Mr Chairman, Dr Samba, Ministers of Health, Honored guests, colleagues ladies and gentlemen

Thank you for asking the World Medical Association to join this important conference.
Oral health is an inherent part of the general health of each one of us. The open mouth is a window into a myriad of diseases and disorders that afflict us - from anemia, malnutrition, vitamin deficiencies to allergies, aids and Behcets disease.

We have a shared mission to improve the health of each patient who comes to see us and as health professionals to serve all humanity. The WMA embraces some 80 national medical associations. We agree and set international standards in medical practice Each member association is an advocate for improving the health of their own nation and with us making a difference internationally. For instance, the ethical standards in the WMA's Declaration of Helsinki underpin research on patients equally worldwide and are a great protection for 'subjects' consenting to participate in clinical trials - trials that are so essential for the advancement of medical science to the benefit of all humanity. We have recently developed standards for a Child's Right to Healthcare.

It has long been recognized that poor oral health can have a profound effect on general health and the quality of life. Throughout the world most children show signs of gingivitis (bleeding gums). Severe periodontal disease, which may result in tooth loss, is found in a significant proportion of people in industrialized countries. Dental caries affects 60-90% of children and the vast majority of adults in 'developed' countries. In the UK, dental caries, which had been reduced to a much lower level in children is now deteriorating as the government dental services disintegrate. A lesson for all countries!

Caries has a relatively low incidence in Africa. With the changing lifestyle involving a growing consumption of sugars and an inadequate exposure to fluorides, the incidence of caries is expected to increase. The danger is real .For every $1 spent by WHO to improve nutrition worldwide, $500 are spent by the food industry to promote processed foods.

Untreated dental problems are the third most common reason for attending outpatients at a Regional Hospital in Kabale Uganda. Untreated dental infections can result in loss of life. Some dental pain is amongst the most severe and intolerable pain suffered by the human race. Dental pain can last for years interfering with eating, sleeping. and family life.

Dental plaque and the associated periodontal disease, as your President has reminded us can serve as a reservoir of infection contributing to respiratory tract infections and carry an increased risk of cardiovascular disease. Studies in the USA also point to a possible association between these infections and an increased risk of pre-term birth.

Studies show that smoking contributes to more than half of adult periodontal disease. It's prevalence has decreased in countries where tobacco use has been reduced.

Oral cancer is the eighth most common cancer worldwide. It is largely preventable. It is directly related to smoking, chewing tobacco and betel nuts and alcohol. The incidence of oral cancer has increased in Denmark and Central and Eastern Europe where cigarette smoking is more common.

One of the most serious of oral diseases for young children in Africa as well as Latin America and Asia is cancrum oris or 'noma'. as Dr Piccard illustrated so dramatically to us yesterday This flesh eating infection particularly occurs in malnourished children under 6 years of age. It has been estimated that around 100,000 children are affected each year. Untreated between 70 and 90% will die. The others will be permanently disfigured. With early recognition and appropriate treatment each of these children would survive.

One of the most appalling customs, referred to as infant oral mutilation, is practiced in Uganda, Sudan Tanzania and Kenya. The infants baby teeth are removed from under their gums by unclean tools causing pain, suffering and disfigurement with damage to the permanent teeth. Some infants die of septicemia. Others die of tetanus.

Access to dental care is very limited in many parts of the world particularly where the need is greatest in those countries who have been riven by internal strife and armed conflict and driven into poverty. In some countries the number of dental surgeons has fallen to less that one in a million!
Few dentists serve in poor rural areas and, when they do,are poorly equipped. Without dental services high risk 'street dentistry' is practiced in developing countries using pliers for the 'knocking out of teeth'.

How do we improve this 'Cinderella' of the health services? We should create change through giving priority to the care of our children. The WMA policy on children is clear in our Declaration on the Right of a childs to health care. The emphasis is on primary care, prevention and the eradication of traditional practices prejudicial to the health of the child. Care for children needs to begin during pregnancy; it involves the parents; linking with families and spreading out through the local community. We should act locally to solve our global problem.

It means ensuring oral health is an integral part of the positive health, social and education programme starting in the early years in village and urban communities and continuing through school. A 'close to client' system. Healthy children learn better, become healthy productive adults and make better economic progress for their country. It is a win, win-win situation. It means increasing dental awareness. It means placing a high value on teeth and the African pride in the African smile as we heard from the children yesterday. It means reinforcing individually and in groups, good oral hygiene with dietary advice and fluoridation where possible through a dental team of auxiliaries, dental health educators, therapists, hygienists and dental surgeons. It means doing the do-able with basic technology with projects such as the six year molar 'focus' by Toothsavers in nine countries. It means stopping the promotion of tobacco products to vulnerable communities. It means banning smoking in public places in accordance with Article 8 of the WHO's Framework Convention on Tobacco control. It means stopping the distortion of healthy diets by reducing the sugar and acid content of popular carbonated drinks and It means keeping the consumption of confectionery low through a policy of education, responsible marketing and perhaps selective taxation. We must create a culture in which the practice of oral mutilation would be stopped forthwith.

Most dental disease is preventable. We have the will, we must find the wind to help us on our way I will take back the results of your deliberations here to our Council next month. We will continue to work with the FDI at national and international level as partners in this important mission.

Ashanti sana

James Appleyard MA (Oxon), MD (Kent), FRCP (Lon), MRCS (Eng), FRCPCH.(UK)
President World Medical Association

SPEECH on 15th April 2004 @ 10.30 am Nairobi, Kenya

(With a lot of help and advice from my wife Mrs E. A. Appleyard BDS LDS,RCS )