In February 2008, an NYUCD outreach team consisting of nine NYUCD faculty members, pediatric dentistry residents, and staff, flew to Bethel, a city near the west coast of Alaska, for the first leg of what would be a unique one-week outreach visit to the remote village of Kasigluk in the Yukon-Kuskokwim Delta, an area comprising 54 villages, 30,000 inhabitants, and no dentist. The outreach was funded by the Rasmusson Foundation, a private foundation dedicated to supporting well-managed, nonprofit organizations in Alaska, and facilitated by the Yukon-Kuskokwim Health Corporation (YKHC), which administers health care in the region, and the Bethel Community Services Foundation (BCSF). Dr. Stuart M. Hirsch, Associate Dean for International Affairs and Development, and Dr. Amr Moursi, Associate Professor and Chairman of the Department of Pediatric Dentistry, led the team.
The outreach team traveled with their own dental equipment, compressors, gloves, gauze, and even paper to write on. They brought their own food, sleeping bags, air mattresses, and other provisions. Though there is a general store in the village, its offerings are limited. In Kasigluk, the team was fortunate to find a fairly new community center, where they set up a waiting room, exam room, and radiography room. But they slept in the school, which had flush toilets and showers, as compared to the community center, which did not. Each day the temperature was between 30 and 50 degrees below zero.
Caries rates in the region are two-and-a-half times higher than any other place in the U.S. When people in Kasigluk and surrounding areas require dental care, they must travel up to 150 miles -- usually at government expense -- to receive care from YKHC-affiliated dentists in Bethel. Not surprisingly, people tend not to see a dentist until they are in great pain and the need is urgent. For the majority of children, this means ending up in the operating room, to be treated under general anesthesia. The NYUCD outreach visit was designed specifically to break the cycle of lack of access to care, suffering, and expensive visits to the OR.
The team had the dual goal of treating existing dental disease in children up to the age of 12, and of developing and implementing a sustainable, preventive dental care model that would significantly decrease the level of dental disease among schoolchildren in Kasigluk, and could be replicated in villages throughout the region. Dr. Moursi demonstrated caring for children in the knee-to-knee position to do an exam and apply the fluoride varnish. He also left a year’s supply of the materials, including varnish, gauze, and gloves.
Sara Shoffstall, the Acting Director of YKHC, said, I think we are going to see a lot fewer people from Kasigluk in Bethel, which is going to save the government money they would otherwise have to spend to fly these people in. I think it’s going to be especially important for the kids. This intervention is going to save them a lot of pain and ultimately help them to do better in school.
The team completed 90 percent of the treatment needs of all children in two schools. We did an assessment when we came in to understand baseline needs, explained Dr. Hirsch. We’d like to come back in 10 months, do another assessment, and make sure that we achieved a minimum 50 percent decrease in disease. We’re also going to compare the number of children who were treated in the OR 10 months before we arrived with the number treated in the OR after our visit. We’re likely to see a dramatic decrease in that number as well.
Our next step is to invite the chairs of four other, large dental school–based pediatric programs to join us next year at a second village. These people will become the leaders in the third year, so that we will have five teams to go out to villages and ultimately be able to provide sustainable care to people in all 54 Yukon Delta villages.
To view a video of the NYUCD outreach to Alaska, please go to