Should dental outreach be done at home or abroad?

This article originally appeared as a point-counterpoint feature in the Winter 2013 issue of Mouth. One viewpoint is presented here; read the student response.

To improve population oral health, focus on prevention and start at home

Most students and faculty who organize and participate in overseas mission trips are motivated by the sincere desire to help others. Often they pay for their own travel through combinations of personal assets, donations and active fundraising. I think these mission trips are well-intended acts of caring. However, as a public health dentist I question the decision to spend so much time and money providing services that generally do very little to eliminate the underlying disease process, do not empower communities to improve their health status and waste resources on travel that might be spent in a much more cost-effective way to achieve improved oral health.

Why do our dental students travel to the ends of the earth to extract teeth and fill holes when there are massive unmet oral health needs in their own back yards? There is barely a county in America that does not have a sizable population with urgent needs for dental care. The oral health surveillance system we’ve established in Alachua County, Fla. – home of the University of Florida College of Dentistry – found that 30 percent of third graders have untreated cavities, 7 percent have such severe disease that they are either in pain or have dental abscesses when we see them, and more than 60 percent do not have dental sealants on permanent molars. In rural counties, where dentists are fewer in number, poverty is more prevalent and community water fluoridation is less common, the situation is worse.

Last year, there were 169,000 visits to hospital emergency departments in Florida for dental-related problems, with charges totaling more than $225 million—most of which was charged to Medicaid or unreimbursed. This inappropriate use of taxpayer dollars in a setting not equipped or staffed to provide dental services is driven by the crisis in access to routine dental care in Florida, a situation that unfortunately exists in almost every state in the nation. One need not fly overseas to find communities and people that desperately need dental services.

Public health has long recognized that focusing only on treating advanced disease is unsustainable and won’t reduce the burden of disease. Our work in low-income nations would be better focused on establishing community-based prevention programs, training local personnel to provide basic dental services and working with governments to establish culturally competent systems for preventing and managing disease. Meanwhile, U.S. dental students and faculty can find many opportunities within their local communities to volunteer their services to help prevent and control oral disease.

~ Dr. Scott L. Tomar, MPH, Dr.PH, professor, University of Florida College of Dentistry, Department of Community Dentistry and Behavioral Science

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