Every day for weeks on end, 6-year-old Srey Nuch was tormented by severe pain caused by several of her teeth rotting away.
Her mother, Lay Vicheka, despaired when she heard her daughter’s cries, knowing the family was far too poor to pay a dentist to fix the problem.
“She couldn’t eat rice or other things since her teeth couldn’t bite them,” said Ms. Vicheka, a 31-year-old resident of Phnom Penh’s Meanchey district. “When she got a toothache, we gave her Paracetamol. After a short time, she started crying again.”
Srey Nuch’s story is not uncommon in Cambodia, where the average six-year-old has nine decaying teeth, according to Dr. Callum Durward, head of the Department of Dentistry at Puthisastra University.
“It’s one of the highest rates in the world—certainly the highest in Southeast Asia,” said Dr. Durward, who also advises the Ministry of Health.
“In Australia and New Zealand, the U.S., the U.K., the rate is about one or two decaying teeth at age six,” he said.
Faced with an unfeasible bill of $40 at a rudimentary clinic staffed by unqualified technicians, Ms. Vicheka was relieved when she heard about a dental service where her daughter could receive treatment for free.
CHOICE Cambodia, a charity run largely by Phnom Penh-based expats, set up a dental clinic about a year ago at their rural base in Kandal province’s Kompong Svay commune.
It’s one of the few places in the country where people can receive free dental care, and a small queue of villagers forms outside when the clinic opens its doors every second Saturday.
“We don’t have a public dental clinic in the district. Some districts, if they have the resources, they might have a clinic but poor districts do not,” said Tiang Se, director of the district health center in Tahkmao City.
“I would like the district to have a public clinic. If we had a clinic it would cut poverty because people would not have to spend their money,” he said.
In addition to dental services, CHOICE provides schooling, vocational training, water supplies and basic medical care to hundreds of impoverished families living in small shacks perched next to the roadside, on government-owned land.
“Everybody’s idea of poverty is different, but our classification of poverty is you must have absolutely no land—if your house is on dirt and the stumps are sitting on dirt you don’t own,” said CHOICE trustee Ross Wright. “They are squatters.”
Although the charity exists primarily to help the Kompong Svay villagers, they do not turn away those from other areas, including Ms. Vicheka and her daughter, who made the trip when the clinic opened on a Saturday earlier this month.
Dutch dentist Evelien Hoedemaker, who works for private practice Malis Dental Clinic in Phnom Penh and volunteers for CHOICE, was on hand to provide dental care for 10 patients including Lay Khorn, 54, who was making his first ever visit to a dentist.
Mr. Khorn had one tooth, which had been causing him agonizing pain, pulled out.
“This center will be a huge help for the people in the community since they do not have to spend their money and the doctor is experienced with teeth,” he said. “We want the government to create public dental [services] since we do not have many in poor communities.”
“It is very easy for the rich people since they have money, therefore they can access any private clinic they want to while we are poor—we only buy painkillers to get rid of the suffering,” Mr. Khorn said.
According to Dr. Durward, who has worked in Cambodia for many years and is also the dental director the One2One Charitable Trust, a New Zealand-based organization running several dental projects in Cambodia, there is actually no shortage of dentists in the country.
In fact, with five dental schools now churning out hundreds of graduates a year and thousands of “traditional” dentists operating without a license, Dr. Durward said many qualified young dentists—unwilling to leave Phnom Penh or offer cheaper rates following seven years of study—are facing unemployment.
Still, he added, “There’s very little treatment available [for poorer people]. I mean, there’s no school dental service, dental is mostly private and even if you go to the hospital you’ve got to pay something to get your teeth pulled.”
If left untreated, dental issues can lead to severe health complications, including infection, abscesses, and cancer, that require hospitalization and put patients at risk of serious illness—and even death.
“Adults generally have a lot of dental problems, not only tooth decay but also gum disease, and the third issue we see is oral cancer, which is one of the top five cancers in Cambodia,” Dr. Durward said.
“A lot of those patients [with oral cancer] here probably go to the hospital. Unfortunately, they tend to present late so often it’s quite advanced so often the prognosis is not good.”
The use of tobacco and betel leaf are the greatest risk factors for oral cancer among adults, while tooth decay in children is caused largely by poor diets laden with cheap sweets and the traditional practice of women breastfeeding toddlers late at night.
A group of volunteer U.K. dentists and dental nurses who traveled to Cambodia in February with the charity Dentaid—offering free treatment to impoverished families—were taken aback by the condition of people’s teeth.
“I was shocked at the amount and extent of decay present in our patient’s mouths and we did the best we could to restore and extract any teeth causing pain,” dental nurse Stacey Montgomery wrote in a report.
“Many patients were unwilling to consent to extractions to unrestorable teeth and belief in ‘tooth worms’ as the cause of tooth ache was common.”
Dentist Mukund Patel added that many people’s teeth were beyond repair. “Most of them wanted their teeth restored, and not extracted. It was impossible in most of the cases to restore them.”
However, some small steps are now being taken to implement preventative oral health measures among children.
The SEAL Cambodia project, an initiative involving One2One and several other organizations, including CamKids, has so far treated 25,000 children to prevent their teeth from further decay.
Fit for School, a daily teeth-brushing and hand-washing program which has had huge success in the Philippines, is into its final stretch of a three-year pilot project supported by the Cambodian and German governments.
And back at the CHOICE center, a similar idea has taken hold to promote oral hygiene among the children. Every student who attends the free school is supervised while brushing their teeth after lunch.
“We tried it the other way, sending them home with a toothbrush and toothpaste, but it was too hard,” said Ross Wright, the CHOICE trustee.
“Out in the village there is no running water—they use handpumps—and the parents don’t brush their own teeth so the children don’t either.”
Dr. Durward said more work needs to be done to educate youngsters about the importance of healthy teeth.
“There’s just a huge amount of decay out there, especially among children, and there’s no way that, even with all the dentists here, if everyone came for treatment there would be enough to treat them,” he said.
“I don’t think that treatment is really the answer—prevention is the answer.”