Story by Fernanda Pires | Photos by Denise Guimarães
Improving oral health care: U-M dental students learn about craniofacial anomalies in Brazil
BAURU, Brazil—Arthur arrived for his dental appointment and eagerly climbed into the familiar dental chair. At just 5 years old, the smiling boy seemed comfortable with the process. It was clear he’d been here many times before.
During his checkup, the dentist joked with her young patient, and soon, she was smiling herself: Arthur had no cavities, which is quite rare for a child like him. He was born prematurely and underweight, with an extensive cleft lip and palate.
The pediatric team at Centrinho, the Craniofacial Anomalies Rehabilitation Hospital at the University of São Paulo, congratulated the boy and his mother, Maria da Conceição Rocha, while a visiting team of students from the University of Michigan observed the joyful interaction.
“He was born early, at six-and-a-half months,” Rocha said. “He was 12.5 inches long and less than a pound. So to gain weight, he ended up ingesting a lot of calories and sugar. But I never neglected his teeth.”
Founded 50 years ago, Centrinho is a world reference center for the treatment of congenital craniofacial anomalies, especially cleft lip and palate, or FLP. In Brazil, one in every 650 children is born with FLP. Worldwide, one in every thousand children is born with the condition.
Expanding educational opportunities and promoting a global vision of dentistry are some of the goals of the U-M Global Initiatives in Oral and Craniofacial Health program, which since 2012 has sent students from the School of Dentistry to selected countries to work, train and learn from dentists, doctors and local patients.
“The access to care is practically the same in Brazil as in the U.S. or India, but the way procedures are done is very different.”
“We want to improve global oral health and promote equality through research, education and services,” said Cristiane Squarize, a professor in the U-M Department of Periodontology and Oral Medicine and one of the program’s coordinators. “This partnership is very important because it is an interchange between internationally prestigious dentistry faculties.”
This year for two weeks, U.S. students shadowed the clinical faculty and staff at the Bauru School of Dentistry at the University of São Paulo, one of the best dental schools in Brazil and a U-M partner since 2012.
“The possibility of meeting the needs of a global community will be better if we use the physical and human resources of the two universities,” said Guilherme Janson, professor and deputy director of faculty at Bauru.
Neha Vazirani, a visiting U-M student who was born in India, graduated as a dentist in Mumbai and completed a master’s program in public health at Tulane University. She is now in her third year of dentistry at U-M.
“The access to care (or diagnosis or treatment recommendations) is practically the same in Brazil as in the U.S. or India,” she said. “But the way procedures are done is very different. It is a privilege to be able to have a global understanding of dentistry and to get to know the integrated treatment offered to patients from all over Brazil.”
Great success story, great learning experience
At this young age, Arthur has endured five surgeries to correct the cleft lip and palate. The first one, usually done at 3 months of age, was delayed, however, until he was 2 years old due to his low weight.
“Arthur is a success story, so it’s important for you to understand his treatment,” said Gisele Dalben, a pediatric dentist. “His mother even managed to breastfeed him and then followed our guidelines, which has greatly facilitated the treatment.”
Rocha, dedicated to her son’s oral health, brings him for a dental cleaning every month.
“We’re already part of this family,” she said. “Our goal is to avoid any cavities to facilitate the treatment.”
A student of the Internationally Trained Dentist program at the U-M School of Dentistry, Mythili Ramakrishna Bhat learned about Arthur’s case with enthusiasm. She knew the complexity of the treatment, the interdisciplinary work required and the long process of integral rehabilitation.
“We are following how dentists, physicians, speech therapists, local clinics and even the distant clinics coordinate care to get the best result possible,” Bhat said. “It’s a great learning experience.”
Palatal prostheses and more interdisciplinarity
Orthodontist Mônica Moraes Lopes and speech therapist Maria Daniela Borro Pinto reviewed three cases of patients born with a cleft lip and palate. Ranging in age from 10 to 42, none were eligible for surgery, so each would be fitted with a special palatal prosthesis to correct speech problems.
The device corrects velopharyngeal dysfunction, which affects a muscular valve located between the nose and the mouth. Its function is to control the air passage.
“This problem can affect a person’s speech in such a way they can not communicate normally,” Borro Pinto said. “If not treated, the patient can endure a negative psychological impact and even quit social life.”
The consequences can go further, according to Centrinho’s researchers, who developed the prosthesis. The distress of being misunderstood and unable to express oneself can stifle creativity and limit one’s ability to learn, they said.
U-M student Vazirani wants to specialize in orthodontics and was fascinated by the speech and hearing clinics, where prosthetics for the mouth, ears, nose and eyes are produced.
“These clinics are a totally new concept for me,” she said. “The teachers explained how the process of speech production works in the patients using these prostheses, and we could see the results during the clinic tests.”
Rita de Cassia Lauris, chief of the Division of Dentistry at Centrinho, also emphasized the importance of interdisciplinarity for a successful rehabilitation treatment that includes mastication, speech, breathing and esthetics.
“Here, an orthodontist, for example, does not live without the plastic surgeon, without the speech therapist or the physiotherapist,” she said. “We also do not achieve the expected success if we do not work with our psychologists.
“Our patients don’t want to look better. They want to fit in, they want to look like their peers and call no attention to themselves.”
Creating palatal prostheses
The most common procedures of the dentistry clinic also drew the U-M students’ attention. In a collective clinic, some 50 fourth-year USP dental students worked in pairs to expedite different types of treatment—from basic calculus and dental cleaning to complex implants and surgeries.
“It’s really cool to see the students working in pairs and helping each other,” said Tamara Mackie, a fourth-year U-M student who wants to specialize in orthodontics. “Here they use different types of composites. They are very precise, sensitive to the techniques and highly attentive to aesthetics.”
“This program offered me a wonderful opportunity to get familiarized with one of the best dental schools in Brazil,” said U-M student Ehsan Mostaghni. “It provided the opportunity to enhance my knowledge and skills in collaborative care and interprofessional education.”
More than learning about USP’s interdisciplinary education and Centrinho’s comprehensive rehabilitation process, Arthur’s mother, Rocha, hopes U-M students can take home something even more precious.
“The emotional side means a lot throughout the process,” she said. “I hope future Michigan professionals can really understand the importance of humanized dentistry so other patients like Arthur can successfully complete their treatments.”
School of Dentistry: Global Initiatives
This trip was co-sponsored by the International College of Dentistry: http://www.usa-icd.org/