ISSUE
               
International Partners in Health
Grenada Outreach Update: The Public Health Approach to Reducing the Decay Rate of a Nation's Children

In February 2011, the NYUCD-Henry Schein Cares Global Student Outreach Program, with the generous support of Colgate-Palmolive, inaugurated the first phase of a National School-based Oral Health Plan to decrease new decay in Grenadian children by 50 percent over three years and to build capacity among the local public health infrastructure to prevent dental caries and promote oral health.

The outreach followed a yearlong period of planning and assessment of the oral health status of the children of the tri-island nation of Grenada, which found that Grenadian children had one of the highest, if not the highest, incidence of dental caries in the world, and the acceptance by the Grenadian government's Ministry of Health (MOH) of an NYUCD proposal to create a sustainable, school-based plan to ameliorate the situation. The initiative was conceived and is overseen jointly by NYUCD's Office of International Initiatives and Development and its Department of Cariology and Comprehensive Care.

According to Dr. Mark Wolff, survey director for the Grenada outreach, associate dean for predoctoral clinical education, and professor and chair of the Department of Cariology and Comprehensive Care, "Grenada represents a different kind of outreach from initiatives undertaken in the past, in that it is focused not just on treating disease, but on preventing disease on a long-term basis."

In just two weeks in February, a 20-member team of dental providers from NYUCD and the MOH visited 110 schools, providing preventive oral health services for the 22,000 children living in Grenada, Carriacou, and Petite Martinique. The February initiative launched the school-based brushing program in every classroom in the country. The cooperation of the schools, and particularly of the teachers and principals, was key to the program's implementation, and will continue to be the critical factor in ensuring the program's future sustainability. This two-week visit was followed by a return visit in April, marking the second of eight visits planned by the NYUCD-Henry Schein Cares Global Student Outreach Program over the next two-and-a-half years, during which NYUCD will continue to work with the MOH and the Ministry of Education (MOE) to implement the National School-based Oral Health Plan.

From April 16 to May 7, 30 NYUCD outreach team members provided fluoride varnish for 16,000 children and applied 6.000 sealants. NYUCD, in collaboration with the MOH, also provided several evening sessions for all public health nurses to educate and train them in prevention and in nutrition needs of children and infants, as well as to provide fluoride varnish and toothbrushes to be kept in the public health clinics and used for infants and toddlers as an added measure to prevent tooth decay.

NYUCD's overall commitment includes building capacity within the present infrastructure by:

  • training public health nurses, who provide health care and health education for pregnant women and for infants and toddlers who are not yet in the nation's school system,
  • training teachers to implement classroom-based tooth-brushing programs using individual toothbrushes for youngsters who never before had their own toothbrushes, and using fluoridated toothpaste,
  • training local providers to apply fluoride varnish, which requires no special equipment or cleanings and has been shown to result in a 40 to 70 percent reduction in decay, when applied regularly.
  • providing oral health education for students and their caregivers, and
  • mobilizing PTA groups.

"The NYUCD-Henry Schein Cares Global Student Outreach Program," notes Dr. Wolff, "is designed to demonstrate in both a dramatic and a pragmatic way that it's time to move from fixing teeth to improving health and the healthcare system in a locally sustainable model."