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Oral Health in Syria International Dental Journal (2004) 54, 383–388 Oral health in Syria N. Beiruti Damascus, Syria W.H. van Palenstein Helderman Nijmegen, The Netherlands The aim of this paper is to describe and analyse the oral health situation in The Syrian Arab Republic lies on Syria in the last two decades and to propose recommendations for improve- the Eastern coast of the Mediterra- ment of the current situation. The epidemiological data on caries of the last nean Sea. The land area is 185,500 two decades did not indicate a decrease in the DMFT value of various age km2 and the total population was groups, nor was a decrease in the percentage of untreated caries apparent. about 17 million in 2002, of which The unequal distribution of oral health care continued to exist throughout 18% lived in the capital Damascus. the country, despite an enormous increase in the number of dentists from The estimated annual population about 2,000 in 1985 to about 14,500 in 2002. The affluent part of the growth rate was 2.6%. Infant population is served with technically oriented expensive dental services. mortality was 23/1,000 and life The public sector suffers from limited finance, the absence of appropriate expectancy for women was 75 technology in restorative dentistry and the lack of a community and years and for men 72 years, with preventive oriented approach. It is recommended to utilise dental hygienists 41% of the population comprising in the public sector, since these auxiliaries if appropriately trained can offer 418-year-olds. The GNP per the preventive and curative oral care wanted and demanded by the poor and capita was US$1,130 in 2002. that the government and the people can afford. About 45% of the population was Key words: Epidemiology, oral health status, dental workforce, oral health dependent on agriculture as a live- care, Syria lihood. The allocation for health, including oral health was 3% of the general budget1. The aim of this paper is to describe and analyse the oral health situation in Syria over the last two decades and to make recommen- dations for improvement. Dental caries The results of studies using WHO criteria showed a high prevalence of dental caries among 5-year-old children. The prevalence of caries of 5-year-olds in Damascus was 77% in 19852 and 74% in 19913 and the mean dmft score was 5.2 and 4.6, respectively. The mean DMFT scores for different age groups and cohorts are presented in Figure 1. In the last two decades, the mean DMFT score of 12-year-old-children showed a fluctuating pattern rang- ing from 1.4 to 2.5. A secular Correspondence to: Dr. Nabil Beiruti, School Health Department, Jisser Alabiad Square, P.O Box 60184, Damascus, Syria. E-mail: [email protected] change of caries experience was not © 2004 FDI/World Dental Press 0020-6539/04/06383-06 384 Figure 1. DMFT-values of various age cohorts in Syria, recorded between 1980–1998. The y-axis represents the DMFT-score. Each x-axis represents a specific age cohort. Each z-axis shows cohorts of increasing age. apparent for 12-year-olds nor was Oral hygiene and periodontal general medical risk, but are respon- a change over time apparent for diseases sible for the occurrence of dental the 15-year-olds. fluorosis. For example, it was According to the national oral The mean DMFT score of 5- reported that 78% of 1315-year- health survey of 1998 only 615% year olds and the mean DMFT old children in Palmyra exhibited of 15-year- and 3544-year-olds score of 12 and 15-year-old chil- fluorosis of which 31% had it in a were free of gingival bleeding, dren consisted mainly of the D- moderate to severe form15. In calculus and periodontal pockets11. component; 8090% in the 5-year Alhasaka, 15% of 12-year-old Poor oral hygiene was common and 12-year-olds, and 7080% in children were reported to have among 15-year-olds of whom 94% the 15-year-olds (Figure 2). The moderate to severe fluorosis14. had a high accumulation of dental percentages of untreated caries have The prevalence of dental inju- plaque12. About 311% of the 35 not changed substantially over the ries to the permanent incisors of 44-year-old Syrians suffered from last two decades. Dentine lesions children in Damascus was 5% severe periodontal diseases13. in children up to the age of 12 among 9-year-olds and 12% among years are predominantly observed 12-year-olds16. in occlusal surfaces of first molars. Other conditions The high percentage of untreated There are several areas in Syria caries in children resulted in an M where the fluoride content of Perceived oral health problems component of the DMFT count water is elevated, ranging from and knowledge on oral health of 4050% in the 3544-year- 0.8 to1.9ppm F14. These fluoride With regard to perceived oral olds410. concentrations do not pose a health, only 27% of 1315-year- International Dental Journal (2004) Vol. 54/No.6 (Supplement) 385 Figure 2. Proportional distribution of the DMFT components in 5-year-old children and the DMFT components of 12-, 15-, and 35-44-year- old Syrians in the period 1981–1998. old children in Palmyra reported Table 1 Number of dentists and dental auxiliaries in Syria between being free of oral health problems. 1985–2002 Overall, 29% mentioned pain due Year Dentists Dentist/pop ratio Hygienists Technicians to untreated caries, 24% to gingival bleeding and 24% to orthodontic 1985 1,975 5,200 150 500 cosmetic problems15. Poor oral 1990 3,272 3,800 250 750 1995 8,500 2,150 450 2,200 health knowledge was found 1998 11,506 1,500 575 2,900 among 15-year-old children and 2002 14,610 1,172 750 4,000 among schoolteachers, school nurses and physicians17,18. areas in either their own private 1985 to 2002 is shown in Table 1. clinic or in a public dental clinic for The number of dental technicians Dental education and dental two years. The large and increasing is high and many have started workforce number of qualified dentists poses working in another profession, a considerable socio-economic and whereas dental hygienists face Dental education professional problem as they difficulties in finding jobs in public There are four public dental prefer to stay in the more affluent and private sectors. colleges in Syria, in Damascus cities rather than working in rural (1919), Aleppo (1984), Hama areas. About 10% of them have (1984) and Lattakia (1995). The found employment in Arabic Gulf Oral health care system number of graduating dentists countries20. Public oral health care is delivered increased dramatically in the to the population under the period 1985 to 2002 (Table 1)19. authority of the Ministry of Health The dental curriculum lasts for five Auxiliary education in Maternity and Child Health years and is mainly based on a west- Three intermediate dental institutes Centres (MCH) and in 15 hospitals ern, technically oriented training for dental technicians and dental where specialists render oral surgi- rather than on a community and hygienists have been established in cal procedures. Under the Ministry preventive oriented approach that Damascus (1973), Aleppo (1988) of Education, school oral health meets the needs and requirements and in Hama (1997). The duration programmes and services are of the population. About 10% of of training is two years. The curricu- delivered to children aged 618 the newly graduated dentists lum for dental hygienists is not years. The private sector, including become enrolled in postgraduate tailored to the priority needs of the dental services in companies and education organised by the Dental majority of the population. About industries comprise the majority of College in Damascus, the Ministry 300 dental technicians and 50 curative dental services. of Health and Military Medical dental hygienists per year have In 1990, the National Oral Services Department. Dentists who graduated in recent years21. The Health Plan (NOHP) was compiled do not enrol in postgraduate number of dental technicians and aimed at achieving the WHO education, have to serve in rural dental hygienists graduating from global goals for the year 200022. Beiruti and van Palenstein Helderman: Oral health in Syria 386 The NOHP was based on the adop- Oral health education and promotion unit. The services given to the tion of: This component was directed schoolchildren are restorative treat- A preventive strategy through towards 1st and 6th grades. ment through the traditional and providing comprehensive oral Facilitators were dentists, school the ART approach, treatment of health education and promo- health assistants and in-service periodontal tissues and extractions. tion programmes for target trained schoolteachers. About 50% Limited applications of fissure seal- groups. of primary schoolchildren were ants were provided in some school A supportive curative strategy involved in this programme. In dental clinics. through providing oral care 1998, the action oriented school About 5% of the target children services for mothers and their health curriculum (AOSHC) was (grades 2 and 5) have benefited children aged 018 years. adopted in the school oral health from the school dental curative programme24. This AOSHC is an services27. This coverage percent- innovative approach based on the age has not substantially changed Maternity and Child Health principle of discover, do and use. since 1990. Limited financial resources Care Centres (MCH) It is thought that schoolchildren and problems with maintenance Curative oral care in MCH centres acquire motivation and skills to care of the technical dental equip- is delivered on demand. There are perform actions beneficial to them- ment have restricted this type of 1,114 MCH centres in the country selves, their community and their school curative dental service.
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