India - Training oral health workers to provide basic dental care in Ladakh


Wisdomtooth is a non-profit, international dental volunteer organization. (

The goal of the Organization is to empower the local people in a community to provide basic dental care within their own communities. Wisdomtooth is currently involved in oral heath projects in Ladakh (North India) and Nepal.


There are about 5 dentists in Leh, the capital of Ladakh, and one in Zanskar.

Map of Leh, Ladakh in India. Source:

Three of the dentists are at the hospital, and two have private practices. This is for a total population in the region of about 280,000 people and an area of 87000 km 2.

Traditionally caries and periodontal disease prevention has not been a way of life in Leh. There has always been a problem with periodontitis but today you can see an increase in caries as children have greater access to sweets.

A study conducted in 2008 at Lamdon school in Leh, under the guidance of Drs Eugenio Baltran of the Centre for Disease Control, USA, and Judy Hollander showed that 80% of the children suffer from caries in primary dentition. Over 90% of the students 12 years and above have calculus deposits (1).

Programme Outline

Wisdomtooth aims to train local health workers to deliver much needed basic oral health education and care to the communities.

The health workers will be taught basic dental diseases- caries and periodontal disease- causes, diagnosis, sealant placement, and deep cleaning. As their skills develop, it is planned to introduce more curative treatments such as fillings and extractions.

There are two programmes going on in Ladakh

- The training Programme for the Amchis (2011)
- The oral health Programme at Lamdon school (2008)


Training Programme for the Amchis

Amchis from Ladakh. Courtesy -

Amchis are doctors in Tibetan traditional medicine (a doctor of traditional Tibetan medicine, who uses plant and mineral substances. This type of medicine is widespread in Ladakh and Tibet). Dedicated to providing care to the poorest and most remote Ladakhi communities, the Amchis typically travel throughout Ladakh in small groups for a few days at a time providing for the health needs of the people.

In 2010, Dr. Doten met with the Venerable Dr. Tsering Palmo, founder and head Nun of the Ladakh Nuns Association that summer. Dr. Palmo saw the benefit of providing dental training for her fellow Amchis.

The Amchis, through the Wisdomtooth Organization, receive additional dental care training in how to identify, prevent, and treat tooth decay and gum diseases.

The Lamdon school project

Ms Yangchen Dolma receiving training on oral health care
Courtesy -

In 2008, Wisedomtooth sent two volunteer dentists to Lamdon school to train Ms. Yangchen Dolma , long time school nurse ,in oral health care. She received basic training in preventive dental care, toothbrushing, sealants and Atraumatic Restorative Treatment (ART) fillings.

Volunteer dentists come back every year, to provide Ms Yangchen more training for example in examinations and extractions.

Since Ms Yangchen speaks the local language and deeply understands the local children and culture, contributes to the success of the programme.


Amchi Training Programme

Dr Judith Hall training the Amchis in oral health care

Courtesy -

  • Training began in May of 2011 with Dr. Judith Hall laying a foundation course and a few practical preventative clinical skills that the Amchis can immediately utilize during their field trips. Two more volunteers were scheduled for October and November 2011 to continue training.
  • During May -June 2013, six Amchis will be trained for two months.
  • The training will be out in the remote villages they serve.
  • Amchis will be trained in instructing mothers on proper tooth brushing, nutrition, and applying sealants to primary and first permanent molars of children and scaling of teeth.
  • As their skills develop, more curative treatments such as fillings and extractions will be introduced.

The Lamdon school project

  • In addition to general and oral health instructions, Ms. Yangchen Dolma is now providing dental care for about 2000 students at the school, doing examinations, sealants and toothbrushing instructions and simple extractions.
  • She will continue to receive more education and training in oral health care, once a year from volunteer dentists coming into Ladakh on a yearly basis.

Ms Yangchen Dolma attending on a child at the school
Courtesy -


The Amchis have the best access to health care and resources in the Ladakh area. They also travel to the very remote regions of Ladakh, providing medical care to the poorest in the region. Training them in oral health education and dental care will spread the knowledge about how to achieve oral health, especially in remote areas.

Training the School Nurse to include oral health education and care for the school children is helping the community in improving their quality of life.



by Irwe L, Doten J and Stjernswärd J