Surgery and Healing in the Developing World - Dartmouth-Hitchcock

CHAPTER 1
CHAPTER 25
Dentistry
David Foskett and Anthony M. Vandersteen
Introduction
Good primary preventive dentistry in the developed world, for instance the addition
of fluoride to drinking water and the promotion of good tooth brushing, has
still far from eliminated disease of the teeth and gums. In the developing world
dentists are not widely accessible to patients, hence you will be faced with dental
and gum disease as well as surgical disease of the oral cavity. In this review, we
describe simple dental care appropriate to rural economies. Suitable preventive dentistry
using basic equipment is described. How to diagnose and treat tooth decay
and gingivitis is illustrated with simple algorithms and photographs. These simple
methods are within the grasp of medically trained personnel and can be of great
benefit in the absence of a fully trained dentist.
The Teeth
There are thirty-two permanent teeth, four upper and four lower incisors, two
upper and two lower canines, four upper and four lower premolars, and six upper
and six lower molars (Fig. 1).
A child will have grown twenty milk teeth by around the age of two. Between the
ages of six and twelve, these are replaced by permanent teeth. The incisors cut food
into smaller particles whilst molars chew the food, increasing its surface area and
mixing with saliva to enable swallowing and initiate digestion.
The visible surface of a tooth consists of hard enamel. A layer of dentine separates
enamel from the pulp of nerves and blood vessels. The root of a tooth is anchored
to the maxillary or mandibular bone by the fibers of the periodontal membrane
(Fig. 2).
Toothbrushings and Oral Hygiene 2
Equipment
A wooden twig with a splayed end or attached toweling will make a suitable
toothbrush. Toothpaste powder can be made from a one to one mixture of salt and
sodium bicarbonate (Fig. 3).
Method
Teeth should be brushed from the gums to the tips of the teeth, at least ten
times. The top surfaces of the teeth should also be cleaned. Encourage brushing for
a minimum of two minutes twice daily, after breakfast and before going to bed.
Surgery and Healing in the Developing World, edited by Glenn Geelhoed.