The Royal College of Physicians & Surgeons of Glasgow (RCPSG) has been a very strong supporter of the MalDent Project since its inception. In September 2017, the RCPSG funded my airfare to Malawi when I made my first ever visit there for the initial BDS curriculum conference. Subsequently, in 2018, it hosted a dinner for colleagues from the University of Malawi College of Medicine (now Kamuzu University of Health Sciences [KUHeS]) and in 2020, the HOPE Foundation of the RCPSG supported the transport of a container of dental equipment to Lilongwe.

Towards the end of last year, following an introduction by Professor Christine Goodall, Dean of the Dental Faculty at the RCPSG, I met with Mrs Alison Lannigan, a Consultant Surgeon who is Chair of the RCPSG HOPE Foundation, to discuss possible initiatives linked to the MalDent Project. As a result of this discussion, we agreed to explore the possibility of bringing two of the senior dental students from KUHeS to Glasgow for an elective visit. Whilst I was visiting Malawi in February this year, I met with senior colleagues at KUHeS to discuss the possibility and there was overwhelming support. We wrote a paper which detailed the logistics and cost of such a visit, for review by the Trustees of the HOPE Foundation Board. The Board was supportive, and the plan was finally approved by the College Council in April 2024.

In due course, Dr James Mchenga, Head of the BDS programme at KUHeS, established a competitive entry process for the 10 students in the BDS 5 class, and the successful applicants were Esther Khomba and Chifundo Banda. It is the visit by Esther and Chifundo that will form the basis of the next few blog posts.

Day 1 – Sunday 25th August: Arrival

Chifundo and Esther departed from Kamuzu International Airport, Lilongwe, on Saturday 24th August to begin their journey to Glasgow:

Their routing took them via Nairobi Kenyatta Airport and Dubai, where they would board an Airbus A380 for the final leg of the journey.

I arrived at Glasgow Airport in good time to meet the Emirates flight which was scheduled to arrive from Dubai at 12.45pm. The plane arrived on time and after about an hour, Esther arrived through the security gates …

… followed a while later by Chifundo …

We took the obligatory photo beneath the ‘International arrivals’ sign, marking the start of their three week long elective visit to Scotland.

We called in at the Marks & Spencer food store at the airport to buy a few items for later in the evening and then headed to the taxi rank. The weather was dreadful with pouring rain and a brisk wind – in stark contrast with The Warm Heart of Africa! Thankfully we didn’t have to wait too long for a taxi and were soon on our way to the Airbnb address in St Vincent Street that had been booked a few days earlier by colleagues at the RCPSG.

Once we had gained entry to the apartment we took a brief look round and then had a chat before I left for home, allowing Esther and Chifundo to settle in and have a much needed sleep. We agreed that I would call to pick them up at 9.00am the next morning for the 10 minute walk to the Dental School in Sauchiehall Street.

Day 2 – Monday 26th August

The first morning at the Dental School was spent dealing with various elements of induction and talking through the timetable that had been prepared for their visit. We organised scrubs for Esther and Chifundo to wear in the clinics (many thanks to Lezley-Ann Walker) and door entry cards. We took time to call in to see Paul and Robert, two members of the team of hospital porters who had been so helpful with managing the storage and loading of the dental chairs donated by Glasgow Dental Hospital, that had been sent to Dentaid for servicing and subsequent shipping to the Dental Department at Kamuzu Central Hospital in Lilongwe. These chairs have made a significant difference to the clinical learning experience of Esther, Chifundo and their fellow students.

Towards the end of the morning, Andrew Paterson and Niall Rogerson treated Esther and Chifundo to lunch as part of an extended tour of the Dental Hospital & School building. Both Andrew and Niall had met Esther and Chifundo twice previously in Malawi, including during the recent Flying Faculty visit in February.

Earlier in the year, on the Smileawi stand at the Scottish Dental Show, I had met Hannah Macdonald, a BDS 3 student at Glasgow Dental School, who had shown great interest in the MalDent Project. I had mentioned that we would be hosting two students from KUHeS, and Hannah was keen to be involved.

Hannah pulled together a small group of ‘buddies’ from her year group who will help to host the visit by Esther and Chifundo. They all met together at the end of the first day, established a WhatsApp group, and agreed that their first joint trip would be to the Kelvingrove Art Gallery & Museum and to the Botanical Gardens on Sunday 1st September.

Once the timetabled activities were complete, Esther, Chifundo and I enjoyed dinner, before heading to a Tesco supermarket for a ‘weekly shop’ and then home. It had been an excellent first day.

Day 3 – Tuesday 27th August

The dreadful weather that had greeted Esther and Chifundo on arrival in Glasgow made a comeback on the Tuesday morning, so I had extra umbrellas with me when I met them at their accommodation to walk to the Dental School.

Once at the Dental School they changed into the scrubs that Lezley-Ann Walker had provided for them. They were then ready for their first session on maxillofacial radiology.

The whole morning was spent with Dr Neil Henderson, Clinical Senior Lecturer / Honorary Consultant in Dental and Maxillofacial Radiology. Neil showed Esther and Chifundo the various items of imaging equipment in the department and discussed aspects of radiographic diagnosis with them.

At the lunch break, I took Esther and Chifundo to the EE Store in Buchanan Street to purchase pay as you go SIM cards for their phones. This was dealt with very quickly and efficiently, then we headed back to the Dental School for lunch.

Whilst in the Hi Cafe at the Dental School we were joined by Robbie and Patricia Thomson, long-time friends and colleagues of mine. Having sold their dental practice, Robbie and Patricia now deliver clinical teaching in the Dental School, using their many years of experience to the benefit of the students on the BDS course. We had a very enjoyable chat and no doubt Esther and Chifundo will be meeting them again during some of their timetabled sessions.

On the first day of their visit, I had asked Esther and Chifundo whether there were any activities missing from the timetable we had prepared that they would like us to insert. The answer was ‘wire bending’ and thanks to Mr Neil Nairn, Lecturer in Orthodontic Technology, a session was included early in the afternoon of Day 2.

Both Esther and Chifundo really enjoyed getting to grips with the exercises that were set by Neil – the same exercises that the Glasgow dental students grapple with.

The final stop of the day was on Level 9 of the Dental School in the Decontamination Training Laboratory. This is a unique facility where students are taught in detail the practical aspects of running quality-controlled dental instrument decontamination and sterilisation processes. The laboratory is run by Mr Stuart Smith, a qualified equipment engineer, and ensures that graduates have all the necessary theoretical and practical knowledge to run a dental instrument decontamination facility.

In this session, Esther and Chifundo were joined by three visiting elective students from Hong Kong – an international symposium on dental instrument decontamination!

It had been a busy day, which we rounded off with dinner followed by a walk home from the city centre. Our route took us past the Royal College of Physicians & Surgeons in St. Vincent Street, the ‘home’ of the HOPE Foundation which is generously funding the visit by Esther and Chifundo. The sun was out and we took the opportunity to capture some photos at the public entrance …

… and the formal entrance …

It was a fitting end to a very successful day.

Day 4 – Wednesday 28th August

We had agreed between us that Esther and Chifundo would find their own way to the Dental School from their accommodation, having now practised the route several times with me. It was no problem and we met at the Sauchiehall Street entrance as planned at 8.30am.

After donning their scrubs, it was straight off to a 9.00am periodontology tutorial, followed by attendance at a BDS 5 student periodontology clinic.

Once the morning clinic was over, we were treated to a very enjoyable lunch at Café Anti Pasti with Professor Aileen Bell, the Head of Glasgow Dental School, who is part of the team that has been responsible for the visit by Esther and Chifundo.

After lunch, Esther and Chifundo enjoyed a hands-on endodontics session in the Pre-clinical Skills Facility under the direction of Dr Mohammad Tiba, a Clinical Lecturer in Endodontology.

Following the theoretical instruction …

… it was time to cut access cavities in the central incisor replica teeth. Following Mohammad’s teaching, both Esther …

… and Chifundo …

… began the practical exercise, supervised carefully by Mohammad.

At each stage of the process, Mohammad took Esther and Chifundo across to the double-headed operating microscope to review their work critically:

Once the access cavities were prepared to Mohammad’s satisfaction, Esther and Chifundo instrumented the canals and obturated them. The moment of truth was when the teeth were radiographed:

The results were impressive and followed up by some discussion with Mohammad and with Dr David Brunton, another very experienced member of academic staff working in the Pre-clinical Skills Facility that afternoon.

The session finished with a cheerful group photo:

It had been a very full day and we rounded it off with a visit to an ice cream parlour close to the Dental School …

… before heading home to rest and prepare for Day 5.

Day 5 – Thursday 29th August

Day 5 was spent in scrubs, observing in clinics, so there was no scope for photographs. In the morning, Esther and Chifundo attended a BDS 5 student clinical session in Restorative Dentistry. In the afternoon they joined Dr Abisola Asuni , who they knew very well from the Flying Faculty visit in February this year, for an endodontic treatment session

After work activities included a visit to Primark!

Day 6 – Friday 30th August

The morning of Day 6 was spent in the Oral Surgery Department, observing a sinus lift and implant placement procedure. Esther and Chifundo were met by Dr Craig Mather, the Oral Surgeon in the team, who would be operating with Dr Gareth Calvert, Consultant in Restorative Dentistry.

Whilst Esther and Chifundo had read about this type of procedure, it was a great opportunity for them to observe the operation in real life. Once the session was completed, they changed out of their scrubs and we headed to a nearby Nando’s restaurant for lunch. Chifundo was very pleased to see corn on the cob, one of his favourite foods, on the menu!

After lunch, it was back into scrubs to attend a sedation symposium with Dr Kurt Naudi and Dr Conor O’Brien.

Esther and Chifundo joined a group of BDS 4 students and had opportunity to engage in simulations of some of the practical skills required for administration of sedation:

It was hard to believe that it was already the end of the first working week in Glasgow for Esther and Chifundo. Now it was time to turn our thoughts to the weekend. Chifundo had been missing his regular intake of nsima, which is a staple food in Malawi. It is a thick porridge that is made from maize flour and water, which is normally eaten with vegetables and a source of protein such as meat, fish or beans. In order to remedy this situation we went to the African food shop in Great Western Road where Chifundo was delighted to find the maize flour he needed to make some nsima over the weekend.

We walked back through Kelvingrove Park and came across ‘The Maverick’, just five minutes walk from their apartment, and decided that a Friday night drink would be in order.

We enjoyed a good chat about the week’s activities and a preview of what was to come in the following week.

Finally, we made arrangements for the early morning pick up the next day when we would be visiting Nigel and Vicky Milne, our Smileawi colleagues, in Dunoon and attending the Cowal Highland Gathering – some Scottish culture to temper the dental learning!

Day 7 – Saturday 31st August

Since Esther and Chifundo had arrived in Glasgow, the weather had been disappointing, with heavy rain a frequent feature. Today would demonstrate to our visitors that Scotland can also experience days of blue sky and sun. I picked up Esther and Chifundo from their apartment at 8.00am and we set out on the two hour drive to Dunoon via the A82, A83 ‘Rest and Be Thankful’ through Glen Croe and, finally, the A815. At 10.00am we reached the lodge that is temporarily home for Nigel and Vicky Milne, whilst their own house undergoes renovation. Nigel and Vicky greeted us in their Smileawi branded merchandise:

After a brief chat we headed into Dunoon and parked up outside The Hollies Dental Practice, which Nigel and Vicky had owned and run for many years before their retirement in 2023. The new owner kindly allowed us to visit so that Esther and Chifundo could see inside a UK general practice.

After the tour, and a photo outside the practice …

… we walked through Dunoon town centre en route to Dunoon Stadium. On the way we passed by Dunoon Burgh Hall, which turns out to have a very direct link to the MalDent Project.

As regular readers will know, the architectural practice that is designing the new dental teaching facility / student hub on the Blantyre Campus of KUHeS is John McAslan + Partners (JMP). John McAslan was born in Dunoon, and in 2008 the John McAslan Family Trust acquired the Burgh Hall before undertaking a major programme of refurbishment, resulting in its current use as a vibrant arts and culture hub.

A plaque on one of the interior walls recognises this tremendous contribution by John and his family to the local community. It was a perfect opportunity for a photograph with Esther and Chifundo, two budding young dental professionals who, like many other other dental students, qualified dentists and patients in Malawi, will benefit greatly from the new JMP-designed dental facility on the Blantyre Campus of KUHeS once it is complete.

Our walk through Dunoon ended at the Dunoon Stadium, where the Cowal Highland Gathering was underway …

The beautiful weather had attracted large crowds to the event …

… but we soon found a pitch and settled down to a lovely picnic kindly prepared by Vicky:

After lunch, Chifundo, Nigel and I went for a walk around the grounds and found suitable hoardings for some photos:

All afternoon, a succession of pipe bands marched out into the arena and played under the watchful eyes of the judges and onlookers. Here’s a short sample:

It was very warm, so ice creams and cool drinks were the order of the day:

Nigel and Vicky had been practising dentistry in Dunoon for many years and met a large number of their friends among the crowds. One of these was Andy Lancaster, who has visited Malawi as a member of Smileawi Spanners, along with Alan Stewart who has figured frequently in this blog.

In addition to the pipe bands there were the Finals of the World Highland Dancing Championship and athletes competing in a large variety of Scottish sports including tossing the caber, backhold wrestling and hammer throwing.

The gathering was a great opportunity for Esther and Chifundo to experience some traditional Scottish culture and we are very grateful to Nigel and Vicky for suggesting and organising our visit.

On the way home we had hoped to stop for dinner at the The Coylet Inn, a 17th century coaching inn close to Dunoon, but it was a busy Saturday night and we would have had to wait a long time to be served. We decided to carry on with the journey, but took the opportunity to capture a photo of Esther and Chifundo at the beautiful Loch Eck, opposite the inn, before we set off again.

Our eventual stop for dinner was at The Tarbet Hotel, where we ordered a ‘haggis, neeps and tatties’ starter for Esther and Chifundo to try, ahead of our main dishes. Both agreed it was very tasty and a suitable end to a day of Scottish culture.

By the time we reached Glasgow we had been out for 14 hours and were weary, but very pleasantly so after a great trip.

Day 8 – Sunday 1st September

On Sunday, Esther and Chifundo spent time with Hannah MacDonald and Jack Houston, two of their Glasgow BDS 3 buddies. They spent time at the Kelvingrove Art Gallery and Museum, then walked along Kelvin Way …

… to Glasgow Botanic Gardens:

Esther and Chifundo had reached the end of their first full week in Glasgow! Keep an eye open for the next blog post which will cover Week 2.

I was recently given the opportunity to speak briefly about The MalDent Project during a meeting at Edinburgh City Chambers on 12th August between John Swinney, First Minister of Scotland, and the Scotland Malawi Partnership.

The meeting also involved Angus Robertson MSP, the Scottish Government’s Cabinet Secretary for International Development, and Sarah Boyack MSP, Vice Convenor of Holyrood’s Malawi Cross-Party Group.

A full account of the event, including video recordings of the adresses by John Swinney and Angus Robertson, has been published by the Scotland Malawi Partnership and can be viewed here.

The evening demonstrated the vibrancy of the many civic society links between Scotland and Malawi across multiple sectors. It was a privilege to participate and, in the case of The MalDent Project, to acknowledge the significant financial support we have received from the Scottish Government International Development programme.

The event closed with comments from Stuart Brown, the Chief Executive Officer of the Scotland Malawi Partnership:

Many congratulations are due to Stuart and his team for organising such an impactful and engaging event.

Acknowledgement

Photos: Kirsty Stroma Photography, courtesy of the Scotland Malawi Partnership (SMP)

This is a guest post written by George Kafera, a Final Year student on the Bachelor of Dental Surgery degree course at Kamuzu University of Health Sciences.

My Profile 

I am George Kafera, a final year dental student at Kamuzu University of Health Sciences, aiming to graduate this coming December. I am passionate about dental public health, data analytics and academics. I am constantly reading and writing more on dental public health to sharpen my skills and shape my career path. My ambition is to become a senior figure in dental public health in Malawi not many years from now, helping to enhance oral and dental health for all Malawians. I would be glad to receive any mentorship or help from anyone which could help me to achieve this goal. 

How I found the OpenWHO course 

Following the multi-sectoral child oral health workshop in Mponela, where the results of the first Malawi National Child Oral Health Survey were being disseminated on 15th and 16th May, 2024, the MalDent Project blog published a post on 25 May which summarised the workshop content and outcomes. This blog mentioned a recorded lecture by Dr. Yuka Makino, the WHO Technical Officer for Africa, who highlighted the scale of dental problems in the WHO African region. It was pointed out that prevention should be the ultimate goal in addressing oral diseases in Africa. Dr Makino, Prof Bagg and his team recommended a free course that provided helpful teaching materials on oral disease prevention: OpenWHO course ‘Oral Health Training Course for Community Health Workers in Africa’. I enrolled on the course and obtained my certificate on May 31, 2024:

Why I took the course 

I took the course to improve my knowledge on how I can give simple and well understood information during dental awareness campaigns. I saw that the course would help me teach leaders of the community and schools on maintaining good oral health, as not everyone can have a chance of taking this course. Since I am deeply interested in public health, I saw this course as an opportunity to learn and sharpen my skills towards my career path of dental public health. 

What I learned 

The course had five modules encompassing basic, yet important, information on oral health with its focus on public health. Module one was on general oral health, covering pregnancy, infancy, childhood, adolescence, adulthood and older people. This was followed by module two on common oral diseases, risk factors and oral screenings. Module three covered oral health promotion and oral disease prevention and management. Module four was very important as it aligned with public health, dealing with school and community based oral health promotion. The last module discussed oral health data monitoring and management. 

How it will be useful in my life 

The course simplified oral health and will be my teaching aid to the community whenever a need arises. It has also inspired me to increase my interest in public health following the statistics and general facts about oral health I learnt through doing this course. It also reminded me of the basics of oral health and what one needs to focus on to play a role in the community. I would encourage my fellow students to take the course – it is a very important teaching aid when giving oral health instruction and when community dentistry is needed.

A recent post described the very successful child oral health improvement workshop at Mponela in May. One of the main outcomes, suggested by the representatives from the Ministries of Health and Education, was to establish a Task Force that would develop a National Child Oral Health Improvement Plan. Work is now underway between Malawian and Scottish stakeholders to draft a Concept Paper and Terms of Reference for the Task Force, which will be submitted to the Ministry of Health for comment and approval.

In an earlier post, we had introduced some of the Assistant Lecturers who had been appointed through World Bank funding as teaching staff for the new Bachelor of Dental Surgery degree programme at Kamuzu University of Health Sciences (KUHeS). One of these staff members is Don Chiwaya, who is currently in South Africa pursuing specialist training in Dental Public Health, prior to returning to his academic post at KUHeS. When Don read our blog post about the Mponela meeting, he contacted Lorna Macpherson, who provides him with informal mentoring. Don is at a stage in his postgraduate training when he needs to undertake some project work for his dissertation, ideally operating at a national level in Malawi. Lorna and I, therefore, set up a Zoom call with Don to discuss possibilities.

As a result of this call, and following discussions with Malawian colleagues, it has been agreed that Don will join the Task Force being established to develop a National Child Oral Health Improvement Plan. This will provide him with great experience of working at a national level and ensure that when he returns to Malawi at the end of his specialist training in dental public health he will be perfectly placed to participate in the implementation of the programme developed by the Task Force.

Prior to the meeting at Mponela, Yuka had alerted us to a WHO and UNICEF collaboration entitled “Well-Child and Adolescent Care Visits: Programmatic Direction”. The package provides guidance on scheduled child and adolescent well-care visits – seventeen interactions from birth through the teenage years. Oral health assessments are already incorporated into some of the visits. The programme is being overseen by Dr Anne Rerimoi, a paediatrician and epidemiologist who is currently employed as a WHO consultant based in Liverpool, U.K.. Lorna, Yuka and I had a very useful Zoom call with Anne in April, following which she kindly provided a pre-recorded presentation that we were able to share with the workshop delegates in Mponela:

There is a special relevance to our ongoing work on child oral health because Malawi is one of the countries that has been chosen to pilot the WHO/UNICEF package. This provides a potential opportunity for us to link the work of the Task Force developing a Child Oral Health Improvement Plan with introduction of the new WHO/UNICEF package, potentially benefitting both programmes.

In order to pursue discussions further, Lorna and I invited Anne to visit us in Glasgow. Anne travelled from Liverpool on Sunday 14th July and we met her on the Monday morning at the hotel in which she had stayed overnight.

We walked to the Dental School and then spent a very valuable morning identifying the ways in which we could integrate our efforts. Anne explained that she would be visiting Malawi at the end of July to meet with key stakeholders, some of whom are Ministry of Health officials already familiar with the MalDent Project. It was a great opportunity for Lorna and I to provide Anne with a detailed summary of the various facets of the MalDent Project and of our ambitions around child oral health improvement. Similarly, Anne was able to provide us with additional information on her own programme of work.

Following our deliberations during the morning we headed across to our favourite local Italian restaurant, Café Anti Pasti, to continue the discussions.

It was a fantastic day which identified many exciting opportunities for collaboration. We are very grateful to Dr Yuka Makino for alerting us to the planned pilot in Malawi of the WHO/UNICEF programme of child welfare visits. Joining forces at this early stage will allow us to plan activities and collaborate in a logical, structured fashion. Watch out for future posts as we take this work stream forward.

In recent weeks, a number of the MalDent Project work streams have been making significant progress. This post provides some brief updates.

Collaboration with AMECA at Chilomoni Health Centre

Previous blog posts have introduced the collaboration we have established with the charity AMECA to enhance the physical healthcare infrastructure at Chilomoni Health Centre, just outside Blantyre. Ruthie Markus, the dynamic CEO of AMECA, was back in the UK for several weeks over the Summer and on 25th June I visited her for lunch at her home. We were joined by Paul Thomas, the Medical Director of AMECA …

… and by Chig Amin, who has been Ruthie’s dentist in the UK for many years …

Chig has a longstanding interest in AMECA’a work in Malawi and is now very keen to identify any ways in which he can engage with the work of the MalDent Project. To that end, I am extremely excited that Chig is going to travel out to Blantyre with me on 17th September this year and will stay for a week, which will provide a great opportunity for him to meet key players and to learn about our vision for the future.

In relation to the planned developments at Chilomoni, joint working between Jan Sonke, our architect in Malawi, and Chris Cox at Henry Schein Dental has resulted in a fully worked up plan for the new dental clinic:

The tremendous step forward is that Ruthie and the Trustees of AMECA have very generously agreed to provide £15k to cover the costs of the building work required to convert the identified space into the footprint shown in the diagram above. The work is due to commence in early September this year. My job, together with friends and colleagues, is to raise the funds for the equipment that is required and this exercise is now underway. We will provide regular updates on progress over the next few months.

Transportation of phantom head units and related dental equipment from Dentaid HQ in Southampton to Blantyre, Malawi

Last year, a large number of A-Dec phantom head units were removed from the University of Sheffield Dental School as part of a refurbishment programme. These very high quality units were generously donated by the University of Sheffield to our partner Dentaid for servicing and subsequent installation in the new building that is currently in the final planning stages for the Blantyre Campus of Kamuzu University of Health Sciences (see below).

Dentaid arranged for the transfer of the phantom heads to Southampton and over a period of several months checked and serviced every unit meticulously. The phantom heads were stored in a shipping container, which also contained some additional items for the planned new building.

During a recent refurbishment of one of the clinics at the University of Glasgow Dental School, four functional A-Dec dental chairs were removed and placed in storage. Thanks to the good offices of Andrew Paterson, Senior Lecturer / Honorary Consultant in Restorative Dentistry, and Lauren Hughes, NHS Liaison Manager at the Dental School, these chairs were generously donated to the MalDent Project by NHS Greater Glasgow & Clyde.

On Tuesday 2nd July I hired a van to take these four chairs, together with a number of operating stools, down to Southampton. I hired from Little’s Vehicle Hire, a company I had not used previously, and they provided excellent customer service.

When I arrived at the Glasgow Dental Hospital & School building at about 08.20, Paul Deans and Robert Ryan, two members of the Dental Hospitals’s superb portering team, had already begun the process of moving the chairs up from the basement. As a result, we had loaded the van by 09.15 and I was able to make an early start on the road heading south. I broke my journey overnight at Membury Services on the M4 and arrived at Dentaid’s HQ in Southampton at 08.45 on the Wednesday morning. I was greeted by my good friend Stuart Bassham, Workshop Manager at Dentaid, and we enjoyed a coffee before starting the hard work. After coffee we were joined by Richard Hill, Dentaid’s Transport Manager, who accompanied us to the storage yard where the shipping container was located. We set about unloading the van …

… at the end of which the container was full:

As a link to the previous section of this post, the three brown boxes contain equipment that Ruthie Markus had acquired in the UK for use in AMECA’s work in Malawi and which I had collected when I visited her in June. Transportation of small consignments of bulky items to Malawi is a very expensive business and collaboration among partners when a container is being dispatched makes good use of a valuable resource.

It was very heavy work and massive thanks are due to Stuart and Richard for their efficiency and good humour.

We returned to Dentaid HQ for another coffee before I hit the road for the drive back to Glasgow. There were several pockets of congestion and road works en route but I was back in Glasgow by 11pm. Stuart has now prepared all the documentation for shipping the container, so the next time I see it will be later this year in Malawi!

Final stages of design for the new student hub and dental teaching facility at Kamuzu University of Health Sciences.

The phantom head units alluded to in the section above are destined for the new building that is to be built on the Blantyre Campus of Kamuzu University of Health Sciences. Previous blog posts have covered earlier work on the design together with the visit by Peter Lee, Studio Lead for John McAslan + Partners Edinburgh Studio.

Since Peter’s visit to Malawi in February, extensive work has been underway to finalise the plans within the $5.2m budget available from the World Bank. This has resulted in some modifications to the original concept but retaining all the functionality. The working plan now is for a cubical structure with a central atrium. The atrium acts as a solar chimney to draw out heat and pull fresh air through the building.

A model has been produced by the design team that showcases the planned structure:

The model can be dis-assembled floor-by-floor to show each level. Here is the model with the roof removed:

Here, the top floor has been removed to reveal the level that will include the dental clinical teaching facility:

Finally, this view shows the basement of the building:

Images of the external aspect of the building show the overhanging slats which provide some solar shading …

… together with the landscaping that will set the building in a pleasing green environment:

The plans are being reviewed by Blantyre City Council in July. Subsequently the steps required to procure a contractor can be initiated as the project moves towards commencement of construction.

Visit to Kamuzu University of Health Sciences by the CEO and Deputy CEO of the Scotland Malawi Partnership

As part of a two week visit to Malawi, Mr Stuart Brown, CEO of the Scotland Malawi Partnership (SMP) and Mr Chad Morse (Deputy CEO of the SMP) were able to visit the Blantyre Campus of Kamuzu University of Health Sciences. They met Dr Mwapatsa Mipando, Dr Peter Chimimba and Mr George Chirambo, for discussions about the Scottish Government-funded Blantyre-Blantyre and MalDent Projects.

As part of their visit, Peter and Mwapatsa were able to show Stuart and Chad the planned site for the new student hub and dental teaching facility, as discussed in the section above.

Whilst the four sections of this post are separate items, they are linked by a common thread of activities to enhance the training environment for dentists and upgrade the physical infrastructure in which oral health professionals can use their skills to improve the oral health of Malawi’s people. It’s a long journey but as Vincent Van Gogh said:

Great things are not done by impulse but by a series of small things brought together

This is a guest post written by Nigel and Vicky Milne of Smileawi.

Dzaleka is a UNHCR run protracted refugee camp on the outskirts of Lilongwe which had 52678 persons of concern in December 2021 and an estimated 300 new arrivals per month since then. 62% of the refugees are from the DRC with the remainder coming mostly from Burundi and Rwanda.

In May of this year, following on from a workshop in Mponela, five of us, Nigel Milne, Vicky Milne and Lisa Taylor of Smileawi, Lorna MacPherson of the Borrow Foundation and David Conway of the University of Glasgow, decided to visit Dzaleka Refugee Camp at the invitation of Dr Jean Bolobolo. Jean became a friend of Smileawi in 2021 when he took part in the Smileawi/Bridge2 Aid course which trained him to teach volunteers to deliver vital oral health messages to their communities. Smileawi were delighted to then fund him to train 20 Oral Health Promotors within the Dzaleka camp and were pleased to be able to meet 13 of them during this visit.

Unfortunately, due to work commitments Jean was unable to join us and we were instead greeted by Hope Etete, one of the Oral Health Promotors. We met at the Efata Clinic which is a dental clinic at the gates of the camp set up by a Korean dentist Dr James Kang but which is rarely open due to the lack of personnel and resources. It is hoped that with the help of volunteers and some funding this clinic will help to relieve pain for patients within the confines of the camp. Smileawi is keen to be involved and in fact we have recently sent an autoclave from Scotland which should arrive by the end of June. We have also provided local anaesthetic cartridges, needles and an emergency dental kit.

After spending time at the Efata Clinic, we drove through the camp with Hope to meet the Oral Health Promotors. We spent a valuable hour and a half in dialogue with them and were delighted to hear of the work they are doing, spreading important oral health messages to their friends and families, within schools and throughout their communities. They are faced with daily challenges but see the importance of their role and were proud to wear their Oral Health Promotor T-shirts.

One of the main challenges they face is that the price of toothbrushes and toothpaste is very expensive but sweets and sugar products are relatively cheap. Professor Conway confirmed this, when he visited the small shop across the road from the school/church complex we had met in and found plentiful sweets and sugar sweetened beverages on sale, including a highly acidic/high sugar powder designed to be added to water as a drink. 

A particular concern for the oral health promotors was the high number of people within their communities suffering from dental pain and the lack of access to treatment. This brought home to us the importance of the Efata clinic. The Oral Health Promotors were pleased to hear that Dr Bolobolo, Dr Kang and colleagues were volunteering to run clinics to help these patients whenever time and resources allowed and Smileawi are committed to supporting these good men in this project.

At the end of the visit we were all very aware that the problems and challenges faced by the Oral Health Promotors in Dzaleka refugee camp are the same as we have encountered across the country of Malawi, but the fact that the people are also all refugees adds an unimaginable number of other issues which we felt unable to comprehend. We came away humbled by the kindness we were shown and warm welcome we received and a resolve to help where we can. 

As regular readers will know, a large number of organisations from multiple sectors have played critical roles in the MalDent Project. For some months a number of us had been advocating a meeting that would bring key players together for face-to-face discussions during which we could share ideas for the next steps. That meeting became a reality on Tuesday 4th June, when a group of us met for a one-day workshop in Nottingham.

It was extremely fortunate that Dr Mwapatsa Mipando, whose vision and drive had underpinned the birth of the MalDent Project in 2017, had arrived in the United Kingdom from Malawi on Sunday 2nd June. He was in Scotland on University of Glasgow business but was able to take time to join us for the workshop. Other delegates included representatives from Bridge2Aid, Dentaid, Smileawi, The Borrow Foundation, AMECA, Henry Schein Dental, Medical Aid International, ProDental CPD and the Universities of Dundee, Glasgow and London.

Many thanks are due to Shaenna Loughnane, CEO of Bridge2Aid, who undertook much of the organisation, including the identification of our venue. One of Bridge2Aid’s supporters is Colin Campbell, who has established The Campbell Academy as an integral educational component of his dental practice in Nottingham. Colin provided this fantastic facility for us free of charge and also supplied all of the catering – a very generous contribution to the cause.

The meeting room was perfect for our purposes. Coffee was available for us all as we arrived and prepared for the meeting to kick-off at 10am.

In addition to those of us attending in person, there was a Zoom link for colleagues to join on-line, and this allowed Lorna Macpherson, Kathy Wilson and David Williams to participate. Shaenna welcomed everyone to the meeting and thanked Colin for use of the facility.

Prior to the meeting, each organisation had submitted a written summary of its activities, interests and expertise. Shaenna had collated these and made them available online to delegates. However, after Shaenna’s welcome, representatives from each organisation were invited to say a few additional words about their interests and potential roles in Malawi. By the end of the session, we were very well informed about each other’s activities.

I provided a short overview of some of the more significant partnerships and collaborations that have contributed to the MalDent Project’s progress since 2017.

I finished the brief presentation with a slide that identified the network of partners from across multiple sectors who have generously supported and engaged with the various work streams to date:

We then broke for coffee and croissants, while networking continued.

After coffee we reminded ourselves of the seven pillars of Malawi’s National Oral Health Policy…

… and the objectives of the policy as stated by the Malawi Government Ministry of Health:

The work proper then began for the delegates, who were divided into two separate groups to discuss the question ‘What would success look like in five year’s time?’. Post-it notes and flip charts were provided …

… and both groups engaged fully with the discussion, including those on-line who joined the group in the main meeting room via Zoom on the laptop:

By the end of the session both flip charts were well populated with ideas that had been subsequently grouped into themes:

Discussion continued over lunch, as we enjoyed the delicious food suppled by Colin and his team:

After lunch, each team fed back with a summary of their discussions:

During the general discussion that followed, we began identifying and prioritising key work streams. Some were very clear, including the work to develop a child oral health improvement programme for Malawi and the need for a plan to address the challenges that face equipment installation, maintenance and repair. However, we need to distill the many ideas that were shared during the workshop to produce a coherent and integrated plan that maps back onto the Ministry of Health objectives for the National Oral Health Policy. That work is now underway and will be shared in due course with colleagues in Malawi, to allow them to provide further comment and insights. These agreed outputs will then form the basis of funding bids to support continuation of the partnership working.

As is customary, we closed the event with a group photograph, including our colleagues who had joined on-line via the laptop.

The workshop offered a wonderful opportunity for all the players to get to know one another better, and the discussions have furnished us with a rich source of ideas for our next steps. Thanks are due to all the delegates who gave up time in very busy schedules to travel to Nottingham and to contribute in such a positive manner. Having Mwapatsa with us for the day was a special bonus, providing important insights from a Malawian perspective.

Massive thanks are due to Colin Campbell for providing us with such a wonderful facility at no charge and to the Academy Manager, Brooke, who ensured that everything ran smoothly on the day. Finally, many thanks to Shaenna, who worked so hard behind the scenes and on the day to prepare for, and deliver, the event.

So much of what we discussed during the day involved education in a variety of environments. Themes included sustaining high quality teaching of dental therapists and dentists, up-skilling other cadres of health workers and community volunteers to deliver oral health messages, delivering biomedical engineering training to ensure continuing functionality of dental equipment, and engaging with the school sector to develop child oral health improvement interventions.

The quote from Nelson Mandela, high up on the wall of our meeting room at The Campbell Academy, could not have been better chosen for the day’s activities.

This is a guest blog post written by two of the Final Year Dental Students at Kamuzu University of Health Sciences – Chifundo Banda, BDS Year 5, President of the Dental Surgery Students Association, with input from George Kafera, BDS Year 5 Class President.

The 18th of May, 2024, was a big day for the Bachelor of Dental Surgery degree students at the Kamuzu University of Health Sciences, Mahatma Gandhi campus, Blantyre. Everyone was excited and had been looking forward to this day. Dentistry students from Lilongwe campus came all the way to Blantyre to witness the event. It was the day that we were officially welcoming the foundational year students into the programme.

The event was celebrated under the theme: ‘A happy mouth is worth taking action for‘.

The Organizing Committee, led by the Dental Surgery Students Association (DSSA) President, Chifundo Banda, made a wonderful job of organizing the event and ensuring that everything was in order. This included sourcing funds for the event, identifying guests, caterers, the venue, and everything that was needed. It was a great privilege to have a beautiful poster for the event made by our very own foundational year student, Nishat Sema. We also invited representatives from other programmes like Pharmacy, Medical Lab Science and Physiotherapy.

Dressed in black, dental students and all the invited guests started arriving at the John Chiphangwi Lecture Theatres and took their seats for the event. Some of the excited students are seen here …

In no time, the event started with a word of prayer by Emma Thawani who is in BDS Year 3.

The hosts for the event, Jaffar Manyozowho in BDS Year 1, commonly called Bleu, and Wezzie Nkhata who is in BDS Year 3, made sure that everyone was attentive and the function was interesting.

The audience enjoyed the special dance by Mr. Bleu in what he referred to as “showing them love”. The hosts prepared a good foundation for all those that spoke during the event.

The DJ, Luka Phiri, BDS Year 5 did an amazing job. He made sure that everyone was happy by playing modern and trending songs in Malawi:

Alinafe Makhumbo Gondwe, one of the foundational year students, represented her fellow premeds by speaking on behalf of them. She stressed that most of them do not know anything about BDS except removing teeth. She had been wondering how one can study just a tooth for 6 years. She thanked the DSSA executive for organizing this event since it answered most of their questions and motivated them in different areas.

George Kafera, a BDS Year 5 student and Class President for the BDS Year 5 …

and Williams Kumwenda, a BDS Year 4 student …

… gave a motivational talk to the students. They both emphasised tips that students can use to become successful in the BDS programme. They highlighted the importance of having a vision and goals. They also encouraged the other students to work hard and never give up, as the failures are the stepping stone to success.

The DSSA President, Chifundo Banda, who is in BDS Year 5, delivered a speech to the audience on behalf of the DSSA Executive.

It was well prepared, profound and on point. He started by congratulating all the premeds for choosing BDS. He emphasised that for them to achieve great things in life, they must go beyond the boundaries of their comfort, which is hard work. Therefore, they should be ready to embrace discomfort in order to unleash their potential. He thanked everyone who made this event a success through their financial support. These included Prof. Jeremy Bagg, Dr. Niall Rogerson, Dr. Peter Chimimba, Dr. James Mchenga, Dr. Yusuf Maundala, Dr J. Mlotha-Namarika and Mr. Innocent Bamusi among others. He thanked the DSSA community for entrusting him as their President and hence promised to deliver on their mandate. Previously, Chifundo served as a Secretary and also as a Treasurer for the Association.

To inform students of what dentistry is like in the outside world, there was a session in which the invited practising doctors were asked some questions on how students should prepare for work outside the classroom. The panellists were Dr. Shabana Yusuf …

… and Dr. Robert Mbianshu.

This session was very beneficial as the doctors clearly expounded what the students should be doing right now for the future. Students were encouraged to do more whilst they are students, as some mistakes they make now can be forgiven but not when out of the school. This session was co-hosted by Nivah Mwafulirwa, BDS Year 4 and Judith Magona, BDS Year 2.

It was a real honour to have Dr. Shabana Yusuf as our Guest of Honour. This is because she has been in practice for over two decades and is a part-time Lecturer in Orthodontics at the university. Besides, she owns her own private practice.

Her speech covered all areas on how to be a good student, why the BDS programme is a good choice and how one can prepare to have a private practice. She explained the various opportunities and different areas of specialisation that are available in the field of dentistry.

A special event was prepared to happily welcome the newly selected students. There was a cake decorated with dental stuff:

One of the premeds, Aubrey Gama, represented the rest in cake cutting together with the Guest of Honour:

Each foundational year student received a gift and photos were taken:

This was done to remind them how much we care for them.

Lastly, photos were taken with the Guest of Honour and different BDS Classes:

Everyone enjoyed their food while interacting with one another:

It was indeed a day to remember!

One of the original aims of the MalDent Project had been to develop a National Oral Health Policy for Malawi. This aim has been achieved and the policy was launched by the Ministry of Health in April 2022. Publication of the policy was an important landmark, but as with all policies the impact is only realised when the policy is translated into action. With that in mind, an implementation meeting had been held in Lilongwe in November 2022, resulting in the development of an action plan.

An important component of the policy and action plan is the establishment of a child oral health improvement programme. Several relevant work streams have been underway over the past three years, which have provided valuable information that could underpin such a programme. The next stage was to hold a workshop with key stakeholders, to facilitate an exchange of information and views that would feed into the creation of a child oral health improvement programme.

Earlier this year, agreement was reached with the key stakeholders in both Malawi and the UK that a workshop would be held in Malawi on 15th and 16th May, 2024. On Monday 13th May, Lorna Macpherson, Lisa Taylor, David Conway and I set off from the UK to join the meeting.

Whilst long, as always, the journey was uneventful. We were met at Kamuzu International Airport by a driver from Kamuzu University of Health Sciences. We made a detour into Lilongwe to pick up Drs Peter Chimimba and Linda Nyondo-Mipando, then headed to Chikho Hotel in Mponela, where the workshop was to be held.

On arrival, we were met by our friends Nigel and Vicky Milne of Smileawi, who had travelled out from the UK a few days earlier. We enjoyed dinner together before turning in for an early night, ahead of the meeting the next day.

DAY 1

We were up early on the Wednesday morning to prepare the meeting room for the delegates and to check the technicalities of the AV system. The room was ideal for our two-day event, with one half set up for the lecture presentations on Day 1 and the back half an open area that we could set up for the small group work on Day 2

The Ministry of Health had asked Dr Peter Chimimba to chair Day 1 of the workshop. After welcoming those present, Peter read a short speech, prepared by Dr Nitta Chinyama Nayeja, Deputy Director of Clinical Services at the Ministry of Health, wishing us a successful event.

After Peter had completed the introductory formalities, I gave a very short summary of the MalDent Project activities to date. This provided some general context for the workshop, illustrating that work on child oral health improvement is an important part of a jigsaw of activities aimed at improving oral health for all members of the population.

We were delighted that Maureen Maguza-Tembo, Deputy Director for School Health, Nutrition and HIV & AIDS in the Malawi Government Ministry of Education, had agreed to deliver the keynote lecture covering Malawi’s school health and nutrition guidelines.

This high-level presentation at the beginning of the day was extremely valuable in setting a policy context for us from the perspective of the Ministry of Education.

Following this excellent keynote lecture, Dr Chimimba invited Professor Lorna Macpherson to introduce the report on Malawi’s first national child oral health survey that had been undertaken in October 2023. This would be a double-act presentation with Dr Lisa Taylor who, with Nigel and Vicky Milne, had participated in the planning and fieldwork for the survey.

Lorna gave the first segment of the presentation:

She provided background information on the global scale of oral disease, the low priority it has been afforded and the more recent recognition of its importance, for example the WHO Global Oral Health Action Plan 2023-2030, and the establishment of a Lancet Commission on Oral Health, of which Lorna is a member:

Lorna described the survey design, based on WHO Pathfinder methodology, which had been put together in partnership between the Malawian and UK team members. Lorna then handed over to Lisa who gave a fully illustrated presentation on the training and calibration that was delivered for the UK team and nine Malawian dental therapists who undertook the survey. Lisa also provided valuable insights into the execution of the survey itself, during which 2941 children were examined, and cited some lessons learned for any future survey.

Lorna returned to the lectern to present the survey results, first for the six-year-olds …

… then for the 12-year-olds:

These findings from the survey, showing high levels of untreated dental caries in both six- and 12-year-olds, provided objective evidence of the scale of the problem and the importance of work to establish a caries prevention programme for Malawian children. Lorna concluded the presentation, before a break in proceedings for coffee and discussion.

The second session of the morning began with a presentation by Professor David Conway.

David provided an overview of the importance of upstream interventions and the outcome of a review of systematic reviews of caries prevention measures in childhood. The latter was a piece of work that had been initiated by Ronald Manjomo, a PhD student at Kamuzu University of Health Sciences, who very sadly died of COVID. David dedicated his presentation to the memory of Ronald.

David provided an extensive overview of the multiple interventions that have been examined across the globe for caries prevention in children. He included a very clear description of upstream interventions …

… some of which included the following:

He then proceeded to discuss the overview of systematic reviews, the outcome of which was summarised in two slides:

The next speaker was Associate Professor Linda Nyondo-Mipando, who presented a preliminary situation analysis based on data collected by a group of Masters in Public Health students at Kamuzu University of Health Sciences. Linda is supervising one of the seven students who are undertaking projects linked to the MalDent Project. The students’ work is focused on identifying how well the existing infrastructure in Malawi, such as school facilities, would support specific child oral health interventions of the type described by David in the previous presentation.

Linda is a health services research subject expert and her talk highlighted some of the challenges that will have to be overcome as we develop the child oral health improvement programme:

Linda’s presentation brought the morning’s proceedings to a close and we had a very enjoyable lunch break.

After lunch, we had a session of four pre-recorded presentations. The first of these was from Dr. Yuka Makino, the WHO Technical Officer for Africa. Yuka is a good friend of the MalDent Project and was a member of the task force that prepared Malawi’s National Oral Health Policy. We have always ensured that MalDent Project initiatives align with WHO recommendations for the African Region.

Yuka gave an excellent overview which, like Lorna’s introductory comments earlier in the day, highlighted the significant impact of oral disease on the world’s population, particularly in low- and middle-income countries. The costs of treatment, as well as the productivity losses due to oral disease, are both very high:

The statistics Yuka quoted for the African Region illustrated how important it is to push a disease prevention agenda:

In keeping with Yuka’s presentation, integration of oral health into general health systems, and recognition that oral diseases are an integral part of the Non Communicable Disease agenda, are essential components of Malawi’s National Oral Health Policy, including initiatives aimed at child oral health improvement.

Prior to the meeting at Mponela, Yuka had alerted us to a WHO and UNICEF collaboration entitled “Well-Child and Adolescent Care Visits: Programmatic Direction”. The programme is being overseen by Dr Anne Rerimoi, a paediatrician and epidemiologist who is currently based in Liverpool, UK. Lorna, Yuka and I had a very useful Zoom call with Anne in April:

The package provides guidance on scheduled child and adolescent well-care visits – seventeen interactions from birth through the teenage years. Oral health assessments are already included at some of the visits.

Anne kindly provided a pre-recorded presentation, which we were able to share with the workshop delegates:

There was a special relevance to our workshop programme, because Malawi is one of the countries that has been chosen to pilot the scheme. It provides, therefore, a potential opportunity for us to link our plans for a child oral health improvement programme with introduction of the new WHO/UNICEF package, helping to realise the vision of the both programmes:

This is an extremely exciting opportunity and we look forward to continuing our discussions with Anne and the team.

In addition to these two pre-recorded presentations we also showed a module of the free online OpenWHO course ‘Oral Health Training Course for Community Health Workers in Africa’. Yuka had mentioned this course in her talk and we recommended it to those present as a valuable teaching aid:

The final pre-recorded presentation had been kindly prepared by Dr Andrew Paterson, a key member of the MalDent Project team. He described the cascade training programme developed by Bridge2Aid, Smileawi, ProDental CPD and the Dental Association of Malawi, through which dental therapists in the Northern Region of Malawi had been trained to deliver teaching on oral health to community volunteers. The latter, termed Oral Health Promoters, were then equipped to deliver oral health messages within their communities. We would hear more about this later in the day from Vicky Milne of Smileawi, together with a dental therapist and an Oral Health Promoter involved in the programme.

Just before the afternoon tea break we headed down to the hotel entrance for the obligatory group photo:

The final session commenced with a presentation by Mr. Fred Sambani, the Country Director of Teethsavers International in Malawi. He started by showing a video, which you can view here.

Fred went on to describe the work of Teethsavers International, which is a non-profit organisation that focuses on promoting oral health among children in developing countries. As we work together to develop an oral health improvement programme for children in Malawi, it is important that we do so in a collaborative fashion and ensure that those who are already involved in this work are fully engaged.

Our final scheduled speaker for the day was Ms. Maria Soko from Water Aid Malawi, who gave an excellent presentation on the work of the charity in primary schools and early childhood centres. Her talk included a number of top tips for working in schools, some of which were potentially applicable to our own plans for child oral health improvement, such as use of nudges and visual reminders:

We are very keen to investigate the possibility of joining up handwashing, nutrition and toothbrushing in some small-scale feasibility programmes in schools and are delighted that Water Aid is willing to collaborate with us in this endeavour.

Maria’s presentation brought the official programme for Day 1 to a close. However, the delegates present included Mr Edwin Mhango, a dental therapist from Mzimba North and an Oral Health Promoter, Mr Emmanuel Msofi, from the same district. They had both been involved in the project described by Andrew Paterson in his pre-recorded talk earlier in the day and had brought with them some photographs and oral health teaching aids that were provided through the project. We were, therefore, delighted to provide a bonus presentation for delegates from Edwin and Emmanuel. Smileawi was a main partner in the project, providing funding from Scottish Government which they had received pre-COVID, and linking in the therapists with whom Smileawi have been working for many years in Northern Malawi. It was very appropriate, therefore, that Vicky Milne introduced the presentation:

Edwin gave an excellent and positive account of the project from his perspective, together with some of the challenges that dental therapists like himself face on a daily basis.

Edwin and Emmanuel then jointly demonstrated the teaching aids that had been provided through the project and which were suitable for use in very rural areas:

Finally, Emmanuel spoke about his own involvement and experiences in the project as an Oral Health Promoter.

This had been a really valuable addition to the day’s proceedings, providing a very authentic viewpoint of the Oral Health Promoter project from a ‘user’ perspective.

Peter closed the day’s proceedings, thanking all the speakers and whetting everyone’s appetite for the small group discussions that would follow on Day 2, when delegates would have opportunity to contribute to the development of a child oral health improvement plan:

The enthusiasm in the room was evident from the small groups who continued chatting, even after the session had been closed. Dr Ayid Shepard, Oral Health Coordinator at the Ministry of Health, and Dr Lilian Maliro from the Ministry of Health, both had a chat with Edwin and Emmanuel …

… and other groups continued discussions …

… before some of us met for an extended conversation over a drink:

This informal discussion before dinner, which included colleagues from the Ministry of Health, Ministry of Education, WASH, Kamuzu University of Health Sciences, Smileawi and the University of Glasgow, was extremely interesting and very valuable – a perfect way to end Day 1.

DAY 2

Whereas Day 1 of the workshop had comprised multiple presentations, Day 2 was completely interactive and based around three discrete small group discussion sessions. The room was ideally suited to the format and we were able to set up stations for the group work, with flip charts and Post-it notes, separate from the front of the room which retained the Day 1 layout for feedback.

Day 2 was led by David Conway. Each delegate was given a set of briefing notes which provided information presented on Day 1, to act as an aide-memoire and inform the small group discussions.

David reminded delegates about the National Oral Health Policy Implementation Workshop held in November 2022, when the Malawian oral health professionals present had developed a set of actions.

During the discussion groups at this follow-up workshop, the focus would be on child oral health, but building on the work from the meeting in 2022.

The first discussion group work focused on interventions in schools. The groups were each asked to identify some short-term / low-cost interventions, and some mid- / long-term interventions.  This was to be initially done by each individual participant writing proposed actions on Post-it notes (one action per Post-it). These were then to be placed on a flip chart.

The chair then organised the Post-it notes in discussion with the group, identifying those which were repeats or grouped with each other, allowing agreed lists of short-term/low-cost actions and mid-/long-term actions to be defined. 

The next exercise was to discuss the facilitators to implementation of each intervention in the context of Malawi, including:

• Who would need to be involved (at all levels)? 
• What would be needed for it be taken forward?
• When could it be commenced?

Following this discussion of actions and facilitators, priority ranking for the list of short-term/low-cost actions and for the list of mid-/long-term actions was to be agreed.

A scribe took notes during the discussions and a rapporteur was selected for each group to feed back in the plenary session.

Once the Post-it notes started hitting the flip charts, the hubbub of discussion rapidly rose.

Each of the flip charts was photographed at the end of the session to provide a permanent record:

Once the groups had completed their discussions, everyone came together at the front of the room for the feedback session. David summarised the views expressed as they were fed in.

Following completion of the discussions on school-based interventions, the same process was repeated on two further occasions, once for Community-based Actions and finally for Policy-level Actions 

The three sessions of group work were interspersed by coffee, lunch and tea breaks, during which the conversations continued.

Once all three discussion groups were complete, it fell to Lorna to extract and summarise some of the key outcomes. The discussions had been very rich and yielded a plethora of information which will be very valuable as we consider ways in which we can take the child oral health improvement programme forward.

The meeting closed with a summing up by Mr Albert Saka, Chief Education Officer in Malawi’s Ministry of Education. He started by thanking the various teams of people who had participated in the workshop. He explained that the Ministry of Education is using the schools platform to introduce health subjects, such as oral health. He praised the teachers in schools and guaranteed that if we provide them with correct information, they will teach it.

In order to progress the agenda, it needs to be presented to the Principal Secretaries for Health and Education at the respective Ministries if the work is to be taken forward with Government funds. We have objective evidence of the disease burden from the survey, which is powerful. We need to move forward in a coordinated fashion, engaging the Ministries of Health; Education; Water & Sanitation; Gender, Community Development & Social Welfare; and Local Government, Unity & Culture. There is a cross-cutting School Health Group at Government-level, and it is suggested that we establish a Child Oral Health Task Force that can feed into this Group. Multi-sectoral collaboration will be key to success.

Finally, Albert thanked all the supporting staff who had made the workshop possible and acknowledged the generous financial support of The Borrow Foundation and the Scottish Government.

The final word came from our fantastic chairperson, Dr. Peter Chimimba. Peter is the powerhouse behind so many of the MalDent Project activities and this workshop was no different. He had worn at least three different hats over the two days and with his characteristic efficiency and sense of humour had kept us all on track. He added his thanks to those of Albert and wished everyone safe travels home.

This had been a very intensive workshop but also an exceptionally useful event as we plan our next steps towards establishing an integrated child oral health improvement programme that is applicable in a Malawian context. We could not have hoped for a more successful outcome!

Acknowledgements

The workshop was made possible through generous financial support from The Borrow Foundation and Scottish Government International Development.

Thanks are due to all the speakers and to those involved in the organisation of the event.

The photographs in this post have been selected from a combined collection submitted by participants, to whom thanks are due.

Finally, many thanks are due to the delegates, who worked very hard and with great enthusiasm to provide a body of knowledge that will inform the multi-sectoral work now needed to develop a child oral health improvement programme in Malawi.

This is a guest blog post with a difference. During the Flying Faculty visit in February this year I had an interesting conversation with one of the BDS 5 students, Emmanuel Kapininga. He explained that he had recently participated in a writing competition and had chosen oral health as his theme. This guest blog, written by Emmanuel, incorporates a selection of the pieces that he wrote daily.

My name is Emmanuel Kapininga, 23 years of age, pursuing a bachelor’s degree in dental surgery at Kamuzu University of Health Sciences. I am in my final year. Earlier this year 2024, the student publications director organised a 30 day writing challenge. The aim of the challenge was to entertain, raise awareness and help students to develop a habit of writing. The pieces of the writing were posted on Facebook each day for 30 days. I joined to develop my writing skills.

Luckily, at the end of the competition, I was announced a winner on the third position and got away with a 5,000 kwacha which is roughly 2USD.

In the competition, I decide to write about oral health and I got positive feedback from people on social media and those from my neighbourhood. I am glad that I participated in this challenge and wish I could have more opportunities to sharpen my skills and increase interest in writing. Most of all I was happy to know that I educated a good number of people through this. The main challenge that I faced was to translate some of the medical terms to plain English or local language for many people to understand.  The following are some of the pieces that I wrote during the competition. 

𝐖𝐇𝐀𝐓 𝐈𝐒 𝐎𝐑𝐀𝐋 𝐇𝐄𝐀𝐋𝐓𝐇?

𝑰𝒏𝒕𝒓𝒐𝒅𝒖𝒄𝒕𝒊𝒐𝒏

Oral health is the state of the mouth, teeth and orofacial structures that enables individuals to perform essential functions such as eating, breathing and speaking, and encompasses psychosocial dimensions such as self-confidence, well-being and the ability to socialize and work without pain, discomfort and embarrassment (WHO, n.d.). As any aspect of the body it changes with age, physiological and environmental state.

𝑾𝒉𝒚 𝒐𝒓𝒂𝒍 𝒉𝒆𝒂𝒍𝒕𝒉

It is necessary to have knowledge about the oral health of one self. It helps know what is normal and what is not and seek assistance from professionals, it also helps recognise some systemic pathologies or diseases which have oral manifestations. 

𝑶𝒓𝒂𝒍 𝒉𝒆𝒂𝒍𝒕𝒉

As stated in the definition, oral health is the state of the mouth and the orofacial structures. That is to say good oral health will mean, having normal function and good aesthetics that will not negatively affect an individual in the social environment.

On the other hand, bad or poor oral health means a deviation from comfortability and function on the mouth and related structures. Having a bad breath, bleeding gums, dental caries, mobile teeth are examples of states of poor oral health.

𝑪𝒐𝒏𝒄𝒍𝒖𝒔𝒊𝒐𝒏

As any aspect of health, oral health must be taken seriously. Selfcare, prevention and seeking dental assistance from dental professionals are the best ways that will help each one of you to achieve good oral health. Join me in the 30 day writing challenge as I tackle some of the frequent oral health conditions, how to recognise the abnormal, how to provide oral health care and when to seek assistance.

𝑩𝒊𝒃𝒍𝒊𝒐𝒈𝒓𝒂𝒑𝒉𝒚

WHO. (n.d.). world oral health organisation. Retrieved from https://www.who.int/health-topics/oral-health#tab=tab_1

𝐖𝐇𝐘 𝐃𝐎 𝐖𝐄 𝐁𝐑𝐔𝐒𝐇 𝐎𝐔𝐑 𝐓𝐄𝐄𝐓𝐇 𝐖𝐈𝐓𝐇 𝐅𝐋𝐔𝐎𝐑𝐈𝐃𝐀𝐓𝐄𝐃 𝐓𝐎𝐎𝐓𝐇𝐏𝐀𝐒𝐓𝐄?

𝑰𝒏𝒕𝒓𝒐𝒅𝒖𝒄𝒕𝒊𝒐𝒏

Have you ever wondered why you brush teeth? List three reasons why you brush your teeth. I bet some of you will say; to whiten teeth, avoid bad breath or have the sweet smell from the toothpaste. Well, you are not very far from the truth but those are secondary benefits of brushing your teeth with toothpaste. I will explain the scientific reasons for toothbrushing and what is needed to achieve this.

𝑾𝒉𝒚 𝒘𝒆 𝒃𝒓𝒖𝒔𝒉 𝒕𝒆𝒆𝒕𝒉

The main reasons for brushing are; to remove food debris (remains) from the oral cavity, to remove plaque, and to sufficiently apply fluoride to the teeth. If this is done properly, you can not have a bad breath unless there are other causes than poor oral hygiene. It also helps avoid the initiation and progression of dental caries.

For these goals for cleaning to be achieved there is a need to follow the principles of timing and technique for brushing as well as the right brushes and tooth paste.

𝑪𝒐𝒏𝒄𝒍𝒖𝒔𝒊𝒐𝒏

Knowing the reasons why we brush teeth will help you understand the importance of brushing and the right way of brushing. In my next article, I will explain the principles for effective tooth brushing. This will deepen your knowledge on how and why we brush. Therefore, I urge you to keep on reading my posts throughout this journey.

𝑴𝒆𝒂𝒏𝒊𝒏𝒈𝒔 𝒐𝒇 𝒘𝒐𝒓𝒅𝒔

1. Plaque: a sticky film that coats the teeth and contains bacteria

2. Dental caries: in simple terms, it is tooth decay

3. Fluoridated toothpaste: this the tooth paste that has fluoride as one of its components. Most of the commercially available tooth pastes have fluoride. It is written on the tooth paste tube and it is necessary to check before you buy.

𝐏𝐑𝐈𝐍𝐂𝐈𝐏𝐋𝐄𝐒 𝐎𝐅 𝐓𝐎𝐎𝐓𝐇 𝐁𝐑𝐔𝐒𝐇𝐈𝐍𝐆

𝑰𝒏𝒕𝒓𝒐𝒅𝒖𝒄𝒕𝒊𝒐𝒏

As discussed earlier, toothbrushing has goals. There are a couple of principles that help make sure that we are effectively brushing our teeth. There are principles of timing, technique, type of tooth brush and toothpaste.

𝑷𝒓𝒊𝒏𝒄𝒊𝒑𝒍𝒆𝒔 𝒐𝒇 𝒕𝒐𝒐𝒕𝒉 𝒃𝒓𝒖𝒔𝒉𝒊𝒏𝒈

The first principle is timing. This discusses how long and when to brush teeth. The ideal time to brush teeth is after meals. This can be after breakfast in the morning, after lunch and after supper at night. The essence is to remove all food that remains in the mouth after eating. When brushing, it is recommended that you spend at least two minutes. Brushing has to be done every day, at least two times a day with at night being the most important.

On the technique, you have to place the tooth brush bristles 45° to the gums, this helps to clean the gum pockets. Scrub the teeth gently (not violently as most people do)

The type of tooth brush has to be medium. This is to avoid hurting your gums and destroying tooth structure. Soft brushes can be used in people who experience pain when brushing. You can check the pack in stores before you buy any tooth brush, it is written whether its medium, hard or soft. Alternatively, you can dip the brush in warm water and the bristles will become soft.

The toothpaste has to have fluoride as this will help strengthen the tooth and prevent it from initiating decay

𝑪𝒐𝒏𝒄𝒍𝒖𝒔𝒊𝒐𝒏

Brushing without following these rules, is as good as not brushing and sometimes it can cause more harm than good. 

𝐖𝐇𝐘 𝐃𝐎 𝐘𝐎𝐔𝐑 𝐆𝐔𝐌𝐒 𝐁𝐋𝐄𝐄𝐃?

𝑰𝒏𝒕𝒓𝒐𝒅𝒖𝒄𝒕𝒊𝒐𝒏

A good number of people have ever been victim to bleeding gums. It could be either during toothbrushing, spontaneous (on its own) or when chewing. This can come with or without pain. I will discuss why it occurs and how to deal with it.

𝑾𝒉𝒚 𝒈𝒖𝒎𝒔 𝒃𝒍𝒆𝒆𝒅

Gums could bleed from traumatic tooth brushing. This happens because of using heavy forces when brushing or using toothbrushes with hard bristles.

It could happen due to inflammation of the gums. This is the most common cause. This happens due to poor brushing technique which leaves food remains in the gingival pockets (space between the gums and the tooth). The food that remains creates a favourable environment for micro-organisms including bacteria. This causes irritation to the gums causing inflammation. Inflammation causes the gums to bleed after a light touch like when brushing.

𝑪𝒐𝒏𝒄𝒍𝒖𝒔𝒊𝒐𝒏

Consistent toothbrushing and following the principles for tooth brushing is the best way to prevent bleeding gums. If your gums bleed while brushing, try and use a softer brush and read my next content on how to brush and the bleeding will stop within seven days.

𝐇𝐎𝐖 𝐓𝐎 𝐁𝐑𝐔𝐒𝐇 𝐘𝐎𝐔𝐑 𝐓𝐄𝐄𝐓𝐇

𝑰𝒏𝒕𝒓𝒐𝒅𝒖𝒄𝒕𝒊𝒐𝒏

As obvious it may seem, toothbrushing has to be done with care and gentleness. I discussed the principles for tooth brushing, and technique is one of the crucial principles. In this piece, I will discuss the technique for brushing in depth.

𝑯𝒐𝒘 𝒕𝒐 𝒃𝒓𝒖𝒔𝒉

First of all, you need to have a medium or soft tooth brush to avoid hurting your gums. The brush has to have straight bristles, not flared up due to overuse.

Apply the toothpaste and position the brush 45^o to the tooth. Move the brush in circular motion, gently on each tooth and on all sides of the tooth. Most people are fond of cleaning the front surfaces only.

Shake the foam from the paste and spit out. DO NOT RINSE. Yes, you read it right, do not wash your mouth with water. Just spit the toothpaste. This will give the toothpaste time to effectively perform its function.

𝑪𝒐𝒏𝒄𝒍𝒖𝒔𝒊𝒐𝒏

As uncomfortable as you may feel not rinsing your mouth, keep on. You will get used in a few days. You are not supposed to eat or drink anything within 30 minutes after brushing.

𝐃𝐄𝐍𝐓𝐀𝐋 𝐂𝐀𝐑𝐈𝐄𝐒 (𝐓𝐎𝐎𝐓𝐇 𝐃𝐄𝐂𝐀𝐘) 

𝑰𝒏𝒕𝒓𝒐𝒅𝒖𝒄𝒕𝒊𝒐𝒏

Tooth decay is one of the common causes of dental pain. It leads to cavitation (ku bowooka) of the tooth which leads to inflammation of the pulp (pain of the tooth). It may also cause swelling, headaches and sleepless nights, depending on severity of destruction. This essay will discuss the causes of tooth decay.

𝑫𝒆𝒏𝒕𝒂𝒍 𝒄𝒂𝒓𝒊𝒆𝒔

It is influenced by both familial and environmental factors. Familial factors means that it can be inherited (taken) from parents. It is not necessarily inherited as tooth decay, but rather a high risk to caries. That is to say other people are likely to develop dental caries than others.

Environmental factors include diet and oral health hygiene. Sugary food like chocolates, sweets, tea and sweet beverages can increase chances of one to develop caries. It is advised that if you cannot resist taking sweet food, it is better to eat them in one setting within a short period of time than continuously eat them over a long duration. This gives time for your teeth to be cleaned by saliva.

Poor oral hygiene (poor tooth brushing) is another influencing factor for caries development.

𝑪𝒐𝒏𝒄𝒍𝒖𝒔𝒊𝒐𝒏

There is a more scientific explanation to the development of caries, but that is the basic idea that will help you prevent tooth decay. I will explain the characteristics of tooth decay and how to prevent dental caries in my next pieces. Stay with me.

𝑵𝑩

I was requested, by some people, to put the words in plain language. That is why I have some words in brackets. Some in Chichewa and some in a closest relative word.

𝐍𝐔𝐑𝐒𝐈𝐍𝐆 𝐁𝐎𝐓𝐓𝐋𝐄 𝐂𝐀𝐑𝐈𝐄𝐒

𝑰𝒏𝒕𝒓𝒐𝒅𝒖𝒄𝒕𝒊𝒐𝒏

A nursing bottle 🍼 is a bottle which is used to feed children, especially just after their breastfeeding period. Nursing bottle caries, in simple terms, is a pattern of tooth decay where the upper baby teeth are more disrupted. They are also known as ‘bottle mouth caries’. The lower teeth are spared in the sense that they can be mildly affected or completely healthy.

𝑩𝒐𝒕𝒕𝒍𝒆 𝒎𝒐𝒖𝒕𝒉 𝒄𝒂𝒓𝒊𝒆𝒔

These are caused by excessive drinking of sweet beverages from bottles. It could be squash, fanta, tea and all that you can name. Try to drink from a bottle. You will observe that your tongue covers the lower teeth and you pour the drink on the upper teeth. This is why the upper teeth are the highly affected. This is common in babies because parents give them drinks to make them sleep while they work. It can be given to the children when going to school as well. After a long time of this habit, you will observe that the upper teeth are getting dark spots. That is decay.

𝑪𝒐𝒏𝒄𝒍𝒖𝒔𝒊𝒐𝒏

This can also happen in adults with the habit but it is not as common because the teeth are somewhat resistant. It can happen to anyone! The best way to prevent this is to reduce frequency of drinking sweet beverages. Instead, you can be taking water. Most of all, clean your teeth.

𝐈𝐍𝐒𝐓𝐑𝐔𝐂𝐓𝐈𝐎𝐍𝐒 𝐀𝐅𝐓𝐄𝐑 𝐓𝐎𝐎𝐓𝐇 𝐄𝐗𝐓𝐑𝐀𝐂𝐓𝐈𝐎𝐍

𝑰𝒏𝒕𝒓𝒐𝒅𝒖𝒄𝒕𝒊𝒐𝒏

It is very important to understand and adhere to the instructions that are given after we have had our tooth removed at the hospital. I will discuss the instructions and reasons behind.

𝑷𝒐𝒔𝒕 𝒆𝒙𝒕𝒓𝒂𝒄𝒕𝒊𝒐𝒏 𝒊𝒏𝒔𝒕𝒓𝒖𝒄𝒕𝒊𝒐𝒏𝒔

First of all, you are given a cotton gauze to bite on. You are supposed to bite on it for not less than 30 minutes. You should not chew on it; limit talking and swallow your saliva. This is to stop bleeding. 

You should take the pain killer given just after removing the cotton and continue as prescribed. You take the painkiller to reduce pain before the anaesthesia (Dzanzi lokupha msempha) wears out. If given antibiotics, take them as told.

You should not do any physical exercise or work like farming, carrying goods. This is to avoid raising blood pressure which may lead to bleeding.

You can use ice packs to reduce the size of swelling. Use two pillows when sleeping to allow venous return (magazi aziyenda) and reduce swelling.

You are supposed to start rinsing your mouth with warm salty water, at least four times a day. Rinsing should start the next day after tooth removal 𝗡𝗢𝗧 𝗧𝗛𝗘 𝗦𝗔𝗠𝗘 𝗗𝗔𝗬!

 If you start the same day, the wound does not heal.

Do not brush or eat using the side that has been extracted until it heals.

𝑪𝒐𝒏𝒄𝒍𝒖𝒔𝒊𝒐𝒏

Following the instructions will make the healing less painful and it will prevent other complications that may arise due to poor adherence.

DIABETES MELLITUS AND PERIODONTAL DISEASE

Diabetes Mellitus [DM] is a condition where the body fails to regulate blood sugar levels due to low insulin production, or ineffective insulin usage. (Insulin is a hormone responsible for blood sugar regulation).

Periodontal (gum) Disease [PD] simply means infection of tissues that surround the teeth.

There is a bidirectional relationship between the two, in that they’re both risk factors for each other. Chronic inflammation of the gums, as in PD, is associated with ineffective usage of insulin by the body, worsening DM.

On the other hand, poorly controlled diabetes provides a favorable environment for bacteria in the gums.

It is for this reason that gum disease is more common in those with diabetes mellitus. Having periodontal disease treatment does not improve diabetes mellitus. Proper medical treatment is needed for glycemic control.

𝐂𝐎𝐍𝐂𝐋𝐔𝐒𝐈𝐎𝐍

Much as periodontal disease can be prevented through good oral hygiene, in those with risk factors such as diabetes, good blood sugar control is just as important in preventing gum disease.

This can be achieved through adhering to lifestyle modifications, blood sugar control medications and not forgetting practicing good oral hygiene.

𝐁𝐑𝐀𝐂𝐄𝐒

This is a famous word in modern society. This is an appliance that is used to move teeth in different directions. It could be rotation, pulling, forward or backward movement.

Many people have taken this to be a fashion trend. Since it is expensive to have braces, people have started to think this a sign of wealth. 

Well, they are expensive, but this is a treatment for a problem. 

This needs to be made clear because many people wish to have braces but they do not know what they are for. 

Just like any other treatment, having braces has its own risks. There might be worsening of one’s condition of teeth by over rotating teeth. Having braces on, increases the difficulty of toothbrushing.

Use, importance and risks of wearing braces should be known. It is rather a treatment not a sign of being rich

𝐇𝐎𝐖 𝐓𝐄𝐄𝐓𝐇 𝐁𝐄𝐂𝐎𝐌𝐄 𝐌𝐎𝐁𝐈𝐋𝐄

Tooth mobility is the movement of the tooth that happens due to loosening of its attachment to the tooth socket.

Many people have experienced or have this problem.

Tooth mobility can be caused by several reasons. The first reason is trauma. This is caused by a physical blow to the teeth. The other reason is periodontal disease. This causes destruction to the fibers that hold the teeth in place. Periodontal disease can be caused by poor oral health and its progress is enhanced by extreme age or systemic diseases like diabetes.

The other reason for tooth mobility is normal exfoliation. This happens in children when they are about to have adult teeth. 

Whenever you feel like your tooth is mobile, visit a dentist. You will be told the cause and helped accordingly.

𝐒𝐌𝐎𝐊𝐈𝐍𝐆 𝐕𝐒 𝐎𝐑𝐀𝐋 𝐇𝐄𝐀𝐋𝐓𝐇

Smoking is one of the pleasures of the world. Cigarette smoking has a big impact on one’s oral health status. 

It reduces the amount of oxygen in the oral cavity. This creates a favorable condition for harmful microorganisms. Smoking also constricts the blood vessels in the oral cavity. This reduces the ability to fight harmful microorganisms in the mouth. All these effects lead to rapid progression of periodontal disease and destruction (destruction of the gums and fibers that hold teeth). This leads to persistent bad breath and may lead to loss of teeth. In addition to that, smoking stains teeth. The particles from the smoke stick on teeth and they alter the appearance of the teeth, making them appear darker than normal.

Smoking is bad and should be avoided at all costs. Not only is it bad for oral health but also for social and general health as well.

𝐃𝐄𝐍𝐓𝐀𝐋 𝐓𝐑𝐄𝐀𝐓𝐌𝐄𝐍𝐓 𝐀𝐍𝐃 𝐀𝐍𝐗𝐈𝐄𝐓𝐘 𝐃𝐈𝐒𝐎𝐑𝐃𝐄𝐑𝐒

For most people who might have undergone dental treatment, pain is a common complaint. This has been known to cause fear in a lot of people which is normal. Whenever this fear becomes persistent, unrealistic and causes avoidance of dental care at all costs, it becomes known as dental phobia (dental anxiety).

Dental phobia is usually provoked by past experiences, observing other people’s reactions to treatment and largely because of rumors. Patients with dental phobia may develop typical signs of other anxiety disorders such as panic attacks, generalized anxiety, agoraphobia or just specific phobias when going through dental treatment.

Dental phobia is not easily recognizable since most patients react differently to fear. Some go through vegetative reactions which include sweating, blood pressure changes and increased heart rate. Psychomotor reactions include stiff positions on the dental chair, nervous body movements and anxious facial expressions. Others have emotional reactions.

The problem concerns not only oral health, but also the general condition of the body: difficulty chewing and digesting food can cause serious digestive disorders, dental problems affect speech, bad breath and smile affect self-esteem when communicating with others.

Like all anxiety disorders, dentophobia requires special treatment that is offered through psychiatric services.

𝐂𝐎𝐍𝐂𝐋𝐔𝐒𝐈𝐎𝐍

Panic disorders warrant special attention during dental encounters. This is because of the extensive prevalence of antidepressant-induced dry mouth and periodontal disease. Some dental prescriptions may react badly with the psychiatric therapy the patient may be receiving. Always let your dentist know this regarding your general health condition so that they administer medications with caution.

DENTAL HEALTH AND SOCIAL-ECONOMIC STATUS

Dental health like every aspect of health is determined by several factors in a person’s life. These range from genetics and luck, lifestyle and environment, social and economic factors.

Dental treatment has made remarkable improvements in the quality of services that it provides. However, most of these treatments are quite expensive for the average Malawian.

It is for this reason that discrepancies exist between social classes when it comes to choosing dental treatment options. Those better off economically have an upper hand than their less affluent counterparts. Lack of knowledge on good oral hygiene, poor nutrition, lack of dental insurance also brings about differences in the quality of oral health.

The good news is: several efforts have been put in place to ensure equity in our health care system here in Malawi. Primary dental care is free in our health system. This means that everyone can access basic dental therapy for free.

Home oral care expenses are cheaper in most of our settings. Almost everyone can afford a toothbrush.

The addition of fluoride to drinking water has also improved oral health in those with a lower socioeconomic status.

Other interventions such as wearing helmets on bikes and mouth guards during sports to prevent facial injuries also improve oral health.

𝐂𝐨𝐧𝐜𝐥𝐮𝐬𝐢𝐨𝐧

In spite of one’s socioeconomic status, everyone can play a conscious role in as far as improving their oral health is concerned. We can all protect our teeth from physical injury, go for free dental checkups and practice regular oral hygiene.

DENTAL HEALTH IN THE ELDERLY

Most of us have an elderly person in our lives who is dear to us. As lifespan continues to increase, dental health is important in ensuring quality of life than quantity.

Dental conditions tend to worsen with increased time progression. In the elderly, this is commonly seen. Most of our elderly may have missing teeth, or many gum diseases.

Several factors play a role in the development of such. As discussed earlier, some chronic diseases such as diabetes, osteoporosis, and heart disease, which are very common in the elderly, worsen gum diseases. Immunity is also known to decrease as age increases, affecting healing in the gums.

Diet also plays an important role as most of the elderly prefer refined sugars in their diets. In some cases, memory loss may hinder routine care in as much as oral hygiene is concerned.

The best way to prevent dental disease is through proper oral care throughout one’s life. This however, may be difficult in the elderly experiencing problems with mobility, memory and material support. 

Caregivers ought to take into consideration these factors and plan how to adapt to individual disabilities while maintaining oral health.

In addition, early detection and treatment of systemic diseases is important.

Limiting the consumption of refined sugar, may be an effective way for the elderly to prevent the onset and progression of gum disease.

𝐂𝐨𝐧𝐜𝐥𝐮𝐬𝐢𝐨𝐧

Much as most dental conditions are treatable, preventing proves to be much better than cure for the elderly. This reduces the stress of going to the hospital and improves their quality of life by being disease free.

ARE YOU CHEWING ON YOUR OWN TEETH?

Bruxism a condition where a person grinds or clenches or gnaws their own teeth. This can happen during both day time and at night. Over time, this can wear down the enamel (hard part covering the tooth), making the teeth sensitive. It can also lead to jaw muscle pain and chipping of teeth.

You will usually know when you have bruxism if you produce a grinding sound at night time, which can sometimes be detected by a partner, headache upon waking up, pain or tightness with jaw muscles.

Bruxism is often caused by stress and anxiety, alcohol and caffeine consumption, smoking or as a side effect of some medications. Sometimes, bruxism is just present because of the person’s genes.

When you get a dental checkup, bruxism is diagnosed and different treatment options are provided depending on the cause. These include: stress management, mouth guards, improving sleep posture, and repair of the worn-out teeth with crowns and other procedures.

𝐂𝐨𝐧𝐜𝐥𝐮𝐬𝐢𝐨𝐧

While this condition might be common, those who have it may suffer social discrimination. It’s important to have this checked out for the benefit of your oral health as well as your mental health.

WHY YOU SHOULD GO TO THE HOSPITAL WHEN YOU HAVE A TOOTHACHE INSTEAD OF TAKING PAIN KILLERS

A lot of people have had a painful tooth before. Although it is advised to go to the hospital as soon as possible, some people take painkillers.

The truth of the matter is that the pain killers will only stop the pain but will not heal the tooth. This may lead to serious complications. 

There is a complication called Ludwig’s angina. Ludwig’s angina is a type of bacterial infection that occurs in the floor of the mouth, under the tongue. It often develops after an infection of the roots of the teeth (such as tooth abscess) or a mouth injury. This comes about when a decaying lower tooth has not been removed or treated. This is not always the case but it is a possibility in some individuals. It is recognized by a swelling that is painful and it crosses the neck. 

In extreme cases, it may lead to death due to airway obstruction (blocking of the path of breathing)

Whenever you have a toothache, it is necessary to visit a dental clinic and be treated accordingly. 

𝐃𝐑𝐘 𝐒𝐎𝐂𝐊𝐄𝐓

Dry socket is a painful condition that sometimes may happen after tooth removal. It happens when a blood clot at the site where the tooth was removed does not form, comes out or dissolves before the wound has healed. 

A blood clot forms at the site where the tooth has been removed. This protects the underlying bone and nerves. When it is removed before the wound heals, it causes severe pain which may start a few days after tooth removal. A bone may be visible in the socket and there is bad taste in your mouth. 

In most cases, people who present with dry socket are those who did not adhere to instructions after tooth removal. They start rinsing their mouth with warm salty water on the same day of extraction. This removes the blood clot. Rinsing with warm salty water should be done after 24 hours from the time of tooth removal.

𝐎𝐑𝐀𝐋 𝐓𝐇𝐑𝐔𝐒𝐇/𝐂𝐀𝐍𝐃𝐈𝐃𝐈𝐀𝐒𝐈𝐒

This is an infection in which a fungus called Candida albicans accumulates in the mouth. It is common in babies, people with poor body immunity and those who use steroid sprays for asthma. 

Other factors like, diabetes (shuga) dentures, poor nutrition and recent use of antibiotics may lead to the disease.

This disease can be recognized by white patches in the mouth that can be wiped off, leaving behind red areas that might bleed slightly. There is a loss of taste or unpleasant taste in the mouth. It may also create cracks at the corners of the mouth. 

This disease is not cancer and it is not a sexually transmitted infection (STI) but you should visit a dental professional whenever you suspect it. 

OPEN BITE

An open bite is a dental condition where the upper and lower front teeth don’t touch when the jaw is closed. This leaves a gap between them. 

In addition to genetic factors, environmental factors such as thumb sucking, pacifier overuse and tongue thrusting can cause an open bite.

If you leave your open bite untreated, it can lead to overall oral and health problems such as difficulty in chewing, speech impediments and breathing disorders.

When open bites happen in children who still have their baby teeth, it may get fixed on its own so long they stop the habits like thumb sucking.

Open bites make people uncomfortable and should be dealt with as early as possible.

DENTAL PLAQUE AND CALCULUS 

Plaque is a sticky, whitish film that forms naturally on teeth. You can remove and prevent plaque by practicing proper hygiene. Calculus is a hard, solidified plaque with a yellowish, darker appearance. The only proven way of removing calculus is through professional cleaning.

You’re more likely to develop plaque and calculus if you don’t brush or floss as often as you should (at a minimum of two times a day).

Generally, it takes about 24 to 72 hours for the plaque to start hardening to calculus.  The process can be accelerated by certain factors. Dry mouth and tobacco are some of the examples. 

The best way to avoid and prevent this whole process is to intercept it by applying proper tooth brushing methods.

ORAL/MOUTH CANCERS

Mouth cancer, also known as oral cancer or cancer of the oral cavity, is often used to describe a number of cancers that start in the region of the mouth. These most commonly occur on the lips, tongue and floor of the mouth but can also start in the cheeks, gums, roof of the mouth, tonsils and salivary glands.

You can suspect mouth cancer when you develop a lump in your neck, loose teeth, swelling or a sore on your lip that won’t heal, difficult or painful swallowing, bleeding or numbness in the mouth, white or red patches on the mouth, tongue or gums and unexplained weight loss.

There are so many causes of mouth cancer, infections, poor oral hygiene and gum disease, and exposure to the sun. The main risk factors for mouth cancers are tobacco and alcohol consumption. The risk is even higher in those whose close family member had a certain type of cancer before.

Cancer diagnosis can be made by your doctor or dentist during regular checkups. Treatment for mouth cancer depends on the type of cancer, where it is located and how far it has spread. Options available include surgery, chemotherapy and radiotherapy in some settings.

Conclusion

While mouth cancers can be treated once diagnosed, the best way to prevent them is to avoid smoking and alcohol consumption. Regular dental checkups and practicing proper oral hygiene go a long way in preventing these cancers.

CLEFT LIP AND PALATE

A cleft lip is an opening or split in the upper lip that occurs when developing facial structures in an unborn baby don’t close completely. A cleft lip may be on one side or both sides of the mouth. A baby with a cleft lip may also experience a cleft in the roof of the mouth (cleft palate). 

There are a lot of misconceptions about the cleft lip and palate. Some say it happens when the mother is a cheater or she provoked “Gule wamkulu” when she was pregnant. 

Deficiency of B vitamins and folic acid in maternal diet is the commonly associated cause of cleft lip and palate in the new born. Parents who are older than usual at the time of birth of their baby are at higher risk of having children with cleft lip and or palate.

Having a baby born with congenital anomalies like cleft lip or cleft palate is unpreventable. However, you can do things to reduce your risk, like avoiding using cigarettes, alcohol, and certain medications. Talk to your healthcare provider if you are concerned about cleft lip or cleft palate.

Many congratulations to Emmanuel for showing the initiative to participate in this competition. He is one of the pioneer group of BDS students who are poised to graduate in a few month’s time as Malawi’s first ever home-trained dentists. The knowledge demonstrated in Emmanuel’s writings above reflect the contribution that these young dentists will make to improving the oral health of the people of Malawi.