UNC students launch dental prevention program for Siler City clinic’s Spanish-speaking patients

By VICTORIA JOHNSON

SILER CITY — Inside an unassuming brick building just off 401 N. Ivey Ave., two UNC dental students have hatched a months-long program to instill in patients the necessary habits — and hope — to achieve lifelong oral health.

Literally.

The program — called H.O.P.E., or Hispanic Oral health Prevention and Education — seeks to offer Spanish-speaking patients critical oral health education and individualized care at Vidas de Esperanza, a medical and dental clinic in Siler City. H.O.P.E.’s goal, according to co-founders Sylvette Ramos-Díaz and Arlet Montes Sánchez is to empower patients to take charge of their own oral health and prevent debilitating — and costly — oral complications later in life.

“We’re trying to reshape the way that they see dentistry and how they can actively work towards keeping their teeth,” Ramos-Díaz, a second-year dental student at the UNC Adams School of Dentistry, told the News & Record. “Many of them expect to just lose all their teeth with age, and that’s not accurate, so we’re just educating them as much as we possibly can.”

Vidas de Esperanza first partnered with UNC’s dental school to offer the community free bilingual dental services about five or six years ago. Since then, UNC students and licensed faculty have run dental clinics there usually two Saturdays a month, providing primarily fillings and extractions for patients in need.

But now, Ramos-Díaz, Montes Sánchez and a small team of volunteers have been spending nearly every Saturday at Vidas, attending to patients from 8 a.m. to 6 p.m. — and sometimes even later. On a typical day, Ramos-Díaz said, they might see an average of 16 patients, both old and new.

As of Monday afternoon, 44 patients had enrolled in H.O.P.E. — and counting.

“The hope is that we get to at least in the 80s by the end of the project,” said Montes Sánchez, a third-year dental student.

The H.O.P.E. program lasts about three months from the initial paperwork to the project’s exit survey. And the best part? It’s all in Spanish. Ramos-Díaz and Montes Sánchez are native Spanish speakers from Puerto Rico and Cuba respectively.

After new patients complete their medical paperwork, Ramos-Díaz and Montes Sánchez first treat them to a nearly 19-minute educational video, which explains the program, talks about treatment options and goes over basic dental concepts.

“We basically look like two news reporters, and we show pictures every once in a while,” said Ramos-Díaz with a laugh. “Like, ‘This is a cavity. This is amalgam. This is composite.’ That kind of thing.”

Once patients watch the video, they then undergo a series of exams — including X-rays and plaque and salivary analyses — which will determine the kind of treatment and education they receive. That, too, is when they’ll begin to go over basic oral hygiene instruction.

“We actually stand with our patients and watch them brush,” Ramos-Díaz said. “We give them a toothbrush and toothpaste, and give them pointers, let them know what they’re doing right, what they need to improve.”

For the next series of visits, the H.O.P.E. team monitors patients’ oral hygiene habits and steadily goes through their treatment plans. Depending on patients’ needs, they’ll provide prophylaxis, or dental cleaning, plus scaling and root planing (SRP), better known as deep cleanings — both services that Vidas’ bimonthly dental clinics rarely provide due to time and resource restraints.

At the three-month visit, patients receive an exit survey to gauge what they’ve learned, plus a six-month follow-up appointment with Vidas’ regular dental clinic.

“We’re really trying hard to make sure … that we’re charting to bring them back within a year for a follow-up because before there was no such thing as following up with a patient,” Ramos-Díaz said. “It was always first come, first serve, and so we’re trying to be a little bit more structured just to make sure no patients fall through the cracks.”

‘The best way we can help them’

Dressed from head to toe in PPE, Ramos-Díaz first stepped foot into Vidas de Esperanza last October with a team of other dental students to resume dental services at the clinic after a months-long pandemic-related hiatus.

She’d just started dental school a couple of months before that and had been eager to get involved with the student-run dental clinic. After a few weeks, however, she and Montes Sánchez noticed a big problem.

“Many of our patients were coming back to our clinic with the same issues that they came in with the very first time we saw them,” Ramos-Díaz said. “It just seemed like things were not getting necessarily better — sometimes maybe were progressing and not in the best way.”

They realized it all came down to little or no oral health education, she said; many of their patients didn’t know how to properly take care of their teeth — and instead of educating their patients, students were just “drilling, filling and pulling teeth” at Vidas.

She and Montes Sánchez decided to do something about it. Their solution? Education and prevention.

“Some of our patients have told us that they’ve never touched a toothbrush in their lives,” Ramos-Díaz said. “They use a napkin, wrap it around their finger and dip it in hydrogen peroxide to clean their teeth, and so we knew that this was something very much needed.”

The community Vidas de Esperanza serves is “extremely vulnerable,” Montes Sánchez added. For many, barriers to care don’t just stop at exorbitant dental fees; other barriers can include lack of health literacy, or literacy in general, lack of transportation, demanding work schedules and  unreliable or unaffordable child care.

“All of those things affect whether or not they’re able to really own their health and their own oral health and take care of themselves at home,” Montes Sánchez said, adding, “It became extremely clear for us that to be able to give these patients comprehensive care and something that is going to be long lasting for them, we need to start treating the disease. … Putting an emphasis on prevention is the best way that we can help them.”

They began brainstorming ideas late last year — should they create “a huge official program” or just hand out oral hygiene bags? In December of 2020, Ramos-Díaz and Montes Sánchez decided to commit to a full-blown project: They drafted a project proposal and with it, applied for the North Carolina Albert Schweitzer Fellowship.

In March, they got it — and from there, they began a lengthy planning process.

The fellowship supplied them enough funding to get the project going, and their two advisors — Dr. Steve Kizer from Vidas de Esperanza and UNC’s Dr. Apoena Ribeiro — helped them perfect it. The Hispanic Student Dental Association, which oversees Vidas’ dental clinic, also chipped in manpower and support.

“It’s taken up a lot of planning,” Ramos-Díaz said. “From December to basically, July, that was all nothing but planning.”

In early August, Ramos-Díaz and Montes Sánchez held their first H.O.P.E. clinic — and in just two months, H.O.P.E. has already left its mark on Vidas de Esperanza, its co-founders, and of course, its patients. For Ramos-Díaz and Montes Sánchez, serving and empowering patients has been the most rewarding part of the entire program.

“Many of them are just mind-blown when we talk to them about these things,” said Ramos-Díaz, “so, we know that they’re learning and they’re very appreciative of the education that we’re providing them with … I was calling a patient and she said she is so excited to finally get a cleaning tomorrow. It’s a really wonderful feeling to be working with these patients.”

Last month, Montes Sánchez worked with a patient who hadn’t gone to the dentist in years because she’d felt “mortified.” After she started H.O.P.E., though, that all changed.

“We had her back for her recall, she was like, ‘Oh, I love coming here now. Like, I used to be so terrified of the dentist, but you guys are so gentle, and so nice, and you treat me so well,’” Montes Sánchez said. “It’s just knowing that we are actually making a difference in people’s lives in that way, even though we’re mostly focusing on just educating them and sitting down with them going through these concepts.”

According to Vidas de Esperanza’s volunteer staff, H.O.P.E. has also worked wonders to expand the clinic’s services, improve its standard of care and reduce its long dental waitlist.

“We have been able to get people signed up to have their teeth cleaned on a regular basis, so people seem to be taking to the program,” Ascary Arias, Vidas founder and president, told the News & Record. “They seem to like it. I think, this prevention thing, if it works, it’s really a program that should be applied everywhere.”

According to Carolina Torres, the assistant director of Vidas’ medical and dental clinics, patients might wait months — perhaps even years — for dental treatment at the clinic. Recently, the waitlist numbered between 200 and 300 people, she said, but now with H.O.P.E., that number has been steadily decreasing.

“So, with this program we have been able to see more patients,” Torres said. “ … The patients with emergencies are definitely waiting less time.”

Torres hopes the program will continue indefinitely, as do its co-founders.

Their fellowship officially ends in April of 2022, but Montes Sánchez and Ramos-Díaz have already been taking steps to ensure the program survives. Even now, just two months in, they’ve been bringing in and training other students passionate about the program’s goals.

According to Ramos-Díaz, those students could apply to continue the program next year as Schweitzer Fellows.

“We want this (H.O.P.E.) to be the new way that we bring patients in,” she said, “ … (by educating them) on what their options are, how to properly brush and floss, the very basics that should have been honestly part of the clinic before but weren’t. That’s what we’re aiming for. We want this to be the new norm at the clinic.”