Fall/Winter 2005 Table of Contents
International Partners in Health
Developing an Oral Health Profile of Haiti

Dr. Christina LaFontaine takes saliva samples from children.

University of Haiti School of Dentistry Professor Dr. Samuel Prophete, a coinvestigator on the early childhood malnutrition study, examines a child in Jeremie. Dr. Prophete was a Visiting Professor at NYUCD in November 2005.

Dr. Walter Psoter with children in the study.
NYUCD and University of Haiti Partner on Epidemiologic Research

NYUCD and the University of Haiti School of Dentistry have entered into a formal agreement to jointly research oral conditions in Haiti over the next five years in order to help the island nation’s government plan effective oral health programs for the future. The agreement has the added goal of building a cadre of epidemiologists who are qualified to conduct future oral health research on the island. To that end, University of Haiti students will be mentored to become epidemiologic researchers.

"This agreement helps us begin to correct the problems caused by a scarcity of data about oral health in Haiti," said Dr. Ralph V. Katz, Professor and Chairman of NYU’s Department of Epidemiology & Health Promotion. Added Dr. Ernst Joseph, Dean of the University of Haiti School of Dentistry, "Because so little research has been conducted to date, the picture of oral health in Haiti today is virtually a blank canvas. With this agreement, we can begin to fill in the picture."

By agreeing to jointly plan and implement a series of epidemiologic studies, the two schools are expanding a relationship that began eight years ago, when they collaborated on the first - and, to date, only - national survey of Haitian children’s oral health. That study, which was limited to 12- and 15-year-olds, found that while Haiti had the Western Hemisphere’s lowest prevalence of dental caries in these two age groups, the unmet treatment need, as measured by the ratio of treated to untreated lesions (i.e., D/D+F), was among the highest in the Western Hemisphere.

More recently, Dr. Walter Psoter, Assistant Professor of Epidemiology & Health Promotion, was able to secure a three-year, $1.6 million NIH grant to investigate the impact of early childhood malnutrition on the development and diseases of the permanent dentition in teenagers in rural Jeremie.

Despite an abundance of breadfruit, mango, and papaya, many in the rural mountain villages of Haiti lack basic nutrients, often subsisting on just one major meal daily - typically a bowl of corn meal porridge. In 1998, the Haitian Health Foundation, a Non-Governmental Health Organization (NGO) - created and administered by a Connecticut orthodontist, Dr. Jerry Lowney, and operated daily in Jeremie by Bette Gebrian, RN, PhD, a nurse anthropologist - stepped in. The Haitian Health Foundation sought to address the problem by enrolling over 16,000 children in a nutrition program, and creating a database to track each child’s weight. Using the database, Dr. Psoter was able to identify 1,000 children who could be categorized according to five levels of malnutrition status, ranging from none to severe. With the help of the NIH grant, he is examining the children to determine whether specific levels of malnutrition correlate with the development of specific oral health problems, such as susceptibility to dental decay, decreased saliva flow, and enamel hypoplasia - a deterioration of the tooth surface.

The general immobility of the target population - most rural residents remain in the same village all their lives - provides Dr. Psoter with a relatively concentrated and easy-to-track population for long-term study.

Last summer, the field phase of the study was completed. All of the 1,000 13- to 18-year-olds were examined for dental caries by a research team consisting of NYUCD faculty, University of Haiti dental faculty, recent graduates of the University of Haiti School of Dentistry, and current MS in Clinical Research Program students at NYUCD. In addition to completing the main objectives of the study, the research team was able to conduct a pilot study on periodontal disease in a subset of these Haitian teenagers, as well as a pilot study on developing a survey instrument for establishing the prevalence of NOMA, a rapidly progressive and highly destructive infectious eroding of the face.

Dr. Psoter’s work in Haiti has already led one recent University of Haiti School of Dentistry graduate to consider a career in epidemiologic research. While working as his research assistant and observing the children’s malnutrition, Dr. Christina LaFontaine decided to postpone her plans to work in a private practice in relatively affluent Port-au-Prince in order to spend more time working on Dr. Psoter’s study and preparing to apply for advanced study programs in epidemiology in the United States.

The following is an excerpt from Dr. LaFontaine’s journal.
"Right after I gave my agreement to enroll for the study, I attended calibration sessions under the guidance of Dr. Walter Psoter and Dr. Ralph Katz (respectively Principal Investigator and Coinvestigator of the study). From May 3 to May 11, 2005, these sessions occurred in theoretical and practical phases. The main objectives of this calibration were to ensure standard and accurate assessment of dental status and salivary gland function by examiner and valid registration of oral data by recorders. The theoretical part covered overview of the study design and review of diagnostic and scoring criteria for visual-tactile dental examination. Then the examiners and the recorders proceeded to calibration for saliva tests for the children ...During these weeks we received our last shots of Typhoid, Tetanus and Hepatitis A vaccine. May 12 was free so everybody could set personal matters in order. We would be away from home for a long period of time."