Carlos W. WERNER1
Peggy P. GRAGG2
Kathleen M. GEURINK3
1Faculdade de Odontologia de Lins, Universidade Metodista
de Piracicaba, Lins, SP, Brasil
2Department of Dental Diagnosis Science, Dental School, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
3Department of Dental Hygiene Education, School of Allied Health, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
Braz Dent J (2000) 11(2): 127-133 ISSN 0103-6440
Introduction | Program description | Program outcomes | Discussion | Conclusion | Resumo | References
The main goal of the University of Texas Health Science Center (UTHSCSA) dental van programs is to provide training in delivering care to diverse segments of the population. The UTHSCSA is the Academic Health Center for all of South Texas, a region with 25% of the State's population and 60% Hispanic. About 60% of the region's counties are federally designated dental health personnel shortage areas. Interdepartmental efforts with the participation of dental hygiene, community dentistry, oral diagnosis, periodontics and general practice carried out two programs during the 1994-95 academic year. At the Saint Philip of Jesus Clinic, a charity clinic, and at the Willows Development Center for Severely and Profoundly Mentally Retarded, the dental van was used to provide preventive and restorative care. A questionnaire to measure the value of the programs indicated that students perceived them as important educational activities which increased their confidence in treating persons in the community, especially persons with disabilities. Program output was quantitatively assessed. An average of 8 preventive procedures, 7 fillings, 2 sealants and 1 extraction or referral were provided each working day. Eighty patients were seen at the Saint Philip Clinic (2.5 visits per patient) and 130 patients were seen at the Willows Development Center. Overall, 80 students and 6 faculty participated in providing screening, treatment and referral services. Dental van programs promote access to dental care and increase the visibility of dental schools within the university and community. Current tendencies to halt new program initiatives and phase out existing programs due to shifting financial priorities should be carefully considered in view of the 1995 Institute of Medicine (IOM) report on the future of dental education.
Key Words: dental education, community program, mobile dental unit, dental health services.
The clinical competencies at the University of Texas Health Science Center at San Antonio (UTHSCSA) Dental School recommend as an important clinical learning experience the need to assess of medically, mentally or physically compromised patients and socially and culturally disadvantaged patients. Dental and dental hygiene curriculum guidelines also include recommendations for treatment of special needs populations (Trusselle, 1984; Casamassino, 1985). For over 2 decades dental and dental hygiene programs at UTHSCSA have been using mobile dental van programs to promote professional dental education and provide treatment to special needs patients. Dental and dental hygiene students have the opportunity to further their education by providing care in a non-traditional setting and the community receives much needed services. The UTHSCSA has carried out such programs under decreasing financial support for outreach programs and current plans even include the restoration of the two dental vans.
A literature review using MEDLINE and combining the keywords `dental health services' and `mobile health units' was carried out. For the last 30 years only three mobile dental van programs in the USA (Doherty et al., 1977; Pool, 1982; McManus et al., 1992) were reported. The other references were related to either portable equipment transported in vans or mobile dental van programs outside the USA.
Specific articles on the use of mobile dental van programs as part of professional dental education were not found. Consequently issues related to the logistics and economic viability of mobile dental van programs used by academic institutions have not been reported. This paper describes two mobile dental van programs, discusses their facilitating role in professional dental education and identifies areas lacking research data.
The UTHSCSA is the Academic Health Center for all of South Texas, a region with about 25% of the State's population (4 million people) and 60% Hispanic. Approximately 60% of the counties in this region are federally designated dental health personnel shortage areas with a population-to-dentist ratio of less than 5000:1. The primary mission of the Dental School outreach programs using mobile dental vans is to provide dental health professional training in delivering care to diverse segments of the population. These programs are possible due to the collaboration of the dental school departments of community dentistry, oral diagnosis, general dentistry, dental hygiene and periodontics. The mobile dental vans are a component of the dental clinical facilities, are maintained by the University physical plant division and are cleaned by housekeeping.
Programs carried out by the UTHSCSA mobile dental van in the San Antonio metropolitan area target migrant schoolchildren, indigent and other special needs populations. This paper describes the program at a charitable clinic called Saint Philip of Jesus Community Clinic and a program at the Willows Development Center for Severely and Profoundly Mentally Retarded. These two programs were carried out twice a week during the spring semester of the 1994-95 academic year. The procedures performed followed the dental school's clinical and infection control guidelines. Patients of any age were allowed into the programs. Thirty dental hygiene students, 35 senior year dental students, 15 graduate students from the Periodontics department and 6 faculty participated in these programs. All procedures performed by undergraduate students were supervised by faculty.
At the Saint Philip of Jesus Clinic the following dental services were
provided: treatment planning, oral health education, dental prophylaxis,
scaling, X-rays, dental restorations, extraction and dental sealants. Patients
requiring root canal treatment,
complex exodontia, castings or removable prostheses were referred to the community-based treatment sites, the local dental society and the dental school. A list of community health clinics and hospitals was also provided. At the Willows Development Center for Severely and Profoundly Mentally Retarded, screening and oral hygiene treatment were provided.
Outcomes at the Saint Philip of Jesus Community Clinic are presented based on the number of procedures carried on during the 1995 spring semester. Fifty-eight patients were seen with an average of 2.5 visits per patient. The average number of procedures per working day was: 8 preventive procedures, 7 restorations, 2 sealants and 1 extraction or referral. Figures 1 and 2 show the total number of restorations and other interventions provided by dental students. Most restorations provided did not fall into the category of complex restorations. Most of the other interventions were radiographs, sealants and extraction.
Graduate students in periodontics screened approximately 100 Willow's
residents. Sixty-eight patients were treated by the dental hygiene students
with an average of 1.5 visits per patient and 8 treatments per day. At
the Willows program, the change of student
attitude and confidence levels for treating patients with disabilities was measured by using pre- and post-questionnaires. Figure 3 shows the mean results of a 0-5 scale measuring: gained experience, confidence in treating persons with disability, confidence in treating persons with severe disabilities, and level of interest to treat people with disabilities. The questionnaire results indicated that this experience increased the students' confidence and interest in treating persons with disabilities. Although not statistically significant, the post-result survey consistently showed higher mean scores for all the items. The positive effects of extramural programs on student attitude towards providing care to the mentally retarded confirmed previously published results (Block et al., 1980). Figure 4 shows the level of confidence in treating persons with disabilities. The direction is clearly towards an increase in confidence levels as shown by the shift in the bar chart from little/none confidence towards the most confident.
Course evaluations following the van programs showed that students perceived mobile dental van programs as an important educational activity and recommended the continuation of the programs.
Outreach programs using mobile dental vans are a desirable model of clinical practice in a non-conventional setting and helps the student to dissociate the image that good dentistry can only be practiced in conventional clinical settings. Confrontation with limited choices and economic barriers to dental care for those patients requiring more extensive procedures also serve as an additional learning experience and reference for future professional involvement in community-based programs.
The logistics of running mobile dental van programs may be complex. Specific difficulties such as contacting community leaders, establishing lasting community links and overcoming operational barriers are always a challenge for community-based programs. Continuity of programs may also be affected by changes in community oral health needs and desire to participate in the programs. Such difficulties should not be ignored but should not become a deterrent to the involvement of academic institutions in the community. The 1995 Institute of Medicine (IOM) report on the future of dental education (National Academy of Sciences, 1995) challenges dental schools to demonstrate their value to communities rather than perpetuate the image of an isolated technical center of excellence. The use of mobile dental vans can have a relevant role in this process as they can cover a large geographical area and serve multiple sites in both urban and rural populations.
The costs of implementing and maintaining mobile dental van programs vary and historically has been perceived as higher than fixed clinics (Wisan et al., 1947). In the 70's a study on the costs of dental services provided by mobile and fixed dental clinics in Tennessee was small and not statistically significant (Doherty et al., 1976). Studies on costs of mobile dental programs organized by academic institutions were not found. More studies on the economic viability of mobile dental van programs and optimization of their use in academic institutions for educational purposes should be carried out.
Apart from the educational and operational aspects of the mobile dental van programs, the demonstration of social commitment of the academic center to the community is also an important component of these programs. The Texas governor's wife requested a tour of the mobile dental van during a recent visit to the UTHSCSA. This request suggests that educational activities using mobile dental clinics increase the visibility of the dental school within the university and community and should be valued accordingly.
The few mobile dental programs found in the review of literature suggest that such programs have not been widely used in the USA within the last three decades. Such shortage of articles may also be due to the fact that people working in such programs are more service than research oriented and only a few articles reporting their activities found their way into the literature.
The 1995 IOM report on the future of dental education points to community involvement and responsibility of reducing the wide disparities in oral health and access to care. In light of this report, the implementation of outreach programs and specifically mobile dental van programs calls for more information on costs, optimization of use of resources and guidelines for program planning, implementation and evaluation.
Institutions currently using mobile dental vans should add a research component to their programs and more effectively publish the service and research results of their mobile dental van programs.
Werner CW, Gragg PP, Geurink KM: Formação do cirurgião dentista utilizando programas de clinicas móveis. Braz Dent J 11(2): 127-133, 2000.
O principal objetivo dos programas de clínicas móveis do Centro de Ciências da Saúde da Universidade do Texas (UTHSCSA) é promover o treinamento do estudante no atendimento a diferentes segmentos populacionais. O UTHSCSA é um centro de formação de profissionais da área da saúde que atende o sul do estado do Texas. Esta região compreende 25% da população do estado sendo 60% de origem hispânica. O governo federal designou que 60% dos municípios desta área geográfica seriam considerados como área deficitária de profissionais da saúde. A Faculdade de Odontologia da UTHSCSA através dos departamentos de Odontologia Comunitária, Diagnóstico Oral, Periodontia, Clínica Geral e a Faculdade de Formação de Higienista Dental, desenvolveram como parte das atividades acadêmicas, dois programas com clínicas móveis entre 1994-95. Uma clínica de atendimento a população carente (Saint Philip of Jesus Clinic) e um centro de pacientes com alto grau de retardamento (Willows Development Center) receberam visitas semanais. A avaliação do programa indicou que os estudantes qualificaram a experiência como muito importante para a sua formação profissional e desenvolvimento da auto-confiança no tratamento de populações carentes e pacientes especiais. Oitenta pacientes foram atendidos no Saint Philip of Jesus Clinic com uma média de 2,5 visitas por paciente. Na clínica Willows, 130 pacientes foram atendidos. Oitenta estudantes e 6 professores participaram dos procedimentos que constavam de uma avaliação inicial, tratamento e quando necessário, referencia para a faculdade de odontologia. Os programas educacionais utilizando clínicas móveis, promovem também um melhor acesso ao tratamento dentário e aumentam a visibilidade da faculdade de odontologia na universidade e na comunidade. As atuais tendências de diminuição de programas utilizando clínicas móveis devido ao custo financeiro deveriam ser reconsideradas em vista das recomendações do relatório do Instituto de Medicina (IOM) sobre o futuro da educação de cirurgiões dentistas.
Unitermos: educação, programas comunitários, clínicas móveis, serviço de atendimento odontológico.
Block MJ, Walen JW: Effect of an extramural program on student attitudes
toward dental care for the mentally retarded. J Dent Educ 44: 158-161,
Casamassimo PS: Curriculum guidelines for dentistry for the person with a handicap. J Dent Educ 49: 118-122, 1985
Doherty N, Paturzo D: Costs of dental care in mobile clinics. J Pub Health Dent 37: 266-274, 1977
Doherty N, Viviam S: Cost of publicly financed dental care for children in three different types of practice settings. J Pub Health Dent 36: 3-8, 1976
IOM Report. The Future of Dental Education. National Academy of Sciences National Academy Press, 1995
McManus J, Monajem S, Dincer E: Mobile mission. New York State Dent J 58: 51-52, 1992
Pool DM: Dental care for the handicapped adolescent. Int Dent J 32: 194-202, 1982
Trusselle SM: Curricular guidelines for dental hygiene care for the handicapped. J Dent Educ 48: 266-268, 1984
Wisan JM, Galagan DJ, Chilton NW: Studies in dental public health administration: I. Cost analyses of the New Jersey dental treatment program, 1944-45. J Am Dent Assoc 34: 322-339, 1947
Correspondence: Dr. Carlos W. Werner, Faculdade de Odontologia de Lins, Campus Lins, Universidade Metodista de Piracicaba, R. Ten. Florêncio Pupo Netto 300, Jardim Americano, 16400-680 Lins, SP, Brasil. Tel/Fax: +55-14-522-5418. E-mail: email@example.com
Accepted February 23, 2000
Eletronic publication october, 2000