Global Health Nexus, Summer 2003

A Visit to Guyana Inspires a How-To Guide for Dentists in Remote Regions

Dr. Meredith Glen, Class of 2000, is a first-year postdoctoral student in pediatric dentistry.

Although many people living in Guyana’s jungle villages rarely use a toothbrush or see a dentist, they nevertheless consider dental care a good thing. So last October, when the local villagers learned that Dr. Page Caufield, Professor and Head of the Division of Diagnostics, Infectious Disease, and Health Promotion, and I were scheduled to visit their homeland in South America’s Amazon Basin, they waited for hours in the oppressive equatorial heat outside local health clinics hoping to be seen. When we discovered that the clinics were little more than bare-walled rooms with no electricity, I wondered how we could possibly meet their expectations. True, we had brought some instruments from New York, but how could we efficiently treat a range of chronic conditions when we didn’t even have a dental chair at our disposal?

Before long, I was busy adapting techniques I had learned at NYU Dentistry to this strange new environment. But it was a trial and error process that left me wishing that I could simply open a book for advice on working in a remote, isolated setting. Amazingly, by the conclusion of our two-week trip, I felt I had learned enough to write such a guide myself.

Dr. Caufield and I began our trip by visiting a series of rudimentary clinics set up deep inside Guyana’s rain forest by Rural Area Medical, an organization founded by Stan Brock, former host of TV’s Wild Kingdom, and a local Rotary Club. At our first stop, we found dozens of people of all ages waiting for us. Given our time constraints, we decided to focus on extractions to relieve the most acute decay. Second, we figured out how to use our scant resources most efficiently. Lacking plumbing, we used buckets instead of spittoons. We made fidgety children comfortable by placing them in a chair borrowed from the schoolhouse. This enabled a child to lean back and relax his or her head in my lap. No electricity? I had brought along a solar-powered drill that worked wonders in the tropical sun and helped us replace the standard amalgam filling with a rapid atraumatic restorative treatment (ART) based on a glass ionomer sealed with a self-adhesive bonding agent donated by 3M ESPE.

We also learned first-hand about the effects of the villagers’ longstanding poor oral hygiene. There were many cases of hypoplastic teeth apparently caused by childhood malnutrition progressing to more serious decay in adulthood. Children and adults alike consumed large quantities of tropical cassava root and refined sugar, but few bothered to brush away the sweet, starchy residue. And there were many instances in which we had to apply extensive sutures and pressure to stop excessive bleeding caused by extractions in people with severe decay.

I quickly realized that we could make a bigger impact on long-term health by shifting our focus from extractions and fillings to preventive sealants. So our goal became to place sealants on as many people’s teeth as possible, while continuing to relieve acute pain. Once again, we found a way around limited resources. We set the liquid sealant with a battery-operated 1,000-watt handheld curing light, also donated by 3M ESPE. By the time we left, we had placed sealants on 500 villagers, and I returned to New York feeling like we had made a lasting difference in people’s lives.

Back home, I began to write my guide for dentists working in remote regions. When it’s completed, it will include advice on everything from packing equipment to comfortably positioning patients in ordinary chairs. It’s my hope that it will encourage other dentists to reach out to people in medically underserved areas of the world.