Gumboot experience of community outreach program in India

Community outreach programs are an exciting way to reach out to the rural population and provide them care at their doorstep. Effective outreach programs can have a huge impact on the overall disease levels. It was a distinct pleasure for us to be part of an observership program between the University of Iowa, USA, and the Indira Gandhi Institute of Dental Sciences, Sri Balaji Vidyapeeth. As part of this program, we were involved in many outreach activities. We visited a nearby rural village for a “door-to-door oral cancer screening program.” We observed that majority of the villagers were receptive to oral examinations at their home. Oral examination using ice cream sticks (Australian Dental Association Type III examination) was an efficient and hygienic way of oral examination. The door-to-door program for the village appears to be an effective means in providing the rural outskirts with incentives to come for dental treatment at the Indira Gandhi Institute of Dental Sciences.

School oral health screenings were done in public schools and many children had dental needs. Oral hygiene measures and also restorations were required for those children. A visit to a school for special needs children was organized. Many children had good oral hygiene and oral hygiene education was given to the caretakers. A few of the children were unable to cooperate for the dental procedures, thus emphasizing the need for preventive measures. Exploration of non- invasive treatment modalities should be done.

We also had a great experience in being part of a comprehensive oral health program for transgenders. This population is the most underserved, as social stigma prevents them from accessing oral health-care services. The patients had multiple dental caries and oral lesions associated with systemic diseases. They were very cooperative and showed gratitude for providing oral health care to them.

Having worked for 30 years with an underserved population of Native Americans (“American Indians”) our indigenous/aboriginal peoples in the USA, I could see many similarities that the populations above shared with the US group just mentioned. Caries rates and gingivitis/periodontitis disease are much higher in these populations than average.

With the population of India roughly being over 1.3 billion, and large and growing underserved populations in the USA, traditional “drill and fill” techniques will never keep up with the disease burden presented to the dental profession. Therefore, the increasing evidence for the use of silver-containing products, such as silver nitrate and silver diamine fluoride (SDF), supports their clinical use.

These products are safe and effective, low cost, and “low tech” as far as the expertise needed for their placement. The ease of placement is appealing to the children, their parents, and the health providers that work with them versus conventional dentistry requiring needles, drills, and costly and time-consuming appointments, many times involving traveling great distances and/or keeping parents away from their necessary work assignments.

Special populations, like those in the schools of special needs children, are prime targets for the use of silver products to arrest caries already present, along with primary prevention using OTC toothpaste and fluoride varnishes. These children and young adults are a challenge for conventional “drill and fill” dentistry. They often lack the cooperation needed for traditional dentistry and would greatly benefit from primary prevention including fluoride varnish and the arresting of dental caries with products such as silver nitrate and SDF. They are fast, effective, and readily accepted by patients and parents.

These products, silver nitrate and SDF, can also be used in populations of adults, like those with dementia, and other medically compromised persons, to arrest the caries and keep the patient stable with little intervention.