Chapter 7: Treating Some Common Problems
You must make a good diagnosis to treat a problem so it finishes and does not return. Why treat a sore on the face by cleaning it when the sore is from pus draining from a tooth with an abscess? You need to know the cause of the sore to give the best kind of treatment.
After you make the diagnosis, you must decide whether you or a more experienced dental worker should provide the treatment.
In the following pages, we describe the kinds of problems you as a health worker may see, and we also give the treatment for each problem. Use the table below to help you find the right page.
Before you touch the inside of anyone’s mouth, learn how to keep clean. See the next rules.
THE FIRST RULE FOR TREATMENT: STAY CLEAN!
No matter what problem you are treating, be sure that your workplace, your instruments, and you are always clean. For example, prevent infection by always washing your hands before you examine or treat someone.
The mouth is a natural home for germs. They usually do not cause problems because the body is used to them. In fact, many germs are helpful. For example, when we eat, some germs break down chewed food into parts small enough for the body to use.
There are problems when the number of these ordinary germs increases greatly, or when strange, harmful germs come into a healthy body from outside. Fever and swelling follow. It is an infection.
When we regularly clean the mouth, the number of germs stays normal. You can teach others to clean teeth and gums, but cleaning is each person’s responsibility.
However, dental workers have one serious responsibility. You must not spread germs from a sick person to a healthy person. You must do everything you can to make sure your instruments are clean.
Germs hide inside bits of old food, cement, or blood on an instrument. There they can continue to live, even in boiling water.
This is why you must be sure to scrub the working end of each instrument carefully with soap and water. Rinse, and then look carefully to see that it is clean and shiny.
Remember that ‘clean looking’ is not necessarily ‘clean’. Truly ‘clean’ means free of germs. Unless you sterilize, that instrument may still have germs, the kind that cause infection in the next person that it touches.
Sterilizing means killing germs. The best way to sterilize is with heat. High heat kills almost all harmful germs - especially those that cause hepatitis, tetanus, and mouth infections. Wet heat (steam) is always more effective than dry heat from an oven.
Here is a simple rule to use in deciding when to sterilize:
Boil any instrument that has touched blood.
That means always sterilize with steam all syringes, needles, and instruments you use when scaling teeth (Chapter 8) or when taking out a tooth (Chapter 11).
Instruments left in boiling water need 30 minutes to become sterile. A pot with a cover to trap the steam can act faster. The inside becomes hotter and 20 minutes is enough. But remember that water can rust metal instruments. To prevent rust:
Sterilizing with steam under pressure is the fastest and surest method. It kills harmful germs in 15 minutes. You need a strong pot with a tight fitting lid. But be sure to make a small hole in the lid so steam can escape when the pressure becomes too great.
A special pot called a pressure cooker is perfect for this. It even has a safety hole on it to release extra steam.
Sterilizing with heat is not necessary for instruments that do not touch blood. For example, after you examine a person or place a temporary filling, you can clean your instruments and then soak them in a solution of alcohol or bleach.
Find the cheapest brand name in your area for bleach. Examples are Javex, Clorox, Purex, and Cidex. Make 1 liter of solution with a mixture of 1/2 cup (100 ml) of bleach and 3 1/2 cups (900 ml) of clean water.
Unfortunately, bleach rusts metal instruments. To reduce rust, add 1 large spoonful of baking soda (sodium bicarbonate) to the solution, and leave your instruments in the solution for only 30 minutes.
Wipe each instrument with alcohol to remove the film of bleach. Then store it dry inside a clean cloth or in another covered pan.
PART 1: PROBLEMS YOU WILL SEE MOST OFTEN
CAVITIES AND LOST OR BROKEN FILLINGS
A cavity can occur in any tooth. A cavity can also start around an old filling, especially if it is dirty. The deeper a cavity gets inside the tooth where the nerve lives, the more the tooth hurts.
TREATMENT (when there is no abscess):
Try to remove any loose piece of filling with a probe. Then, following the steps in Chapter 10, put in a temporary filling.
A groove on the neck of a tooth is a more difficult cavity to fill. For the temporary cement to hold properly, you need to shape the groove with a drill. To help temporarily, you can paint the groove with fluoride water. Do this once each week until the inside part of the groove is stronger and the tooth hurts less. Or, you can paint the inside of the groove with oil of cloves (eugenol) to reduce the pain.
To avoid making the problem worse, (1) do not use a hard toothbrush; (2) do not brush back and forth along the gums; and (3) do not chew betel nut and do not hold it against the teeth.
A cavity that is not filled grows bigger and deeper until it touches the nerve. Germs travel inside the tooth’s root and start an infection called an abscess.
Pus forms at the end of the root, inside the bone. As the pus increases, it causes great pressure. This is why an abscess causes severe pain.
If there is no swelling, take out the tooth immediately (unless you are able to give root canal treatment). This allows the pus to escape and relieves the pain. See Chapter 11.
If there is swelling, treat the swelling first. Take out the tooth only after the swelling goes down. This is necessary because an anesthetic (see Chapter 9) will not work if there is swelling. If the anesthetic works, then it is safe to take out the tooth.
To treat the swelling, give an antibiotic. Penicillin by mouth is best. Use an injection only when the person is in immediate danger. For example, inject penicillin when the person has a fever or if the swelling is pressing against the throat. But remember you can treat most serious infections with simple penicillin by mouth. For the doses for serious infections, look below the box on the next page. If you still think an injection is necessary, look at the section on ‘aqueous procaine penicillin’.
Adults and children over 25 kg. (60 pounds) of weight should take the same amount of oral penicillin. Children under 25 kg. should take 1/2 as much. For most infections, penicillin by mouth is taken 13 times: a very large first dose and 12 smaller doses every 6 hours for 3 days. The person should take all of the penicillin, even if the pain or swelling goes down. For the correct doses, see the next page.
For serious infections, it may be necessary to take the antibiotics for a longer time. Take the same first dose as above, then take 1/2 the first dose every 6 hours until the condition begins to improve. Then take the second, smaller dose every 6 hours until the end of five days, or seven days if it is very serious.* Usually you can take out the tooth 1 or 2 days before the end of the antibiotic treatment, but the person must continue to take all of the tablets, even after you have taken out the tooth.
Take aspirin or acetaminophen 4 times a day. Every 6 hours, adults can take 2 tablets, children 8 to 12 years take 1 tablet, and children 3 to 7 take 1/2 tablet. Children 1 to 2 years should only take acetaminophen, 1/4 tablet 4 times a day.
A sinus is a hollow place inside the bone. There is a sinus under the eyes, on each side of the nose. Because the sinus is very close to the roots of the top teeth, these teeth may hurt if the sinus becomes infected.
Do not take out any teeth. They will feel better after you treat the sinus infection.
1. Give penicillin for 3 days.
2. Explain to the person that she should:
1. Broken tooth
It is possible to save a broken tooth. It depends on where the tooth is broken and whether its nerve is still covered.
Take out the broken tooth if:
2. Tooth knocked out
When a tooth is knocked out of the mouth, you should ask two questions: (1.) Was it a baby tooth? and (2.) How long ago did it happen?
Baby tooth. There is no reason to try to put a baby tooth back into the socket. Tell the child to bite on some cotton to stop the bleeding. Then wait for the permanent tooth to replace it. Warn the mother that the permanent tooth may take more time than usual to grow into the mouth.
Similarly, there is no need for treatment if the baby tooth is pushed up under the gum.
The tooth may grow back into the right place later, or it may turn dark and die. If you see a darkened tooth or a gum bubble, take out the baby tooth before it hurts the permanent tooth that is growing under it.
Permanent tooth. A permanent tooth is worth saving. How long ago was it knocked out? If it was less than 12 hours ago, you can put a permanent tooth back into the socket. The sooner you do this the better, so do not wait. If you replace the tooth in the first hour, it has a much better chance of joining with the gum and bone. In order to heal and to join the bone, the tooth must be held firmly.
1. Wash the tooth gently with clean water. There should not be any bits of dirt on the root of the tooth.
Keep the tooth damp with wet cotton gauze.
Do not scrape away any skin from the root or from the inside of the socket.
2. Gently push the tooth up into the socket. As you push it up, use a slight turning movement back and forth.
The biting edge of the loose tooth should be at the same level as the teeth beside it.
Hold it in place with your fingers for about 5 minutes.
3. Soften some beeswax and form it into 2 thin rolls. Place 1 roll near the gums on the front side of five teeth: the loose tooth and the two teeth on each side of it. Press the wax firmly, but carefully, against these teeth.
Do the same with the second roll of wax on the back side of the same teeth, again near the gums.
It is good if the wax on the back side is touching the wax on the front side. This helps the wax hold the teeth more firmly. To do this, you can push the wax between the teeth with the end of your cotton tweezers.
Tell the person with the injured tooth to return to see you several times. The tooth may die several months or even several years later. If that happens, you must take out the tooth, unless you can do root canal treatment.
If it is possible, take an X-ray of the tooth 6 months later and then again each year. Look at the X-ray picture of the root to be sure an infection is not eating it away. To do this, compare the root with the roots of the teeth beside it.
A tooth may be loose for one of several reasons. Decide the reason before giving the treatment.
A tooth may also be loose because another tooth is biting too hard against it.
You need to remove a bit of each of the teeth that are biting too hard. Use either a dental worker’s drill, a small file, or a hard stone.
1. Smooth the inside edge of the upper tooth.
NEW TOOTH GROWING IN
A new tooth cuts through the gums when it grows into the mouth. Germs can easily go under the gums in that place and cause an infection. When the opposite tooth bites against the sore gum it can make an infection worse.
Do not take out a new tooth while there is still infection and pain. Wait for the infection to finish. Then decide if there is room for the tooth to grow in. A dental X-ray can help you make that decision. New molar teeth are often difficult to take out. Ask an experienced dental worker to take out the tooth, if it must be done.
What you can do
First, treat the infection. Then wait for the new tooth to grow more into the mouth. Tell the person what is happening. Tell him what he can do to keep the gums healthy while the tooth grows in:
When babies and small children first get their teeth, it is called teething. This can make the child unhappy, because his gums are sore.
Teething does not cause fever, head colds, or cough.
But a child can have any of these problems at the same time as he gets a new tooth.
If the child has another sickness, do not blame it on teething. Look for another cause and treat it separately. Also, do not cut the gum over the new tooth. Let the tooth grow through the gum by itself.
Infection can start in the gums whenever the teeth near them are not clean. For example, there may be swelling (called an epulis) between only 2 teeth or between many teeth. In addition, gums that are weak from poor nutrition are not able to resist the infection. This is why a pregnant woman must take special care to eat well and clean her teeth carefully.
Explain to the person the cause of her gum problem and what she can do to help herself.
Vincent’s Infection of the gums, also called trench mouth, affects both adults and children. In its worst form, it can eat a hole through the cheek of a weak child.
A person with Vincent’s Infection may not want to eat because his teeth hurt when he chews food. That can make a child’s malnutrition worse.
You must prevent this problem from starting, especially in a child who is weak from sickness. Teach mothers to clean their children’s teeth and to get their children to rinse their mouths with warm salt water.
You will need to see the person over a two-week period. Start some treatment NOW:
Herpes virus causes fever blisters. Herpes virus is a kind of germ. Fever blisters are sores that can form either inside the mouth on the gums, or outside on the lips.
When the sores are inside the mouth, it is a serious problem. It usually affects children between 1 and 5 years old. A child with fever blisters in his mouth can become very sick. He will not be able to eat properly. If he does not drink enough fluids, he can become dehydrated (lose his body water). This is dangerous!
Medicine cannot kill the Herpes virus. The sores will go away by themselves in about 10 days. The treatment is to help the person feel more comfortable and to be sure he gets enough to eat and drink.
These sores go away in about 1 week. To prevent them from becoming infected, paint the sores with gentian violet, tincture of benzoin, or petroleum jelly. If you hold ice against the sores for several minutes each day, it may help them heal faster.
Thrush is a kind of infection. It often appears when a person is weak and poorly nourished, or sick and taking medicine like tetracycline or ampicillin. In a baby, thrush usually appears on the tongue or top of the mouth. It can stop the baby from sucking. In an adult, thrush often occurs under a denture.
There is usually something else present which is helping thrush to grow. Try to find what it is and deal with it. For example, treat the malnutrition, change or stop the antibiotic medicine, or leave the denture out of the mouth for a while. Then:
1. Put some nystatin creme on top of the white patch with a bit of cotton.
Show the mother how she can do this in her child’s mouth at home. If you have no nystatin creme, paint gentian violet on the white area. The mother should paint the child’s mouth 2 times a day.
Do not use penicillin or any other antibiotic unless you need to treat something different. Thrush can get worse when a person uses an antibiotic for a long time.
2. Continue breast feeding. For older persons, make their food soft and easy to chew.
IMPORTANT: Sometimes white lines appear on the inside of an adult’s cheek or on the roof of the mouth. If these lines become sore, they can change into a cancer. To prevent this cancer, ask the person to stop smoking (especially pipes), stop chewing betel nut, and get dentures adjusted if they do not fit properly.
A virus can cause canker sores, as with fever blisters. Unlike fever blisters, canker sores usually affect adults rather than children.
One or more sores can appear at any time. These sores hurt, especially when pieces of food touch them.
A canker sore goes away by itself in about 10 days. Medicine does not make that happen any faster. (However, smoothing a denture does help.) The treatment is simple. Tell the person how to feel more comfortable while waiting for the 10 days to pass:
Eat foods that are soft and not likely to hurt the sore. Do not eat food with a lot of pepper. Drink lots of water. Chew food on the other side of the mouth, away from the sore.
A denture which does not fit should be remade.
In the meantime, leave the denture out of the mouth for 2-3 days.
Ask the person to rinse with warm salt water, 4 cups each day until the sore is better.
If the sore continues after 10 days, it may be infected. Give penicillin.
A sore that does not heal after antibiotic treatment may be cancer. See a doctor immediately.
SORES AT THE CORNERS OF THE MOUTH
Teeth support the lips. When they come together for chewing, the teeth stop the person’s chin from moving any closer to the nose.
A person without many teeth looks old. A person with a poor fitting denture also looks old.
The distance from his chin to his nose is shorter than normal.
He must close his jaw further to eat. That causes lines to form at the corners of his mouth.
Poor health can make lines at the corners of the mouth crack and become sore.
A person with missing teeth needs dentures. Dentures will help him chew more food and make him look younger. They support his lips and open his mouth more.
A child who has had a fever or measles often has dry lips. The corners of her mouth can crack and become sore.
The child needs to eat the kind of foods that give strength, energy, and protection. Feed her beans, milk, eggs, fish, oils, fruits, and green leafy vegetables.
TREATMENT (when sores occur):
You will find some problems that are too serious for you to treat. If you can, send the sick person to a more experienced dental worker as soon as possible.
Sometimes, however, it is better to start some of the treatment yourself. Early treatment can prevent some problems from becoming more serious. Also, if you know what to do when someone returns from the hospital, you can help that person to get well faster.
Sometimes, you will find it impossible to get help. Therefore, we will discuss each of these more serious problems in detail, so you can give as much help as necessary.
Three main bones form the face and lower jaw.
A bone can break completely, or part of it can crack. In either case, the teeth are usually pushed out of position. Look for this as a sign of a broken bone.
SIGNS of a broken bone:
SIGNS of a cracked bone around the tooth’s roots:
When a bone is broken or cracked, the treatment is to hold the broken parts together so that the parts can rejoin. The usual way to do this is to put wires around the teeth. An experienced dental worker should do this. There are two things you can do. First, provide emergency care. Later, show the person how to eat and how to keep his mouth clean.
1. Be sure the person can breathe.
Later, carry him to the hospital in that position. If he goes in a car, be sure he sits with his head forward. His jaw and tongue will be forward and he will breathe more easily.
Look inside the mouth to see if any tooth is broken and very loose. A broken piece of tooth can fall out and block the person’s airway, so take out the broken part now. You can leave in the root, but if you do, tell the dental workers at the hospital. They will remove the root when they put on the final wires.
2. Stop the bleeding.
Wipe away the dried blood from his face and from inside his mouth. Look for the place that is bleeding. Sew any deep cuts on his face (see Where There Is No Doctor). If you gently press cotton gauze against the bleeding gums, it will usually control the bleeding.
Bleeding inside the mouth, from between the broken parts of the bone, is more difficult to stop. You must pull the two sides together and hold them in that position. To do this, you need wire that is thin, strong, and bends easily. ‘Ligature wire’ (0.20 gauge) is best.
Place a piece of wire around two teeth, one on each side of the break. Choose the strongest tooth on each side - the ones with the longest or the most roots.
Tighten the wire around the two strong teeth with pliers or a hemostat.
Ask the person to close his teeth. Lift up the broken part of the jaw and hold it so the lower teeth meet the upper teeth properly. This is the normal way the jawbone holds the teeth.
Now join the wires. Twist and tighten them together. This may be painful. You can inject local anesthetic - see Chapter 8. You must twist the wire tight enough to hold the broken parts together.
Bend the end of the twisted wire toward the teeth. Now it cannot poke the person’s lips or cheek.
3. Put on a head bandage.
Gently close the person’s jaw so that his teeth come together. Support it in this position with a head-and-chin bandage.
Tie the bandage to support the jaw, not to pull it. Do not make it too tight. It is all right if his mouth stays partly open with the teeth slightly apart.
Be sure not to let the bandage choke the person.
4. Give penicillin by injection for 5 days to stop infection inside the bone.
5. Give something for pain. Aspirin may be enough. If there is a lot of pain and the person cannot sleep, give codeine. The dose for an adult is 30 mg.
Send the person to the hospital as soon as possible. The person must have wires placed on his teeth within a week of the accident. The wires must remain there for 4 to 6 weeks. Every week, the person must return to the hospital to have the wires tightened. During this time he cannot open his mouth to chew food or brush his teeth.
1. Give liquid foods for strength and energy.
Prepare food in two ways: (1) First, a milk-oil drink to build strength; and then (2) a special soup to keep him strong and give him energy.
To build strength: Milk-oil drink
Mix for him each day at your clinic:
To keep strength and give energy: Special vegetable soup
Cut into small pieces and cook together in a pot of water:
Pour the soup into an empty tin with small holes made in the bottom. Use the back of a spoon to press as much of the cooked food as you can through the holes. The person can suck the soup between the teeth to the throat and then swallow it. Clean the tin and set it in boiling water, so you can use it again the next day.
2. Keep the teeth clean and the gums tough.
The person must learn to clean teeth and gums or the gums can quickly become infected and the mouth will feel sore. So:
If a person opens her mouth wide and then is unable to close it, we say her jaw is dislocated. It is stuck in the open position. This problem often happens to a person who does not have several of her back teeth. When she opens wide to yawn or shout, the part of her jaw that joins her head moves too far forward inside the joint. It is then unable to return to its normal position.
The treatment is to try to move the lower jaw back where it belongs. Then hold it in that position until the muscles can relax.
A joint is the place where one bone joins another. The jawbone has two joints, for it joins the head in front of each ear.
The mouth opens and closes because:
Pain in these joints may be because:
Before you treat, decide what is causing the pain. We will discuss the three causes mentioned above.
Talk with the person and help, if you can, to find a solution to her personal problems. This can do much to help her and her muscles relax. In addition, explain how to care for the sore joint:
If an X-ray shows a fracture, the person needs expert help. A dentist can wire the teeth in a way that will allow the bone to heal.
3. Teeth do not fit together properly.
Imagine a line that passes between the two middle upper teeth and the two middle lower teeth in the person’s closed mouth. When the person opens the mouth, this line becomes longer, but it is still a straight line. If it is not, this condition can, after a long time, cause pain in the joint.
When you see teeth that do not fit properly:
SWOLLEN GUMS AND EPILEPSY
Many persons who suffer from epilepsy (see Where There Is No Doctor) have a problem with swollen gums. In severe cases, the gums are so swollen that they cover the teeth. This problem is caused not by epilepsy but by diphenylhydantoin (Dilantin), a drug used to control epilepsy.
When you see swollen gums, find out what medicines the person is taking. If possible, change to a different drug. If the person must continue using diphenylhydantoin, explain how to prevent this swelling of the gums. Show the person this book. Persons who take this drug may be able to prevent the swelling by brushing the teeth carefully after each meal, and taking special care to clean between the teeth.
BLOOD IN THE MOUTH
Use wet cotton gauze to wipe away the old blood from inside the mouth. Then you can see where it is coming from. Treat the cause of the bleeding.
PROBLEMS AFTER YOU TAKE OUT A TOOTH
Problems like swelling, severe pain, and bleeding can occur after you take out a tooth. Tetanus, a more serious problem, can also occur, especially if your instruments were not clean.
Swelling of the face
You can expect some swelling after you take out a tooth. But if the swelling continues to grow, and it is painful, this is not normal. Probably an infection has started. The treatment is the same as for a tooth abscess: penicillin for 3 days to fight infection, heat to reduce the swelling, and aspirin for pain. See “Tooth abscess” for the proper doses.
Pain from the Socket
There is always some pain after a tooth is taken out. Aspirin is usually enough to help.
However, sometimes a severe kind of pain starts inside the tooth’s ‘socket’ (the wound) 2 to 3 days after you take out the tooth. This problem is called dry socket and it needs special care.
1. Place a dressing inside the socket. Change it each day until the pain stops.
2. Give aspirin for pain.
Bleeding from the socket
When you take out a tooth it leaves a wound, so you can expect some blood. However, if the person bites firmly against a piece of cotton, it usually controls the bleeding. To help the wound heal (from a clot), tell the person not to rinse with salt water or spit for 1 or 2 days after you take out the tooth.
When the first bleeding occurs, put a new piece of cotton on top of the wound and ask the person to close her teeth against it for an hour. Keep her there with you, to be sure she continues to bite on the cotton. (If it is too painful, you may want to inject anesthetic. See Chapter 9.) Change the cotton if it becomes soaked with blood.
TREATMENT (if the bleeding continues):
This is a very serious infection. Tetanus germs enter the body when a wound, like a wound on the bottom of the foot, gets dirty. Germs can also be carried to the socket when you use a dirty instrument to take out a tooth. To avoid this, carefully read the rules in Chapter 7.
A person with signs of tetanus requires immediate medical help. See Where There Is No Doctor, if you cannot get help immediately.
INFECTION INSIDE THE SPIT GLAND
Spit glands are places where the spit is made. They are located in front of the ear and under the jaw, on each side of the head. If there is an infection inside a spit gland, the face will become swollen and the area will hurt.
Spit is sent from the gland to the mouth through a thin pipe called a duct. Ducts open into the mouth in two places: on the inside of each cheek, and under the tongue.
A small stone can often block a duct and cause an infection in the spit gland and swelling of the face. You may be able to feel the stone near where the duct enters the mouth.
Reduce the infection and swelling first. Later try to remove the stone.
Whenever you see a sore on a person’s cheek or under his chin, remember there may be a tooth or gum problem. If it is a gum problem, it may be Noma.
A bad tooth:
Ask him to open his mouth. Look for an infected tooth in the area of the sore.
There may be a large cavity and the tooth may be loose.
Or the tooth may be darker in color than the others. This is because it is dead.
The pus is draining onto the skin, so the pressure is reduced and the person does not complain of pain.
When a child is sick, a simple gum infection can get out of control and spread through the cheek to the face. When that happens the condition is called Noma or Cancrum Oris. Noma is a complication of Vincent’s Infection of the gums.
You will usually see noma in children. It will only develop if these 3 things are true:
The infection starts in the mouth.
Then it passes to the gums.
Finally, it affects the cheek.
You must start treatment for noma immediately in order to prevent the hole from getting bigger. The bigger the hole, the tighter the scar that forms after you close the hole. A tight scar will prevent the child from opening his mouth and chewing the food he needs to grow stronger.
1. Give fluids.
The child needs to overcome both the lack of body water (dehydration) and his lack of resistance to disease.
Start giving the Milk-oil drink.
If he cannot drink by himself, help him. Use a spoon or syringe.
Place the fluid on the inside of the healthy cheek and ask the child to swallow.
2. Treat the anemia.
Start giving iron now. The child should continue taking the tablets or mixture for 3 months.
Also give food rich in iron: meat, fish, eggs, dark green leafy vegetables, peas and beans.
Note: a child may have anemia because he has hookworm. It is wise not to wait for a test for hookworm. Begin now giving hookworm medicine such as thiabendazole and folic acid (see Where There Is No Doctor).
3. Start antibiotics.
Penicillin is the best antibiotic to use. As the child may not be able to swallow pills easily, it is best to start with penicillin injections.
If you do not have penicillin, you can give sulfadimidine 4 times a day. It comes in 500 mg. tablets or in syrup that has 500 mg. in 5 ml. To decide how much to give, weigh the child.
4. Treat the other illness that helped noma to develop.
It is wise to assume that the child has malaria and to begin treating with antimalarial drugs (see Where There Is No Doctor).
Look for any other illnesses and treat them, too.
5. Clean the sore.
Gently pull away any dead skin with tweezers. Wash the inside of the sore with hydrogen peroxide. (Be sure you measure the hydrogen peroxide carefully.) Then put in a wet dressing.
You can use a local anesthetic (Chapter 9). Usually there is not much bleeding. If gums are loose, join them with a suture.
7. Keep the mouth clean.
Unfortunately, the child will probably need surgery, to release the scar. Without this surgery, the child will not be able to open his mouth properly.
Send the child for medical help when the infection is finished and the wound starts to close.
You may also need a dentist’s help at this time. The child’s jaws may need to be wired. The wires are put on the healthy teeth in a way that holds the mouth open while the tight scar is forming. When the wires are removed, the child will be able to open and close his mouth to chew food.
PREVENTION of Noma:
Noma need not occur. We can prevent it. Always give special attention to the mouth of a sick child, to be sure to keep his teeth clean.
Whenever someone is nursing or caring for a sick child, that person should clean the child’s teeth as a normal activity. This is especially true for a child who is weak, undernourished, and with little body water (dehydration).
Such a child should always:
A tumor is a lump that grows under the skin or inside the bone. It grows slowly but steadily, usually without any pain.
Do not waste any more medicine or any more time. A tumor may be cancer. Send for medical help. Surgery is needed to remove a tumor.
Any sore that does not heal may be cancer. The lips and tongue are the two places in the mouth where cancer starts most often.
Cancer is deadly.
Medicine cannot help.
Cancer can spread quickly to the inside of the person’s body where you cannot see it. This can lead to the person’s death.
Whenever you treat a sore and it does not get better, send the person for medical help immediately. A doctor can cut out a piece from the sore, look at it under a microscope, and decide if it is cancer.
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