Before Anthony Lee ’19, and a team of students, faculty, and staff from NYU’s College of Dentistry traveled to Phnom Penh, Cambodia, last year to carry out a weeklong pediatric oral health program, they discussed in advance some of the barriers to health they might encounter, including a so-called “snack alley” behind the school they would be visiting where vendors peddle sweet fares to children.
One thing they couldn’t predict: An apparent aversion to orange toothpaste.
The NYU cohort learned that parents of the schoolchildren didn’t trust the toothpaste distributed by the school as part of a daytime brushing program because it wasn’t white like many better-known brands.
Issues of perception are just part of the many nuances addressed through the decades-old international service program at the college that has evolved into a comprehensive oral health effort tailored to a specific communities’ needs. The NYU College of Dentistry/Henry Schein Cares Global Student Outreach Program currently operates in five countries outside the United States (Ecuador, Nicaragua, Nepal, Cambodia, and Mexico), as well as in Maine and New York State, and has plans to expand to Armenia, Chile, and Ghana.
The program began about 25 years ago with faculty taking small groups of students to provide emergency dental care in locations where they might have contacts. But after then-Dean Michael C. Alfano asked Stuart M. Hirsch, professor and vice dean of international initiatives and continuing education, to help coordinate the ad hoc efforts, the program became more formalized. It has continued to shift and tighten its focus under the direction of Rachel M. Hill, who joined as a program administrator in 2008 and now serves as senior director for global outreach and international initiatives.
“I started asking lots of questions, like, ‘This is great, and everyone feels good about what they’re doing, but, at the end of the day, what difference are we actually making?’” she recalls.
To emphasize sustainability and prevention rather than one-time, emergency treatments, Hirsch and Hill, who earned her master’s from NYU’s College of Global Public Health in 2014 while working for the program, began to prioritize children’s oral health in school settings where good habits can be supported by teachers and staff. Generally, adults are treated on a first-come, first-served basis for urgent needs only.
“The feeling was, ‘Well, if we can implement some school-based preventive programs, we could start to get sustainable results,’” Hirsch says. “So, we moved in that direction.”
The impact of the program continues to grow. In the past year alone, about 200 NYU students, faculty, and staff have provided oral health education, preventive care, and treatment to nearly 2,500 children and adults.
Even as Hill has helped sharpen the program’s focus on prevention and sustainability, she has used her public health background to broaden the experience for participating NYU students. The trips have always provided an intense clinical experience: Under the supervision of faculty, students rotate through restorative care (such as fillings), oral surgery, and root canals, among other procedures. But now students also learn more about the context in which they practice.
“Our attention has shifted away from just the clinical experience and has become more of a public health education in the field,” Hill explains. “We want students to understand their role as a dentist—as a healthcare professional—in improving population health, improving access to health for those who can’t come to a private office and pay the bill.”
Before each trip, Hill and her team scout out “community-based experiences” for the students. During an April trip to Machias, Maine, for example, students learned about the town’s struggles with opioid addiction through visits to the local sheriff’s office, economic council, or a faith-based recovery group.
“Normally dentists think in terms of individual patients who come into their office with needs and are treated accordingly,” Hirsch explains. “We want our students thinking about communities as well as individuals.”
That’s why public health-centered discussions—such as those about snack alley and orange toothpaste—take place before, during, and after trips (to address Phnom Penh parents’ concerns, the school sent a note confirming the colored toothpaste was safe to use). Last spring, Hill also helped launch a new elective—Dental Leaders in Global Public Health—that includes lectures and discussions on public health theory and the determinants of health and health policy.
Under Hirsch and Hill, the Global Student Outreach Program has implemented detailed research practices, measuring and tracking oral health in each of the communities it serves. That allows students and faculty to adjust their methods, if necessary, to achieve better results. As one example, Hirsch says that, after his research team noticed tooth decay rates were not decreasing in a community despite the program’s use of fluoridated varnish, the clinicians switched to silver diamine fluoride, which has been shown to arrest existing decay in addition to preventing future decay.
In Machias, where NYU has been in operation since 2010, Teresa Alley, a local dental health professional who helps coordinate the NYU trips, believes the switch, made in 2016, has had an impact. The prevalence of tooth decay among children in Machias went from 41 percent in April 2014 to 21 percent this year—though program staff cautioned that they can’t attribute this decrease solely to the intervention since there are many variables beyond the program’s control.
What’s clear is that the program does work—for the communities in which it operates and for the students who participate, who grow as clinicians and future dental public health professionals.
Lee adds that one of his most meaningful experiences in Cambodia came when he had the opportunity to be part of a team treating a young girl whose “maxillary anterior” teeth—or the top ones most visible in the front of her mouth—were rampant with decay. Over a two-day period, Lee helped restore the teeth by building them up with composites after someone else performed root canals.
“We gave her back her smile,” he says. “I saw how she showed her friends afterwards. She seemed very happy.”