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May 13, 2008

By Michelle R. Mathieson

Ever think about traveling to another country to provide dental care? I first thought about it after one of my interviews for dental school, but not again until last fall when the opportunity arose to go on a weeklong trip to Jamaica in the summer. Luck was on my side, because I was one of 30-some students selected from a large pool of worthy applicants.

Jamaica was such a change of pace for me as a dental student. I was not reading texts or taking exams; instead I was working with patients. We only spent a week in Jamaica, but I learned so much in the short time spent there.

Each day began by loading boxes filled with instruments and materials onto buses that dropped us off at different locations. The sites were local churches and elementary schools that functioned as dental offices for the day. Since the sites were not true dental offices, our team had to improvise in order to create a smoothly running dental workplace. Patients sat in church pews or in camping chairs we brought from the United States while we worked by standing behind the patients. For overhead lights, we used headlamps intended for hiking or camping. Many of the sites were not air conditioned, so the windows were open in hope of a passing breeze. Sweat dripped down our brows as we worked. Despite the conditions, we worked hard and saw many patients each day.

Posing with the children in the church

One of the most exciting experiences was interacting with patients after two years of book work in dental school. It was my turn to explain the risks and benefits of a procedure, and what could happen if we did not perform the procedure. It felt good to finally be able to share my knowledge and skills with people, especially those desperately needing dental care.

One patient, a young boy about 5 years old who was accompanied by his mother, came to us with rampant decay of his deciduous maxillary teeth. This was a serious case of either negligence or ignorance, or both. We educated his mother on the boy's current dental condition, and how it might affect his adult teeth as they start to erupt into a mouth full of bacteria. We then showed her and her son how to properly brush their teeth to prevent future decay. Throughout the week, I worked with other children and learned to follow the mantra, "Tell, show, do." Forget one step and you will end up with a child who is afraid, making it very difficult to regain his or her trust.

Handing out toothbrushes and stickers to local children

Giving injections was another skill I had little practice doing until I went to Jamaica. I had given a few injections, but only on classmates during our scheduled anesthesia rotations. I was very nervous about performing an inferior alveolar block on a complete stranger. After treating numerous patients and performing successful blocks, I feel more comfortable because I can feel the anatomy, so I know when I am in the right location. I also gained confidence in giving injections necessary for surgical cases. Before, I could only imagine what it felt like to give a periodontal ligament injection. Now I know how to position the needle inside the periodontal pocket and can feel the resistance as the anesthetic is injected into the pocket.

Not only did I gain experience in performing injections, but I also worked with many patients per day compared to dental school where I see one patient each half day. Every morning we were greeted with lines of patients, and all of them badly needed to be seen by a dentist. Some patients arrived hours before we arrived to the site. With so many patients to be seen in such little time, I learned how to quickly assess the situation and determine what needed to be done for that individual.

This trip was not just about what I or other student dentists gained in experience, but it was also about the treatment received by the patients. Countless patients arrived in pain due to loose teeth or infections. The treatment we provided relieved patients of agonizing pain. One woman had a single canine remaining in her mouth when she came to us. I felt sad extracting her last tooth, but she kept smiling because she was glad the cause of her pain was gone.

Michelle Mathieson and a patient

As we extracted more of their teeth, the patients lost their smiles and the functionality of their mouths decreased significantly. The first day we were there, my first patient came in with a rudimentary maxillary partial denture held in place by the canines. Those canines were her last upper teeth. Unfortunately, both of the canines were severely decayed and not strong abutment teeth for the partial denture. The patient needed the canines to support the denture, but the teeth needed to be extracted because they were in such poor condition. It was quite a dilemma. We informed the patient of the risks and benefits of losing those crucial teeth. After the extraction we tested her denture, and as predicted the denture kept falling. Moments like those made me wish we had the time and tools to make new dentures for patients who really needed them. I can only hope that the people with ill-fitting dentures are willing to find a dentist and have the means to pay for a better fitting denture.

Ping Ping DeLucia and a patient

Even though we provided a great service to numerous people, I wish we had been able to provide more complete care. Most of the procedures performed were extractions, with only a small number of restorations. Some of the extractions may have been prevented if we had the instruments, time, and people available to provide periodontal or endodontic treatment.

Anna Fedak working on a patient

One of the most important tools we lacked was the ability to take radiographs. Our team did not have a way of exposing or developing radiographs. We could only estimate the extent of the infection based on the patient's symptoms, and we hoped for uncomplicated root anatomy. Although we had a large team of dentists, we had a larger number of patients. This ratio put pressure on us to see as many patients as we could each day, while making sure each patient received quality care.

Even though we were limited in the type of treatment we could provide, the care we did provide was more than welcomed. The care was free so people who could not afford to visit a dentist came to us. Several patients showed their appreciation by bringing us fresh pineapples, bananas, sugar cane, and coconuts that they grew themselves. It was a nice treat to know patients appreciated what we had done for them.

Ping Ping, Michelle, and Anna at a banquet before heading home

This trip was extremely beneficial for me. I gained dental experience in an environment that is unlike the dental communities in U.S. cities. I learned how to communicate with patients about dental care in ways they could comprehend. It was hard work, but at the end of the day I was happy with the services I provided and the people I met. It was a very rewarding experience that I will never forget.

Michelle Mathieson is a dental student at Nova Southeastern University in Fort Lauderdale, Fla. She is the president of Nova's AAWD chapter. She is a recipient of the 2008 Summer Dental Student Award from NIH, and will be conducting research on Sjögren's Syndrome at the National Institute of Dental and Craniofacial Research in Bethesda, Md. E-mail her at mmathieson@gmail.com.

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