Share Your Story: A week in rural Honduras from the students’ perspective
A week on a mobile dental clinic from the students’ perspective
Last March, for a week, we were fortunate enough to participate in an outreach mission to Honduras. The mission was led by pediatrician Dr. F. Gorodzinsky and pediatric dentist Dr. C. Friedman, and included pediatric dentists, pediatric residents, and registered nurses. It was the first time in fifteen years that dental students participated in such a mission and it has been the most eye-opening experience of our careers as dental students, thus far.
Daily, before joining our brigades, where we provided emergent dental care, we had the opportunity to meet with the public health dental team in Gracias. The meeting served to develop a risk management program intended to improve oral health in school-aged children.
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Then, the day began by engaging the local team in a dialogue in order to assess the needs of the community, the current state of oral health, and the perceived barriers to care. The Honduran dentists identified a common theme: the relationship between oral health and general health with an emphasis on oral infection and general infection and the main barriers to care identified were access and resources. Once those were identified, together we prioritized the issues and set specific, measurable, attainable, realistic and timely (“SMART”) goals for the community.
Together with the local oral health team, we created a pilot program whereby supervised tooth brushing would be implemented in primary schools. The pulp involvement, ulceration, fistula, and abscess “PUFA” oral health evaluation system, which identifies infection, was also introduced to the public health team and was accepted with enthusiasm to help determine baseline and outcome impacts of any intervention.
This system is best used in countries where decay rates are extremely high (90-99%). In such situations, assigning DMFT values alone would not be appropriate and a more advanced description of the stage of infection is needed.
Research shows that supervised tooth brushing programs are among the most effective ways to reduce caries rates. In high risk areas, such as rural Honduras, resources are scarce and a tooth brushing program can be a cost-effective way to reduce infection. For this reason, we decided, with the local dentists, to initiate a study to demonstrate how supervised tooth brushing can help reduce the prevalence of tooth decay.
Following this initial meeting, we worked with the local dental team to hone their evaluation skills using the PUFA system. We visited a school in the district of Guanteque where each dentist scored the same children to ensure inter-rater reliability for the study. After collecting these baseline PUFA scores, we reviewed tooth brushing techniques with the school teacher to ensure that the tooth brushing program would be properly supervised. For some of these children, even access to toothbrushes and toothpaste is scarce. It was very rewarding to see the excitement of these children as they showed off their brushing skills!
This pilot program involves seven members of the public dental team who would be working in different communities. Each members is responsible for collecting data for the schools in their district to give a representative sample of rural Honduras. We have committed to supply the materials needed to drive this program for two years. The mayor of Gracias, who is also a dentist, was an enthusiastic supporter of developing this pilot project and promoting Gracias as a model for cost-effective sustainable interventions to improve overall health. After two years, PUFA scores would be taken again and compared to the baseline scores. This will provide an information base to facilitate the design of prevention programs.
With the seeds of the study planted, the remainder of our trip was spent on daily pediatric brigades to underserviced communities. News of our brigades quickly spread to surrounding villages, and there were people who walked for miles to visit the dentist. Every day, we transformed a classroom into a mobile dental clinic. Children flooded into the room where they were first triaged and then directed to the proper area for care. Treatment included fluoride varnish, disinfection with iodine and silver nitrate, atraumatic restorative treatment (ART) and multiple extractions. All children received toothbrushes, toothpaste, and instructions on proper tooth brushing technique.
It was heartbreaking to see such an extent of infection and the impact it has on the children’s quality of life. Most children were malnourished and showed signs of failure to thrive, due in large part to their chronic dental pain. The question for us was not “are you in pain?”, but rather “which tooth hurts the most?” Although we were able to provide some pain relief, there is still much more work to be done.
This experience was enlightening in that it reinforced the idea that we as dentists should not be merely filling a hole or extracting a tooth, but rather managing a dynamic disease process. We are fortunate to have witnessed this at such an early stage in our dental careers. This has triggered a shift in us from focusing primarily on restorative care to prevention and health promotion, and taught us to see not only the tooth in question but more broadly the individual as a whole.