Hesperian Health Guides
Chapter 7 Part 2: Some Special Problems
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.
Contents
Broken Bone
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.
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 1. cheek bone
2. upper jaw bone
(lower jaw joins the head here)
3. lower jaw bone |
Signs of a broken bone:
- The person has had an injury.
- When teeth are closed, some upper teeth do not meet lower teeth.
- The person cannot open or close the mouth properly.
- There is bleeding from between 2 teeth.
- There is swelling or a bruise on the face or jaw.
- There is bleeding into the eye.
Signs of a cracked bone around the tooth’s roots:
- When you move one tooth, the tooth beside it also moves.
- When you move the loose tooth, the bone moves with it.
- Blood is coming from under the gums.
Treatment:
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.
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Be sure the person can breathe.
Lay him on his side so that his tongue and jaw fall forward.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.
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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, page 86). 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 2 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 9. 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.
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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. - Give penicillin by injection for 10 days to stop infection inside the bone.
- Give something for pain. Aspirin, paracetamol (acetaminophen), or ibuprofen 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, 4 to 6 times a day as needed.
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.
Caring for a person who cannot eat properly
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Give liquid foods for strength and energy.
Prepare food in two ways: (a) First, a milk-oil drink to build strength and then (b) 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:- 9 cups of water
- 3 cups of milk powder
- 150 ml of peanut oil or coconut milk
- ½ cup of honey or 1 cup of sugar
Leave some near his bed, and keep the rest in a cool place.
To keep strength and give energy: Special vegetable soup
Cut into small pieces and cook together in a pot of water:- ½ tin of fish or a handful of dried fish
- 4 small spoonfuls of peanut oil or palm oil
- 6 sweet potatoes or small yams
- 1 large handful of green leaves
- 1 small spoonful of salt
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. -
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:
- Scrub both the wires and the teeth with a soft brush after drinking soup.
- Rinse with warm salt water, 2 cups every day.
Loose teeth
If the bone around the roots of the teeth is cracked, those teeth will be loose. Do not take the teeth out until the bone is healed. Otherwise, bone will come out with the teeth and there will be a big hole in the jaw. Instead, support the teeth, in order to hold both sides of the bone steady.
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| Bend the needle around the tooth so it does not stick out |
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| Use a strong hemostat or needle holder |
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- With your thumb and finger, gently move the loose teeth and bone back into normal position.
- Cut a hypodermic needle and use it as a splint. Make it long enough to fit around two strong teeth on each side of the loose teeth. Curve the needle so it fits the curve of the teeth. To make the sharp ends smooth, use a file or rub the ends against a stone.
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Tie each tooth to the needle. Use short pieces of 0.20 gauge ligature wire.
Put one end of the wire under the needle. Bring it around the back of one tooth and out to the front again over the needle.
Use the end of a small instrument to hold down the wire at the back of the teeth. Then twist the ends together. Tighten the wire around each one of the 6 teeth. - Cut the ends of the ligature wire. Turn them toward the teeth, so they will not cut the lip.
- Tighten the wires the next day, and then once each week. But be careful. Only ½ a turn usually is needed. More, and the wire will break. Always twist in the direction a clock moves. With this habit, you will remember which way tightens the wire and which way loosens it.
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Explain to the person that it takes 4 weeks for the bone to heal. The wires must remain on the teeth for this time. To help the teeth to heal, ask the person to:
- give these teeth a rest. Use other teeth for chewing.
- clean both the teeth and the wires with a soft brush.
- rinse with warm salt water, 2 cups every day.
- return to have the wires tightened every week.
- After 4 weeks, cut and remove the wires. Ask the person to watch those teeth. A dark tooth and gum bubble are signs that the tooth is dying. Take it out, unless you can give special nerve treatment.