PART 2
DATA COLLECTION AND FOLLOW UP
JUST ANOTHER
SUMMER HOLIDAY ? CAN A SHORT-TERM DENTAL PROJECT BE USEFUL ?
BY A P NOAR ST JOHN ’ S COLLEGE , OXFORD AND J H NOAR MSC ; BDS ; FDSRCS ( ED ); FDSRCS ( ENG ); DORTHRCS ( ENG ); MORTHRCS ( ENG ); FHEA CONSULTANT / HON . SENIOR LECTURER , ORTHODONTIC UNIT , DIVISION OF CRANIOFACIAL & DEVELOPMENT SCIENCES , EASTMAN DENTAL HOSPITAL / INSTITUTE , LONDON
DATA COLLECTED Most adults reported that they use a toothbrush to clean their teeth with most using toothpaste . Many however cannot afford toothpaste and brush their teeth with a toothbrush or their fingers alone . Amongst the elderly there are many who still use their fingers and sand to clean their teeth . The effects are dramatic for some , with severe tooth surface loss , often leading to tooth loss . The periodontal condition was overwhelmingly poor with gross calculus deposits particularly behind the lower incisors and the posterior teeth which were regularly neglected . The pattern of dental decay was also consistent .
THE IMPACT OF SUGAR Due to the introduction of refined sugars in recent times combined with the lack of education in toothbrushing techniques , the posterior teeth were mainly affected , with most anterior teeth being undamaged . As many Likomans were chronically hungry , sugar ( which is cheap ) brings a much-needed sugar boost when available ( most Likomans have 2-3 heaped tablespoons of sugar in their tea ) and sugarcane ( grown on the island ) can be sucked for many hours at a time .
DENTAL TREATMENT As there were no dental facilities on the island , apart from the extraction service once a week , untreated caries generally progressed uninterrupted and patients often presented with retained carious roots following several bouts of dental pain . Toothache and infection can have serious consequences in a population that is already compromised economically and often medically . Clinical activity ( one week ) Monday-Friday 8.00am-3.30pm ( 40 minutes break for lunch ). Number of patients registered 116 , Number of patients treated = 99 with a Median age = 34.5 ( Oldest = 75 / Youngest = 6 )
Each patient contact was treated as a teaching contact . Extractions were carried out using best practice ( initial use of elevators and then extraction forceps ). All patients had their medical histories checked and most patients were healthy with no known diseases . Each patient who attended the hospital carried a medical card outlining their medical history . The main medical issue found was hypertension . These patients were referred to the clinical medical officer for his assessment before any extractions were carried out and all were sutured .
All gingival margins that were torn or where there were multiple teeth adjacent to each other that were removed , sutures were placed and the patients were invited to come back to the hospital in two days for review . Of those seen , 17 people received no treatment : three were children who were related to the hospital administrators who wanted them to have a checkup . Each one had carious deciduous teeth but it was felt that with the amount of disease in the adult population , deciduous teeth would only be extracted if the child was in significant pain . None had pain when seen . Two children had ectopically positioned erupted canines that they wanted reassurance about . In addition , three adults had severe hypertension and one evidence of goitre . It was felt where there was a significant medical risk of post extraction complications , treatment should not be attempted .
In total , 97 teeth were taken out . Of these , 12 were for periodontal reasons ( gross mobility and gingival inflammation with associated pain ). The majority of the affected teeth were molars - 17 were third molars which were grossly broken down ( of which 8 were lowers ) These teeth were particularly challenging as there was no suction or dental light as there was no electricity .
Extractions took between a few seconds ( for the very periodontally involved teeth ) to 50 minutes for a patient with gross caries where two roots fractured during extraction . One root was left in place . After 15 minutes of excavation it could not be removed . If there had been electricity to support adequate suction and a dental drill , it might have been possible to remove it but none were available .
Every patient who had active infection beyond the apex of the tooth or where a root was fractured , received post extraction analgesia and antibiotics ( Amoxycillin 250mg tds ) for five days . Of these , 78 % said they used a toothbrush and almost all of those used toothpaste . Of the rest , they used their fingers with either nothing or sand . Furthermore , 63 % had calculus and u
Dental Practice Magazine
43