ULAANBAATAR, Mongolia -- Fourteen-year-old Erdenebileg's face betrayed the throbbing pain he described to U.S. Navy Lt. Ryan Davis, a general dentist with 3rd Dental Battalion.
After tooth decay compromised Erdenebileg's molar, bacteria invaded the tooth's fleshy pulp and caused an infection. Finally, the infection spread to the teenager's jaw, causing inflammation.
Erdenebileg came to the Health Service Support Engagement outreach June 18, 2018, hosted by the Mongolian Armed Forces, at the 134th School in Ulaanbaatar, Mongolia, looking for care. Working in partnership with his Mongolian Armed Forces counterparts, Ryan offered the relief Erdenebileg was seeking.
With students gone for summer vacation, the school was converted into a clinic for the outreach. Desks pushed to the side in neat rows, classrooms were filled with examination chairs and tables bearing gleaming dental instruments, blood-test vials and blood pressure cuffs.
U.S. Navy Lt. Mary Morin, officer in charge of the Marine Corps' 3rd Law Enforcement Battalion medical unit, said she was pleased with her Sailors' participation in the effort.
“(The Mongolian Armed Forces) hosts the Health Services Support Engagement every year as part of Khaan Quest as an outreach to provide care,” Morin said. “It's a great opportunity for us to be a part of it.”
Khaan Quest 2018 is a combined (multinational) joint (multi-service) training exercise designed to strengthen the capabilities of U.S., Mongolian and other partner nations in international peace support operations.
Dozens of local residents lined up outside the school with expectations of access to experts in dental care, women's health, cardiopulmonary wellness and other specialties. Though most Health Services Support Engagement disciplines were staffed solely by Mongolian medical providers, dental was a unique partnership between Davis, his four enlisted Sailors, a Qatar Armed Forces doctor, and a Mongolian staff led by dentist Capt. G Unurjargal and maxillofacial surgeon 2nd Lt. T. Khangarid.
Khangarid said a patient visit began with a short consultation determining how they were feeling, followed by a dental examination. The surgeon then determined which tooth was causing the problem.
Khangarid consulted with the patient to see if the tooth could be repaired or if it needed to be removed. In the case of removal, he explained the steps to the patient. He asked them about any allergies, whether the patient had diabetes, and checked for high blood pressure to ensure the patient was ready for immediate care.
U.S. Navy Hospitalman Alex Price, who continually sanitized dental instruments throughout the day, handed Khangarid a sterile syringe, and the surgeon injected a local anesthetic precisely where it needed to go to numb the affected tooth. After two minutes, with the tooth and jaw impervious to pain, Khangarid removed the tooth.
Throughout the course of the day, Davis worked with Mongolian patients of all ages, but he said he especially relished working with children.
“Oofchin?” Davis said, asking in Mongolian if Erdenebileg was feeling pain.
The teenager nodded slowly.
“Ama-angah.” Davis said. “Open.”
The dentist said he understands how patients can feel apprehensive, especially when tooth extraction is required, and he does everything he can to alleviate their fears.
“So much of good bedside manner is taking something I am educated about in terms of what is going on with the patient's tooth or why they're having pain and finding a way to verbalize that information for someone who knows little about dentistry or why their mouth hurts,” Davis explained. “I can't speak the same language as my patients right now, so I'm using a lot of hand motions and noises.”
When Davis made an initial diagnosis, he consulted with his Mongolian Armed Forces counterparts and asked the patients deeper questions through an interpreter.
Davis said the pace was quicker than he is accustomed to with the small dental staff helping 72 patients during the day.
“It's definitely a different level of stress because I'm seeing so many patients so fast, and there are so many moving pieces,” Davis said, explaining the staff still took measures to ensure sterility despite the fast tempo. “I want to make sure everyone is staying safe – not only the patients – but also those who are working with the patients.”
Peering through magnification loupes embedded in his glasses, Davis honed in on the tooth giving Erdenebileg grief. With the assistance of Khangarid, he reached in with a set of dental pliers and wrested the offending tooth free, removing the source of the infection that plagued the boy.
With antibiotics and time, Erdenebileg's ordeal would pass, and – thanks to Khangarid and Davis – he would trade his melancholy face for a smile.