How do you define dental health in a society striving to become the Happiest Country in the World? This question framed the work of the International Extremity Project Team Dental (IEP-TD) during a recent humanitarian mission to Bhutan. Our dental team joined fellow IEP volunteers who specialize in lower extremity care, working together to assess and improve health outcomes for underserved populations.
On this mission, IEP-TD focused on oral health and its role within a healthcare system guided by a philosophy unlike any other.
Bhutan has redefined progress through the concept of Gross National Happiness. Rather than measuring success through economic output alone, the Bhutanese government evaluates national well-being using four pillars:
- Sustainable development
- Cultural preservation
- Environmental conservation
- Good governance
At the invitation of the Bhutanese government and Her Majesty Gyalyum Kesang Choeden Wangchuck, IEP was asked to assist in assessing and improving health services.
While IEP is best known for treating complex lower extremity deformities, this mission included a dental team consisting of Dr. Richard Kao, DDS, a periodontist with extensive international experience, and me, a predental student from Colby College, to address oral and periodontal health needs. I have participated in seven prior IEP missions; this experience marked my second mission focused directly on dentistry and aligned closely with my future professional goals.
All dental care in Bhutan is provided at government hospitals by general dentists, with a few specialists in prosthodontics, endodontics, oral surgery, and orthodontics. Notable missing elements are periodontists and dental implant surgical expertise.
All dentists are trained abroad after four years of undergrad studies in Bhutan before going to countries such as India, China, Malaysia, and the Philippines. After dental school, they return home to serve in a public healthcare system that provides dental services free of charge, except for cosmetic procedures and orthodontics. Despite these constraints, Bhutan has succeeded in delivering basic dental care nationwide.
Our mission objective was to improve access to advanced periodontal surgical care and emphasize the need for preventive oral hygiene support. The absence of dental hygienists places a heavy burden on dentists, who must manage both treatment and prevention. Bhutan currently does not have a practicing periodontist, though its first is completing specialty training in the Philippines.
Our IEP dental team provided a group of seven dentists, which we call Team Bhutan, with didactic lectures, demonstration surgeries, and supervised their surgical training in advanced periodontal surgical procedures that focused on:
- Pocket reduction (modified Widman, flap curettage, and flap osseous surgery)
- Mucogingival surgery (free gingival and connective tissue grafts)
- Crown lengthening (functional and aesthetic)
IEP Dental will continue to work closely with Team Bhutan and Bhutanese dentists to strengthen skills in periodontal triage, supportive, and advanced procedures. Plans are underway to further strengthen and support Team Bhutan by sending a digital periodontal charting package, an intraoral camera, and small surgical instruments to help them continue developing their surgical skills.
IEP will continue collaborative efforts for Zoom treatment planning and work with the Bhutan Ministry of Health and the University to develop policies for implementing an effective dental hygiene and auxiliary program.
This experience by IEP Dental and Team Bhutan reinforced a vital truth: High-quality dentistry is defined not by technology alone, but by adaptability, humility, and commitment to patients. In Bhutan, oral health is inseparable from dignity, well-being, and Gross National Happiness itself.
A special thank you to Mid-Peninsula Dental Society for supporting IEP-TD with donations and supplies.
— Logan Lehnert
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