Are we truly helping?
By Assoc Prof Lim Ghee Seong, Assoc Prof Azwatee Abd Aziz
For years, well-intentioned volunteers have travelled to Orang Asli villages with portable dental chairs, toothbrushes and fluoridated toothpaste. We conduct screenings, provide oral health education and basic treatment, and leave hoping that we have made a difference. Yet our experiences in these communities have prompted an important question: are we providing the kind of help that Orang Asli communities truly need?
During community outreach activities, we have often observed oral health patterns that appear different from those commonly encountered in urban populations. These observations have made us reflect on how changing lifestyles, particularly dietary changes and the increasing availability of processed foods, may be influencing oral health among Orang Asli communities.
However, observations from outreach programmes alone cannot establish whether these changes are responsible for increasing disease. They should instead encourage us to look more carefully at the broader social, cultural and environmental factors shaping health.
The Orang Asli have inhabited Peninsular Malaysia for generations and possess their own traditions and knowledge related to health and wellbeing. Among the Semai, for example, traditional healers known as Tok Halaq continue to play a role in health promotion and healing. Traditional practices may involve the use of leaves, roots and other organic materials for personal and oral hygiene.
Betel quid chewing, or sirih, similarly carries cultural and social meaning in some communities. Its association with oral potentially malignant disorders and oral cancer must certainly be addressed, but effective health promotion also requires an understanding of why the practice persists. Importantly, Orang Asli communities are not necessarily unaware of oral health risks. Studies have reported awareness that poor oral hygiene may contribute to dental and periodontal disease and that components used in betel quid chewing may be harmful.
One emerging concern is the transition from traditional diets towards increasingly accessible processed foods. Similar nutrition transitions have been described among Indigenous populations worldwide, but their effects are complex and should not be attributed to a single cause. Malaysian oral health data nevertheless indicate a substantial disease burden. A 2019 study among Orang Asli children aged 11–12 years in Cameron Highlands reported that 61.6% had dental caries and 96% showed signs of gingivitis. Interestingly, many reported brushing twice daily with fluoridated toothpaste, suggesting that oral hygiene education alone may not be sufficient to address the problem.
This is where we should reflect on the way dental outreach is currently delivered. One-off dental programmes undoubtedly have value. They may identify previously undiagnosed disease, relieve pain, provide treatment and connect underserved communities with healthcare professionals. But episodic interventions without continuity of care or local capacity-building may have limited long-term impact. Orang Asli communities continue to face practical barriers to accessing oral healthcare, including geographical distance and time constraints. Some may self-medicate or seek assistance from traditional healers when symptoms persist.
Perhaps, therefore, the question should not simply be “How much treatment can we provide during our next visit?” but “What can remain after we leave?”
A more sustainable approach could begin by recognising existing community knowledge rather than if modern healthcare must replace it. Traditional healers, Tok Batin, families and other trusted community members could become partners in oral health promotion.
Community members could potentially be trained as oral health advocates, while mobile dental services could provide more regular follow-up rather than isolated visits. Nutrition education should also address the increasing availability of processed foods while remaining sensitive to traditional food practices and the realities of food access.
Most importantly, interventions should be developed with Orang Asli communities rather than simply for them. This means asking communities what they consider important, understanding barriers from their perspective and designing programmes around their priorities. Evidence-based dentistry and traditional knowledge do not necessarily compete; there may be opportunities for respectful engagement while remaining clear about practices known to cause harm.
The question, then, is not whether Orang Asli communities should receive oral healthcare. Equitable access to quality dental care remains essential. The challenge is determining what form that care should take and how its benefits can extend beyond a single outreach programme.
The goal should not simply be to bring more services into Orang Asli communities, but to build healthier and more sustainable systems with them, systems that improve access to evidence-based care while respecting cultural knowledge, community priorities and self-determination.
The authors are from the Faculty of Dentistry, Universiti Malaya.