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Lee and Jung: An exploratory study on development policy and the status of oral health care in the North Korea during the Kim Jong-Un era
Original Article

J Korean Acad Oral Health 2020;44(1):26-33.

Published online: 15 March 2020

DOI: https://doi.org/10.11149/jkaoh.2020.44.1.26

An exploratory study on development policy and the status of oral health care in the North Korea during the Kim Jong-Un era

Sae-Rom Lee1, Se-Hwan Jung2,

1Department of Preventive and Social Dentistry, College of Dentistry, Kyung Hee University, Seoul, Korea

2Department of Preventive and Public Health Dentistry, College of Dentistry, Gangneung-Wonju National University, Gangneung, Korea

Corresponding Author: Se-Hwan Jung Department of Preventive and Public Health Dentistry, College of Dentistry, Gangneung-Wonju National University, 7 Jukheon-gil, Gangneung 25457, Korea Tel: +82-33-640-2751 Fax: +82-33-640-3103 E-mail: feeljsh@gwnu.ac.kr https://orcid.org/0000-0001-7529-6270

Received 11 February 2020       Revised 3 March 2020       Accepted 7 March 2020

Copyright © 2020 by Journal of Korean Academy of Oral Health

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Studies on oral health care in North Korea are being pursued in South Korea. However, the covertness of North Korea offers substantial resistance to the access of information from the country, including in the field of oral health care. In this study, we explored North Korea's oral health care policy and its status in the Kim Jong-Un Era.

Methods

We used existing information from Internet searches and also interviewed three health care professionals who had recently contact with North Korea.

Results

At present, there are four development policies of oral health care in North Korea: expansion of dental institutions and resource support, strengthening the prevention and treatment of dental diseases, improvement of dental prosthetics, and increasing the responsibility and role of the dental workforce. In addition, there has been an increasing interest in children's oral health with the development of a few programs.

Conclusions

In order to improve overall oral health care, cooperation is required from North Korea in accessing relevant information in the field of children's oral health, dental prosthetics, and dental materials. For this to occur, there should be a preliminary trust building process between North Korea and South Korea as well as access to information from reliable sources.

Keywords: Exploratory study, North Korea, Oral health care

References

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3. Yonhapnews. North Korea, Kim Jong-Un visits the construction site of Pyongyang dental hospital [Internet]. [Cited 2013 Sep 23]. Available from:. https://www.yna.co.kr/view/AKR20130924018800014?input=1179m.
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Table 1.
Analyzed documents for exploring oral health care in the North Korea during the Kim Jong-Un era
− Hwang GM11). Policy and justification for the development of dental care by the great leader Kim Jong-Il. Dentistry, Ophthalmology, Otorhinolaryngology 2016;6(4):3-4.
− Tarvonen PL et al12). Awareness of and compliance with healthy oral habits reported by children and their parents in Democratic People’s Republic of Korea after a preventive programme. Acta Odontologica Scandinavica 2016;74:525-531.
− Tarvonen PL et al13). Comparison of two preventive interventions on dental caries among children in Democratic People’s Republic of Korea. International Journal of Dental Hygiene 2016;14:301-306.
− Tarvonen PL et al14). Association between oral health habits and dental caries among children in Pyongyang, Democratic People’s Republic of Korea. International Journal of Dental Hygiene 2017;15:e136-e142.
− Tarvonen PL15). Children’s oral health promotion programme in the Democratic People’s Republic of Korea [Ph.D thesis]. Finland: Univ. of Eastern Finland;2017. [English].
Table 2.
Basic information on interviewees and interview schedule
Basic information Interview schedule
− Kim ○○. 53 yrs old/female/officer in 2019.2.11.
charge of inter-Korea unification of the 10:00-12:00
ministry of health and welfare.
− Shin ○○. 55 yrs old/male/professor in 2018.12.13.
department of preventive medicine. 16:00-18:00
− Jung ○○. 46 yrs old/male/dentist. 2019.1.5.
15:30-17:30
Table 3.
Development policy of oral health care in the North Korea during the Kim Jong-Un era11)
ㆍExpansion of dental institutions and resource support
− Proper installation of dental hospitals and dental clinics in the community
− Proper placement of dental workforce and support of dental facilities and equipment
ㆍStrengthening the prevention and treatment of dental diseases
− Strengthening daily dental hygiene control
− Strengthening dental diagnosis by reinforced clinical examination and functional diagnosis facility
− Acceptance of new advanced dental treatments
− Expansion of modern dental facilities and strengthening dental scientific research
− Development and improvement of dental specialization
ㆍImprovement of dental prosthetics
− Proper supply and quality improvement of materials and instruments in dental prosthetic
− Rapid development of dental prosthetic technology and capacity building of prosthetic workers
ㆍIncreasing the responsibility and role of dental workforce
− Capacity building on self reliance ideology of dentists and dental technicians
− Strengthening technical capacity of dentists and dental technicians
Table 4.
Outline of the PDCSP in the North Korea by FI15)
Classification Contents
Background ㆍ Development of collaboration to promote children’s oral health in the North Korea between the Pyongyang local authorities and FI
− The initiative for the cooperation came from local authorities. They contacted the project officers of other projects by FI already present in the North Korea.
− The rapid increase in dental caries incidence among young generations had alarmed the local authorities to seek foreign cooperation.
Goal ㆍ To reduce dental caries and improve oral health among children and adolescents in the North Korea
Implementation & spread ㆍ Planning and implementation of the COHPP
− The programme was initiated in central Pyongyang city in 2007 and target population was children at kindergarten and primary schools.
− The programme aimed to promote children’s oral health by training local trainers, by providing the most important self-care dental products (toothbrush, fluoride toothpaste) and education materials and by disseminating healthy oral behavior widely among decision-makers and ordinary people.
− Toothbrushes, fluoride toothpaste and a children’s workbook were provided to the children.
− Supervised toothbrushing was part of the daily schedule at the schools and kindergartens.
− The results were evaluated as part of the research co-operation between the UEF and PMC.
− The programme covered the entire capital area in 2013 and was expanded to Jongju city of North Phy-ongan Province in 2012 and to Sepo Country of Gangwon Province in 2014.
ㆍ Development of dental health services in the cooperation hospitals
− The three cooperation hospitals were situated in downtown Pyongyang. Additionally, some support was provided to Jongju City Hospital.
− Mechanical expertise has enabled the reinstallation and maintenance of donated equipment and professional construction workers have realized the required renovations of the hospital premises.
− These hospitals were also provided with necessary equipment, mainly modern dental units and instrument care machinery, as well as materials for treatment procedures of primary oral care.
ㆍ Upgraded operation capacity and practical functions of dental workforce
− The highest-level educators are the four Master Teachers in the dental faculty of PMC, about 273 educators were trained and an organization of the educators was established.
− The topics included oral examination, preventive treatment procedures, atraumatic restoration treatment (ART), instrument hygiene practices, and basics in periodontal treatment procedures, oral epidemiology and articular functions.
− The training included a practical, hands-on session, which provided the participants experience in the use of the new appliances and materials introduced in the educations.

COHPP, Children’s oral health promotion programme; FI, Fida international; PDCSP, Primary dental care support programme; PMC, Pyongyang medical college; UEF, University of eastern finland.

Table 5.
Experience of dental caries in Pyongyang children before and after the COHPP13,15)
Age Classification
 Baseline: 2007 Three years later: 2010 Six years later: 2013
Index
7 Percentages of the children with dental caries in need of treatment (%) 83% 67% −
The number of teeth with caries experience (n) dt 0.81 0.70 −
DT 0.25 0.10 −
dt+DT 1.05 0.79 −
ft+FT 0.11 0.10 −
dt+DT+ft+FT 1.16 0.89 −
10 Percentages of the children with dental caries in need of treatment (%) − 34% 20%
The number of teeth with caries experience (n) dt − 0.11 0.11
DT − 0.27 0.09
dt+DT − 0.38 0.20
ft+FT − 0.48 0.49
dt+DT+ft+FT − 0.86 0.69
13 Percentages of the children with dental caries in need of treatment (%) − − 25%
The number of teeth with caries experience (n) dt − − 0.00
DT − − 0.26
dt+DT − − 0.26
ft+FT − − 0.57
dt+DT+ft+FT − − 0.83

COHPP, Children’s oral health promotion programme.

Table 6.
Awareness and practice of oral health behaviors in Pyongyang children after the COHPP, 201312,14,15)
Awareness (%)
 Practice (%)
Oral health behaviors Six years later
 The duration of oral health education varied: 13 yrs old Six years later
 The duration of oral health education varied: 13 yrs old
10 yrs old 13 yrs old 10 yrs old 13 yrs old
Toothbushing: ≥2/day 99.6% 100.0% 99.1% 92.0% 95.9% 96.2%
Fluoride toothpaste: in use 99.6% 99.6% 99.0% 100.0% 100.0% 98.9%
Sweet snacking: <2/day 99.6% 100.0% 92.0% 10.8% 11.9% 22.3%
Water as the main thirst quencher 99.6% 99.2% 92.7% 71.6% 70.1% 76.1%

COHPP, Children’s oral health promotion programme.

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