Smoking is a significant risk factor for both oral and general health, Dean of the Faculty of Dental Surgery at the University of Malta, Professor Nikolai Attard, told The Malta Independent while discussing the work carried out by the University's Mobile Dental Unit (MDU).

Smoking cessation is one of the services provided by the MDU, along with its free dental check-ups and advice. The MDU is celebrating its 10th year of existence, during which it has visited communities and schools promoting health hygiene.

Attard said that one of the staff members who works in the mobile clinic is Anne Buttigieg, who Attard said is a smoking cessation practitioner with extensive years of experience in the field. "Having someone who is a professional at smoking cessation on the team means she is able to offer free advice, therapy, and prescriptions for nicotine replacement therapies."

"The mouth is not separate from the body," Attard remarked, as he spoke of how the MDU actively tries to emphasise that oral health forms a part of one's general health. He continued that smoking especially is one of the biggest risk factors for lung and oral cancer, as well as periodontal disease and research is linking it to a number of ailments and diseases.

He also spoke of how having smoking cessation as part of the MDU's duties means that the students who work in the mobile clinic receive training and experience in that regard as well. He added that the dental faculty is also expanding the existing study units to not only deal with smoking only, but also other types of addictions beyond substance abuse, such as gambling. "These addictions all impact the decisions we take, vis-a-vis how we plan our budgets, how we are going to take care of our health and such things." He remarked that these changes in the courses offered by the Faculty enrich the students' experiences and better prepare them for the future whilst remaining up to date with people's needs. It helps prevent the course from becoming static and ineffective.

Speaking further on the topic of smoking, Attard mentioned how the growing trend of vaping, especially among younger adults, also presents its own challenges when it comes to oral health.

Anne-Marie Agius, also a lecturer at the Faculty of Dental Surgery who works in the MDU, commented that the notion that vaping is less detrimental than smoking should be challenged, reflecting that further research is still being conducted to determine the real risk factors.

On the topic of tobacco pouches, which are also potential alternatives to smoking, Agius said that one can see that the area of the mouth where such pouches are placed tend to become eroded or ulcerated with frequent use. "In the long-term, the ongoing insult to the mouth's lining can result into oral cancer," she said.

Shining a light on oral health

Attard said that a prominent aspect of the MDU is that it is shining a light on the nation's oral health. He spoke of how it has contributed to other projects, including how some years ago the mobile unit had gone to Gozo for what was meant to be a few sessions, but was ultimately expanded into a whole summer period. He said that while that period in Gozo was taking place, the MDU was taking a sample of the state of oral health in Gozo. He remarked that, at the time, the situation in Gozo was "one that deserved attention to realign it again to what Gozo stood for - a beacon of good oral health". He said that the MDU communicated with the authorities, such as the Gozo Ministry, and also received communication from the Curia.

Attard said that eventually the Gozo teaching clinic was then established in Ghajnsielem, and has been operational for two years in part with the intention of helping improve Gozo's overall oral health situation. He also added that the MDU is truly a perfect example how the University of Malta is a direct contributor and pillar of the Maltese community, through this and other projects. He mentioned this within context of some negative feedback that is directed to the University when mishaps happen.

Agius said that she believes the most significant ongoing research that the MDU has been doing is with regard to the National Oral Health Survey, which is described by the University of Malta as data which is being compiled in order to tap into the oral health status and the needs of the Maltese population.

Agius said that students have been helping with this research as well, adding that it will ultimately also be part of their own studies and dissertations. She said that the main aim of such research is that while the MDU provides a service to the community, such as by providing check-ups, giving advice, and also referring people for treatment, it is also gathering data to identify and support the needs of the population.

She described such research as a "big undertaking" and continued that it is something which will help dictate policy in the future, both for national health services in order to determine where efforts should be focused, and also with regard to the dental faculty and what needs to be taught and given more emphasis.

Once this particular survey is concluded, Agius said that the plan, once the go-ahead from the necessary entities, such as the University's ethics committee, is provided, is to begin the child survey and to compare the findings of the original research with the child survey.

Asked if there have been any noticeable trends throughout the research and data compiled so far, Agius said that trends are currently being studied and that actual trends based on real data can be determined in around a couple of years.

Attard expressed hope that the interventions now taking place within the Gozitan community will help shift the trends previously observed in Gozo, but he remarked that health-related changes at a community level take time. "It's going to be very interesting to see. Hopefully, we'll see an improved epidemiological picture, with more retention of teeth, because tooth loss also affects the quality of life, and there is plenty of research showing that."

Lack of awareness

On the notion of lack of oral health issues being a result of lack of awareness, Attard said that he hopes that the MDU can play a role in changing such trends. He pointed out a particularly positive development: while the MDU previously had to reach out to schools, it is now the schools that take the initiative to contact the MDU. "They call us on an annual basis... technically speaking, the mobile unit is part of their curriculum, so that's a shift in mentality, and we get way more requests now."

He remarked that when school administrators make such decisions, it reflects a positive shift, as it helps raise children's awareness of the importance of oral health.

Agius said that awareness is very important, but particularly "awareness at all levels of society". She continued that what will really change the dynamic is the awareness of politicians and policymakers in every strata of society, such as a change in the mentality of school headmasters and teachers, which would ultimately impact schoolchildren.

She said that what needs to change is that there should be a move from curative and treatment-based thinking to a more preventive ideology. "What's important are meaningful policies that are enacted and implemented. They change the fabric of society, and they change and improve over time."

Agius stated that in commemoration of the MDU's 10th anniversary, there will be an event on the morning of 22 September in front of Parliament in Valletta. She explained that staff and students from the Faculty of Dental Surgery will be providing free dental check-ups and advice to all attendees, while also offering smoking cessation services.