Misson Report on Oral Health in the Tokelau
11 June - 18 July 1999
by Dr Terence William Cutress

EXECUTIVE SUMMARY OF A MISSION REPORT

Objectives of mission:
In collaboration with national counterparts:

• to review the dental epidemiological situation and dental care services, in particular, carry out a follow-up check on the recent dental survey and review of the survey data;
• to support the inventory of the equipment and materials and assess the range of equipment, and recommend an appropriate system of purchasing, servicing and repair;
• to assess the level and type of training required, both short and long-term, in dental care; and
• to develop, based on findings of the above activities, appropriate strategies, to improve the delivery of dental services particularly for the community.

Summary of activities, findings, conclusions and recommendations:
Oral health conditions of children and adults are poor, with most of the community showing overt signs of treatment needs. Dental decay is the prime problem in children starting in the first few years of life. Preliminary survey data reveal that by age 5-I0 years children average more than five decayed teeth primary teeth. In adults neglected oral hygiene, the carry-over of untreated decay as children, together with adult decay and chronic gum disease, show as progressive dental deterioration with need for multiple tooth extractions. By the fourth to fifth decade of life at least 15 % of adults are toothless. The dental care provided at the dental clinics on all three atoll clinics is primarily ad hoc emergency tooth extractions on demand. No rehabilitative care or denture services are available on the atolls.

The three dental clinics are physically inadequate, too small, and in a run-down condition; the dental equipment, plumbing and furniture are mostly obsolete and/or in disrepair; dental materials are unavailable, or in short supply. No clinic has functional chair-side lighting. Difficult treatment and denture needs can be met only by travel to Samoa (one or two days by boat). No current disease preventive programme exists. The dental operators require urgent refresher and extended training. The potential exists for failure of even the present emergency care service.

Recommendations include:
A complete, urgent, overhaul of the oral health care programme is required. Priority needs are:

• Refresher training courses of all therapists should be held as a priority and in the short term.
• All three hospital dental clinics should be upgraded.
• Dental disease preventive programmes should be implemented for pre-school children, schoolchildren and adults without delay.
• A therapist should be identified as the senior dental co-ordinator's duties would include ordering, maintaining and auditing essential levels of materials, instruments, equipment.
• The Director of Health should monitor activities of dental personnel and review salaries.
• New therapy students should commence dental therapy training in 2000 and 2001.