Studying oral health in the United States vs. foreign countries
The aim of this study was to compare the oral health status of underserved individuals in the United States with underserved individuals in two other countries, Colombia and Kenya. Each year, dental students from the Ostrow School of Dentistry of University of Southern California (USC), Dental Humanitarian Outreach Program (DHOP) travel overseas to countries where residents with untreated dental problems have no access to dental care.
The 2011 and 2012 locations visited were Cartagena, Colombia, and Nairobi, Kenya; both are considered third-world countries.
Inhabitants in these locations were compared to Los Angeles residents who also had untreated dental problems with no access to dental care. All patients at each of the three dental clinic locations were treatment planned by student dentists, obtaining approval for proceeding with dental care from USC dental school volunteer faculty.
Once formal and appropriate data were collected, specific dental needs were determined as low, moderate or severe. Dental treatment was limited to prophylaxis, restorative treatment and extractions. Final analysis of dental care from each of the three clinics showed that the individuals from both third-world communities as well as Los Angeles had varying degrees of dental needs. Regardless of whether patients treated lived in third-world countries or in the United States, their needs for dental care were emergent and crucial to bettering their general and oral health condition.
The DHOP dental students travel overseas each year to countries where residents are underserved with respect to their dental needs. Dental treatment and procedures completed included (a) periodontal cleanings; (b) restorative dentistry, i.e., caries cleanout followed by amalgam or composite-resin restorations; and (c) oral surgery for patients with unrestorable teeth. The 2011 and 2012 abroad clinic locations visited were Cartagena, Colombia, and Nairobi, Kenya. Both cities were considered to be third-world populations and the patients treated resided in slum areas within these cities. A review of the literature verified that dental needs in third-world countries were more extreme than those found within the United States (Nunn et al., 2008). This study was conducted to evaluate and compare the oral health status of individuals from the following three locations: Cartagena, Colombia; Nairobi, Kenya; and Los Angeles.
Materials and methods
Data were gathered from clinics in three countries: Colombia, Kenya and the United States. All patients at each of the three city locations were treatment planned by student dentists, obtaining approval for proceeding with dental care from USC dental school volunteer faculty.
After oral examination and radiographic screening, data were collected; the need and priority for specific dental care was determined. Periodontal health was assessed from levels of (a) plaque, (b) calculus and (c) inflammation and measured as low, moderate or severe. USC student dentists and faculty assessed inflammation levels as either localized (< 30 percent) or generalized (> 30 percent). Bone level and gingival attachment were measured to finalize each patient’s periodontal diagnosis.
The severity of decay and restorability of teeth were also evaluated. Dental treatment was limited to (a) scaling and root planing, (b) restorative treatment, and (c) tooth extractions due to constraints such as time, financial resources and volume of patients.
Data analysis from each of the three dental clinics showed that individuals in underserved, third-world communities had varying degrees of dental needs, but greater than did U.S. citizens. Data were collected from 490 patients in Colombia, 187 patients in Kenya and 110 patients in the United States.
Periodontal health and restorative needs were the most impacted variables. Poor access to care and financial restraints were two primary restrictions for achieving optimal oral health. Overall dental care data indicated the following extent of needs: (a) moderate to severe in Cartagena, Colombia; (b) severe in Nairobi, Kenya; and (c) low to moderate in Los Angeles.
Need for dental care was measured based on the following parameters:
Low: Prophylaxis treatment and no carious teeth
Moderate: Prophylaxis treatment and one to three carious teeth
High: Prophylaxis treatment, three or more carious teeth and/or one or more unrestorable teeth due to caries or infection
Proportionally, more prophylaxes than restorative treatments were completed in Cartagena, suggesting that many patients had previous dental treatment and/or better oral hygiene. In Kenya, dental prophylaxis and restorative treatments were found to be equal, with no patient records of previous dental treatment. The decreased numbers of patients treated in Kenya compared to Colombia were affected by (a) limited power supply, (b) supply arrival delays and (c) time allotted to treating each patient as a result of the severity of dental needs.
To improve the oral health status of individuals in these countries, USC dental students (a) delivered 15,000 toothbrushes to patients and their families; (b) provided oral hygiene instructions to each patient, emphasizing the importance of proper brushing and flossing; and (c) reviewed nutritional counseling to all patients with poor eating habits.
Regardless of whether individuals live in third-world countries or the United States, the need for dental care and maintenance is imperative. Alarmingly, one does not have to visit a foreign country to see conditions of third-world oral health. As dental professionals, it is our ethical responsibility and moral obligation to society, adhering to the principles of social justice, to provide dental care to less fortunate individuals in our communities.
While this study concentrated on oral health status comparisons from the three countries, no formal oral health surveys have been conducted in specific areas of Kenya, Colombia and the United States (Kaimenyi, 2004).
Although the results of this study are not representative for each of these populations as a whole, they did provide a general understanding and appreciation for the oral health status of the Kenyan, Colombian and American populaces.
Note: This article was published in Ortho Tribune U.S. Edition, Vol. 8, No. 1, Spring 2013 issue. A complete list of references is available upon request from the publisher.