Columbia dentists target chronic oral health problems in sub-Saharan Africa

A new initiative from Columbia University Medical Center will be the first to target chronic oral health problems in sub-Saharan Africa, where the vast majority of chronic diseases are left undetected and untreated.

The initiative is the result of an anonymous $1.5 million gift to support the Millennium Villages, which aims to fight extreme poverty and related challenges such as disease, hunger and lack of access to water and sanitation though scientifically sound and sustainable interventions. A third of the gift will be devoted to supporting the oral health program.

Chronic diseases will soon become the leading cause of health problems in the developing world, and oral health conditions are one of the most common chronic disorders, according to the World Health Organization. Initial Columbia research in the village of Koraro, Ethiopia, found that more than half of the population complained of oral pain. The generous donation will fund the first extensive initiative, led by Columbia's College of Dental Medicine, to directly target oral health problems in sub-Saharan Africa with a sustainable prevention and treatment program.

"Oral health is important to total health, so it's essential that efforts to improve the lives of impoverished communities include a dental component," said Ira Lamster, DDS, dean of the College of Dental Medicine at Columbia University Medical Center. "The faculty and students of Columbia's College of Dental Medicine are committed to addressing the global epidemic of chronic oral health problems through treatment and prevention programs."

"There is currently no access to dental care whatsoever in the remote villages of the world," said Steven Syrop, DDS, associate clinical professor of dentistry at the College of Dental Medicine, who is leading the dental component of the Millennium Villages. "There are only 48 dentists in the entire country of Ethiopia, and most are in the capital, Addis Ababa. We're going to bring dental care to villages where there are no dentists."

The health component of the Millennium Villages grew out of the United Nations Millennium Project and the World Health Organization Commission on Macroeconomics and Health, both of which showed the direct link between improving public health and economic growth. Those reports explained that health improvements can only happen through a broad range of inter-related public health reforms.

The Millennium Villages project, supported by The Earth Institute at Columbia University, Millennium Promise, the United Nations Development Programme, and the UN Millennium Project, currently includes 12 sites in 10 sub-Saharan countries. It reaches more than 400,000 people with plans to increase its reach over time. The project empowers the local health care sector by supporting basic health interventions, building or upgrading clinics, and expanding the pool of community or village health workers. The participating villages are integral partners in the project and take responsibility for the interventions.

In addition to the oral health initiative, the new funding will support Columbia-led interventions to address chronic cardiovascular and mental health disorders in the region.

The dental component of the project is the result of research by Dr. Syrop and his team, who traveled to Koraro, Ethiopia, in the fall of 2006 to assess the oral health situation in the village of 5,100 people. In addition to the common complaint of oral pain, the team found a high incidence of hardened plaque (calculus) and gingival bleeding. Ninety-five percent of the people they examined had significant dental erosion because of the presence of sand in their food as a result of the arid environment and lack of water for rinsing crops.

"We were surprised by the extent of the oral health crisis in Ethiopia," said Dr. Syrop. "In an area where the population has little access to sugary food and fermentable carbohydrates, we didn't expect the problem to be as bad as it is. Developing a sustainable oral health program is an essential ingredient to improving the lives of these people."

Teams of five or so Columbia faculty, staff and students will travel this fall to sub-Saharan countries, including Tanzania, Rwanda and Senegal, to collect data and assess the population's oral health needs. They will use the data to develop a program for three or four villages initially, and then ultimately incorporate oral health as an integral component of improving health care at all of the Millennium Village sites.

The Columbia teams will train local health care workers to provide basic essential dental care, including extractions and control of infections. Additionally, the teams will introduce a comprehensive prevention program in the schools and the overall community by working with local teachers to develop a curriculum that is appropriate and sustainable for the individual village. They also will develop a prevention program to educate mothers about caring for the oral health of their young children.

"Treating and preventing oral health problems is one spoke in the wheel of improving conditions in sub-Saharan Africa," said Dr. Syrop. "By improving their health, we enable this population to be more productive, helping them to improve their economic situation and lift themselves out of poverty."