Postcard: Dr Judi Humphreys on dentistry in Egypt

Posted on: 19 March 2024 by Dr Judi Humphreys in March posts 2024

In collaboration with the Egyptian Orthodontic Society, University of Liverpool School of Dentistry's Dr Judy Humphreys and Professor Sondos Albadri delivered a series of presentations and visited healthcare sites in Cairo to understand more about how dentistry is delivered in Egypt, and how we can work together to improve the standard of care. Dr Humphreys spoke about her trip below:

Can you tell us your full name, title, and role within the University and NHS?

Dr Judi Humphreys, I am a Senior Lecturer / Honorary Consultant in Paediatric Dentistry, based at Liverpool University Dental Hospital and Alder Hey Children's Hospital.

Why was it that you visited Egypt?

My colleague Professor Albadri was invited to speak at a conference in Egypt and invited me to contribute to this. This was a two-day event organised by the Egyptian Orthodontic Society. The audience included postgraduate students in Paediatric Dentistry and Orthodontics, and clinical academics from Universities across Egypt.

I spoke on a variety of topics, including molar-incisor-hypomineralisation and poor prognosis first permanent molars, safeguarding as a paediatric specialist in the UK, and dental management of medically complex patients.

Professor Albadri spoke about treatment planning in the primary dentition, treatment planning in mixed and permanent dentition, and the role of the paediatric dentist in the Multidisciplinary Team

Can you give us a brief outline of the activities you were involved in during your visit?

Alongside lecturing, we had time to visit a local private dental clinic (Mira Dental Centre) and see some local cultural sites - the Pyramids at Giza, The Musuem of Egyptian Civilisation, Muhammed Aly's Palace and the Citadel & Mosque. We networked with academics from several Universities - Professor Hala Mohei Eldin from Cairo University, Dr Passant Nagy from Cairo University, Prof Abeer Abdellatif from Mansoura University, Prof. Karin Dowidar Alexandria University, and Prof. Amr M. Abd El Aziz from Ain Shams University and also the president of the Arab Society of Paediatric Dentistry.

Was the visit in someway connected to a research study or other piece of academic work?

We didn't go with a specific project in mind or already discussed however we discussed the possibility of working on research to implement and assess school toothbrushing projects in deprived areas of Cairo. Discussion regarding funding are underway.

In our interview, you mentioned the interesting cultural differences in how dentistry work is carried out in Egypt in contrast to the U.K, could you speak more to that?

The main cultural difference in provision of Paediatric Dentistry we noted was management of extensive caries in primary and first permanent molar teeth. In the UK we tend to extract more teeth which we deem to be of 'poor long term prognosis'; this is about timing treatment to remove teeth which would require large fillings at a young age, in order that adjacent adult erupt into a good position with minimal spacing. The idea is to avoid leaving a child with a high burden of future dental care, and the likelyhood that they will eventually need the adult tooth to be extracted with no possibility for favourable positioning of adjacent teeth in adulthood. In management of primary teeth, the rationale is to extract all remaining decayed primary teeth which could not be restored whilst the patient was awake, as this is the only certain way to prevent future complications from primary teeth with large restorations which could fail, meaning the child requires a repeat dental general anaesthetic.

In Egypt, the culture is to restore all teeth possible with fairly complex treatment often provided under general anaesthetic, even for primary teeth which will exfoliate naturally in a few years time. This may include provision of root canal treatment and crowns on primary teeth whilst under general anaesthetic. This provides a good aesthetic result for patients and families, but has increased cost to the healthcare system, families and the potential for further treatment to manage post-operative infection or failures.

Whilst on the surface the two approaches seem disparate, both stem from trying to do the right thing for the child and family, and the culture of dentistry and general public plays into this greatly. Families of children with decayed teeth in both countries attend dental appointments expecting the aesthetic approach (Egypt) and for the health based approach in the UK. Dentists are taught to approach treatment planning in the two opposing styles as undergraduate dentists and therefore initially it is easy for any dentist from each country to feel shocked regarding the differences. We were able to find some common ground between the approaches with newer minimally invasive techniques which work well in a government funded health system and for children who find it difficult to cope with dental treatment.

How do you feel these visits benefit you personally?

I really enjoyed experiencing Egyptian culture, cuisine and dentistry. It is useful to understand different treatment approaches in other countries and our hosts fully explained their treatment rationales. I was able to make new friends and colleagues which will hopefully provide international collaborations in research and scholarship. I have also been asked to speak at the Egyptian Paediatric Dentistry Conference in November so will hopefully be travelling to Egyot again soon.

Are there plans for further visits in future?

I have been invited to speak at the Egyptian Paediatric Dentistry Conference in November and if we secure funding for school toothbrushing programmes and research I will no doubt return to help roll-out this out and support research.