Methods

Dental caries and periodontal disease have been considered the most important global oral health burdens. Data on oral health status for Ethiopia is scarce. Immersion in diverse cultural settings is critical for health profession students to understand determinants of health, access to care discrepancies, and patient empowerment around the globe.

Since 2005, the University of Texas Health Science Center at San Antonio (UTHSA), Long School of Medicine has built a longitudinal relationship with the Common River NGO. In 2019, a UTHSA School of Dentistry team was invited to join this collaboration. The collaboration facilitated the overall work of both medical and dental teams, leading to opportunities for future follow up.

Introduction

Upstream Preventative Interprofessional Team Approach for an Ethiopian OutreachD L. Seiler DS4, A. Segura DDS, MS, J. Rosenfeld, DrPH, MPH, R. Berggren MD, M. Zhou DS3, C. Holmes MS4,

D. Sillan MPH, T Tariku and M. Farokhi DDS, MPHUniversity of Texas Health Science Center at San Antonio, Schools of Dentistry and Medicine and Common River Non-governmental organization (NGO)

The Process

Resultso 74.9% of all participants (n=239) presented with either active or early

caries lesions or botho 96.6% of all participants presented with signs of periodontal diseaseo 49.6% of all participants reported pain as the chief complainto 100% of participants received OHI and 97.5% received fluoride varnish

application o 64.4% of participants had active caries lesions and received SDF

applicationso Nearly half (43.5%) were missing teeth. 95.4% (n=226) had most and

3.4% (n=8) had half of their natural teeth present at the time of examination

o The oral health status of the Common River (CR) community of Aleta Wondo, presents with high risks for periodontal disease and caries. This level of risk was associated with a lack of oral hygiene practices and dietary practices such as the frequency of consumption of sugar cane and coffee for hydration.

o This upstream oral health approach empowered Common River employees to learn about OHI with school children, women in the literacy program, and the NGO staff members. Members of the CR community were trained to continue the OHI and fluoride varnish application approaches towards sustainability.

o We believe that this self-management upstream approach will not only lead to improvement in the levels of caries and periodontal disease, but also aligns with WHO’s community-oriented demonstration projects for oral health promotion and prevention of oral diseases. WHO recommends focusing on disadvantaged and poor population groups in developing countries.

o Collaborating with the medical team allowed for observation of the social determinants of health (SDH) for this community.

o SDH was expressed as limited access to oral/health care, low or non-existent fluoride use, poor oral hygiene practices leading to high plaque and calculus scores, along with frequent consumption of coffee and a diet rich in simple carbohydrates. Hence, the compromised periodontal health and the outstanding level of untreated tooth decay.

Acknowledgment

o The recognition of the community’s social determinants of healtho Implementation of an oral health risk assessmento Facilitation of oral hygiene instructions (OHI) for all participantso Oral health education training and empowerment for key staffo Application of fluoride varnish and silver diamine fluoride as neededo We left behind about two years of supplies of toothbrushes and

toothpastes and fluoride varnish

An interprofessional team of dental and medical students/faculty assessed oral health for members of the Aleta Wondo community in Ethiopia, which included school children of the Common River NGO, staff workers, and members of a women’s literacy group (n=239).

The team completed joint “home visits” observing typical living conditions, daily nutrition, clean water access, and at-home hygiene sanitation. Fluoride varnish, Silver Diamine Fluoride (SDF) and oral hygiene instructions (OHI) as teach-back were provided with the assistance of translators in Sidamo and Amharic. The team introduced the use of Federation of Dentistry International's basic package of oral health care Affordable Fluoride Toothpaste preventive measures to manage tooth decay.

Medical and dental students boarded within the community and joined the translators providing guided daily reflections. Information was gathered using REDCap data capture tool. Preventive Upstream Approach Included

Conclusion

Fig.3: The process

Fig. 3: Level of Dental Pain Fig. 4: Caries Experience

Fig 2: Image of the team providing oral and nutrition health empowerment, examination and preventive outreach while training Common River members.

Fig. 1: TheOral Health Risk Assessment Survey

We are grateful for the financial, technical and administrative support that the organizations below provided to make this service learning a reality. We would also like to thank dental students Mr. Keith Usry and Ms. Claudia Samaniego, medical student leaders Ms. Jordan Barton, Mr. Max Feng and Mr. Duff Dean for their excellent leadership efforts during this journey. We aretremendously grateful to the UTHSA Center for Medical Humanities and Ethics and the Office of the Dean at the School of Dentistry for Facilitating this teamwork.