In the mouth of babes

The term was originally “from the mouth of babes” used in reference to the truth. But for today, I changed “from” and used “in” as a literal point regarding the answers to malnutrition in the Philippines where tooth decay, oral bacteria, etc. are now among the prime suspects!

It is not a sexy subject nor is it so controversial that it gets your immediate attention, but when experts from the different fields of agriculture, dental health, economics and academe all start chanting the same message, it is about time we all paid closer attention to the future of the Philippines and all Filipinos.

Call it coincidence but for two weeks running, several guests on the show “AGENDA” on CIGNAL TV and Facebook have raised concerns about growing malnutrition in the country, how malnutrition affects the physical growth of Filipinos leading to stunting and how malnutrition stunts the brain and mental capacity of Filipinos. In Tagalog, “na bo-bobo.” That in turn limits their abilities and job opportunities which in turn affects national productivity, etc. etc.

One of those who quickly reacted to the concerns raised was DILG Secretary Benhur Abalos, who declared that the war against malnutrition should not be when the symptoms present themselves but pre-emptive, meaning from the first sign of conception through the pregnancy and onwards.

That makes perfect sense because even for us who are parents as well as livestock raisers, we build-up, condition and treat in preparation for pregnancy or breeding, as the case may be. Whether in humans or in livestock, you can’t go wrong by nutritionally preparing the mother/parent and continuing through the entire process. The condition of the parents, particularly the mother during term, will tell on the child or offspring.

For the larger population, the Philippines and the government seemed to have covered everything; “seemed” I said. We have all the programs to care for pregnant mothers, all the barangays have people on the ground to assist pregnant women, information is readily available at the barangay or through mobile apps. The DOH strongly promotes breast feeding, the DSWD gives out the 4Ps cash assistance. But why is malnutrition still happening? What or where did we drop the ball or create a space for malnutrition?

Last Friday, on AGENDA, we spoke with Dr. Ryan de Guzman, chairman of the public health community-based program of the Philippine Dental Health Association, who talked about the state of dental health and dental care in the Philippines and why dental services are not part of PhilHealth coverage.

I first shared a story of the guy who needed eight teeth pulled out and about P50,000 worth of dental work. Dr. Ryan raised the ante and said that it was normal and even worse than that, since many kids at four years and above lose or need to have ALL their teeth removed due to infection and decay. When I talked about the link between tooth decay, infection and strokes, Dr. Ryan confirmed it and said that there have been a number of cases where brain abscess and cardiac complications have been associated with or linked to oral bacteria and infections.

Dr. Ryan went on to share that many children who have had recurring infections of the tonsils have been linked to bacteria and infections in the gum and teeth. The unexpected revelation from the interview was that many poor or picky eaters among children, particularly those who prefer to suckle or drink milk or juice only, often have extensive tooth decay or gum disease. In other words, they are in pain but are unable to express the problem, similar to children who have very poor eyesight or hearing. As a result, they are labeled as having behavioral issues until someone notices and tests or checks.

Further complicating matters is that most processed milk and juices given to children “have the equivalent amount of sugar in 3-in-1 coffee,” said Dr. Ryan. Couple that with poor dental hygiene which is no longer “scheduled” in school after lunch and recess and you are setting the stage for tooth decay. The DepEd needs to re-emphasize dental hygiene in all schools.

If children can’t bite hard or chew, how can we expect them to eat grown up food? So, malnutrition begins to creep in and soon low-grade infections become recurring infections or combine with other problems. There are still many Filipinos who get their drinking water out of the ground or deep wells. In communities where there are no sewage treatment plants, septic tanks often drain or drip into the ground, thereby infecting the ground water. Put all of that together and our children are highly at risk beyond malnutrition!

An unexpected issue raised by Dr. Ryan de Guzman was their position on “free dental missions” being given by foreign-based groups, NGOs and local governments. Dr. Ryan explained that instead of being a blessing, the over-supply or too many dental missions in the country have altered the mindset and value of oral care in the Philippines and may be the reason why the PhilHealth has not included dental services in their packages.

Instead of being taught and empowered to care for their teeth, gums and mouth, the majority of dental missions have become known for “libreng bunot” or free teeth extraction. So instead of seeing the dentist every six months for check-up and cleaning, people simply wait for the next “libreng bunot.”

Another problem is those dental missions are conducted usually in the garage or under a tent in a barangay. Sterilization and disinfection are hardly ideal, follow-ups don’t take place, just hand out prescriptions for pain killers.

So, the next time you see a child who doesn’t smile, check. They may have no reason to smile. That’s bad.