In Machias, Maine, in rural Washington County, it is not uncommon to drive 100 miles or more to find a dentist. Only six dentists practice in this 3,200-square-mile county that stretches from the Atlantic coast to the Canadian border.
The case of Michael Krick illustrates the challenges involved in obtaining dental care. When Michael's 10-year-old son, Dashel, needed two extractions, his only option was to travel over 100 miles to see a dentist in a neighboring county.
"I lost a couple of days' work, drove more than 200 miles, and spent $500, plus gas costs," Mr. Krick said, adding that it would take him months to pay off the bills.
I met Mr. Krick in October when he brought his eight-year-old daughter, Sisaly, to be screened by a returning NYUCD-Henry Schein Cares Global Student Outreach team in an improvised clinic in Machias, seat of Washington County. The 31-person team visited Machias for six days, providing comprehensive care to 307 children and emergency care to 234 adult family members. It was the third visit to Maine since October 2010, when the Northeast Delta Dental Foundation awarded a $100,000 grant to NYUCD to help launch a series of visits to the state. Although I have previously written about the Maine outreach program for Global Health Nexus, this was my first in-person visit, enabling me to more fully grasp the needs of the population.
The unemployment rate in Washington County is 10 percent, a fact that is attributable to the seasonal industries—lobstering and blueberry picking among them—in which residents are employed. Families in Machias consider dental care a luxury and have barely enough money to cover essential living expenses for the winter months when there is no work.
It's common to hear people express frustration about finding a dentist. "If you have an emergency, forget it—the nearest dentist usually has months-long waiting lists, so you end up going to the emergency room," said Britannia Balyint, a teacher in Machias who brought her two daughters, Lilyana, two, and River, nine, to be screened by the NYU team.
These obstacles are exacerbated for fishermen living on rocky islands just off the Maine coast who depend on US Postal Service mail delivery boats to take their young children free of charge to the mainland when they need to see a dentist or other healthcare provider. But when the children reach age five and no longer qualify for free passage, many parents cannot afford to transport them to the mainland.
The NYUCD-Henry Schein Cares program offers parents a much-needed alternative, providing comprehensive treatment twice annually for children in a central location. The Washington County Children's Program, a local nonprofit agency, provides the children with two additional fluoride varnish treatments annually, and those receiving ongoing care have seen tooth decay in children decline to more than 30 percent in just one year, from 2010 to 2011.
"NYUCD has brought hands-on care to a community that needs it very much," said Ms. Kathleen Walker, Northeast Delta Dental's director of external affairs.
"We feel that our community has been given a huge gift by the NYUCD-Henry Schein Cares program," added Washington County Children's Program Oral Health Coordinator Ms. Teresa Alley. For their part, students on the trip said that outreach provides a sense of fulfillment.
"This is why I went into dentistry," said Stephanie Serpa, a third-year dental student, adding that she would like to continue to volunteer part-time for community service after she graduates and begins working in private practice.
"This is a life-changing experience," remarked Mohamed Abdelhakim, '13. He added, "On a personal level, it's gratifying to help people with access to care, and as a dentist, I've found myself able to handle lots of challenging cases."
"You gain a lot of respect for what dentists are capable of accomplishing," added Daniel S. Rubinshtein, '13.
The temporary clinic in which the students worked was divided into triage, pediatric dentistry, oral surgery, endodontics, and restorative areas. Students rotated through each section.
"In triage, students have to make clinical judgments quickly," said Dr. Andrew I. Spielman, associate dean for academic affairs and professor of basic science and craniofacial biology.
"Students transition seamlessly and gracefully from the ideal working conditions of the dental school to the more challenging environment of an improvised outreach clinic," added Dr. Spielman.
Dr. Timothy Oh, director of the Caring Hands of Maine Dental Center, a nonprofit clinic in neighboring Hancock County that provides follow-up treatment to patients seen by the NYUCD team, hopes that the experience will convince some students to choose a career in dentistry in rural Maine.
"There are lots of opportunities to have a stable practice in a rural setting without the competitive pressures and high start-up costs of an urban area saturated with dentists," said Dr. Oh, who worked alongside the NYUCD team. "If I could get one or two of the NYUCD students to set up practice here after graduation, it would do a tremendous amount of good."
Outreach Teams Return to Alaska and Upstate New York
NYUCD-Henry Schein Cares Outreach teams traveled to Hudson in upstate New York for five days in October 2011 and again in January 2012, the eighth and ninth visits, respectively, to the public schools in the town since 2009. A 35-person NYUCD team treated 333 children and 120 adults in October and a 20-person team treated 374 children in January. The final two visits of the three-year Hudson, New York, outreach program were conducted in April and June 2012.
In December 2011, a 19-person NYUCD-Henry Schein Cares Outreach team paid its first visit to Yakutat, a remote village in southeastern Alaska, screening and treating 116 children and 50 adults. NYUCD began outreach to rural Alaska in 2009. A return visit is planned for winter 2012.