18-19th Dec, 2012 Acknowledgement The East Africa Dental Project



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Opening session


Opened at 9.07 a.m with a word of prayer

Welcome remarks was given by Francis Kihumba of the Ministry of Environment. He said that the meeting linked the Ministry of Environment and Ministry of Health, World Health Organization and United Nations Environmental Program. Mr. Kihumba reported that the international community was at the time discussing on a legal document on mercury release into environment therefore the meeting was timely to get input from oral health personnel.

Introduction of all delegates was done.

a) Opening remarks by Dr. Desiree Narvaez, UNEP Chemicals, Geneva

,She welcomed all delegates and wished everyone success in the workshop. Since the UNEP regional office for Africa (ROA) is located in Kenya, she requested UNEP ROA to say a few words.

b) Opening remarks by Prof. Bary, UNEP

Prof. Bary expressed his appreciation to the Government of Kenya through the Ministry of Environment and the organizers of the meeting. He thanked the coordinators from Uganda and Tanzania, project partners from WHO, FDI, ILiMA and theIDM. He expected the workshop to be successful

c) Opening remarks by Dr Poul Erik Petersen, WHO Oral Health Programme.

He introduced himself and gave his career background. He has worked for WHO for 22yrs for health systems and quality of care (12), oral health department in NCD department for last 10yrs.Work has previously been done with several partners e.g. IADR, UNEP, FDI, and Dental Manufacturers to know the different aspects of amalgam. He expected the meeting to address local experience and alternatives to amalgam and it would be a feedback mechanism to WHO.

d) Opening remarks by Dr. Lucina, Ministry of Public Health.

She welcomed the workshop delegates on behalf of the team that was working on the project with culmination of today’s workshop. She noted that this was a timely project

e) Opening remarks by Dr. Jane Wamai, Chairperson, Kenya Dental Association.

She noted the following;


  • Kenya Dental Association is an association that represents voice of dentists in the country.

  • She stressed that KDA would like to maintain the use of amalgam as a restorative material.

  • Dental amalgam is amalgamated mercury not mercury free.

  • Dental amalgam is a material that has and is being used for training dentists at the two dental schools. The study here shows that it is most dentists’ first choice for tooth restoration. Amalgam fillings have been extensively used to save teeth.

  • The only materials comparable to dental amalgam are cast gold and ceramics and use of these would be a challenge in our emerging economy.

  • Alternative materials are associated with higher treatment failures and this is highest felt in poor resource areas.

  • Oral health awareness and care is very low in developing countries therefore strengthening of prevention is crucial. A preventive message should be sent out to reduce incidence of dental disease.

  • Delegates were urged to enable dentists to use their materials of choice at the same time caring for the environment. This is possible through promotion and adoption of a proper policy for the environmentally sound life cycle management of amalgam.

  • KDA can create forums where implementation of full lifecycle management of amalgam is implemented.

  • She then welcomed all delegates to workshop.

f) Opening remarks by Dr Stephen Irungu, Chief Dentist, MOMs.

Dr Irungu conveyed greetings to the delegates from the Director of Medical Services and gave his speech on his behalf.

Highlights of the speech were:-


  • Dental amalgam is a filling that has been widely used in management of dental caries for the last 150 years. Dental caries is a major public health problem globally despite much effort in health promotion and disease prevention.

  • Mercury in amalgam is recognized as a chemical of global concern due to its long range transport in the atmosphere, its persistence in the environment, its ability to bioaccumulate in ecosystems and its significant negative effect on human health and the environment.

  • Dental amalgam use represents 10% of total global mercury consumption. It therefore plays a significant role in total mercury contamination of the environment and thus it is important that efforts must be made on how to reduce this effect in the environment.

  • Phasing down amalgam use in management of dental caries has been proposed. Strengthening of disease prevention and health promotion, development and use of alternative materials for dental restorations are two approaches that promote best professional practice.

  • The MOMs is committed to this process and promised to give the division of oral health all the necessary support to ensure success in implementation of the proposed phase down project.

  • He recognized UNEP, WHO, and other partners for their participation and sponsorship of the East African dental amalgam phase down project.

  • He gave a warm welcome to all international delegates.

  • He hoped that this workshop will come up with a way forward on dental amalgam use in this region.

  • He declared this workshop officially open.

2. Situational analysis:

2.1 KENYA


A presentation was made on Dental Amalgam Issue in Kenya, Dr Linus Ndegwa, KDA;

“Dental amalgam issue in Kenya and networking among dentists in Kenya”



  • Dr Ndegwa gave a brief explanation on dental caries and fillings. He highlighted that as the issue of dental amalgam is discussed, it should be noted that this dental amalgam is used to save teeth in our society including those of the poor.

  • Registered dentists In Kenya are 963(70%) for 42million therefore we have a dentist to patient ratio of 1: 41973

He showed the distribution of medical and dental professions per province. Most dentists are located in the city of Nairobi. As at 2011 only 413 dentists were actively registered with Medical Practitioners and Dentists Board(MPDB).

  • Most dentists’ specializations are in Oral and Maxillofacial Surgery with only one specialist in the field of Dental Materials.

  • In Private clinics 50% use dental amalgams.76% of dentists regard amalgam as material of choice

  • Most of the fillings done over the last 4 years are amalgams.

  • Best management practices on amalgam are currently taught at Kenyan dental schools.

  • Majority of cavities are large and large amalgam capsules are used to restore the teeth. The fillings to extractions ratio is 1:30

  • Kenyan institutions support phase down approach. The global shift towards prevention would improve oral health. The cost of dental treatment is high and phase out of amalgam would lead to more extractions as many may not afford alternative materials.

He pointed out that networking between Dentists and KDA was done by via monthly Continuous Professional Development Sessions(CPDS), website, journal, bulk sms and bulk emails.

2.2 UGANDA


Dr. Wandera presented the Amalgam issues in Uganda;

  • Uganda is located to the west of Kenya.

  • It is a landlocked country.

  • Dentistry would be considered a young profession in Uganda.

  • The setup of the Ugandan health system was based on Europe’s health priorities, with the opinion being that there were few dental cases.

  • They initially had a 3 year training course for public health dental assistants on community health and basic dental procedures (extractions and silver fillings).The 4 year Bachelor of Dental Technology started in 2010.

  • Bachelor of Dental Surgery is a 5 years degree course, with 11-15 graduates annually.

  • Most dentists are employed in-Government and faith based clinics

  • There are 300 Bachelor of Dental Surgery degree holders with 80% working in urban areas.

  • There are 800 Public Heath Dental Officers (PHDO) with 50% in urban areas.

  • Upward trend in dental caries prevalence. decayed, missing,filled teeth( DMFT) most due to decay in Uganda.

  • A study done in 1987 shows PDHO, who are supposed to be preventive, are actually more engaged in clinical practice than preventive management?

  • There is a requirement for a full medical and dental checkup before returning to school which has had a positive impact as early caries are detected.

  • Summary of the respondents to the amalgam study comments: amalgam is the least expensive; no local manufacturer of dental materials: amalgam remains strongest restorative material; there is higher secondary decay for alternative materials; consider conservative use of amalgam, maximum number of teeth per mouth that can be restored with amalgam,; amalgam is easy to manipulate; no interference by saliva in amalgam use, easy storage for amalgam.

  • Summary of comments by traders in dental amalgam: import dictated by demand from dentists and patients

  • Amalgam still widely used by dental personnel in Uganda.

  • There is interest by Uganda Dental Association to know the future of amalgam and what new materials are available and comparable.

  • Uganda Dental Association will hold a CPD in March 2013 on amalgam phase down


2.3 TANZANIA:


The Dental amalgam issue in Tanzania was presented by Dr Febby Kahabuka;

  • The different cadres of dental professionals are Dental Therapists, Assistant Dental Officers and Dentists.

  • Dental therapists undergo 3 year training in two schools in Tanzania. There are 190 dental therapists. They are trained to do simple class I fillings using amalgam and glass ionomer cement( GIC).

  • Assistant dental officers in addition will do simple Class II fillings.

  • Dental surgeons are trained at one dental school at Muhimbili University. There are 104 registered dentists.

  • Dental services are offered at 136 hospitals, 63 health centers and 3 dispensaries run by religious based organizations.

  • Dental amalgam is the most commonly used material. Most clinics use amalgam capsules.

  • Disposal of left over amalgam is mainly with other general waste or when patients spit and it is flushed through the suction.

  • Preference of material of choice is not documented. Awareness is also not documented.

  • Dentists preference depends on availability of materials, whether they are practicing in a public or private facility, affordability, accessibility and the level of education and exposure.

  • In 2011, 28,910 restorations were done versus 303,000 extractions.

  • She concluded that there is a need to raise awareness on hazards related to mercury waste and best waste management practices.

  • Need to put in place mechanisms for waste management.
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