Last August, a group from the British Tamil Dental Association travelled to Jaffna, in northern Sri Lanka. The aim of our trip was to help deliver dental aid, resources and oral hygiene education to those with limited access to healthcare. Our organisation, the British Tamil Dental Association (BTDA) represents and brings together Tamil dental professionals in the United Kingdom and beyond.

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Our trip mainly centred on the towns of Jaffna and Kilinochchi, regions that hold particular significance to us and which were heavily affected by the civil war that ended in 2009. Although much time has passed since, many still have limited access to basic healthcare services and this access is further limited by the current economic crisis they are facing. It was apparent that dental services have extreme shortages of equipment and materials.

The first phase of our trip in Jaffna involved enhancing the links created with local healthcare staff at Jaffna Teaching Hospital, as well as delivering oral health (OH) prevention. We delivered our OH preventative talks to local children's homes, orphanages, retirement homes, and schools. The residents were engaged and wanted to know more, which we found extremely rewarding. Through fundraising and kind sponsorship from Colgate, Haleon, VOCO and Curaprox we were able to provide fluoride toothpaste and toothbrushes to over 400 children and adults. We were also able to design, produce and distribute oral health educational material in the local language, which the locals found extremely helpful.

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During the trip, we were able to participate in service learning, by shadowing the local Oral Maxillofacial and Cancer unit at Jaffna Teaching Hospital led by the talented Dr Sarath. In the short time we spent in the unit we were able to examine patients who presented with a range of conditions that we aren't routinely exposed to in our undergraduate studies and gain a deeper understanding of the head and neck pathologies that are prevalent in this community. We spoke to one patient, who presented with a fungating tumour, caused by oral squamous cell carcinoma. After taking a history, the patient expressed his struggle with alcohol for years and explained that he'd never been made aware of the increased risk of malignancy with drinking alcohol.

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We also got the opportunity to perform check-ups and fluoride varnish application for children from the local orphanages, many of whom had never seen a dentist. Very few of the children presented with pain, but decay was evident in many of their dentitions. After making arrangements with orphanage staff we were able to signpost individuals to a clinic where they could receive further treatment and a more thorough examination carried out by us.

Chewing tobacco or ‘paan' plays a large cultural role within the local community, which can predispose to oral submucous fibrosis and cancers, and this habit tends to be more prevalent within the ageing population. We were able to carry out a basic oral cancer screening for those in a retirement home and advice on diet, denture care and toothbrushing.

Our team also ran a small study in the form of questionnaires given to locals on their own perceptions of their oral health and habits. There are currently limited data on the oral health of communities in Jaffna and we wanted to make a small start in identifying areas of need within the population. We found in general, communities were resistant to filling in the questionnaire and speaking with local dentists, they advised us of certain cultural attitudes that may make data collection in the form of questionnaires challenging. This was definitely a point of reflection for us and is something we will consider as we prepare for our next visit to Jaffna.

We were able to signpost individuals to a clinic where they could receive further treatment and a more thorough examination

Of a total of 11 responses with participants ranging from age 63-75, 91% participants fell under the category of a non-regular attender at the dentist. This may be for a variety of reasons, access and availability of dentists being the primary one, but requires further exploration. Forty-five percent of participants reported using a herbal fluoride-free toothpowder to brush their teeth and 36% reported pain from their gums. Of this small cohort, no-one reported to be using paan (chewing tobacco), which we found notable as this practice is extremely prevalent in South Asian countries.

The trip allowed us to form long-lasting links with the local healthcare staff and we hope to visit again in a few years with a larger team and more resources to help play a small part in uplifting the oral and systemic health in the region. We are very grateful for the opportunity and to Dr Kumaralogini Ganeshan and her team for the work they do in this area of high dental need.