Tuesday, December 14, 2010

Dental Clinic Operations

Today was the second day of our dental clinic operations at Paril National High School and other than some equipment issues, everything went pretty well. So far, I think we've seen around 60 patients,all of which were kids, with the exception that Melvin did some anterior restorative work on one of the teachers, today. Some observations: all of the kids seen range in age from 7-8 up to 17. Most have significant decay in permanent teeth, mainly molars. Indeed, it is not at all unusual to see teeth rotted off to the gum-line with either acute abscesses, or draining fistulous tracks leading to chronic abscessed roots. I had hoped that we would be able to do more restorative work this year, however, because of such acute needs, we spend most of our time doing extractions. Jay commented today that, we could easily spend all week on a very few patients, involved in comprehensive dentistry, and probably not even put a dent in the need. The way it works is: we have the school principals at each of the barangay schools pick out the 30 neediest kids from a dental standpoint, and each day, we see only those kids. There are four barangays that we are involved in. Given the experience level of our students and the circumstances that we work under, 30 patients per day is a nice manageable number. On any given day, my students range from second year to senior level dental students, with their individual skill levels very variable. In addition I also have 4 other students from various disciplines who serve in the capacity as dental assistants. We have four "operatories" set up and function without the benefit of x-rays, or alot of the other stuff that most dental offices would have. In spite of these conditions, excellent quality care is delivered. Last year, we had some officials visiting from the Ministry of Health, and they were very impressed with our field clinic set up, and the skill level of our students. They were also very impressed with the numbers of patients treated in the relatively short time spent here. We have been told that the government dentists only make it up into the mountain barangays maybe once a year, and then do no restorative work,or as far as we can tell, not much else, either. The roads are so bad that mobile clinic facilities can't make it up there, and the patients rarely come down the mountain for any care, either. So, the services that we deliver are very valuable to these communities. The question is asked,"Why are these kids in such bad shape"? The answer is very complicated. First of all, potable drinking water is very scarce. One would think that, given this is a tropical climate with incredible amounts of annual rainfall, water shortage would be impossible. The problem is, for the communities in the mountains, there is no way to collect this water for later use and no way to distribute it to individual homes. Certainly, municipal fluoridation is unfeasible. During the dry season(there are no seasons other than the wet season and the dry season), water shrinks to a trickle in the stream beds in the mountain valleys, is significantly polluted, and when used, sometimes has to be hauled by had up tricky mountain trails, sometimes for 3-4 kilometers. As a result, the people become essentially dehydrated, and replace the missing water with fruit juices, and soft drinks, neither of which promote dental health. General nutrition seems to be inadequate, and in many instances, the children exist on snack-food, which is cheaper than quality food, and certainly more convenient, requiring no cooking or preparation. Oral hygiene is inadequate, as well, with tooth brushes and toothpaste being relatively expensive. I suspect that there is also a genetic preponderance to susceptibility to dental disease, which also stacks the deck against these kids . Interesting thing, though, is that these kids are really tough and stoic. It is amazing what some of them must have suffered prior to our being able to treat them, and many of them never even flinch when receiving local anesthesia. Ocasionally, their situations present a technically difficult surgical situation, and in spite of it, they handle it very well. My students are flabbergasted by how cooperative and appreciative these kids are. Often, upon completion of whatever procedure was performed, the child will hug the student and thank them for their treatment. That sure doesn't happen much back home. So, this is a good work, a noble work, and well worth the efforts that we all put forth to make it happen.

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