MOUNT MORIAH, Jamaica — A screaming 4-year-old boy, his legs flailing, is held prone on a battered classroom table as a Tufts University dental student extracts a baby tooth that has decayed beyond the gumline.
It is only the beginning. The boy will have six teeth pulled in all, a victim of the worst case of tooth decay that Jared Wirth, a fourth-year student, has ever seen. Sixteen of the child’s teeth could have been removed, but Wirth wants to leave the boy something to chew with.
Finally, after an excruciating hour — few powered tools, no suction for the blood, and only a local anesthetic — Wirth steps away from the table inside the makeshift clinic, deep in Jamaica’s impoverished mountains.
“All done, all done, all done,” the 28-year-old says, breathing deeply and shaking the tension from his arms.
But children bounce back quickly. A few minutes later, Sheldon high-fives Wirth before heading back home.
The painstaking work was one of hundreds of cases of dental triage performed here recently by 18 students and faculty from the Tufts University School of Dental Medicine, a mission bolstered by two married faculty members and their three sons, all students at the dental school, who made the journey a family affair.
“It keeps your life in perspective. Many of these people have trouble finding three meals a day,” said Dr. Jon Golub, a native of Quincy, Mass. “Maybe there’s a little karma involved, too,” he added with a smile.
Over five challenging days, the Golubs and other Tufts volunteers set up shop in crossroads towns and rain-forest villages, bringing relief and education to thousands of Jamaicans who otherwise would suffer unattended. Along the way, the students learned hard lessons in emergency dentistry — one after another — that cannot be replicated in a Boston classroom.
“You open his mouth, and your heart sort of sinks,” Wirth said after working on Sheldon. “That doesn’t feel good. This is 100 percent preventable.”
The students did not bring portable drills because of spotty electricity. Instead, they relied on basic tools —
mallets, chisels, and forceps — to loosen and pry rotted teeth. Most patients had not seen a dentist for years, if they had ever seen one at all.
The Tufts students rarely see such need, but they can turn for advice to Drs. Jon Golub and Jamie Diament-Golub, who met at Tufts’ dental school and have made humanitarian work a cornerstone of their personal and professional lives.
The couple, who have dental practices in northern New Jersey, also have taken their hands-on philanthropy to Mongolia, Cape Verde, Haiti, Guatemala, and South Africa. Less than two weeks after coming home from Jamaica, they returned to Cambodia.
It’s a calling that has been adopted by their sons — Michael, 27, and twins Benjamin and Zachary, 23.
“My goal is to come back every year,” Michael Golub said in a schoolyard teeming with children in Brown’s Town, a poor, rural community 45 winding miles from the Montego Bay resorts. “The children seem to understand that we’ll take the pain away.”
Just then, a 10-year-old girl named Jada was by his side.
The dentists had just completed six hours of nonstop care, but Jada had not been treated. The top had broken off a lower molar, and the cavity extended into the nerve, putting her at risk of infection.
The dentists would not return for another year, so Jada hurried after Golub, clutching a signed consent form from her parents and tugging on his blue scrubs.
“Do you pull teeth?” Jada asked, her words as much a plea as a question.
Golub, a fourth-year student, had thought he was done for the afternoon. But he didn’t hesitate.
“Come with me,” he said.
Golub led Jada by the hand to a quiet corner of the primary school. Since mid-morning, patients had funneled in and out of the treatment room, a converted study space inside a school where two- and three-person teams of dentists and students worked quickly in synchronized coordination.
Now it was Jada’s turn, and Golub was startled. The thin girl in the crisp blue dress and checkered blouse had scars on her face and on her arms. Golub asked what had caused them, and the frightened girl said she had been abused. The scars on her arms, she told him, were from burning cigarettes.
Jada sat up straight in a school chair, and Golub placed his left leg behind her back for support. The girl grasped his arm as another dentist performed the extraction. Despite the anesthetic, tears fell down her cheeks, and she cried out.
But soon, the tooth had been removed. Smiles and selfies followed.
“I couldn’t leave her here like that. Fifteen minutes to change a person’s life? That’s ridiculous,” Golub said, shaking his head.
The Tufts students know that one week of emergency care is only a Band-Aid for a problem that demands regular attention.
“We always worry about sustainability,” said Dr. John Morgan, the dental school’s director of special programs and global service learning.
To that end, the Tufts contingent set aside time each day to stress prevention, urging children to clean their teeth and sending them home with toothbrushes.
“Brush, brush, brush your teeth,” the Golub brothers sang at one point, all out of tune, brandishing bright-colored posters at the front of a full classroom.
“Who knows what foods are good for your teeth?” Michael asked.
“Vegetables?” one girl answered.
“Good!” Michael said with a grin.
Dr. Noel Brown, a Jamaican dentist who helped organize the trip, pitched in wherever he could. He pointed a flashlight at open mouths, offered nuggets of advice, and moved inquisitively among a long double row of classroom chairs where the extractions, fillings, and simple restorations took place.
Dental and medical care is free in Jamaica, but government clinics are difficult to reach for many rural families, Brown said. Many clinics also are short-staffed, and long waits can frustrate patients who then seek relief from cheap hucksters or private dentists who charge exorbitant fees, he added.
“The dental IQ of the population is very low,” said Brown, a member of Jamaica’s Dental Council.
Brown has alerted clinics that follow-up care might be needed for patients treated by the Americans. If emergency work becomes necessary, Brown said, he is ready to do some of it himself.
The long-term remedy is a deeper pool of Jamaican dentists, and the hope is to have more Jamaican students work with visiting American dentists in future years, Brown said. That’s part of the mission of HealthCare International, a nonprofit group that Brown founded about 25 years ago and that first inspired Jamie Diament-Golub to travel to Jamaica eight years ago.
“The minute I got off the bus, I knew this would be my retirement,” said Diament-Golub, a pediatric dentist who directed the Jamaica trip for Tufts. “When I saw I could actually make a difference in a community with my own two hands, there was something very profound about it.”
On this day, hundreds of patients traveled to Mount Moriah on narrow, rutted roads from as far as 30 miles away. They stood in line for hours, sometimes in the rain, for treatment that had been advertised through local schools and churches.
“We don’t have the money to go to the dentist. I am grateful for them to come here,” said Rosemarie Tulloch, 40, a farmer who walked a mile to the Mount Moriah school. Her 10-year-old daughter, Katland, was having a tooth pulled.
“She’s scared,” said Tulloch, who has had two teeth pulled by American dentists.
Children aren’t the only ones to dread the encounter.
“You have to just make up your mind and do it,” Jennifer Dawkins, 49, said at the end of a long queue in a muddy courtyard. Dawkins, who had been standing for three hours, was prepared to wait as long as necessary to have a dentist fix the hole in her tooth.
The waiting was over for Ojoy Williams, a 23-year-old from a nearby mountain town. He had fainted a few hours earlier when Tufts dental student Jesse Feuerstein took aim at a broken lower molar. Williams, a reed-thin man with a trace of beard along his chin, had never been to the dentist before, and the anxiety caused him to pass out in the chair.
Now, Williams had returned, head tilted back, staring beyond the head lamp that helped Feuerstein, 27, peer into his mouth.
“You’re going to relax, all right?” said Feuerstein, a third-year student who wore a small Jamaican flag as a bandana. “Don’t worry about what I’m doing.”
Easier said than done.
“You’re doing good, buddy. Keep breathing,” Feuerstein said. “OK, I’m going to pull, all right?”
Feuerstein leaned in with a pair of metal forceps and grimaced as he tried to loosen the tooth — squeezing, pulling, and moving the tool slowly from side to side. The molar remained fixed, and Feuerstein stepped back disappointed.
Dr. Kyle Pullen, a visiting dental professor from the University of Michigan, stopped by the chair as a nearby window framed the faces of three wide-eyed children, fascinated by the drama.
Pullen picked up a mallet and chisel. “You might feel a little tapping,” he told Williams.
Two taps on the chisel, then a pause. Two more taps, another pause. After 10 taps, a sliver of space appeared between the tooth and bone.
Feuerstein finished the procedure, reaching in with the forceps and using the extra space to gain a better grip on the stubborn molar.
“It’s coming, it’s coming. Beautiful,” Feuerstein said, breathing deeply and smiling with relief.
“That’s exactly how it’s supposed to work,” Pullen said, nodding in approval as he moved to another patient.
By day’s end, the volunteers had treated 442 people at the Mount Moriah Primary and Infant School, and three buses waited to haul them two hours back to their hotel.
The cleanup was as efficient as the setup. Instruments were gathered, furniture moved, headlamps and goggles and masks collected in a brisk operation that turned the clinic into a schoolhouse again.
On the bumpy ride back, as darkness settled over the mountains, Jamaican singer Bob Marley provided the soundtrack. “Every little thing,” Marley sang, “is gonna be all right.”
For one day, at least, a small piece of that was true.
Brian MacQuarrie can be reached at firstname.lastname@example.org.