GSDM Starts Fluoride Varnishing Program in Nicaragua

From November 21 to November 28, 2015 —during Thanksgiving break—Boston University Henry M. Goldman School of Dental Medicine (GSDM) student Nick Capezio DMD 17 was in Estelí, a city of about 130,000 people in Nicaragua, with Professor in the Department of Health Policy & Health Services Research and Associate Dean for Global & Population Health Dr. Michelle Henshaw. The two were in Nicaragua as part of ongoing efforts between GSDM, Boston University Medical Campus (BUMC), and local and national governmental agencies in Nicaragua, to implement an oral health program that seeks to improve the long-term oral health of the city’s population by providing fluoride varnish treatment to preschool children.

The trip to Estelí, Nicaragua in November was the third—and most recent—trip that members of the GSDM and BUMC community have taken to the country to implement the program, which seeks to equip teachers at 12 different preschools in Estelí, with the knowledge and resources to improve oral health and apply fluoride varnish four times a year to more than 800 children under five years old.

The 12 different preschools were chosen because they are located in Estelí, where the Superemos Foundation, an education-based organization, operates. BUMC has a longstanding relationship with the Superemos Foundation.

The fluoride varnish program is similar to some existing GSDM programs in that it is designed to stop oral health problems before they begin, by providing consistent fluoride varnish treatment to young children. The program is different than those found in the United States because the people who have been trained to apply the fluoride varnish are not health professionals; they are teachers.

The connection between Estelí, Nicaragua and GSDM started with Dr. Peter Loewinthan, a Pediatrician at Dorchester House Community Health Center.

Dr. Loewinthan has a long-standing relationship with Nicaragua’s Superemos Foundation. On one of his volunteer trips to donate medical services and care to the residents of Estelí, he noticed that many of the children he was seeing had poor oral health. Knowing the implications of poor oral health in developing children, he reached out to Dr. Henshaw to explore ways to fight this.

A few months after Dr. Loewinthan reached out to Dr. Henshaw, the first trip to Estelí, Nicaragua, took place from February 21 to March 2, 2014. Representatives from each of the three BUMC schools took part in the trip, which marked the first time that all three schools participated in an international mission trip together.

From GSDM were DMD students John Paul DMD 14, Kenia Rodriguez DMD 14, and Danny Shum DMD 13 AEGD 14, and Assistant Professor in the Department of Health Policy & Health Services Research and Director of School-based Programs Dr. Corinna Culler.

Joining the four GSDM representatives on the February 2014 trip were four medical students; three public health students; Associate Professor in the department of Community Health Sciences and Pediatrics at Boston University School of Medicine (BUSM) Dr. Emily Feinberg; Dr. Loren Wilson (a practicing dentist); and Dr. Peter Loewinthan.

It was determined during this first trip to Estelí that the most effective treatment plan for the population of students at the 12 Superemos schools would be to provide fluoride varnish treatment to children less than five years old. Many children who were more than five years old had already developed numerous oral health problems, and the GSDM and BUMC group decided that the best plan of action would be to halt the progression of poor oral health before it started.

Roughly a year-and-a-half later, with a plan in mind, Dr. Henshaw, Dr. Culler, Nick Capezio DMD 19, and Eleanor Lawrence (an MPH candidate at Boston University School of Public Health) traveled down to Estelí for a second time, from July 5 to July 23, 2015.

The goal of this trip was to collect data to determine the extent of the oral health problem in children less than five years old in Estelí. They found that 77 percent of children less than five years old had some tooth decay. In fact, only four of the 465 students that the GSDM and SPH group observed had ever received any prior dental restorative treatment.

On top of gathering data on the oral health of the children, the GSDM and SPH group did several other things during this July trip: working with school administrators to create an oral health presentation that was specific to Nicaraguan culture and habits, introducing administrators to the practice of fluoride varnishing, and working with various local and federal officials in the country to ensure that the program had adequate support.

Finally, the third and most recent trip to Estelí took place from November 21-28, 2015. Attending this trip were Nick Capezio and Dr. Henshaw.

The goal of this trip was to train the teachers who would be administering the fluoride varnish treatment. Nick Capezio and Dr. Henshaw traveled to 11 of the 12 schools (one school was on vacation during the trip) and provided fluoride varnish competency training to 35 teachers.

Depending on the size of the school, some training sessions had more teachers attend than others, but when all was said and done, every one of the 11 schools visited had at least one teacher certified in applying fluoride varnish.

These trainings in November involved Nick Capezio and Dr. Henshaw explaining to a room full of teachers how to apply the fluoride varnish to a child and then watching the teachers apply the varnish to their students. After insuring that the teachers could apply the fluoride varnish well and that they understood all the adequate infection control protocols, Capezio and Henshaw would provide the teacher with a certificate of competency, declaring them able to apply fluoride varnish alone to the children in the schools.

During this training, the first round of fluoride varnish was applied to all the students that will be participating in the program.

While the number of teachers trained during the November, 2015 trip to Estelí was auspicious, Dr. Henshaw said she was especially pleased with the energy and commitment the teachers showed during the training process.

“The teachers came in with note pads and were taking notes,” said Dr. Henshaw. “They were just so eager and so thankful to be afforded the opportunity to learn about a technique to improve the oral health of their students.”

The next immediate trip to Estelí will take place in February of 2016. During this trip, Dr. Henshaw and others from GSDM will travel down to Estelí to observe the second round of fluoride varnish applications.

“I would like to congratulate Nick Capezio, Dr. Michelle Henshaw, and everyone else in the GSDM and BUMC communities that are working toward making this program a success,” said Dean Jeffrey W. Hutter. “GSDM’s various international programs continue to grow and provide both excellent opportunities for our students and much needed dental care for vulnerable populations.”

Photos from GSDM’s November trip to Estelí, Nicaragua can be found on Facebook and Flickr.