Coming Together for Better International Oral Health: A Model for Hope

Latin America is one region that faces significant challenges in the maintenance of good oral health. The authors' proposed model for effecting change in Xenocoj, Guatemala, involves the Pacific Dental Services^® (PDS) Foundation Clínica Dental, which leverages local partnerships, professional expertise, education, and state-of-the-art technology.

The WHO reports that dental caries and periodontal disease are the most common oral health diseases globally. These two conditions can lead to tooth loss, disability, and difficulty chewing. Additionally, inadequate nutrition exacerbates this public health crisis.

The shortage of dental professionals further contributes to the existing inequities. Guatemala has only one licensed dentist per 100,000 residents, in contrast to 60.7 dentists per 100,000 in the United States.2,3 The high prevalence of unlicensed dentists in many international regions can lead to increased harm and, possibly, even death.

While well intended, the rise of dental service missions can actually create difficulties with sustainable care. Dental service trips frequently clash with local health strategies. The existence of a dual oral health system can result in a lack of trust in local services, leading patients to prefer waiting for free healthcare from foreign providers rather than seeking treatment from local oral health professionals.4 The relatively brief duration of dental missions often means that any aftercare and post-treatment complications will fall into the laps of local oral health providers. The additional workload caused by dental missions can overwhelm local professionals, making it difficult for them to provide adequate care to other patients in an already overloaded environment.4 Because of the singular nature of a volunteer trip without localized continuous care, the success of volunteer treatment is speculative, and often is not measured or tracked.

The PDS Foundation Clínica Dental, led by Dr. Rodrigo Letona Barillas, has developed a sustainable model for providing dental care in Guatemala. By empowering local clinical leaders, incorporating education on the benefits of integrated medical and dental services, and forging partnerships with local universities, the clinic helps patients receive high-quality oral care that is both accessible and sustainable.

Empowering local oral health professionals provides them with greater credibility within their communities and helps ensure continuity of care for patients. Through the use of local suppliers and trusted specialty referrals, the clinic contributes to the growth of the local economy. Additionally, the clinic is committed to improving access to care for disabled populations by partnering with organizations like Beeline Wheelchairs, a group dedicated to meeting mobility needs in underserved communities.

The clinic strongly emphasizes prevention and community engagement, and team members lead various community projects to promote oral health and raise awareness about the importance of preventive dental care. By partnering with the University of San Carlos, the clinic provides dental care and serves as a training center for the next generation of oral health professionals, further contributing to the long-term sustainability of oral health in the region.

While volunteers visit the facility, they do so at the clinical direction of Dr. Letona and in collaboration with the local team. This fosters an environment of cross-learning between the volunteer groups and local professionals, allowing for the exchange of knowledge and expertise.

"I have an obligation to each patient who arrives at the clinic to give the best care possible, and this is only achieved by providing clinical treatment and education for the prevention of oral diseases, including information on how oral health affects overall health," Dr. Letona explains. "There is no culture of prevention [in Xenocoj], and people only visit the dentist when there is already some type of discomfort or they have an accident. This is why oral health professionals must change mindsets and start promoting a culture of prevention."

According to Dr. Marisol King, a volunteer dentist who has visited the Clínica Dental several times, more than half of the region's population lives in rural areas, preventive care is not routinely taught, and most dental care received, if any, is emergency related. "Systemic health is directly linked to oral health," she says. "Guatemala has higher rates of obesity, leading to high rates of cardiovascular disease and diabetes. By teaching the Mouth-Body Connection^®5 and empowering local healthcare providers to oversee the practice, the PDS Foundation offers a hopeful vision for change."

The clinic has implemented a patient education strategy that goes beyond treating the immediate dental issue and instead focuses on educating patients on the broader health implications of periodontal disease. By displaying posters and providing handouts in Spanish, the clinic effectively communicates the links between periodontal disease and systemic conditions. Dr. Letona observes that the conversation around the link between periodontal disease and pre-term births has been particularly notable among patients at the clinic. He has noticed a significant improvement in patient education and engagement since the introduction of these visual aids.

"The explanation for patients is much more didactic," he says. "When I verbally explained the information previously, patients had difficulty understanding. With posters, the explanation is far simpler, and patients sometimes take a photo to read later."

This patient education approach aims to improve oral health outcomes and promote overall health and well-being for the local community. "Many patients who returned for care were curious about preventive dental care," Dr. King says. "They encouraged their children and older generations to come and receive exams, not just for emergency care, but proactively and preventively. This could lead to incremental changes in systemic health long-term."

The authors believe this model can serve as a blueprint for future international dental initiatives that empower local communities and improve oral health outcomes by prioritizing prevention, education, and long-term sustainability. Anyone interested in learning more about the PDS Foundation's efforts in Guatemala may visit its International Service Trips webpage at pdsfoundation.org/programs/international-trips/.

Michael Minh Le, BA, JD, MBA
Executive Director, Pacific Dental Services Foundation, Irvine, California

Rodrigo Letona Barillas, DDS
Dentist, Dental Surgeon, Pacific Dental Services Foundation Clínica Dental, Xenacoj, Guatemala

Marisol King, DDS
Practice Owner and General Dentist,
Albuquerque, New Mexico

1. World Health Organization. Landmark global strategy on oral health adopted at World Health Assembly 75. WHO website. May 28, 2022. www.who.int/news-room/feature-stories/detail/landmark-global-strategy-on-oral-health-adopted-at-world-health-assembly-75. Accessed July 19, 2023.

2. World Health Organization. Oral Health Country Profile: Guatemala. 2022. https://cdn.who.int/media/docs/default-source/country-profiles/oral-health/oral-health-gtm-2022-country-profile.pdf?sfvrsn=54d14306_10&download=true. Accessed July 19, 2023.

3. American Dental Association. The dentist workforce. ADA website. https://www.ada.org/resources/research/health-policy-institute/dentist-workforce#:~:text=How%20many%20dentists%20are%20currently,2001%2D2022%20(XLSX). Accessed July 19, 2023

4. Bauer I. More harm than good? The questionable ethics of medical volunteering and international student placements. Trop Dis Travel Med Vaccines. 2017;3:5. doi: 10.1186/s40794-017-0048-y.

5. Pacific Dental Services. The Mouth-Body Connection^®. https://www.pdsfoundation.org/content/dam/foundation-org/programs-page/special-needs-page/Mouth_Body_Connection.pdf. Accessed July 19, 2023.