Dr. Rosalie Warpeha, a Marist missionary sister, public health dentist, Nine Miles of Smiles Advisor and salt fluoridation champion, sadly passed away this past March. She was 64.
Dr. Warpeha, known in Jamaica as “Doctor Sister,” implemented a groundbreaking salt fluoridation program there in 1987 that led to an 87 percent reduction in tooth decay in 6-year-olds, an 84 percent reduction in 12-year-olds and a 69 percent reduction in 15-year-olds. Although it had never been tested in a developing country, Dr. Warpeha thought that salt fluoridation seemed to be an ideal remedy for an island nation like Jamaica. In discussing those results she was asked whether she would describe the reduction as ‘striking,’ ‘dramatic’ or ‘highly significant.’ She replied with a smile that she personally felt it best be called ‘miraculous.’
In addition to her service as a public health dentist and researcher, Dr. Warpeha was an active educator for dental, salt fluoridation and public health programs worldwide. She was an active participant in the HVO-DO program, serving in Guyana, Jamaica, Turks and Caicos and Vietnam and also serving as both member and chair of the ADA HVO-DO Steering Committee. Her list of publications, accomplishments, honors and awards is lengthy and includes honorary fellowship in the Academy of Dentistry International and an award recognizing her contributions to dentistry in the Caribbean.
She will be remembered for are her accomplishments in helping the poor.
The WHO lists Jamaica as having 220 practicing dentists in 2001.With a population approaching 2.7 million, that averages 1 dentist to every 12,500 people! Availability is not the only obstacle to dental care.
The Ministry of Health implements public health programs however due to lack of funding oral health education in schools doesn’t reach the majority of children and there are only a limited number of school dental services available.
Accessibility to dental clinics is a problem for those Jamaicans that live in remote towns and up in the mountains. NMS, with the support of local organizations, strives to bring dentistry via mobile units to those in isolated communities.
In 1987, Jamaica initiated a comprehensive caries prevention program. An island wide salt fluoridation program was developed, as it was not feasible to implement water fluoridation beyond the capital of Kingston.
The Pan American Health Organization (PAHO) provided the technical assistance in the design and addition of KF (Potassium fluoride) to table salt as well as the training of local personnel in salt fluoridation techniques. A baseline caries prevalence study conducted in 1984 in Jamaica showed that the DMFT for 12 year olds was 6.7, which was well above the WHO goal of DMFT 3 or less.
In order to evaluate the effects of salt fluoridation, an oral health survey was again launched in 1995 to compare the caries score with those observed in 1984. 39 schools out of 800 were randomly selected. The reduction is caries experience in children between 1984 and 1995 was striking. Reduction was 69%, 84%, and 87% in the 15,12 and 6 year olds respectively. The DMFT score for 12 year olds was 1.1. Ninety six percent of the children were fluorosis free, 4% had questionable fluorosis and less than 1% had very mild to mild fluorosis.
The conclusion of the study listed a combination of factors including the continued availability of fluoridated toothpastes that have been available since 1972. The researchers recognized that oral health education in schools did not reach the majority of children and there were only a limited school dental service available.
Estupinan-Day SR, Baez R, Horowitz H, Warpeha R, Sutherland B and Thamer M. Salt fluoridation and dental caries in Jamaica, Community Dental Oral Epidemiol 2001; 29; 247-252.