Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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25 234 Surgery and Healing in the Developing World Figure 1. The adult teeth and palate (Ref. 1, pg. 3). Figure 2. The structure of the tooth (Ref. 1, pg. 4).
Dentistry Figure 3. Toothbrushes of simple materials. 235 Children are especially vulnerable to tooth decay and should be encouraged to eat firm, fibrous fruit and discouraged from eating sweets, cakes, and drinking sugary drinks. Treatment of Gum Disease Poor oral hygiene results in food being left in between the teeth. This provides a good medium for bacteria, which produce enamel-destroying acids. Inflammation of the gums (Gingivitis) is worsened by hardened plaque (tartar) and may progress to destroy the periodontal membrane. The teeth will fall out as a result. A first step in dental care is to promote good oral hygiene. A scaling tool with point and spoon (Fig. 4) is used to scrape off tartar; temporary pain and bleeding may result from this procedure. Immediately after scaling, the patient should rinse thoroughly with 0.2% Chlorhexidine mouthwash. Antibiotic cover is required for those patients with a history of heart disease (see below). The margins of gums may become acutely ulcerated, the breath smells and the gums bleed. Treat with accurate application of 5% chromic acid taking care not to let it drip onto skin or healthy tissue. Advise the patient to keep his mouth clean, rinse with salt solutions and prescribe an antibiotic (a Beta-lactam antibiotic is normally sufficient). Gingivitis may be caused by malnutrition; gum softness may be a sign of vitamin C deficiency (scurvy). Dental Caries and Tooth Extraction Diagnosis of Caries A caries appears as black lesion and during dental examination. Skim the dental probe over the surfaces of the teeth, it will catch on the edge of a carie. The extent to which you treat a diseased tooth will depend upon the availability of local dental services. Temporary fillings can be useful in prolonging the life of a tooth until the patient can reach a dental surgeon. Temporary fillings are only suitable for filling small dental caries. If there is pain on percussion with the end of a mouth mirror, the pulp is infected and extraction is indicated unless the patient can be referred to a dental surgeon for root canal treatment. 25
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Surgery and Healing in the Developi
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Contents Foreword .................
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25. Dentistry .....................
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Editor Contributors Harold P. Adolp
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Foreword Surgery and Healing in the
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“poor, but modern”, as for exam
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There may be at least one considera
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It is that higher accountability th
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1 2 Surgery and Healing in the Deve
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CHAPTER 2 Surgery in Developing Cou
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2 10 Surgery and Healing in the Dev
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CHAPTER 4 International Surgical Ed
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CHAPTER 9 Lab-in-a-Suitcase: Saving
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10 72 Surgery and Healing in the De
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CHAPTER 12 Communication in the Thi
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CHAPTER 13 Anesthesia in the Third
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13 100 Surgery and Healing in the D
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CHAPTER 15 Basic Obstetrics and Obs
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CHAPTER 16 Pointers for American Su
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Page 202 and 203: CHAPTER 20 Chronic Pyogenic Osteomy
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Page 258 and 259: CHAPTER 1 CHAPTER 26 Reconstructive
Page 260 and 261: Reconstructive Surgery in the Tropi
Page 292 and 293: CHAPTER 1 CHAPTER 27 Factors Influe
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CHAPTER 1 CHAPTER 28 Population Dyn
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Population Dynamics Of Surgical Tro
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Metabolic Maladaptation 289 Introdu
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Metabolic Maladaptation 291 some of
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Metabolic Maladaptation 293 In this
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Metabolic Maladaptation Table 1. Si
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Metabolic Maladaptation Table 4. Go
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Metabolic Maladaptation 299 the rev
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Metabolic Maladaptation Table 5. As
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Metabolic Maladaptation Table 6. Co
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Metabolic Maladaptation 305 the ris
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Metabolic Maladaptation Table 8. Go
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Metabolic Maladaptation Table 10. G
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Metabolic Maladaptation Table 12. C
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Metabolic Maladaptation 313 cell an
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Metabolic Maladaptation 315 Biologi
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Metabolic Maladaptation 317 from io
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Metabolic Maladaptation 319 25. Lon
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CHAPTER 1 CHAPTER 30 Nutrition and
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Nutrition and Development in Africa
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CHAPTER 1 CHAPTER 31 Uterine Ruptur
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Uterine Ruptures in Rural Zaire Tab
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Uterine Ruptures in Rural Zaire 329
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CHAPTER 1 CHAPTER 32 Vesicovaginal
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Vesicovaginal Fistula in Democratic
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CHAPTER 1 CHAPTER 33 Ophthalmology
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Ophthalmology Figure 2. Refractive
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Ophthalmology Figure 4. A tonometer
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Ophthalmology 341 ml of 40 mg/ml IV
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Ophthalmology Figure 6. Axis determ
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Ophthalmology 345 thalmic set prepa
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Ophthalmology 347 Procedures Region
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Accommodating Deficits in Material
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Abscesses and Other Infections Trea
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CHAPTER 1 CHAPTER 36 Surgical Train
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Surgical Training of Nurses for Rur
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Training of Medical Assitants in Mo
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CHAPTER 1 CHAPTER 38 Training Surge
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Training Surgeons in the Developing
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Mobile Surgery Figure 1. 405 of tec
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Mobile Surgery Figure 3. 407 Childr
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Mobile Surgery 409 We have realized
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CHAPTER 1 CHAPTER 40 Public Health
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Public Health Problems on Burma Fro
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Medical Adventures in the Nigerian
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CHAPTER 1 CHAPTER 42 Wanted Glenn G
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Wanted 431 Studies Center (//www.am
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Wanted 433 MacArthur (The John D. a
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Wanted 435 most pathologic presenta
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Wanted 437 “outliers” in the he
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World Health 439 challenge: name fo
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CHAPTER 1 CHAPTER 44 Treating Other
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Treating Others: Human Sciences in
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Treating Others: Human Sciences in
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CHAPTER 1 CHAPTER 45 The Impact of
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The Impact of a Volunteer Medical M
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CHAPTER 1 CHAPTER 46 Field Notes on
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Field Notes on a Typical Day in a H
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