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DENTAL REPORT
by Lillna Vega
Resident, University of Rochester
COMMUNITY AND NEEDS ASSESSMENT San Jose and Las Delicias, San Marcos de la Sierra, Intibuca, Honduras
May 2010
The beauty of this trip was the opportunity to share and to get to know the Hondurans. The trip was intense physically and
emotionally but a lot of good experiences and information were obtained.
The University of Rochester has been working in San Marcos de la Sierra area for over 5 years; the dental component started in
2006. Dentistry has been a very important part of the work with this community. Large numbers of people from the community visit
the dental clinic during the brigade.
One of the objectives of this trip was to reevaluate the current status of dental disease after the intervention begun 4 years ago. The
first task was for Dr. Carberry, my supervisor, and me to calibrate our examination criteria. In order to accomplish the calibration,
we performed 65 exams in San Jose Centro. I was able also to learn how to conduct an oral health intervention, school-based oral
rinse program. The intervention consisted of giving fluoride rinse ( 0.2% sodium fluoride) to the children at school under teacher
supervision. Fluoride salts are used to remineralize through the formation of fluropatite, a naturally occurring component of tooth
enamel.
The data substantiates that the goal of improvement after the fluoride program is being accomplished. Eighty-one percent of the “12
plus” children are still disease free. The DMFT-12 rate is 0.18, with 100% of the decay on the occlusal surfaces.
Another part of this brigade was to work in the dental clinic seeing emergency patients. Because these patients come in only for
emergency treatment, basic oral health is neglected. Poor oral hygiene and untreated oral diseases have a significant impact on the
quality of their lives.
While providing emergency dental care, I was able to practice surgical techniques using chisels. These instruments are used to
remove bone and to split teeth and bone. This was a good opportunity to practice a technique very different from the ones we in use
today.
One of the most important aspects of this program is the dental education of the medical resident and medical students. During the
brigade a medical resident rotated into the dental clinic every day. We had the opportunity to discuss interesting cases and to show
them anesthesia techniques. The goal of their dental experience was to expand their knowledge of good oral health and to provide
sufficient skills such that, when necessary, they could diagnose dental pain and infection and be able to stabilize the situation.
LAS DELICIAS.
Background: Las Delicias is part of San Marcos de la Sierra and is approximately 8 miles from San Jose.
Las Delicias is composed of villages populated by people descendents of the aboriginal Lenca Indians.
During the hiking we found several areas where the trail was steep and the footing was more difficult due to old leaves and rotting
mangoes.
The Trip to Delicias was a wonderful experience and worth every physical effort that I put into it.
Eight people hiked (seven Hours) to Las Delicias. We met with several community leaders, nurse, and lead teacher from each small
village.
Main Objective
The main goal of the rapid assessment team was to understand, from the perspective of local residents the key problems in their
community, to clarify their understanding of the causes for these problems and who they perceive to be responsible for causing/
fixing them.
Common theme
Many people spoke of the need for “potable” water; it became clear that this meant water close to home. The most commonly
mentioned needs were in areas of access to water, education, improved community access i.e. road, improved cook stoves, latrines,
home improvements, nutrition, access to health care, improved access to economic opportunity. I should note that all of those needs
are part of the University of Rochester’s program in San Jose.
We spent much of the time listening to them. We had the opportunity to visit their houses. We were able to get some information
about their concerns their needs and priorities. Also we documented our observations during our visits. I visited five houses from Las
Mesitas and five from Coyolar plus the school of Delicias Centro, Las Mesitas and Pilas. This is a much underserved community. It
was very incredible to visit them in their environment.
Dental assessment
The Community of Las Delicias is largely isolated from the dental care point of view. This was the first dental examination for 97 %
of the children; also the first time that someone other than their teacher, family and neighbors had expressed an interest in their dental
health. The other 3% had been treated for emergency visit (Extraction) by the wandering medical brigades that occasionally visit
sites in Honduras.
This population’s diet is very low in refine sugars and rich in simple carbohydrates. There Oral Hygiene habits are very poor.
Children, less than 9 year old, don’t understand simple dental terminology such as tooth brush, tooth paste ( cepillo de dientes, crema
de dientes ). Children older than 9 and have completed school (Colegio) understand a little bit more about Oral hygiene habits. Much
to our pleasant surprise, 53% of the children use salt water to brush their teeth.
We performed 45 surveys about dental knowledge and indigenous dental health practices. We know that their level of knowledge of
and attitudes toward dental health might be a potential barrier to effective oral preventive efforts. We found that 98% of the
population has a tooth brush but 55 % of the population use salt water as a dentifrice. We found that they use a plant with the name
of Quina. They prepare a tea out of the cortex of the tree and rinse several times a day. It seems to help to calm the pain. Also they
use menthol cream to apply in the area for the tooth pain. One person mentioned to drink alcohol (homemade alcohol) for the tooth
pain. Upon our return to Rochester, further research revealed that the bark of the Quina tree has known medicinal properties and
was actually used to treat malaria for World War II service men in the South Pacific.
Part of the dental assessment included 161 WHO style dental exams of the children attending the 4 schools in the area. The data
documented gross dental disease. The %dfs in the 6 – 8 year old children of Delicias was 19% as compared with the base line data
for San Jose of 11%. The documented DMFS rates were 1.9 for 6 -8 year old children; 2.96 for 9 – 11 year old children; and 8.18
for children 12 or older attending those schools. That data documents almost 3 times more dental disease than the WHO published
data for Honduras. During the exams, the teachers were encouraged to start fluoride rinse programs. It is hoped that the rinse
programs will be started even if no other programs were initiated by the U of R clinic. Subsequent to the evaluation, 2 of the 4
teachers (from Centro and Las Mesitas) contacted the clinic and obtained fluoride supplies. It is hoped that the teachers from Las
Pilas and Coloyar do the same.
REFLEXION
In my opinion these community have maintained a part of their simple linguistic and social organization without strong differences
between them and their Lenca ancestors.
During these ten days I just confirm that in a world of unprecedented wealth, a lot of children don’t have access to clean water and
adequate sanitation. Women and young children are forced to spend hours collecting and carrying water, restricting their
opportunities and their choices. Water-borne infectious diseases are holding back effort towards poverty reduction and economic
growth in many places in the world.
I have learned that good dental care can be provided in a resource poor community with a simple intervention to target the most
vulnerable population, children. That has strengthened my desire to work in that area and continue to work for the underserved not
only in developing countries but also in the US.
I would suggest to anybody that wants to go to Delicias to be in good shape emotionally and physically before the trip. I hope you
are not allergic to mangos and Avocados.
I would like to remind my readers of a quote from Edurardo Galenao, who is a Uruguayan journalist, writer. His most well known
work is Las venas abiertas de América Latina, ( Open veins of Latin America, 1971).
We should not go to the people and say, "Here we are. We come to give you the charity of our presence, to teach you our science, to
show you your errors, your lack of culture and your ignorance of elementary things." We should go instead with an inquiring mind
and a humble spirit to learn at that great source of wisdom that is the people.
by Lillna Vega
Resident, University of Rochester
COMMUNITY AND NEEDS ASSESSMENT San Jose and Las Delicias, San Marcos de la Sierra, Intibuca, Honduras
May 2010
The beauty of this trip was the opportunity to share and to get to know the Hondurans. The trip was intense physically and
emotionally but a lot of good experiences and information were obtained.
The University of Rochester has been working in San Marcos de la Sierra area for over 5 years; the dental component started in
2006. Dentistry has been a very important part of the work with this community. Large numbers of people from the community visit
the dental clinic during the brigade.
One of the objectives of this trip was to reevaluate the current status of dental disease after the intervention begun 4 years ago. The
first task was for Dr. Carberry, my supervisor, and me to calibrate our examination criteria. In order to accomplish the calibration,
we performed 65 exams in San Jose Centro. I was able also to learn how to conduct an oral health intervention, school-based oral
rinse program. The intervention consisted of giving fluoride rinse ( 0.2% sodium fluoride) to the children at school under teacher
supervision. Fluoride salts are used to remineralize through the formation of fluropatite, a naturally occurring component of tooth
enamel.
The data substantiates that the goal of improvement after the fluoride program is being accomplished. Eighty-one percent of the “12
plus” children are still disease free. The DMFT-12 rate is 0.18, with 100% of the decay on the occlusal surfaces.
Another part of this brigade was to work in the dental clinic seeing emergency patients. Because these patients come in only for
emergency treatment, basic oral health is neglected. Poor oral hygiene and untreated oral diseases have a significant impact on the
quality of their lives.
While providing emergency dental care, I was able to practice surgical techniques using chisels. These instruments are used to
remove bone and to split teeth and bone. This was a good opportunity to practice a technique very different from the ones we in use
today.
One of the most important aspects of this program is the dental education of the medical resident and medical students. During the
brigade a medical resident rotated into the dental clinic every day. We had the opportunity to discuss interesting cases and to show
them anesthesia techniques. The goal of their dental experience was to expand their knowledge of good oral health and to provide
sufficient skills such that, when necessary, they could diagnose dental pain and infection and be able to stabilize the situation.
LAS DELICIAS.
Background: Las Delicias is part of San Marcos de la Sierra and is approximately 8 miles from San Jose.
Las Delicias is composed of villages populated by people descendents of the aboriginal Lenca Indians.
During the hiking we found several areas where the trail was steep and the footing was more difficult due to old leaves and rotting
mangoes.
The Trip to Delicias was a wonderful experience and worth every physical effort that I put into it.
Eight people hiked (seven Hours) to Las Delicias. We met with several community leaders, nurse, and lead teacher from each small
village.
Main Objective
The main goal of the rapid assessment team was to understand, from the perspective of local residents the key problems in their
community, to clarify their understanding of the causes for these problems and who they perceive to be responsible for causing/
fixing them.
Common theme
Many people spoke of the need for “potable” water; it became clear that this meant water close to home. The most commonly
mentioned needs were in areas of access to water, education, improved community access i.e. road, improved cook stoves, latrines,
home improvements, nutrition, access to health care, improved access to economic opportunity. I should note that all of those needs
are part of the University of Rochester’s program in San Jose.
We spent much of the time listening to them. We had the opportunity to visit their houses. We were able to get some information
about their concerns their needs and priorities. Also we documented our observations during our visits. I visited five houses from Las
Mesitas and five from Coyolar plus the school of Delicias Centro, Las Mesitas and Pilas. This is a much underserved community. It
was very incredible to visit them in their environment.
Dental assessment
The Community of Las Delicias is largely isolated from the dental care point of view. This was the first dental examination for 97 %
of the children; also the first time that someone other than their teacher, family and neighbors had expressed an interest in their dental
health. The other 3% had been treated for emergency visit (Extraction) by the wandering medical brigades that occasionally visit
sites in Honduras.
This population’s diet is very low in refine sugars and rich in simple carbohydrates. There Oral Hygiene habits are very poor.
Children, less than 9 year old, don’t understand simple dental terminology such as tooth brush, tooth paste ( cepillo de dientes, crema
de dientes ). Children older than 9 and have completed school (Colegio) understand a little bit more about Oral hygiene habits. Much
to our pleasant surprise, 53% of the children use salt water to brush their teeth.
We performed 45 surveys about dental knowledge and indigenous dental health practices. We know that their level of knowledge of
and attitudes toward dental health might be a potential barrier to effective oral preventive efforts. We found that 98% of the
population has a tooth brush but 55 % of the population use salt water as a dentifrice. We found that they use a plant with the name
of Quina. They prepare a tea out of the cortex of the tree and rinse several times a day. It seems to help to calm the pain. Also they
use menthol cream to apply in the area for the tooth pain. One person mentioned to drink alcohol (homemade alcohol) for the tooth
pain. Upon our return to Rochester, further research revealed that the bark of the Quina tree has known medicinal properties and
was actually used to treat malaria for World War II service men in the South Pacific.
Part of the dental assessment included 161 WHO style dental exams of the children attending the 4 schools in the area. The data
documented gross dental disease. The %dfs in the 6 – 8 year old children of Delicias was 19% as compared with the base line data
for San Jose of 11%. The documented DMFS rates were 1.9 for 6 -8 year old children; 2.96 for 9 – 11 year old children; and 8.18
for children 12 or older attending those schools. That data documents almost 3 times more dental disease than the WHO published
data for Honduras. During the exams, the teachers were encouraged to start fluoride rinse programs. It is hoped that the rinse
programs will be started even if no other programs were initiated by the U of R clinic. Subsequent to the evaluation, 2 of the 4
teachers (from Centro and Las Mesitas) contacted the clinic and obtained fluoride supplies. It is hoped that the teachers from Las
Pilas and Coloyar do the same.
REFLEXION
In my opinion these community have maintained a part of their simple linguistic and social organization without strong differences
between them and their Lenca ancestors.
During these ten days I just confirm that in a world of unprecedented wealth, a lot of children don’t have access to clean water and
adequate sanitation. Women and young children are forced to spend hours collecting and carrying water, restricting their
opportunities and their choices. Water-borne infectious diseases are holding back effort towards poverty reduction and economic
growth in many places in the world.
I have learned that good dental care can be provided in a resource poor community with a simple intervention to target the most
vulnerable population, children. That has strengthened my desire to work in that area and continue to work for the underserved not
only in developing countries but also in the US.
I would suggest to anybody that wants to go to Delicias to be in good shape emotionally and physically before the trip. I hope you
are not allergic to mangos and Avocados.
I would like to remind my readers of a quote from Edurardo Galenao, who is a Uruguayan journalist, writer. His most well known
work is Las venas abiertas de América Latina, ( Open veins of Latin America, 1971).
We should not go to the people and say, "Here we are. We come to give you the charity of our presence, to teach you our science, to
show you your errors, your lack of culture and your ignorance of elementary things." We should go instead with an inquiring mind
and a humble spirit to learn at that great source of wisdom that is the people.
 |
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Terms and Conditions / Privacy Policy
Albany, New York 12211
ph: 518-465-0044
fax: 518-465-3219
alt: 800-255-2100
nysdf@nysdental.org
Terms and Conditions / Privacy Policy
