Table of Contents
Report by Amish Raichura
In Summer 2007, several colleagues and I embarked upon an incredible journey promising to offer unsurpassable experiences of dentistry in both social and cultural environments vastly different from our own. I wanted to be moved by what I saw, to return home changed for the better, humbled and wiser to the extremities in the standards of health care available around the world.
To achieve my aims, it was essential that we demonstrated the professionalism ingrained within us as members of a greater institution. I felt it necessary to submerge myself in the local culture as far as possible, to experience for a brief time, what the local people experienced on a daily basis. With this platform for an empathetic approach, I felt the dentistry provided would have to be maximally efficient to have any hope of a lasting impact on both the dental health and the dental attitudes of the local community.
To achieve these aims, I contacted the Degenhardt foundation, a charitable organisation endeavouring to improve the life of children worldwide. I conversed with the lead coordinator of the Vietnam Humanitarian Aid subdivision, which amongst its many projects offers a free dental clinic administrated by volunteers.
My colleagues and I were located in Danang (Vietnam) to treat the poor children and orphans in the local villages. We subdivided the team into groups that provided different forms of treatment and then we organised a regular rotation to maximise the variety of dentistry experienced by each student. The first group assessed each patient that arrived and formulated a treatment plan. The second group prepared cavities for receipt of a material using a combination of hand excavation and the fast hand-piece. The third group restored the cavities with the appropriate material. The final group was involved in the extraction of unrestorable teeth. We also set aside a 45-minute period daily for oral hygiene instruction.
In our time in Danang, there were hundreds of patients that arrived with the prospect of receiving treatment. Over half were deemed to have insufficient need of treatment when balanced against those with greater need and the available resources. Of those that were treated, it was the children within the community that necessitated the greatest care. Many had unsalvageable teeth that required extraction. However, with many of the children entering into the mixed dentition, a large proportion of the teeth being treated were permanent and so there was reason to save such teeth if at all feasible. Consequently, there were more restorations performed than originally anticipated. The main restorative materials used were ‘IRM’, ‘Chemfill’ and Fuji II GIC, a longer-term alternative. More complex treatments were not viable given the available resources.
I drew several deductions about the availability of dental care, the delivery of this care, the state of dental health and the level of dental awareness. It was clear that while having a whole host of struggles to combat on a daily basis, dental care was relegated down the extensive list of priorities. The resultant lack of demand for dental care was reflected in poor availability for those that sought it. The results were evident in the dental health of the local children. It was clear that there was a very poor standard of oral hygiene coupled with poor knowledge of cariogenic dietary components, which culminated in a high caries prevalence rate and significant periodontal disease. The local population simply were not aware of the importance of maintaining a healthy intra-oral environment and raising awareness proved to be the biggest issue.
I feel I could extend my work in this environment by increasing dental awareness. While in Danang, I became aware that the majority of the disease I was facing stemmed from a fundamental lack of knowledge in methods of oral preservation. Given the opportunity to further my work, I strongly believe that in-depth instruction in oral hygiene and dietary advice both with visual demonstrations and translated question and answer sessions would help to change attitudes and knowledge in oral maintenance, which is essential for long-term change.
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by Don Funk