Alice Grasveld: oral health programs for children must start from the ground up
Pragmatic community-centred approach to childhood oral health worth understanding for practitioners working in multicultural or low-income settings.
Building oral health from community roots
Alice Grasveld, a dental hygienist and medical anthropologist, runs The Healthy Teeth Foundation (THTF), which she established in 2018 to improve oral health in children living in slums across Kenya and South Africa. Working alongside her doctoral research at ACTA's pediatric dentistry department, Grasveld has found that sustainable change in oral health behaviour requires listening to local communities rather than imposing top-down interventions from government or external organizations.
How local voices shape prevention programs
In Kenya, Grasveld discovered that the people with real influence over community attitudes are elders, religious leaders, and traditional healers. Engaging these figures, alongside school principals and area chiefs, proved essential to gaining buy-in for supervised handwashing and toothbrushing programs in schools. The approach has yielded measurable results: at one school in southern Kenya where THTF began work in 2019, installing a water tower and establishing basic hygiene practices led to improved general health outcomes, reduced absence due to dental pain, and the school being recognized as the region's best. Critically, co-funding arrangements with the school and community created local ownership, a prerequisite for long-term sustainability.
Grasveld trains local grassroots volunteers to deliver oral health education in schools, children's homes, and churches, providing toothbrushes, toothpaste, and soap. She spends a few weeks on-site annually while local teams carry out the work year-round, supported by partners like Colgate Kenya. One partner organization was founded by a woman who grew up on the Dandora Dumpsite, East Africa's largest landfill near Nairobi, and now serves as a role model in her community.
Why bottom-up works in wealthy settings too
Grasveld's doctoral research extended to Amsterdam's Schilderswijk district, where only 20 percent of children attended free school dental services despite eligibility. She identified barriers including parents with migration backgrounds viewing dental care as emergency-only treatment (the norm in their home countries), fear of hidden costs or system contact, and language gaps. In this context, reaching children directly proved more effective than targeting parents, since children often speak Dutch fluently and can relay information home. Additionally, the neighbourhood's food environment of snack bars and candy shops required simultaneous intervention on diet.
According to the 2018 Signalement Mondzorg report, 5-year-old children with both migration backgrounds and low socioeconomic status face disproportionate risk: 75 percent carry dental caries. More broadly, Grasveld's experience shows that sustainable oral health improvement requires engaging local structures, understanding cultural attitudes toward prevention, and removing practical barriers to care, whether in Kenyan slums or Dutch inner cities.
Frequently asked questions
Why do government health programs often fail in Kenyan slums?
Government organizations do not understand local conditions well. Grasveld found that real influence comes from elders, religious leaders, and traditional healers, whose support is essential for behaviour change. Engaging these figures directly is more effective than top-down mandates.
What results has the school project in Kenya achieved?
Since 2019, supervised handwashing and toothbrushing, combined with a water tower and improved sanitation, reduced dental pain-related absences, improved general child health, prevented infection during a regional disease outbreak, and helped the school gain regional recognition and government funding for new classrooms.
Why do migrant families in Amsterdam not use free school dental services?
Parents from backgrounds where dental care is unaffordable or unavailable often view dentists as emergency-only. They may also fear hidden costs, worry about system contact (especially undocumented families), or lack transport passes. Children, who speak Dutch, are often the most effective messengers to parents.
How does The Healthy Teeth Foundation ensure projects last after Grasveld leaves?
THTF builds partnerships with local grassroots organizations rooted in the community. Co-funding arrangements with schools and communities create local ownership. Grasveld trains local volunteers year-round while she visits annually, gradually transitioning responsibility to local teams.
What barrier prevents undocumented children from accessing dental care?
Undocumented children avoid formal health systems for fear of detection, arrest, or deportation. THTF addresses this by funding treatment at trusted local facilities like Kruispost clinics in Amsterdam and hospital dental camps in Kenya, removing the registration barrier.
