Table of Contents
Report by Sarah Akram
As part of my dental elective programme I joined a group of fellow dental students to carry out dental treatment in a rural part of Vietnam with the Degenhardt Foundation. For our trip we set out to fulfil a number of aims aimed at maximising a positive dental influence on as much of the local population as possible. These aims included
- To provide thorough oral screening for both adults and children in the local area.
- To provide as much emergency and basic restorative treatment as permitted by our limited resources. Thereby eliminating pain, reducing infection and restoring function.
- To give oral hygiene instruction sessions on a daily basis, including the correct technique for brushing, the use of fluoride and dietary advice. To ensure the prevention of future disease and to define the importance of oral health.
- To provide as many children as possible with basic oral hygiene aids such as a toothbrush and toothpaste.
- To provide every child as well as adult with a positive dental experience, especially for those who are seeing a dentist for the first time.
- To build our own experience and dental skills in a new and basic environment. In addition to build communication skills with individuals who do not share the same language as us.
Upon arrival we found that we had been given a very basic health centre, which was to be our clinic for the coming week. The first morning was spent unloading the van and unpacking the securely packed dental chairs and assembling them for use, this included the wiring for the dental lights. We had been allocated four rooms and in order to ensure we ran an efficient clinic we designated each room for a different type of treatment.
The first room was set up as the check up room. This did not require a dental chair and so was set up with two chairs facing each other one for the dentist and the other for the patient along with a large tray of disposable dental mirrors for the check up. The second room was designated for the preparation of cavities and so our portable hand piece unit was located here. The third room was the restorative room, here we set up our dental compound with our materials, instruments and gloves . The fourth room was appointed for oral surgery. In order to ensure that patients were aware of where to go following their check up we made signs in both English and Vietnamese.
To ensure cross infection control and health and safety standards were met we all wore personal protective equipment including gloves, masks and glasses. The patients were also given glasses and bibs. We implemented both the use of cling film and foil to cover surfaces between patients and Microzid to disinfect. Initially the foundation gave us bowls to place sharps however the risk of them spilling in the hectic environment was high. Therefore we used emptied water bottles for sharps bins for the reason that even if they toppled the neck was designed to reduce the contents falling out. Contaminated instruments were placed in bowls of water before being sent for scrubbing and then sterilising in our autoclave.
We split ourselves into three groups and rotated between each of the rooms as well as helping the qualified dentist carry out check ups and produce treatment plans. A typical treatment plan involved a visit to each of the rooms. Due to the sheer number of patients we did not all have the luxury of using dental chairs and both chairs and beds were used to seat the patient for treatment. With the help of members of the foundation and local university students we were able to communicate with the locals this was particularly important when giving oral hygiene instruction, post operative instructions and when taking histories. They also assisted in the mixing of dental materials and holding up torch lights for those who did not have dental chairs.
One part of each day was dedicated to oral hygiene seminars, where locals mostly children gathered in the court yard. We split them into small groups and demonstrated brushing on volunteers and even ourselves! To ensure they understood the information we had the help of interpretors and we asked the children to show us how to brush as well. We were able to provide every child we saw with a toothbrush and toothpaste, which was a great achievement.
Total number of check-ups: 1475
No treatment required: 808
Total number of extractions: 576
Total number of restorations: 205
Conclusion and Further Work
Over the seven days we were able to see an extraordinary number of patients. Although a large number did not require treatment they were still screened for oral disease and given preventative advice. A number of ‘no treatment’ patients did require complex treatment, which we were not able to offer in our basic clinic and so they were referred to the local hospital. The oral hygiene levels were poor and many people lacked a basic understanding and so many of the teeth were past the restorable stage, hence the reason for the large number of extractions.
Overall I believe our visit was a great success as we were able to deliver treatment in a very remote part of the world where many people do not have access to and cannot afford dental treatment. Not only were we able to offer much needed pain relief but our oral hygiene instruction, which they were very keen to learn and appreciate and will be passed on for generations to come. In addition our ability to provide every patient we saw with a toothbrush was a very satisfying achievement.
To improve and enhance our work it would be worth visiting the region in the future to see how the individuals are getting on. In addition our clinic did not offer definitive restorative materials such as amalgam and so for a future visit it would be beneficial to provide more sound restorations, whose properties are superior to glass ionomer cements. A shockingly large number of patients we saw were smokers and we provided very little smoking cessation advice. So for a future visit and to improve the quality of care delivered it would be highly beneficial for the locals to learn the risks of smoking.
Before visiting Vietnam I had travelled other countries in the far east, however Vietnam was positively distinct from its neighbours. I found the people of the country to be both humble and hospitable in every way from our friends in the Degenhardt foundation to the shopkeepers and street vendors. The landscape was breathtaking and we were lucky to visit the local mountain regions, ancient pagoda’s and beaches in Danang. This elective experience allowed me to open my eyes to Vietnamese people, culture and way of life.
On one occasion we were exploring the village and a local old lady came out from her house to befriend us. Although we could not communicate with her she insisted on talking to us endlessly in Vietnamese. She introduced us to all the members of her family and instructed them to bring out their chairs and sit with us. This for me sums up the hospitable and kind nature of the Vietnamese people. Still recovering from the war and rebuilding their country they are eager to make foreigners feel welcome.
The tailoring in Vietnam is of exceptional quality and we were all able to take advantage of the local tailors and purchased our own custom made suits and enjoyed in designing our own clothes. To suit foreign needs they had all the latest fashion catalogues available and were able to stitch our clothes in under 24 hours for fitting!
The chance to deliver dental treatment in a completely different setting was both a challenging and highly satisfying experience. Despite the pressure of large numbers of people waiting, the heat and our basic dental equipment our group found great joy in participating in this elective programme. In addition I was able to improve my skills as a dentist particularly in oral surgery
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Vietnam Photo Journal
by Don Funk