MUSC provides much-needed dental services

January 17, 2023
Endodontic resident Dr. Kyle Williams performs a root canal on patient Maurilia Basurto at the Our Lady of Mercy Community Outreach Dental Clinic. Photos by Sarah Pack

Tooth pain is nothing to laugh – or cry – about.

A few months ago, Ravenel, South Carolina, resident Maurilia Basurto experienced some pain on the right side of her mouth. Never having been to a dentist before, she tried to ignore it until the pain got increasingly worse.

After dropping off a neighbor to receive prenatal care at the Our Lady of Mercy Community Outreach’s Women’s Health Clinic, she learned that the facility offered dental services as well. She made an appointment and was recently evaluated for her tooth pain and quickly scheduled to see a specialist during the Jan. 13 endodontics clinic sponsored by Our Lady of Mercy Community Outreach and the MUSC James B. Edwards College of Dental Medicine.

The program marks a return of full endodontic services to the clinic after an extended period, closed at the start of the COVID-19 pandemic, according to Theodore Ravenel, D.M.D., associate professor in the Department of Oral Rehabilitation and director of postgraduate endodontics in the Division of Endodontics.

Basurto was evaluated by endodontist resident Kyle Williams, D.D.S., assisted by volunteer third-year dental student Madison Covington. They talked, took several X-rays and started a root canal of her upper bicuspid tooth. Two hours later, her tooth was almost pain-free.

“Although there are community dental clinics around the Tri-county, none or very few are able to provide endodontic services or the ability to provide root canals for patients,” said Ravenel. MUSC has partnered with the Our Lady of Mercy Community Outreach Dental Clinic over many years and brings our dental students and now residents to respond to the community’s needs.

Prior to the pandemic, Ravenel accompanied dental students as part of a weekly clinical rotation for 1 1/2 years to work at the clinic with patients. As a precaution, the clinic closed for some time and eventually re-opened for general dentistry needs. For a short time, Ravenel coordinated the services of a few dental students at the clinic to perform root canal work for some patients, but the effort didn’t fully launch.

The Our Lady of Mercy Community Outreach Dental Clinic started from humble beginnings in a trailer back in 1989. About 34 years later, it’s now located in a modern facility funded by donations and grants and has expanded to include a small but growing dental clinic located in the heart of downtown Charleston to provide dental services to Tri-county underserved and rural populations, free of charge. The MUSC team volunteers its time and services at the clinic at no charge.

During the Jan. 13 dental clinic, the endodontics team treated 23 patients from 8 a.m. to 5 p.m., with a team that consists of six endodontic residents; two third-year dental students, who are volunteer dental assistants; Ravenel, the faculty preceptor; and dental assistant/endodontics program coordinator Vanessa Chapin.

Endodontics resident Dr. Kyle Williams, center, reviews his patient's dental X-rays with residency director Dr. Theodore Ravenel, right, and dental student Madison Covington. 
Endodontics resident Dr. Kyle Williams, center, reviews his patient's dental X-rays with residency director Dr. Theodore Ravenel, right, and dental student Madison Covington.

First-year endodontics resident Alex Black, D.M.D., assisted Ravenel and the endodontic team in today’s free clinic.“The facilities here at the Our Lady of Mercy Community Outreach Dental Clinic are very good. It’s well-stocked and has the basic items we need as well as our own scopes and other equipment we brought to help us do our work efficiently,” said Black. “The dental clinic personnel does a great job screening patients in advance for this clinic. They provided X-rays, notes and conducted some diagnostic tests on qualified patients prior to today’s treatments.”

Endodontists are dental specialists that focus on the nerves and blood vessels inside the tooth and use advanced techniques to treat dental pulp, root issues and relief of tooth or mouth pain caused by decay, tooth injuries or abscesses.

In many cases, a tooth can be saved, which will help a patient preserve his or her natural teeth, according to Black. After evaluating the tooth for inflammation or infection, the specialist can perform a root canal to remove the infected tissue and pulp, apply a special irrigant to kill bacteria in the tooth and cover it using a temporary filling. Next, a general dentist will provide a tooth buildup to prepare a permanent crown.

Second-year endodontics resident and chief resident Ann Nicholas, D.M.D., explained their approach to patient care.

“As endodontists, a big thing of what we do is conducting a patient history and review of their present illness. We only get a small idea of what’s going on, based on what we see in a patient’s mouth. It’s important that we talk to the patient about what they’ve been doing, what elicits their tooth pain, etc. That information, plus the imaging, testing and what we see in the mouth provides a comprehensive look at the situation so we can determine the best course of care,” said Nicholas.

Time can also present a challenge for endodontists, according to Nicholas. Unlike general dentists, endodontist don’t have the long-term established relationship typically built with their patients – they only see patients for one or two encounters in order to diagnose their situations quickly and provide relief for their pain.

“Sometimes the diagnosis is not black and white; it’s a spectrum, so it’s a challenge for us to take enough time and take the patient’s health history to determine the best treatment for them,” Nicholas said.

Endodontic chief resident Dr. Ann Nicholas talks with a patient via a Spanish-speaking interpreter to explain her care and follow up.  
Endodontics chief resident Dr. Ann Nicholas, center, talks to patient Amy Lopez, left, about her procedure via dental outreach clinic interpreter Lydia Librado-Wybesky.

Fortunately, an endodontist’s work can be very rewarding for both patient and practitioner.

“What we provide – relief from tooth pain – is an immediate, tangible benefit. Oftentimes, dentistry focuses on treatment and providing preventive care for the patient. What we provide mostly is emergent dental care that has a huge effect and positive outcome for the patient. It’s impactful and satisfying to be able to especially help this patient population,” Nicholas said.

At the post-procedure follow up, it was explained to Basurto, via the clinic’s Spanish-speaking receptionist-interpreter, that she received a root canal. Williams also explained that she would need a crown and would experience some soreness that could be relieved with over-the-counter pain relief medicine. He cautioned her to avoid hard foods like ice and nuts and to check for any abnormal swelling.

For Basurto, things were already good. The pain was gone, and already, she was smiling. In a few weeks, she’ll return to the clinic with her husband, as they will both receive their first dental cleaning.