National Dental Health Plan
A proposal for preventive dental health in Armenia.
This concept was discussed from January through June of 2025 in anticipation of the 14th Armenian Medical World Congress in Madrid. The Dental session took place July 5. We anticipate further discussion and development of this plan leading up to the 7th International Medical Congress of Armenia in 2027.
updated 30 October 2026
Pediatric training to examine children's dentition (children see a pediatrician before they see a dentist) OBGYN training can improve prenatal tooth formation. Pediatricians or their staff can perform such procedures as fluoride varnish, SDF, early referral to dentist.
Increased use of fluoride. Fluoridated toothpaste is widely available in Armenia. Fluoridated water is not available, and would be difficult given the varied water sources. Salt fluoridation is a less expensive alternative and has been successful elsewhere (e.g. Europe, Belarus). Acceptance of fluoride is a common obstacle in Armenia as it is in other countries.
Resume the school dental hygiene programs. A dental chair should be available in all schools, so that dentists (and dental students), hygienists and others can examine and provide basic care.
Increase patient contact experience in the dental training programs in Armenia.
Improve funding for preventive dental care in Armenia. The Պետ Պատվեր (Pet Patver = State prevention program) exhausts its funding for preventive care early in the year. The universal health coverage program in Armenia is currently underway.
Increased empowerment of dental assistants, hygienists, nurses & others to offer preventive measures such as dental exam, fluoride varnishes, sealants and SDF.
Highlights:
- Oral health is a major problem in Armenia.1 The vast majority of children in Armenia have dental decay. Parents will typically take a child to the dentist when there is acute pain. Many of the adults are missing many of their teeth.
- Dental and non-dental professionals alike must recognize the importance of a proper oral exam, as dental decay is the most common chronic disease and it is associated with many other chronic diseases.2
- Prevention of dental disease is most important.3
- Prevention of dental decay should start at the time the teeth are forming, including prenatal education. Baby teeth are not "disposable".
- School programs are an effective way to reach Armenian children. Preschool intervention is also needed.
- Dental sealants can protect the 6-year and 12-year molars, which are the permanent teeth most vulnerable to decay. Dental sealants can be applied to the biting surface of these teeth by trained assistants, nurses, dental students or dentists.
- Fluoride varnishes can be applied to all teeth twice a year by a trained teacher, nurse, parent, dental assistant, or dentist.
- SDF (silver diamine fluoride) can arrest the progress of many dental caries. It is traditionally applied by a dentist, but can be applied by a pediatrician who has been trained.
- Oral health curriculum is important for all medical trainees, particularly pediatric trainees as a child is much more likely to see a pediatrician than a dentist before age 5.
- Salt fluoridation presents a very inexpensive alternative to water fluoridation
A complete oral exam is also needed to evaluate for oral, salivary and other neoplasms.
Ancillary measures for dental prevention include tobacco control, and protective gear while playing sports. Taxes on sugar-sweetened beverages and other sweet snacks has been shown to decrease sugar consumption, and is recommended by WHO.
A standard dental reporting form would help standardize care across Armenia. Further investigation into the available dental record software and the ArMed program will be helpful.
See also: https://amicnow.org/293 master list of our dental session planning for the Madrid Congress in July 2025.
...Footnotes
1 In this sense, the Armenian Medical World Congress should be renamed the Armenian Health World Congress. Health is so much more than medical treatments. It involves preventive care, oral care, mental health care, sociologic and economic considerations. You get the idea.
2 It is important for physicians to look in the mouth in front of the tonsils (not just the throat behind the tonsils!) Medical conditions related to oral health include diabetes, coronary disease and others. It is simple and important to examine the mouth for such common conditions as gingival abscess, oral cancers, and others.
3 Community prevention planning is discussed further at https://amicnow.org/299
Developing a Strategy for a National Dental Prevention Program for the Children of Armenia
Living document in anticipation of the 7th International Medical Congress of Armenia, 2027
initial draft is also online at https://docs.google.com/document/d/1woP_PV_TdyfFIOJdU9AbPO87S_PF1cmN
The Problem:
Dental caries is the most common chronic disease in children. In the United States1 it is 4 times more common than childhood asthma and 7 times more common than hay fever. According to the NHANES, the prevalence of dental caries has risen from 24% to 28% between 1988–1994 and 1999–2004 and ∼42% of children ages 2 to 11 years have dental caries in their primary teeth. After decreasing from the early 1970s to the mid-1990s, the prevalence of dental caries in children has been increasing, particularly in young children ages 2 to 5 years.2 The American Academy of Pediatrics recommends an oral health assessment for all children by age 6 months and a first dental visit by age 1 year. 3 Dental-related concerns lead to the loss of more than 54 million school hours each year.4 Regular tooth brushing with fluoride toothpaste by children is very important in preventing dental caries.5
In a 2022 study of children in Armenia, it was found that the prevalence of caries in primary teeth was 91.7% on the average. In 12-year-old schoolchildren the average prevalence of caries in permanent teeth was 87.5%. The prevalence of periodontal lesions in children was 47.8% on the average.6
The Solutions:
Developing a National Dental Program is a major advance toward caries-free children. There are approximately 35,000-40,000 children in Armenia for each age from 6 to 12 years of age, for a total of 274,378 children. It also is a daunting project involving public, private, and government agencies. The best approach for Armenia at this time in developing a National Dental Prevention Program for the Children of Armenia involves working with the Ministry of Health, the Ministry of Education, dental schools and the Governors (?) and Educators of each region.
School Programs-
We envision this to be a national educational, screening, and preventive program in all schools. It would include health education, including instruction for proper brushing with fluoride toothpaste, and educating regarding the dietary influences of high sugar foods.
These programs would include screening and prioritizing each student, educating the parents of the child's needs, and recommendations for the parents to seek dental care for their child.
A fluoride varnish and dental sealant program should be initiated in each school to prevent additional dental disease possibly by supervised auxiliaries. The most susceptible teeth to tooth decay are the biting surfaces of the 6-year and 12-year molars which are also the cornerstone of the dental arch. Dental sealants prevent biting surface tooth decay on 6- and 12-year molars by about 80%.7 This is why it is most important that these teeth are protected from tooth decay. The most cost-effective preventive measure for these teeth is dental sealants. Also, a program of outreach and education to parents of preschool children should be created.
Examples of Diasporan Pediatric Dental Prevention Programs:
Karagheusian Foundation
A school prevention program with fluoride varnish and sealants has been done successfully by the Karagheusian Foundation in Armenia since 2023 and a treatment program for our children, now in 4 different cities since 1993. The Oral Health Foundation for Children of Amenia - OHFAR (formally Hand in Hand) was initiated in Artsakh in 2005.
The HKMBPO launched its free Pediatric Dental
OHFAR: Oral Health Foundation for Children of Armenia
Rooted in care for the children of Armenia, the Oral Health Foundation for Children of Armenia, OHFAR's mission is to enhance the oral health in Southern Armenia through accessible, free comprehensive dental care, education, and advocacy.
Starting in 1998, OHFAR (formerly Hand in Hand-Artsakh) focused on preventive education for families and health professionals, treatment, screenings, and sealant programs. We operated four land-based and two mobile clinics with a team of 15 full-time local dentists and staff who saw an average 24,000 patients every year in Artsakh.
OHFAR now operates one mobile clinic caring for children in remote villages in the Syunik region serving the families who desperately need dental care. The "Adamnabus" mobile clinic is a fully equipped facility with digital and panoramic x-ray units. OHFAR has held educational sessions for physicians and local dentists, screenings for the population, in addition to comprehensive care including sealant programs. Please see ohfar.am for details of our program.
The Children of Armenia Fund is also offering dental services to children as part of their primary care program. As of early 2026, none of the dental services for the above programs are offered by pediatricians.
Initially, an agreement between the Government, schools, and providing organizations need to be signed. Then a detailed written plan of how the program would work would be established, including how to contact the appropriate parties in each school district. Also, a specific written system would be developed to standardize the charting and delivery of each service, eg, fluoride varnish and sealants. The process would be that there be a group of approved organizations and dentists that would follow these protocols and provide the services.
Involvement of the Dental Schools-
Outreach to the dental schools will be done and would be valuable to make sure there is a proper preventive dental care curriculum and to involve the students and dental assistants to apply fluoride varnishes and dental sealants in the public schools.
Getting dental students and the dental schools involved would reach more children at risk and give the dental students a great learning experience. Currently there is one state dental school in Armenia, a five-year program at Yerevan State Medical University, with about 1000 students. These students could have rotations in the schools, providing fluoride varnish and sealants to school children. This could then be expanded to include the two private dental schools, both five-year programs Yerevan Haybusak University and University of Traditional Medicine. The World Federation of Public Health Associations has done a casebook on school dental prevention programs.8
Involvement of the Medical Community-
An educational program for the medical schools, pediatric and family medicine residencies, and practicing physicians should be developed to include allied health professionals to help them understand the caries process and preventive solutions to the caries process, especially from birth to school age. OHFAR has been presenting to limited groups of pediatricians and family physicians which has been well received. But more should be done.
Most children under age five, see a pediatrician before they see a dentist. Most dentists do not see children aged 1- to 5-years-old. More children could be reached if pediatricians and family physicians could be trained to do fluoride varnishes7 and understand when and how to diagnose appropriate situations on and when to use silver diamine fluoride (SDF), a caries arresting medicament. In the US, fluoride varnishes and SDF are recommended by the American Academy of Pediatrics for pediatricians and family physicians to apply.
Fluoridation-
Community water fluoridation and salt fluoridation are the most cost-effective preventive measures for tooth decay as everyone in the community benefits. While community water fluoridation is not realistic for Armenia given different sources of water in different communities. For example, Yerevan has about 10-12 water inlets. In Armenia, about 80-85% of the iodized salt that is used is produced in Armenia.9 This makes it easier to fluoridate the salt as it would be in addition to the iodization of salt, and the cost may be negligible. Depending on other preventive measures, salt fluoridation would prevent tooth decay by about 25%. Salt fluoridation would probably be easier to move forward, but more information and politicking would be needed. Both are safe and extremely cost effective. This would be a tertiary project.
Cost Controls-
The programs would need to be evaluated for cost and implementation. Reimbursement for preventive dental services needs to be discussed. Preventive measures are far less expensive than restorative/surgical dentistry. One solution for revenue could be from a “Sugar Tax” on sweetened beverages, candies, etc. that could generate some funds. It would be up to the government to implement such taxes to fund such programs.
While this is a major project, the significance of the efforts and the potential results are exponential in eliminating dental disease in children, and eventually improve the oral health of the entire population of Armenia.
*This proposal is a joint resolution of a respected worldwide group of physicians and dentists from the Workshop on Oral Health from the Armenian Medical World Congress.
REFERENCES
- National Center for Health Statistics. Healthy People 2010 Final Review. Hyattsville, MD: National Center for Health Statistics; 2012. Available at: www.cdc.gov/nchs/healthy_people/hp2010/hp2010_final_review.htm Accessed January 28, 2014
- Dye BA, Tan S, Smith V, et al. Trends in oral health status: United States, 1988-1994 and 1999-2004. Vital Health Stat 11. 2007 Apr:(248): 1–92 35. https://pubmed.ncbi.nlm.nih.gov/17633507/
- Ismail AI, Bandekar RR. Fluoride supplements and fluorosis: a meta-analysis. Community Dent Oral Epidemiol. 1999;27(1):48–56 https://pubmed.ncbi.nlm.nih.gov/10086926/
- US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000. https://pubmed.ncbi.nlm.nih.gov/11324049/
- Marinho VC, Higgins JP, Sheiham A, Logan S. Fluoride toothpastes for preventing dental caries in children and adolescents. Cochrane https://pmc.ncbi.nlm.nih.gov/articles/PMC8439270/
- Kharazyan, G., and A. Melikyan. "Oral Health Status and Indicators in Children of Armenia Based on the National Surveys." Minerva Pediatrics, vol. 74, no. 6, 2022, pp. 738–745. https://www.minervamedica.it/en/journals/minerva-pediatrics/article.php?cod=R15Y2022N06A0738.
- Ng, Toby Cheuk-Hang et al. “A concise review of dental sealants in caries management.” Frontiers in oral healthvol. 4 1180405. 17 Apr. 2023, https://pmc.ncbi.nlm.nih.gov/articles/PMC10149715/
- World Federation of Public Health Associations. Global School Oral Health Dental sealants prevent biting surface tooth decay on 6- and 12-year molars by about 80% (2). Casebook. World Federation of Public Health Associations, 2024, https://www.wfpha.org/global-school-oral-health-casebook/. Accessed 25 May 2025.
- Avan Salt Plant. About Us. Avan Salt Plant, 2025, https://www.armsalt.am/default_eng.htm . Accessed 25 May 2025.
- Dutt, Upasna. Prevalence of Early Childhood Caries and Its Association with Parental Knowledge, Attitude, and Practice in the Lori Region of Armenia. Master’s thesis, American University of Armenia, 2024. https://chs.aua.am/files/2025/01/Upasna-Dutt-Final-2024-December.pdf.
- World Health Organization. Oral Health Country Profile: Armenia. World Health Organization, 2022. https://cdn.who.int/media/docs/default-source/country-profiles/oral-health/oral-health-arm-2022-country-profile.pdf.
...See also
https://amicnow.org/293 is a link to several of the dental session-related pages on this amicnow site. Others may be found by typing the dental into the search bar above.
Members of AMWC Workgroup:
- Armond Kotikian MD, DDS, FACS, Glendale California, maxillofacial surgeon, member AAMS
- Arnold Weiss DDS, Boston, Tufts Univ. Professor of Dentistry, Dept of Pediatric Dentistry OHFAR
- Myron Allukian Jr, DDS, MPH Harvard School of Dental Medicine
- Georges Mosditchian DDS, Paris France, dentist, member of UMAF-Paris
- Jerry Manoukian MD Internal Medicine, California
- Berdj Kiladjian DDS, Boston, cofounder of Hand in Hand, OHFAR
- Irina Lazarian, Alisa Badalyan DDS, Howard Karagheusian Medical Benevolent Public Organization
- Dr Harmik Minassian DDS, dental surgery, implantology, Lyon, Hand in Hand
- Bedros Yavru Sakuk ChDF, DDS, Paris France, Représentant de l’Armenie à la FDI (Fédération Dentaire Internationale), NYU Professor, Depts of Restorative Dentistry & Periodontics
- David Hovhannisyan Founder “White Castle” Dental Medical Clinic, perioprosthodentist
- Karapet Medzavorian DDS, Postdoctoral fellow, Barcelona Spain
- David Matevosyan DDS, Dental advisor to Ministry of Health of Armenia
- Sareen Armenian
- Carmen Ohanian DDS, Glendale, California
- Gayane Malkhasyan
- Robert A. Bagramian DDS
- Denise Klatchoian DDS,São Paulo, Pediatric dentist, OHFAR Board
- Lazar Yesayan DDS, Yerevan, Dean of YSMU Dental School
