2009). Sister Rosalie Warpeha: 2008 Distinguished Dental Alumna. APHA.
http://www.apha.org/NR/rdonlyres/61EB6FB9-CC0B-4CC2-B327F9E658F7AA24/0/RosalieWarpehaBio.pdf.
Offenbacher, S., Katz, V. Fertik, G., Collins, J., Boyd, D., Maynor, G., McKaig, R., Beck, J.
(1996). Periodontal infection as a possible risk factor for preterm low birth weight
[Abstract]. Pubmed.gov. 67(10). 1103-13.