Honduras Baptist Medical Dental THE DENTAL CLINIC THE PLANNING: Find out as soon as possible who will be on the dental team. Teach them simple
things, like loading syringes, taking blood pressure, and how to clean and sterilize
instruments. If at all possible, plan to have some kind of program in dental health; this
is very important to the Honduran government. OH instruction, demonstrations,
sealants, posters, puppets -- all help in this field. This could be a good place for dental
assistants and hygienists to step in and fill a real void. Have two copies of your
diploma, state license, and passport identity page made. Give them both to your team
captain and he will send one copy of each to the Laurel mission office two months in
advance. He will keep the other for you to have on the field. Also, plan to see about
40-60 patients a day per dentist. Some see more, some less.
Simple extractions will make up 99% of the work done. Very few, if any, impacted
Many older patients will want all of their teeth extracted, whether or not caries is
present. The Honduran government discourages more than five teeth extracted per
person, per day. Also, the age and health of the patient make him, or her, a poor risk
for such surgery. Caution should be taken when considering more than the standard
Some dentists like to do some minor alveoplasty in these situations to prepare the
patient for dentures. Again, caution is advised. Much time can be consumed in such
procedures and the health of the patient can make for post-op complications.
One problem often encountered is in trying to reach an agreement with the
patient as to how many teeth should be extracted. Most often the patient wants far
more taken out than the dentists sees an immediate need for. The Hondurans have
learned that many dentists will not take out a tooth unless there is pain involved;
consequently, if asked, they will respond positively to a request for pain on percussion.
There will be no teeth extracted on the final day in the field (the day of travel). It
is important that we leave the community knowing that bleeding and other problems
have had time to surface and be dealt with.
SUPPLIES AND INSTRUMENTS:
In ordering or taking free supplies, follow the KIS principle."Keep it Simple."
Remember, people who never have seen the inside of a syringe may be loading them.
Several different kinds of needles, anesthetics, and syringes will get very confusing.
Order anesthetic with at least one year remaining on the expiration date at time
of trip. Check with supplier before committing to buying; often it is not current enough.
Gloves (AIDS) - Recent reports from Honduras indicate that AIDS is a critical
problem in the country. At present, 60% of al reported AIDS cases in all of Central
America are in Honduras. All fifteen provinces report confirmed cases of AIDS in both
the heterosexual and homosexual populations. Because of this, all Dentists are asked
to recap their own syringes. Do not allow others to handle sharps. Bring enough sharps
containers to handle the carpules, needles, and suture waste for each day. Bloodied
For the dental team, this means that personal protection for the dentist, his
assistants, and the patient are going to have to approach the standards practiced in the
United States. Furthermore, blood waste will need to be monitored more closely, and
gloves will need to be changed after every dental procedure.
The dentist should not assume any supplies are in Honduras for his use unless
told specifically by a recently returning dentist who can give specific instructions as to
Each dentist is responsible for supplying his own instruments, including forceps,
elevtors, syringes, and miscellaneous surgical instruments. However, there are two sets
of instruments in the area that can be borrowed for the trip. Multiple pairs of the most
commonly used forceps and 6-7 elevators are a must. Also, lower molars are by far the
most commonly extracted teeth. Four to five lower molar forceps would not be too
Expect to have to change your operation after you get to your destination. Be
flexible. But make sure that, if at all possible, you have the necessary instruments to
fulfill your basic mission. (Most dentists carry their instruments in their carry-on onto
One dentist should have a minimum of three auxiliaries. Four would make life a
lot easier. Two dentists could get by with five. Much depends on how medication is
handed out, whether blood pressure is taken pre-op, and whether a translator is
Hondurans have been used in the past to cover some of the gaps in personnel.
Obviously, many of these can be combined or largely reduced with cooperation
from other areas such as the pharmacy and/or medical. It should be noted that some
missionary dentists have gotten along just fine with no help at all from other North
Americans, so don't be discouraged if the proper number doesn't appear at your
On a normal day, a dentist with a moderate background in oral surgery and with a
full compliment of personnel should expect to see between 40-60 patients. However, a
wider range of patient load has frequently been reported, from 30 to as high as 100 for
The Honduran government requires us to keep a record of each patient and what
medications are given to that patient. For the past couple of years either a Honduran
dentist or a Honduran dental assistant has accompanied each team to aid in compiling
these records. The dentist also aids in the oral surgery part of the team while in the
field. The dental assistant is available for assisting and other duties when she is not
At the time of extraction, every effort should be made to note what kind of
extraction was encountered (abscess, root, alveoplasty, etc.). To aid in this, the dentist
should review the Honduran reporting sheet that will be turned in at the end of the trip.
EQUIPMENT AND SETUP:
Portable dental chairs are available at all sites.
Light is provided by flashlight. Make sure that you carry a couple of good ones --
ones that do not have a dead spot in the middle of the beam. Also, make sure that your
Many dentists prefer to work on porches instead of indoors due to the lack of
electricity. Porches tend to stay lighter longer than indoors, and are not as stuffy.
Crowd control, however, is more difficult when working in these areas. Many dentists
believe that an isolated back porch makes the ideal work place.
Water will also be limited; many areas turn on their water late in the afternoon,
and then for only a few hours. In other words, plan on NOT having water, electricity, a
Again, FLEXIBILITY is the key. Don't expect too much and you may be pleasantly
SAMPLE PATIENT RUN-THROUGH:
Patients must receive a dental registration card before seeing the dentist. This is
normally handled at a different location than the dental clinic. They are then required to
attend a church service where some proof of their attendance is put on their card. They
then get in the dental line to see the dentist.
Many teams take their blood pressures at this point. Very few people in mountain
villages have a problem with hypertension; however, many have very low blood
pressure which can clue the dentist to intolerance to excessive stress or dental
anesthesia. Hypertension is very prevalent in the Caribbean Coastal areas and in the
The patient is then seated for examination. Some dentists like for the Honduran
dentist to give this initial examination. He can explain clearly our limitations while at
the same time mark on their card exactly what teeth he feels should be extracted. The
patient is usually anesthetized at this time.
To speed the line, several patients are examined and anesthetized before
beginning any extractions. Seven to ten is the usual backlog of anesthetized patients;
however, some dentists like to have as many as 15 in this group. The important point
of the process is not to have to wait for patients to become numb. If several dentists
are in the team, then the process can be considerably more flexible. The bottleneck
should always be the dentist extracting teeth, nowhere else.
It is very important for the patient to hold on to his own dental card after he has
been examined since it may be as much as an hour before he is back in the dental
chair. His card will be the only record the dentist has of which teeth are to be extracted.
After the extractions are done, the patient is given simple post-op instructions
and medication. Most dentists give all patients some kind of pain medication, either
ibuprophen, aspirin, or acetaminophen. This can be done as the patient leaves the
dental clinic or the patient can be sent to the pharmacy to have the Rx filled. Either
way, the type of medicine must be written on the card.
If the pharmacy has prepackaged this type of medicine into units suitable for the
dental clinic, then it is a simple matter to give them the medication as they leave the
dental clinic. This saves the patient another wait in another line and their card never
leaves the dental clinic. This method is preferred.
ORAL HYGIENE INSTRUCTIONS:
The Honduran government, specifically the Ministry of Health, is becoming
increasingly interested in the oral health of its citizens in the countryside. That is, the
areas where we most often set up our clinics. They encourage any programs that
promote oral hygiene, especially in the young.
Various teams have implemented many types of representations over the last few
years. Some have targeted mothers, other pre-schoolers, and still others, school
children. The only restrictions are supplies and personnel to carry out the programs.
One note of warning; If you want to see all six year olds, you should be prepared
to have a Honduran visit the school early in your stay to arrange a time and place. In
other words, the more the program will take you out of the normal routine, the more
planning and possible personnel will be needed.
In the recent past, it has been the policy of the government to send a dental
assistant with the teams to aid in these kinds of programs. This person should be
worked into any programs brought by the team; however, you should not totally
depend on having such a person available. Sometimes they are not provided.
The duration of your working time in the field will generally be 3 to 3-1/2 days,
during which time you will see between 300 to 400 people. This figure depends on or
varies with the number of dentists that you will be taking with you. One dentist can
expect to see about 300 patients -- two dentists, anywhere from 375 to 400 -- three
dentists, probably not many more than 400.
Each team can expect to have a Honduran dentist and possibly a Honduran dental
assistant travel to the field with them. These professionals are best utilized if you have
the Honduran dentist screening patients and determining their needs and giving
anesthesia and the Honduran dental assistant aiding in patient education. Each dentist
will require one dental assistant and at least one other person to serve as a person to
gather the instruments and clean them between patients. In addition, an interpreter will
be necessary to aid the dentist and assistants in their usual routine.
The following is a list of suggested dental supplies that will accommodate
Heavy Playtex Living Gloves 2 pairs for scrubbers
Paper Towels 1 case (or reusable absorbent towels for drying instruments)
2% Lidocaine w/1:100,000 epi. 1200 carpules
The above dental supplies should adequately cover all needs for approximately
300 patients. If more than one dentist is going, the amounts should be adjusted up
slightly to accommodate for more patients. You are also supplying gloves for the
Honduran dentists who generally have small or medium hands.
In terms of dental instruments, the dentist should take whatever surgical
instruments he commonly uses in his regular practice. He can expect to see quite a
number of surgical type extractions. Therefore, I suggest that in addition to your
normal regimen of instruments that you include a variety of root tip picks and root tip
elevators, a good reriosteal elevator, a large and a small pair of rongours and a mallet
If a large table is available, it could be covered with a plastic back surgical drape
with the paper side up. On this you can lay your instruments out in groups and with a
magic marker put the number of the elevator or forceps directly beneath each group of
instruments. This will allow someone who is cleaning the instruments and is not very
well versed in placement of the particular instruments to put them back where they
It will be necessary that you take a number of 12 x 12 plastic tubs normally used
at a hospital to clean instruments in. One tub should be filled with betadine and water
solution to clean, another with water to rinse and a third with germicide into which the
instruments can be placed for whatever time is available. These tubs also work well for
placing the particular types on patient's lap so that easy access may be gained to the
instruments while you are working. It should be noted that portable dental chairs will
In the area of patient education, we feel that this is one of the most important
services that we can provide to the people of Honduras. We would like to be able to
provide each patient seen in the dental clinic with a toothbrush or even toothbrushes
for their family and instructions on how to properly use them. This is best handled
through the Honduran dental assistant, if possible. Written instructions in Spanish may
be provided if possible and we strongly suggest the use of posters or visual aids to
(Atti per i quali la pubblicazione è una condizione di applicabilità) REGOLAMENTO (CE) N. 2165/2005 DEL CONSIGLIO del 20 dicembre 2005 che modifica il regolamento (CE) n. 1493/1999 relativo all ’ organizzazione comune del mercato vitivinicolo L’allegato IV del regolamento (CE) n. 1493/1999 con-tiene l’elenco delle pratiche e dei trattamenti enologiciautorizzati per l’elab
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