Surgery and Healing in the Developing World - Dartmouth-Hitchcock

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