Table of Contents
Report by Haimisha Mistry
For my elective study, I travelled to South Vietnam along with 4 other UK dental students for an 8-day period of volunteer dentistry with the Degenhardt Foundation, a non-profit aid organisation set up in 2000 in Vietnam.
Aims & Objectives of the Study
- To determine the types of paediatric dental treatment most required in Vietnam
- To provide as much pain relief and basic paediatric restorative treatment as possible
- To provide dentistry of direct benefit to the oral health and quality of life of children in Vietnam, where treatment need is high, and to promote dentistry as a positive experience
- To carry out basic oral hygiene instruction and provide oral hygiene aids, with the aim to define the importance of oral health, prevent future disease and improve overall dental health
Various dental suppliers and practices were contacted for dental equipment and materials donations, which were collected in the UK and brought to Vietnam for the volunteer dentistry period. The study involved 4 days of volunteer dental work at Ho Chi Minh Street Children’s Centre in Ho Chi Minh City, and 4 days at the Health Care Centre of Huong My Commune, Mo Cay District, Ben Tre, to which schools and orphanages in the area were invited to attend for dental treatment. Whilst Ho Chi Minh City is the largest city in Vietnam, Ben Tre is a rural province situated in the delta of the Mekong River. Ben Tre is an area that was severely affected by the Tet Offensive in 1968 during the Vietnam War, and is one of the poorest provinces in Vietnam.
In both Ho Chi Minh City and Ben Tre, we would arrive early each morning and set up for dental work. Portable chairs were folded out to be used as dental chairs. We grouped instruments (mirrors, probes, excavators, forceps, elevators) into separate collections on our ‘clean’ table, so that they could be easily selected as required, along with LA, restorative materials, gloves, masks, disinfectant etc.
A large tub of soapy water was placed under each dental chair for placing 'dirty' instruments in after use, bin liners were attached to the chairs for disposing of clinical waste, and an empty water bottle for a sharps container placed at the end of the 'clean' table, slightly away from the materials and other equipment.
Oral Health Promotion
Before any treatment, each morning and afternoon of dental work started with basic oral hygiene instruction and oral health promotion. A tube of fluoridated toothpaste and appropriate sized toothbrush was distributed to each child. We explained why it is important to prevent decay and how this might be achieved. Correct toothbrushing technique was explained in detail and demonstrated on one of the children. They were asked to practice brushing and demonstrate what they had learnt, and we adjusted and corrected the children individually to improve their technique and make sure they understood how to brush effectively.
Advice to reduce sugary intake and its frequency was also emphasised. In Ben Tre, school teachers and any parents who were present also observed the oral hygiene sessions and listened carefully to dental health advice, so that the oral health message to the Vietnamese community and likely impact of oral health promotion was improved.
The system for dental treatment involved children being called in groups to be seen by the qualified Vietnamese dentist, who would quickly examine the child's dentition and determine a treatment plan. A typical treatment plan would indicate on a basic dental chart the teeth to be extracted or filled, with instruction to either 'extract', 'drill and fill' or 'clean and fill' (i.e. remove caries atraumatically).
We dental student volunteers carried out the suggested dental treatment. The 5 of us rotated between having 3 dentists each working on a patient at a time and 2 ‘runners’ to help bring equipment, mix materials and hold the patient’s ‘dirty’ tray at the dentist’s side. We had 4 translators helping in both Ho Chi Minh City and Ben Tre, who would help set up the treatment room, hold a torch positioned over the patient’s mouth in place of a dental light, and hold the tray of instruments at the dentist’s side, in addition to enabling communication between dentist and patient throughout treatment. We successfully carried out dental work by this system in both Ho Chi Minh City and Ben Tre.
Almost 60% of children examined in Ben Tre required and agreed to have treatment compared to only 30% of children examined in Ho Chi Minh City. The total number of children treated over 4 days was also noticeably greater for Ben Tre, with 131 children treated compared to only 55 treated in Ho Chi Minh City. A much wider spectrum of dental health was observed in Ho Chi Minh City, ranging from children with good oral hygiene and low treatment need to children with widespread gross caries and very little personal dental health care, compared to the gross, visible caries seen in the posterior teeth of most children attending for treatment in Ben Tre. Accordingly, over 4 days of dental work in Ho Chi Minh City, the number of teeth restored was similar to the number extracted, whilst in Ben Tre there was a considerably greater treatment need for extraction compared to restoration. In Ben Tre, 119 patients required tooth extraction compared to only 17 requiring restorative treatment, 5 of whom required both types of treatment. In both locations, the teeth most frequently needing treatment were Ds, Es, 6s and 7s.
The results indicate a high need for paediatric dentistry in Vietnam, and show that populations living in rural areas tend to have a considerably greater need for treatment. The level of poverty is greater in rural areas, so that affording a reasonable lifestyle becomes more of a priority than seeking dental care. Overall, extraction of carious deciduous teeth was required more than any other type of treatment, suggesting that caries develops and progresses without intervention to the extent that the tooth becomes unrestorable. Following from this, I conclude that early oral hygiene education and dental intervention as soon as caries starts would be most beneficial to the dental health of children in Vietnam. Additionally, the role of diet in dental caries needs to be communicated and emphasised to the population as a whole.
All in all, we had a brilliant time in Vietnam with the Degenhardt Foundation. As well as having the opportunity to learn about the lifestyle, culture and history of such a faraway and beautiful country, we enjoyed an invaluable experience of paediatric dentistry. Thank you once again to the Degenhardt Foundation for a fantastic elective experience.
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