Training van de healthworkers

A brief account of the dental training

Dit is het volledige verslag van de opleiding van de  healthworkers in 2010:
Nisha Rana Magar
Gita Naharki
Shanta Regmi

Atraumatic Restorative Treatment (ART) training in Dhulikhel (24 – 29 April, 2010)

1.      Introduction

ART method is based on filling the holes (caused by infection) in the teeth by using the hand tools. Many people in the developing countries as well as refugees have no proper excess of dental treatment and they are forced to go for removing the teeth when that gets infected. ART method is useful for such group of people. This method doesn’t cost that high and doesn’t make the patient that scary as well. We can treat the patient in the beginning of the infection starts and save them from removing the teeth.

Glass ionomer is one of the materials to fill in, which is made of acrylic and a specific type of glass material. This material is most commonly used for fillings below the gum line and for fillings in young children (drilling is still required). Glass ionomers release fluoride, which can help protect the tooth from further decay. However, this material is weaker than composite resin and is more susceptible to wear and prone to fracture. Glass ionomer generally lasts 5 years or less with costs comparable to composite resin.

2.      Objectives:
– The objectives of the training are as follows:
– The participants could explain that their teeth are getting infected
– The participants could be safe / prevent from getting the teeth infected
– The participants could prevent the people from the removal of the (infected) teeth
– The participants could make a prevention and control on the dental infections

3.      Necessary items:
To fill in the gap from the teeth by ART method, the following tools / materials is needed:
a.       Tools:             Mouth mirror, Explorer,  A pair of tweezers,  Hatchet or hoe,  Spoon excavator (small), Spoon excavator (medium), Glassslab/
mixingpad, Spatula, Carver-ash special
b.      Materials :      Cotton roll, Cotton pellet, Glass ionomer filling material – liquid power, Detain conditioner, Varnish or Vaseline, Wedge, Plastic strip, T-band, Clean
water, Syringe and needles, Torch, Water filter pot, Umbrella,

4. Activities
·         There should be a comfortable atmosphere for the patient
·         Should be check first if the teeth is infected
If the tooth is infected:
·         Should be carved away the  infected portion of the tooth
·         Make it clean with normal water and cotton
·         Make it dry (after cleaning)
·         Mix with Glass Ionomer
·         Put the glass ionomer into the infected hole of the tooth by the help of carver
·         Gently press the glass ionomer by finger (when its shine is getting low) so that it would precisely fit in the hole and it makes the filling more solid
·         After 30 second, slightly move the finger in the side and remove the finger
·         Remove the leftover glass ionomer by the help of carver
·         Put a layer of varnish on top of the filling
·         After 30 second, let the patient check with the test bite, and let the patient close the mouth in a normal way, clean the leftover cement by using carver and put a layer
of varnish until it gets dry
·         To remove the leftover portion of glass ionomer, let the patient gargle away with the water
·         To tell the patient not to eat anything least for an hour
·         To suggest the patient to brush the teeth everyday with the fluoride-containing toothpaste

Basic Package of Oral Care – BPOC training in Dailekh (May 24 – June 4, 2010)

1.      Introduction

World Health Organization (WHO) has prescribed Basic Package of Oral Care – BPOC as an essential tool for making the oral health services easily available. This concept supports the people from the third world country who are relatively deprived, for getting the oral healthcare services effectively in the affordable cost. Through the primary healthcare services’ network, BPOC is focus for marginalized community to provide emergency oral treatment, removal of the complex teeth, deal with oral / teeth injury etc. And, it makes the people aware for brushing teeth daily with fluoride–containing toothpaste.  The main objective of this concept is to provide the oral health services to the more people even from the limited resources. The main component of BPOC are; a) Oral Urgent Treatment – OUT, b) Affordable Fluoride Toothpaste – AFT, c) Atraumatic Restorative Treatment – ART. In terms of Nepal, Arrest of Carries Technique – ACT and Oral Health Promotion – OHP also included under it.

2.      Objectives
i.            To be able to understand the oral tissues and skulls
ii.           To be able to understand the structure, type, functions and heterogeneity of the teeth
iii.          To able to understand the time and order of teeth coming and exchanging
iv.          To know the common problem oral problems, e.g. teeth infection, gum infection, oral cancer etc. and be aware of probable consequences and tackle the
appropriate measures of prevention
v.           To deal with common dental injury e.g. broken teeth, rusted teeth etc. And to understand the development of tooth, arrival of wisdom tooth, cellulitis thrush
vi.          To understand the role of fluoride for the teeth prevention from getting infection
vii.         To understand the pandemic control and apply precautions
viii.        To be able to take a proper history of the patient, make a note and suggest preventive measures when necessary
ix.         To understand the nerves / vein related to teeth and gum and be able to make a precise use of anesthesia injection, and manage its consequences
x.          To be able to remove the teeth (not the complicated one) and suggest the patients on dos and dons after the removal

3.      Tools (to remove teeth)

The forceps / elevators are the main tools to remove teeth. The following is the necessary items in detail:
i.            Lower anterior forceps
ii.           Lower universal forceps
iii.          Lower molar forceps
iv.          Lower root forceps
v.           Upper anterior forceps
vi.          Upper universal forceps
vii.         Upper right molar forceps
viii.        Upper left molar forceps
ix.          Upper eight forceps
x.           Upper root forceps / bayonet forceps
xi.          Couplands or criers elevators
xii.         Explorer
xiii.        Pair of tweezers

4.      Activities
Way of removing teeth:
i.           First of all, determine that which teeth should be removed and why
ii.          To enquire the patients if he has any other physical / mental health conditions
iii.         Before the start, the health worker should make aware to the patient about what you are going to do with teeth, how you would do it etc. and make sure that
the patient’s consent is with you
iv.         To make the patient understand how to push and move (the spot / the teeth)
v.          To make a right selection of the tools and keep them in clean place
vi.         Don’t demonstrate the needles / syringe to the patients, some might get afraid beforehand
vii.        Give the injection gently
viii.       Wait 5 to 10 minutes after the injection so that it could show its effect, then check the spotted teeth if that has an effect of the injection.
ix.         To separate the gum, that surrounds the spotted teeth by using coupland elevator. For this, the elevator should be place in the borderline of gum and teeth
and push inside gently
x.          Then the elevator should be reach as deep to the level of bone and it should be slowly rotated
xi.         Use the appropriate forceps and pull the teeth out
xii.        Make sure that there is no remains (roots or pieces of teeth) in the mouth
xiii.       To stop bleeding put the piece of gauze and figure and keep pressing it, and ask the patient to keep biting for half an hour
xiv.       To explain the patient, what you did in his / her teeth and instruct him how to take care of the wound, and prescribe
painkillers /antibiotics (when necessary)
Our Itinerary
We have mentioned in the earlier section about the training we received in two different topics regarding the dental / oral health. Undoubtedly we learned so much of new things from theses trainings, we are thankful towards Stichting Veldwerk the Netherlands (SVN) as well as the sponsors from Holland. Beside the practical and theoretical knowledge on the oral / dental health, both the training locations were new for us. We enjoyed our stay in Dhulikhel and Dailekh as well as travelling to and fro.
For Dhulikhel (the first training) we left home (Dhading) on the 23rd of April, we arrived in SVN office in Kathmandu in the afternoon. Mingma Sherpa and Ramesh Paudyal from SVN helped us a lot to get in their office. After receiving the brief explanations about the training and getting cash money (to pay our food and accommodation during the training) from Ramesh Paudyal, we headed for Dhulikhel in the same day with the companionship of Abhishek Giri from SVN. We stayed in Nabaranga Guest House in Dhulikhel for the whole training period.
There were all together 16 participants and besides us, all were quite seniors (age-wise also) and from the government services. On the behalf of the organizer (Health and Development Society Nepal) of the training, Dr. Kiran Awasthi was there and he leaded the training for entire period. We participated in the dental health organized in the school nearby for three days, which was also our part of the training. We treated there 60 patients including 4 female.
For Dailekh (the 2nd training), we left home on 20 May and reached in SVN office in Kathmandu. We had discussion with Ramesh Paudyal about our travel plan etc. We had to stay in hotel Mustang that day since our bus ticket was arranged for the next day. The next morning we went to the Bus Park but bus were not going to Dailekh as they informed us due to the strike organized locally in Surkhet and Dailekh they couldn’t go. We were bit worried since our training was going to start from 23 May. Luckily, we found one bus for the same evening, but he would only bring us in Kohalpur. We took that also as an option, our bus left Kathmandu at 4 pm and we arrived in Kohalpur next morning 3.30 am. Due to the local strike, there was no other vehicle movement from Kohalpur onwards, thanks to the organizer (especially, Kiran sir), we were picked up by the ambulance from the district health office at 8 am and arrived in Dailekh at 3 pm. It means; we were safely arrived on time for the training starting from the next day.

The resource person for this time was Dr. Ramesh Chaudhary, we had 5 days theory classes and 6 days practical. There was also health camp organized as practical, all together there were 100 patients we treated.
The number of participants of the training was 25 including 4 females. As the previous training, rest of the participants was from government health posts and with quite long working experience.
In the both training, we were thought by using white board, markers. The contact between the resource person and the participants was smooth and easy. The training period was scheduled from 10 am to 5 pm, with a half an hour lunch break from 1 to 1.30 everyday.
We left Dailekh in 4 June, 2 pm and arrived in Surkhet 6 pm. We took the night bus from Surkhet only next day 4 pm and arrived in Malekhu next morning 7 o’clock.

This is how we completed the training and back home safely.

The finance
As we were asked to collect all the bills from our training, travelling and food and accommodation, we did our level best. But in some places, it is hard to find the bill, in such cases, we made our note and handover the expenses record to Ramesh Paudyal.

1.  Training fee – Health and Development Society Nepal 63.000
2.  Food                                                                                         19.229
3.  Accommodation                                                                      8.140
4.  Transportation                                                                        8.700
5.  Miscellaneous                                                                          2.995
Total                                                                                         102.064

Thank you!