International rescue

With 76% of Nepalese people needing dental treatment, figures from Work the World’s 2011 Dental Outreach Projects highlight the problem of oral health within rural communities in the developing world.

The Work the World Dental Outreach Projects run throughout the summer months, with teams of up to 12 dental students heading out to screen, treat and educate in remote communities that have little or no access to dental healthcare.

Working under the supervision of an in-country professional dentist, students in their final year are able to help those who need it most, without compromising the safety of the patients or themselves.

This year, the focus was on Nepal and Ghana, with a total of five projects running in different locations. Extensive work is done in advance to ensure local communities know of the free clinic so, despite their rural locations, every morning it is common for students to be greeted by a queue of people snaking through the village waiting their turn.

And it’s worth staying – 6,357 villagers were screened by the Work the World teams this year.

Asia operations manager Alison explains why there is such a demand: ‘For many rural communities, like Dhampus, the site of our first Nepal project, the long and costly trip to reach a hospital for treatment is reserved for emergencies. Oral and dental health is not considered a priority – at the same time a lack of education about basic preventive measures as well as delays in presenting mean large numbers of the community suffer from advanced pathologies, severe decay and poor oral hygiene.’

Richard, a student from Cork University, worked in Birethanti, Nepal. ‘We had a makeshift marquee outside where patients waited to be first screened in one classroom and then, if required, treated in the one next door. Often, patients had been suffering with recurrent pain and inflammation for a number of years before we were finally able to remove the source of infection.

‘The main areas of treatment are scaling, fillings and extractions – many of which could have been avoided with proper care of teeth and gums. Vijal from Sheffield was keen to make sure children understood this, running regular classes on how to brush teeth properly.’

Limited resources
Depending on where the project takes place, the students are also faced with different dental challenges. In Ghana, there was lots of overcrowding of teeth, a common problem in developing countries, and in Nepal, Pam from Dundee found ‘wearing down of teeth is very common. Although there are no cavities or decay, some have worn down right to the root and have to be extracted’.

The number of extractions caused mixed feelings. Ali from Dundee felt ‘having to extract teeth that, at home, we would be able to save is hard. We just don’t have the equipment here to be able to fill them, and we know they won’t take action if we don’t, so we have to be quite ruthless and extract them. It’s a shame if it’s children.’

For many dental students, the chance to get hands-on work, as well as see advanced pathologies, is the main reason for an elective or placement in the developing world.

Ian, a student from Newcastle, explains: ‘At home we learn about things in textbooks – pathologies are nipped in the bud before they progress too far. In Ghana, we were able to see first-hand the effects of patients who delay presenting. I learnt so much about the realities of gum disease and decay.’

Working with professionals from another country is another huge benefit. Many students found supervisors at home relied on technology and a variety of equipment, but in the clinics the focus was on manual skills and minimal resources. A surprise challenge was a forced lowering in standards of dental practice. Infection control simply cannot be maintained in a temporary clinic miles away from the nearest large town.

Richard, from Newcastle, said: ‘It was often necessary to overlook poor levels of cleanliness and lack of sterilised equipment and concentrate on providing dentistry to those who had often never seen a dentist before.

‘Often patients had been suffering with recurrent pain and inflammation for a number of years before the team was finally able to remove the source of infection.’

Next year, Work the World is planning to focus its Dental Outreach Projects on Nepal.

Faye Stickings, overseas director, said: ‘While the projects do amazing work for the time they are there, we really want to look at their sustainability. We always educate the community about the importance of looking after teeth and gums, but we want to look at what else we can do to ensure the communities maintain good oral health.’

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