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Dental student outreach eyed

New ADA policy emphasizes ethics, supervision in volunteer settings

A growing apprehension over patient safety in dental outreach programs has led the ADA to distribute a new policy on student participation.

Image: Shoulder to Shoulder: Drs. Larry and Jan Tepe of Cincinnati enjoy a hike in Honduras.
Shoulder to Shoulder: Drs. Larry and Jan Tepe of Cincinnati enjoy a hike in Honduras.

Approved by the House of Delegates in Resolution 31H-2010, the policy aims to bolster the safety of patients taking part in outreach programs by reminding students to follow ethics codes, licensed dentists to supervise students, and students to do only what they have been educated and trained to do.

Forwarded to the House by the American Student Dental Association and Pennsylvania Dental Association, Res. 31H-2010 follows reports of dental and predental students performing irreversible operative procedures, administering anesthesia and extracting teeth during outreach programs.

“There is often an impression that there is so much need in some areas that anything being done is better than nothing,” said Dr. Larry Tepe.

Over the past 11 years, Dr. Tepe and his wife, Dr. Jan Tepe, have worked with Shoulder to Shoulder Inc. to help establish three dental clinics in Honduras. Dr. Jan Tepe, a part-time clinical faculty member at the Ohio State University College of Dentistry, has organized dental student trips to the clinics in Honduras.

“We run the student supervision as it is in the clinics at Ohio State,” said Dr. Larry Tepe. “We received permission from the Colegio de Cirujanos Dentistas de Honduras for the dental students to work at the clinic with supervision and have a Honduran dentist present. Every step of the student’s procedure is checked, just like in dental school.”

Dr. Tepe recommends that sponsoring organizations spend time researching the laws and regulations of any country they plan to visit.

“We need to become more aware of the existing dental organizations in other countries and work with them to improve oral care,” said Dr. Tepe. “Countries have laws regulating dental care and it is our responsibility to abide by them. The local dentists and physicians are often left to treat the postoperative complications after these brigades have left.”

The ADA Council on Dental Education and Licensure and the Committee on International Programs and Development recently sent a memo outlining the new ADA policy to deans of U.S. dental schools, ASDA, the National Association of Advisors for the Health Professions and U.S.-based international dental volunteer organizations.

“The dedication of the growing number of volunteers who work in some of the world’s most deprived communities is fully supported by the American Dental Association,” wrote Dr. Brian T. Kennedy, CDEL chair, and Dr. Kathryn Kell, CIPD chair.

“However, we have experienced a sense of increasing unease that some volunteers, albeit with good intentions, may be inadequately supervised or may perform procedures without receiving sufficient training or education to ensure that no harm is done to patients.”

Volunteerism among colleges, universities and dental schools is on the rise, said Dr. Kell, which is a great trend for the profession.

“This policy reinforces the fact that we want to ensure good oral health programs throughout the world and that we want to maintain good relationships with our international dental organizations and keep problems from occurring,” she said. 

Res. 31H is particularly focused on predental students, said Dr. Kennedy. “Many times, people go on these types of missions with the idea that they will increase their attractiveness as a candidate to dental school,” he said.

Working in austere environments with limited resources complicates the situation for sponsoring organizations, said Dr. Kennedy. There can be fewer dentists to supervise students and little time for preparation.

“When you go out into the Third World, we realize it’s not the same as working in the U.S., but we’re trying to find a middle road in terms of setting policy,” said Dr. Kennedy.

The policy states: “Resolved, that it be policy of the American Dental Association that students in U.S. dental schools and predental programs who participate in a dental outreach program (e.g., international service trips, domestic service trips, volunteerism in underserved areas, etc.) be strongly encouraged:

  • to adhere to the ASDA Student Code of Ethics and the ADA Principles of Ethics and Code of Professional Conduct;
  • to be directly supervised by dentists licensed to practice or teach in the United States;
  • to perform only procedures for which the volunteer has received proper education and training.”

The American Dental Education Association in 2010 adopted Guidelines for Predental Students Providing Patient Care During Clinical Experiences Abroad describing the consequences of having inadequately educated and trained students in these situations. Possible harm to the patient and the student, legal issues with authorities and the risk of being involved with a fraudulent organization are included, along with steps predental students can take before participating in outreach programs.

“Recognizing that your organization has a vested interest in the public’s oral health and plays a role in dental outreach programs, we hope that you will give the ADA’s new policy serious consideration,” Drs. Kennedy and Kell wrote in their memo. “Help us to ensure the well-being of all patients while instilling in our students/health professionals that they have an ethical duty to protect patients, including vulnerable populations, by practicing within the limits of their training and expertise.”