Glen with a patient
team's overnight accomodations.
Meredith Glen, Class of 2000, is a first-year postdoctoral student
in pediatric dentistry.
Although many people living in Guyana’s jungle villages rarely use
a toothbrush or see a dentist, they nevertheless consider dental care
a good thing. So last October, when the local villagers learned that
Dr. Page Caufield, Professor and Head of the Division of Diagnostics,
Infectious Disease, and Health Promotion, and I were scheduled to
visit their homeland in South America’s Amazon Basin, they waited
for hours in the oppressive equatorial heat outside local health clinics
hoping to be seen. When we discovered that the clinics were little
more than bare-walled rooms with no electricity, I wondered how we
could possibly meet their expectations. True, we had brought some
instruments from New York, but how could we efficiently treat a range
of chronic conditions when we didn’t even have a dental chair at our
Before long, I was busy adapting techniques I had learned at NYUCD
to this strange new environment. But it was a trial and error process
that left me wishing that I could simply open a book for advice on
working in a remote, isolated setting. Amazingly, by the conclusion
of our two-week trip, I felt I had learned enough to write such a
Dr. Caufield and I began our trip by visiting a series of rudimentary
clinics set up deep inside Guyana’s rain forest by Rural Area Medical,
an organization founded by Stan Brock, former host of TV’s Wild Kingdom,
and a local Rotary Club. At our first stop, we found dozens of people
of all ages waiting for us. Given our time constraints, we decided
to focus on extractions to relieve the most acute decay. Second, we
figured out how to use our scant resources most efficiently. Lacking
plumbing, we used buckets instead of spittoons. We made fidgety children
comfortable by placing them in a chair borrowed from the schoolhouse.
This enabled a child to lean back and relax his or her head in my
lap. No electricity? I had brought along a solar-powered drill that
worked wonders in the tropical sun and helped us replace the standard
amalgam filling with a rapid atraumatic restorative treatment (ART)
based on a glass ionomer sealed with a self-adhesive bonding agent
donated by 3M ESPE.
We also learned first-hand about the effects of the villagers’ longstanding
poor oral hygiene. There were many cases of hypoplastic teeth apparently
caused by childhood malnutrition progressing to more serious decay
in adulthood. Children and adults alike consumed large quantities
of tropical cassava root and refined sugar, but few bothered to brush
away the sweet, starchy residue. And there were many instances in
which we had to apply extensive sutures and pressure to stop excessive
bleeding caused by extractions in people with severe decay.
I quickly realized that we could make a bigger impact on long-term
health by shifting our focus from extractions and fillings to preventive
sealants. So our goal became to place sealants on as many people’s
teeth as possible, while continuing to relieve acute pain. Once again,
we found a way around limited resources. We set the liquid sealant
with a battery-operated 1,000-watt handheld curing light, also donated
by 3M ESPE. By the time we left, we had placed sealants on 500 villagers,
and I returned to New York feeling like we had made a lasting difference
in people’s lives.
Back home, I began to write my guide for dentists working in remote
regions. When it’s completed, it will include advice on everything
from packing equipment to comfortably positioning patients in ordinary
chairs. It’s my hope that it will encourage other dentists to reach
out to people in medically underserved areas of the world.