The Seychelles Dental Service.

The Seychelles Dental Service dates back to the 1920s, growing from rudimentary dentistry to the evidence-based dentistry of today. Until the 1970s, dental care was provided by a small number of dentists. However, since the establishment of the School Dental Service (SDS) in the 1980s, child oral health has been the responsibility of Dental Therapists (DTs). Today Seychelles has a well organised oral health care system in place with modern infrastructure and equipment and trained personnel. Locally trained DTs constitute 85% of the SDS workforce. A national oral health plan serves as a guide to ensure that programmes are developed in accordance with WHO global oral health goals, guided by periodic reviews. We present a resume of the major strengths and challenges of the Seychelles Dental Service, concluding with recommendations for staff development. Findings and recommendations of reviews and assessments of various dental health issues conducted in the country between 1977 and 1999 are summarised in the appendix.

The oral health status of children aged 12 years in Seychelles in the years 1994 and 2000.

The results of two national oral health surveys in 1993/4 led the Seychelles School Dental Service (SDS) to implement an oral health improvement strategy through the adoption of a targeted population approach. The aim was to attain the World Health Organization's (WHO) goal for 12-year-olds, of a DMFT (decayed, missing, filled permanent teeth) of less than 3.0, by the year 2000. Primary 5 (P5) children from all state schools were selected as the target population. Although all the children (1538) were exposed to the targeted service interventions, 500 were sampled out for study, through random sampling of school class lists. Data was collected at the beginning of 1998 and end of 2000, through clinical examination and self-administered questionnaires. All examinations and interventions were carried out by dental therapists (DTs), in their respective clinics. For the purpose of this paper comparisons made between 12-year-olds of 1994 and those of 2000 are based only on the dental examination data. Interventions were spread over three years from 1998 to 2000. These included an initial dental examination followed by any dental treatment required, an annual recall visit, dental health education at class and individual level, and weekly school-based fluoride mouth rinses. Parameters investigated were 1) community periodontal index of treatment needs (CPITN), 2) dental health status (DMFT), 3) enamel defect, and 4) clinic attendance. All parameters improved significantly between the cohort of 1994 and that of 2000. The proportion of children and of sextants with healthy gingivae increased from 3.4% to 51.8% and from 25.9% to 70.9% respectively. Children with no enamel defects increased from 51.1% to. 92.6%, while children with newly decayed teeth decreased from 61% to 33%. The mean number of newly decayed teeth fell from 2.0 to 0.8. The proportion of children attending their clinic at least once a year for check up increased from 51% in 1994 through 73% in 1998 to almost 100% in 2000. The WHO goal for children aged 12 years to have a DMFT of less than 3 was met, with a change from 3.2 in 1994 to 1.9 in 2000.