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Partners working very close together in this project:

AKA-Sweden – Association Kébémer Amitiés – a sister organisation of the French non-profit as­sociation AKA

Objective:  AKA is a humanitarian non-profit organisation working in the town of Kébémer in Sé­négal. It supports education and dental health according to the principle of aid to self-help and has a special focus on supporting strong women and girls.

Doctor Daouda Faye – dental surgeon, Assistant Head of the department of health service at the Odontological faculty of the University of Dakar and Head of the department of oral hy­giene in Sénégal at the Ministry of Health in Dakar

Doctor Mamadou Mbaye – dental surgeon at Centre de Santé de Kébémer and locally res­pon­sible for the fluoride rinsing project of AKA Sweden at École Mbaye Fatma Kébé

Fluoride rinse – why?

In the late 40ties it was noticed in Sweden that the frequency of caries in the population was very high and this observation was valid in the first place in areas, where the natural content of fluoride in drinking-water was very low. In Uppsala on the other hand situated North of Stockholm for example with a natural content of fluoride of 1 p.p.m. in the drinking-water the fre­quency of caries was very low. In 1958 a project was started in the nine-year compulsory school with weekly fluoride rinse of the teeth of all the pupils of the schools. Suddenly a totally new category of staff appeared in the schools – the fluoride lady – and the ex­pe­ri­ment continued until the beginning of the 80ties, when it gradually came to an end. The in­te­resting expe­rien­ce was that during the years of this experiment there was a dramatic re­duction of the frequency of caries among the children. The reason why it came to an end was that the use of fluoride tooth paste had become generally accepted and the authorities be­lie­ved that this fact would make fluoride rinse unnecessary. They just made one – but very se­rious - mistake. The child­ren who were part of the most important risk category for at­tacks of caries did not brush their teeth and they did definitely not use fluoride tooth paste. So when the time came back without any fluoride ladies the dental hygiene deteriorated again and because of that there has been a limited return to this extraordinarily successful experiment in Sweden.

The non-profit organisation AKA-Sweden consists of pedagogues and dental surgeons. We started our engagement in Kébémer in the elementary school of École Mbaye Fatma Kébé. We tried to help very poor children and especially girls to attend school. It became very natural for us to continue our commitment to dental hygiene. We could no­tice that the natural con­tent of fluoride in the drinking water was very low, that the diet of the children was very unbalanced and that the knowledge of teeth-brushing and dental hy­giene was extremely limi­ted. There was a very high frequency of caries in the molars. We could also understand that the situation is even worse in Dakar probably depending on a higher level of consumption of sweets. The density of dental surgeons in Sénégal is on average low and this situation is re­inforced in the countryside and in small villages and towns. We could also report that the only dental equipment in the local hospital of Kébémer was in extremely bad condition and that the supply of water in the schools was very insufficient. In the homes there was normally no water supply at all.

AKA-Sweden has supported Centre de Santé de Kébémer among other things with two com­plete sets of dental equipments for the local dental cabinet, which has to serve 120 000 people whose dental status is very low. We had very detailed discussions with the head­mist­ress of Éco­le Mbaye Fatma Kébé, the school that we supported during many years, and doctor Mamadou Mbaye, the dental surgeon of Centre de Santé de Kébémer, considering how we could contribute  to an improved situation. We told them very much about the Swedish expe­rience of fluoride rinse that was such a tremendous success. A very strong argument for an experiment of that kind is no doubt that it is extremely cheap and it works without having to try to change the diet amongst the children as that is a very long and expensive process. Un­fortunately the children in the developing countries copy the bad habits of the so called de­veloped countries with a very high consumption of sweet and unwholesome products that are indeed ca­tastrophic for the dental health. During our discussions the following wishes were ex­pressed by our partners in Kébémer.

a)     running water to the school

b)     toilets

c)     information and instruction about tooth-brushing

d)     fluoride rinse during a trial period in École Mbaye Fatma Kébé

e)     spreading this project over the years to more schools in Kébémer, to the department of Kébémer, to the region and hopefully finally to the whole of Sénégal

We started our work for an improved oral hygiene by bringing tooth brushes and fluoride tooth paste from Sweden and by introducing tooth-brushing on the schedule of the school eve­­ry morning. Four years ago we then started the project with fluoride rinse of all child­­ren of École Mbaye Fatma Kébé every week. Just to guarantee that this would work we had to equip the school with a so called ‘bloc sanitaire’ – toilets and running water. An enormously im­portant effect of this installation is the fact that girls no longer leave school when they en­ter the age of puberty as they did before, because they were embarrassed at the lack of separate toilets for girls.

We started the fluoride rinse project when the three dental surgeons of AKA-Sweden came to Kébémer and registered caries of all the pupils of the school. From then on fluoride ladies have organised the fluoride rinse of the children every week. This fluoride rinse even oc­cur­red during the summer vacation for those pupils that were at home, thanks to teachers who were zealous supporters of the project. Doctor Mamadou Mbaye has then accomplished re­gu­lar controls of the children. The Swedish dental surgeons have made regular annual visits to Ké­bé­mer and they have had very detailed discussions with doctor Mbaye about the deve­lopment of the project.

Doctor Mbaye and AKA-Sweden has for some time been discussing very thoroughly the possi­bi­lity of an expansion of the project. Our vision has been to spread it to more schools in the town and department of Kébémer, to the region of Louga and hopefully to the whole country of Sénégal. Our argument for this has always been the fact that the project of fluoride rinse cheap, effective and works without a need to make so radical and very long processes as changing the diet habits. It would of course be very fortunate and successful to achieve these effects in a country with limited resources and with a very low density of dental sur­geons compared to the situation in Europe.

In order to discuss these very important matters doctor Mbaye introduced us to doctor Daou­da Faye, who is dental surgeon, Assistant Head of the department of health service at the Odon­to­lo­gical faculty of the University of Dakar and Head of the department of oral hy­giene in Sé­né­gal at the Ministry of Health in Dakar. After some very stimulating, construc­ti­ve and fruitful discussions in Doctor Faye’s office in the Ministry of Health in Dakar and a few days later a meeting with the dental surgeons of the region of Louga our common ambi­tion is to widen the project according to our earlier plans in close cooperation with doctor Faye and the Ministry of Health in Dakar. An extremely important consequence of the ful­filment of a successful fluoride rinse project is that it can lead to a very changed situa­tion for women and girls in Sénégal. We had in Sweden studied some international reports from which we had understood that women/girls with very bad status of teeth or even with­out teeth can be subjected to a much worse social situation compared to men/boys, such as divorce. Doctor Faye very clearly confirmed this. Thus a successful fluoride rinse project could have a decisive importance for an increased equality between women and men and for the develop­ment of the country.

All partners who are involved in the fluoride rinse project in Kébémer are of the very firm opi­nion that the principle behind it is aid to self-help. We have all a very important, fas­ci­nating and reciprocal responsibility for the success of the project. In the short run it could – and should – mean an improved oral health in Sénégal but in the long run it might even gene­rate a development for the country since more girls will continue their studies and thus support the equality between girls and boys.