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FEATURED SPRING 2011 ARTICLE

Public Practice Graduates from Temple’s Kornberg School of Dentistry treat thousands of patients suffering from lack of dental care, share their knowledge and provide relief to developing nations. Story by JoAnn Greco

Temple dental students treat patients at an outdoor, makeshift clinic. Photo courtesy of Temple Haiti Club.

The image of one 5-year-old patient remains particularly vivid for Joshua Bresler, DEN ’03, pediatric dentist and Temple adjunct assistant professor of pediatric dentistry. “He had an infected tooth that had been neglected for too long, and his entire face was badly swollen,” Bresler recalls. “He also had a fistula on his cheek.”

It is not the kind of problem that Bresler normally would encounter in his Philadelphia-area office. And it is not what comes to mind when most of us consider our own routine dental health. The occasional filling, the less-frequent crown or bridge and the no-longer-so-dreaded root canal are just more
appointments to squeeze into our schedules.

But such sights are common in developing nations such as Haiti, where Bresler treated that suffering boy. According to the World Health Organization,
limited access to services and equipment, poor nutrition and diets, and a general lack of education have combined to make dental health a significant concern in many countries.

“The Third World is the only place on Earth where people can actually die from dental disease,” Jeremiah Lowney Jr., DEN ’61, says. “Decaying teeth
can become infected quickly, and those infections can move on to other organs. There are all kinds of links between dental infections and heart infections, and
it’s a pretty short route from the teeth to the brain.”

A host of private foundations are tackling the issue—and Kornberg School of Dentistry graduates are rising to the challenge by participating as volunteers around the world. Not only do these dentists donate their services, they also often pay their own expenses while forfeiting revenue back home for weeks at a time.

Lowney is an extraordinary example. Twenty-nine years ago, the Norwich, Conn.-based orthodontist started the Haitian Health Foundation (HHF) after visiting the country as the only dentist in a volunteer group sponsored by his local church. Coming “from one of America’s wealthiest states to the poorest country in the Western hemisphere,” Lowney says he was so struck by the poverty, he returned to Port-au-Prince three months later.

After a few years of working for weeks at a time in the Haitian capital, he relocated to Jérémie, a remote city on the far western part of the island, at the request of Mother Teresa, who was setting up an outpost there. These days, HHF operates out of the 27,000-square-foot poured concrete clinic that Lowney and his wife opened in Jérémie in 1988. A staff of physicians, nurses and other healthcare
providers — including one full-time dentist — ministers to a regional population of about 600,000. Over the years, HHF has enlisted approximately 100 dentists
to help with extractions and other treatments.

A Family Affair
Joshua Bresler first journeyed to Haiti with HHF in 2001, while a dental student. He was accompanied by his father, David, CLA ’75, DEN ’79, an adjunct professor of pediatric dentistry at Temple. Joshua returns to Haiti once a year as faculty advisor for the Temple Haiti Club, a group of dental students who travel there to treat the local community. Joshua has been accompanied by students including his younger
brother, Jason, DEN ’06, now an assistant professor of pediatric dentistry at Temple.

Typically, Joshua and his contingent set out to visit two villages a day, armed with a beach chair and a few dental tools. They arrive to find dozens of people—some of whom have walked for days—waiting to be treated.

“Normally, there are only a few dentists covering the entire region,” Bresler says, “so there’s really no dental maintenance to speak of. There are no toothbrushes or toothpaste, and that’s compounded by a very poor diet, of which the main source of calories comes from chewing sugar cane.”

According to Bresler, the group performs thousands of extractions in a single five-day stint. “Their teeth are in terrible shape, with multiple infections and abscesses,” Bresler says. “Sometimes, all 32 teeth have decayed down to the gum line, and we numb them and take out their teeth.

“In America, we have one tooth removed and we worry about getting an implant or a bridge,” he adds. “That’s not an option here. They’re happy just to be
out of pain. It changes their lives.”

Before departing a village, the group reviews home care and distributes the cases of toothbrushes and toothpaste the volunteers have brought with them.
“Education is a very important component,” he notes.

Leaving Knowledge Behind
Michael Faktor, DEN ’03, of Crested Butte, Colo., agrees. “My goal is always to get out there and try to treat [people], but after that, we really place an emphasis on helping them understand their mouths and taking care of their teeth,” he says. Faktor works with numerous Cambodian health agencies, including the Angkor Hospital for Children in Siem Reap and the Lake Clinic in the Tonle Sap region.

He remembers the same problems when he treated Philadelphia children in need as a dental student at Temple. “Seeing poor dental health day in and day out made me realize that everyone deserves equally good treatment,” he says.

In a separate effort that begins in Rwanda this spring, Faktor will teach that region’s next generation of dentists. “The country has no medical or dental schools,” he says. “I’ll be lecturing as part of a new two-year program that takes kids right out of high school and gives them a general medical education.”
The hope, he says, is to foster a regular culture of caring for teeth.

Marc Rothman, DEN ’88, also nurtures a new and better generation of dental workers. His work with Alpha Omega International Dental Fraternity and the Global Oral Health Initiative led him to Jewish Healthcare International (JHI) in Atlanta. As a JHI board member, Rothman worked to create a dental center of excellence at Bikur Holim, a Jewish hospital in Riga, Latvia.

“The existing dental center had no sterilization protocol in place, and a lot of other systems were similarly haphazard,” Rothman says. “During the past 10 years, we’ve implemented new systems of treatment planning, infection control, pathology recognition, periodontics and endodontics, dental implantology and advanced surgical procedures.” Now, he adds, “these practitioners are some of the most capable dentists I know.”

In addition to the importance of dentistry to overall health, Rothman points out another side of dental neglect: the impact on psychological health and even on prosperity. “It can be really hard for a person with poor dentition—broken, misaligned, badly stained teeth—to be accepted into and comfortable with normal society, no matter how good their general hygiene is or how intelligent and
capable they are. They may have difficulty getting hired because of their appearance.”

Removing Stigmas, Renewing Lives
Some volunteer dentists say that the stigma associated with dental problems can be even more pronounced than what Rothman describes. “In the Cambodian
countryside, one will constantly run into little children with huge abscesses,” Faktor says. “Theirs is a very superstitious society, and people say such abscesses are evidence of the devil.”

The same fate awaits those born with similar defects in areas of Venezuela, where Laurence Stone, DEN ’73, worked with San Francisco-based Rotaplast International Inc. to assist plastic surgeons in correcting cleft palates and cleft lips. “They see it as a sin coming back to the family,” Stone says.

According to Stone, the incidence of clefts in South America is approximately six times higher than it is in the U.S. The primary causes for clefts, he adds, are
poor nutrition and genetics. “In wealthier countries, such as ours, these things are taken care of within the first year of an infant’s life,” he adds. Not only do clefts have an impact on children’s appearances, they severely limit their ability to ingest solid foods and even to suckle breast milk in places already threatened by malnutrition.

During his first visit to Venezuela, Stone was the only dentist on a team of 28 that included plastic surgeons, anesthesiologists and nurses. They performed 110 procedures on 81 patients — nearly $500,000 in services. “It’s so moving to see the gratitude of the families,” he says. “These are life-changing surgeries.”

The experience has been eye-opening for Stone. “These are the not kinds of things that a general dentist is normally involved in,” he says. “I saw more abnormal dental conditions in Venezuela than I have
seen in my 35-year career.”

Such moments of realization are common among those who have embarked on service trips. “Our dental education is so advanced in comparison with
other countries,” Jack Belchinsky, DEN ’66, says. “In Santarem, Brazil, where I worked for about six weeks through Health Volunteers Overseas, the average
income was just $1,100 per year. Even though Brazil is an economic force and its services are more than adequate, poverty is still a factor.”

That’s why Belchinsky, at 71 years old, currently is looking for another overseas volunteer opportunity. “I still remember what one of my Temple professors
said to me more than 40 years ago,” he remarks. “He said, ‘The best place to practice is where you’re needed most.’”

JoAnn Greco is a Philadelphia-based freelance writer whose work has been published in National Geographic Traveler, The Washington Post, Art & Antiques, Pennsylvania Gazette and more.