In this chapter we consider those parts of the expertise of the dentist, periodontologist, and oral surgeon that are within your scope. Dental abscesses are described elsewhere (5.8), and so is your role as a maxillofacial surgeon (62.1). Don't forget that a hospital can play a key role in dental health education[md]improved oral hygiene is one of the main ways to combat caries, and periodontal disease, and to keep the community's teeth in its mouth. When treatment is needed, dental auxiliaries are the main way of giving the community the care it needs at a cost it can afford.
Anaesthesia for operations round the mouth. As so often, much of what you can do will be limited by your anaesthetic skills, or those of your assistant. You can however do much with local infiltration, and with maxillary or pterygopalatine blocks (A 6.3 and 6.4). You can also do many procedures under ketamine (A 8.1), and although this is not usually recommended for work in the mouth, it is likely to be safer than an inexpert general anaesthetic, especially for babies and children under 2 years, as an alternative to intubation. If a patient as small as this is to be intubated, the tiny tracheal tube that he needs is easily blocked. When you use ketamine, you must share with the anaesthetist the critical task of clearing blood from his airwway whenever necessary, and have a swab on dissecting forceps, and a sucker, with a catheter at its tip, instantly ready (see also A 8.1).
Here is the basic equipment you will need:
CHAIR, operating dental, one only. A dental chair is expensive. If you don't have one you may be able to adapt a strong chair, and fit it with a rest to support the patient's head, when it is pushed firmly backwards, especially when you extract upper teeth.
DENTAL MIRROR, serrated handle, with No. 4 size plane head, as A, Fig. 26-1, one only.
DENTAL PROBE, single-ended, as Ash No. 14 (B, 26-1), one only.
DENTAL DRESSING TWEEZERS, Guttman, as Ash No. 13 (C, 26-1), one only.
''PLASTIC INSTRUMENT' Ash No. 6 (D, 26-1), one only. This is for inserting filling material into a cavity.
SPATULA, metal, for mixing filling material (E, 26-1), one only.
SCALER, dental, Cumine, as Ash No. 152 (F, 26-1), one only.
DENTAL MATERIALS, clove oil for dental use, 100 ml only. Zinc oxide powder, 1 kg only. When mixed together on a glass slab with the spatula listed above, these make an effective analgesic and a mildly antiseptic dressing for a dental cavity.
Halestrap DJ, ''Simple dental care for rural hospitals, (4th edn 1981). The Medical Missionary Association, 6 Cannonbury Place, London N1 2HJ. Fig. 26-1 SOME DENTAL INSTRUMENTS. A, a mirror. B, a probe. C, forceps. D, a ''plastic instrument' for putting filling into a tooth. E, a spatula. F, a Cumine scaler. From the Ash instrument catalogue.