Total and Partial Dentures for the Population of Marampaqui, Cusco (Peru)

Request to the Dental Industry

 
About Con Corazón

Con Corazón is a regionally established sustainable humanitarian NGO based in Switzerland and Peru. We offer services in the Peruvian Andes improving fundamental rights, including health and education. The specific rural population where we make interventions is Marampaqui, three hours from the city of Cusco. The responsible and leader of this project is Dr. Saulo Gamarra, a Peruvian dentist focused in the humanitarian field in low- and middle-income countries. He is also director of Con Corazón Peru.


Overview

According to the National Epidemiological Study carried out in the years 2001-2002 (2), the prevalence of dental caries is 90.4% (1), as a consequence we see missing teeth in adults from Marampaqui. The Con Corazón Medical Center has already implemented measures to prevent it through a dental office and oral health prevention and promotion activities.

Tooth loss is a reflection of a person's history of dental disease and its treatment by dental services throughout life (5). Tooth loss reflects not only dental disease, but also the attitudes of patients and dentists, the dentist-patient relationship, the availability and accessibility of dental services, and the prevailing philosophies of dental care (6).

The majority of adults in Marampaqui have a high prevalence of missing teeth so it will not be difficult to select patients who need dental prosthetics. They only visit the dentist for teeth extractions and not for teeth fillings. Therefore, they have become accustomed to smiling and chewing with the few remaining teeth or even without teeth. Unfortunately, due to their economic condition, they are not able to afford a fee for any type of denture, otherwise that will produce financial hardship to them.

In many developing countries, a lack of human and financial resources prevents the implementation of effective oral health programs. Capacity building involves achieving measurable and sustainable results in training, research and care delivery. Actions include advancing knowledge, attitudes and skills, broadening support, and developing cohesion and partnerships (3).

In these countries, there are clear and growing gaps between dental needs and the existing capacity to meet these needs in terms of financial and human resources. Concerted efforts are required to improve access to oral health care through appropriate financing mechanisms and donor support. Peru is no exception, so there is a need to implement capacity building and encourage the workforce to provide evidence-based services while promoting community participation and a multidisciplinary approach (4).
 

Objectives

  1. Return the chewing ability and aesthetics of the beneficiaries from Marampaqui.
  2. We want to take advantage of this opportunity by training dentists through the elaboration of dental prosthetics. The selected dentists will be professionals who do not yet have much experience in the area of dental prosthetics and those who show interest in learning and/or improving their techniques. Through the ‘Colegio Odontológico del Cusco’ (Cusco’s Dental Board) we will invite dentists who will be selected based in a personal interview.
  3. This project will be the beginning of many educational activities for dentists with an emphasis on social projection.
  4. After this activity, participating dentists will be able to deal with cases of patients who need dental prostheses in a more effective way based on evidence. This will improve the results of future treatments for their own patients. For future projects, these dentists will be considered for further education and social activities.

This is a pilot project for which we request support. We know of the academic and clinical experience of the project actors, which will guarantee the success in the implementation of a larger and more sustainable project in the long term. The need for both oral health of patients and education of dentists is great.

Five specialists in prosthodontics will be in charge of the theoretical and practical teaching. As a result of this effort, the quality of the dentures will be guaranteed and Marampaqui patients will be the most benefited.


Envisaged Process

For this phase, we intend to bring patients, previously evaluated and selected, according to our inclusion criterion developed later in the paper. The intention is to bring patients from Marampaqui to the city of Cusco to carry out with their treatments.

To achieve this, the project will include a dental team as follows:

  • 01 coordinator
  • 05 dentists (preferably prosthetics specialists)
  • 05 dental assistants
  • 10 general dentist who are willing to learn and/or improve their skills
  • 10 dental students willing to learn (they will act as dental assistants too)
  • 05 lab technicians
  • 01 oral health promotor from Marampaqui

It is our intention to encourage volunteer work by welcoming participants from overseas and locals such as general dentists, dental hygienists, dental assistants, students and all people who wants to collaborate with the project. That would increase our health workforce. The benefits for the participants include continuing dental education, hands on and most important the satisfaction to help out the poor and needy.
 

Dental Board of Cusco

The Colegio Odontologico del Cusco is the governing body of the Dental Board of Peru in the Cusco Region, which has jurisdiction in the territorial circumscription of the department of Cusco and groups all of its dental surgeons. The intervention will be held within its facility who has twenty dental chairs installed within the building. We already have the permission of the to use its facilities (Annex 1).

‘Colegio Odontologico del Cusco’ (Dental Board Building) twenty dental chairs at the ‘Colegio Odontologico del Cusco’ (Dental Board Building)

 
Inclusion criteria for patients

Potential patients who really want dental prosthesis, should do either maintenance work in our greenhouse or one of our current community projects or around our Medical Center in Marampaqui. The dental team will do the selection at Con Corazón Medical Center.

  • Patients preferably from Marampaqui and nearby area.
  • We will include partially or totally edentulous patients. Pre prosthetic surgery will be done if needed.
  • We will also consider patients with ideal oral conditions to ensure treatment success.
  • Patients with periodontal disease will not be eligible.
  • We will provide twenty dentures. Some patients will receive two dentures, upper and lower.
  • Patients with good oral health conditions. The mouth conditioning will be done by Con Corazón dental team.

 
Inclusion criteria for participating dentist and dental students

  • General dentists willing to enroll the activity, will be interviewed either personal or through video conference.
  • General dentist who work in rural areas will have a special consideration for the application.
  • Dental students will be selected based on their interest level. They will be assistants only. There will be expert dental assistants provided by Con Corazón.
  • There will be a preference for dentists who have volunteered with Con Corazón already.

 
Activities

  • Patients recruitment trough community meetings and local radio. The patients screening will be done by Con Corazón dental team. Their mouths should be conditioned before their first visit.
  • One lecture for general dentists and students, prior to their first visit. Hands on phase will begin in the first visit.
  • Making process:

1st visit (one day)

  • Screening day in Marampaqui

2nd visit (one day)

  • Peri apical X-rays and study cast impressions for all patients
  • Dental treatments for all candidates, including cleaning, fillings and exodontias
  • Planning with cast dental impressions
  • Mouth conditioning, including parallelization, elaboration of occlusal support, retention and bracing for removable partial dentures
  • Final dental impressions with customized trays

Note: patients who have undergone exodontia treatment must wait three weeks for the wound to heal.

3rd visit (one day)

  • Metal try in (for partial dentures) including bite rim elaboration and intermaxillary relation registration
  • Articulation of models
  • Setting up the teeth in wax
  • Teeth try in
  • Acrylic pressing and polishing
  • Installation of dentures

4th visit (one day)

 

  • 1st follow up after 24 hours
  • Adjustments
  • The patients must overnight in Cusco city in order to do their 1st follow up

5th visit (one day)

 

  • 2nd follow up after 72 to 96 hours
  • Final adjustments
  • Debriefing, report and exchange of experiences within the Dental Board facility

Regular follow ups will be carried out by our Con Corazón dental team during our regular outreaches to Marampaqui.

Outputs

The planned outputs are as follows:

  • Patient satisfaction through improved chewing ability.
  • Oral health promotion and prevention as a basis for sustainability.
  • Personal satisfaction of volunteers. Some will have a learning experience.
  • Monitoring and evaluation. Data collection.
  • A report detailing the experiences and impact of the project as a basis for replicability.
  • Strengthen a working relationship and collaboration between Secours Dentaire International (SDI), dental industry, Colegio Odontológico del Cusco (Dental board) and Con Corazón.


Summary and Benefit

Trough the implementation of this project, we want to contribute improving our patients chewing ability and aesthetics. The personal satisfaction of volunteers, learning experience and team work will benefit both the residents of Marampaqui and the professional dental community of Cusco and our supporters abroad like the dental industry. We believe that our track record, managerial competencies qualify us to make this project a success.
 

References

1 World Health Organization. World Oral Health Report 2003. Ginebra: World Health Organization; 2004.

2 Ministerio de Salud. Documento Técnico Plan Nacional de Salud Bucal: Sonríe Siempre Perú 2001- 2002. Lima, Perú: MINSA; 2005.

3 Mumghamba, E & Joury, Easter & Fatusi, Olawunmi & Oluoch, Jakinda & Onigbanjo, R & Honkala, Sisko. (2015). Capacity Building and Financing Oral Health in the African and Middle East Region. Advances in dental research.

4 Mills A,  Ataguba  JE,  Akazili  J,  Borghi  J,  Garshong  B,  Makawia  S,  Mtei  G,  Harris B, Macha J, Meheus F, et al. 2012. Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage. Lancet. 380(9837):126–133.

5 Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005 Sep; 83(9):661-9.

6 Baelum V, van Palenstein Helderman W, Hugoson A, Yee R, Fejerskov O.A global perspective on changes in the burden of caries and periodontitis: implications for dentistry. J Oral Rehabil. 2007 Dec; 34(12):872-906; discussion 940.

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