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pain or severe infection develops is an attempt made to find treatment. This is often provided by a general health worker or a traditional healer in private practice. This treatment may be extremely costly when counted in terms of loss of earnings, production lost, travel costs and fees that may be as high as those charged by dentists. Delaying treatment until there is severe infection causes a high rate of debilitating and even life threatening conditions in such communities.
     The approach that seems likely to provide an effective alternative solution is called Atraumatic Restorative Technique (ART) combined with community participation in local oral care organization. ART has the potential to revolutionize the type of care that can be given in the community. It is based on using dental hand instruments and glass ionomer, a rather recently developed dental filling material. The technique does not need electricity or clean piped water as do traditional dental drills and equipment. As glass ionomer sticks very well to tooth tissues, the carious teeth do not need to be cut and shaped with a dental drill as is needed when amalgam is used. This means that small caries cavities can be treated using hand instruments to scrape out and remove the diseased parts of teeth, and then cavities can be filled with glass ionomer which is also capable of having a preventive effect.
     For this approach to be successful, it needs to be part of a community organization that provides both prevention and disease control care. Members of the community need to feel responsible for the good functioning and success of the service. Otherwise, people will continue to demand care only when they have pain and by that time the caries lesions will be too large to be adequately treated with this technique. The aim is to avoid having to use more traditional types of care, which are invasive and too costly.
Community participation
     Alternative oral care systems based on collaboration with and participation of members of the community have the potential to change the way oral health and care services function. The community can participate through:
     ■ Involving people in prevention and promoting "self care”. When people realize that toothache is not an inevitable part of life, the responsibility for active reduction of the need for moderate level interventive treatment acts as a catalyst for change;
     ■ Organizing regular community campaigns to examine people's mouths to identify early lesions while still small enough to treat with ART;
     ■ Participating in decision making about needs and priorities for oral care;
     ■ Training members of the community of provide low level care;
     ■ Use of locally constructed equipment;
     ■ Devising and managing the financing arrangements for oral care.
     Associated with this and other approaches are training systems which focus on optimal ergonometric principles. A set of manuals for learning these procedures and a set of well designed, low cost equipment for both learning and care is available from WHO and UNICEF.
     It is important to realize that the use of approaches such as ART and the new type of equipment and training technology are not being pr