The Dental Kit

This content is from
pages 207 to 212 of Where There Is No Dentist

In this section, there are lists of medicines, instruments, and other supplies recommended in this book. Keep them together in a kit. You may want to change some of them, or add others to meet your own needs.

As a dental worker, you will be able to get many of the items on the lists from your government medical stores. Some things you will have to buy yourself. That can be expensive, so we make several suggestions to help you save money.

Before you order, decide how many of each thing you need. Ask yourself: How many persons do I treat each day? For what problems? Then order enough medicines and supplies for three months.

Note: As more people learn about the treatment you can give, more will come to ask for your help. Remember this when you order. Remember, also, that some persons may need more than one treatment.

In the following table we give an example. We recommend how many medicines, supplies, and instruments you will need if you see 10 people a day — 200 a month. You cannot be exact, of course, because you cannot predict exactly what problems will arise. However, we can say that, on the average:

In a group of 10 persons with urgent problems:

6 persons need you to take out 1 or more teeth (so you must inject)
2 persons need cement fillings
2 persons need medicine before you can treat them.

Many of these persons must return for another visit:

5 persons need you to scale their teeth and teach them how to care for them better
1 person will need a cement filling
2 persons will need treatment after taking medicine.

Use	Proper Name	Local name (write in here)	Amount you need in 3 months	Amount to keep in kit
For pain	1. aspirin, 300 mg tablets	_______________	2,000 tablets	100 tablets
For pain	2. paracetamol (acetaminophen), 500 mg tablets	_______________	500 tablets	10 tablets
3. ibuprofen, 200 mg tablets, 500 mg tablets	_______________	500 tablets	10 tablets
For infections	1. penicillin, 250 mg tablets	_______________	2,000 tablets	100 tablets
	2. erythromycin, 250 mg tablets	_______________	500 tablets	40 tablets
	3. nystatin, drops	_______________	12 small bottles	2 small bottles

Another antibiotic, tetracycline, is not recommended for any of the treatments in this book because it is a broad-spectrum antibiotic. Narrow spectrum antibiotics are usually safer and just as effective for most dental problems. If you do use tetracycline, read page 355 of Where There ls No Doctor and remember, do not give tetracycline to a person who is pregnant or breastfeeding or to a young child. Tetracycline can make young, developing teeth turn dark.

Suggestions:

Compare prices before you buy medicines. Often the same medicine has many different names. The generic name (the name we use on here) usually is cheapest, and the medicine is just as good as the brand-name medicines. Use the generic name to order and buy, not the brand name.
Always look for a date on the package. It is called the expiration date (or expiry date). If today is later than that date, do not buy or use that medicine.
Be careful to give the correct dose. Read the next section carefully, as well as the Treatment section of each problem in Chapter 7. If the next section is not clear to you, read Chapter 8 of Where There ls No Doctor.
See more information on serious infections.

The correct dose

Before you give medicine, think about the sick person’s weight and age. The smaller children are, the less medicine they need. For example, pain medicine such as aspirin (300 mg tablets) or acetaminophen (500 mg tablets) can be broken up into smaller tablets:

Four times a day:

Adults take 2 tablets	Childen 8–12 take 1 tablet paracetamol	Children 3–7 take ½ tablet paracetamol	Babies take paracetamol only, ¼ tablet

NOTE: Do not hold aspirin on the bad tooth. Aspirin has acid that can hurt the tooth. Always swallow aspirin immediately. For severe pain, when aspirin does not help, an adult can take 30 mg of codeine 4 to 6 times a day, as needed. Use paracetamol (acetaminophen) instead of aspirin for children under 12 years, especially for babies or for children with flu signs. Aspirin can be dangerous for them and for people with asthma.

Antibiotics: To fight infection

Antibiotics kill bacteria that cause infections. Some antibiotics work better than others on certain bacteria. If you can, test the pus to find which antibiotic works best.

Do not give penicillin to a person who is allergic to it. Ask about the person’s allergies before you give penicillin pills or injections. When you inject penicillin, always keep epinephrine (Adrenalin) ready to inject if the person shows signs of allergic shock. Stay with the person for 30 minutes. If you see these signs…

cool, moist, pale, gray skin (cold sweat)
weak, rapid pulse (heartbeat)
difficulty breathing
loss of consciousness

… immediately inject epinephrine (1 mg/mL medicine) in the thigh: .5 ml for adults or .25 ml for children. If needed, give a second dose in 5 to 15 minutes, and a third dose in 5 to 15 minutes after that. Do not give more than 3 doses. For more information on allergic shock, see Where There Is No Doctor, pages 70 to 71.

Always give the full dose of penicillin or any antibiotic, even if the person feels better. Check the correct dose of penicillin or erythromycin. Erythromycin also comes in liquid form. It has 125 mg in 5 ml, so 10 ml of liquid (about 2 large teaspoons) is the same as one 250 mg tablet.

Injections: For severe infections

3 ml syringe

.5

1

1.5

2

2.5

3

It is always safer to take medicine by mouth. Sometimes, however, an infection is so bad that you need to give medicine by injection. Learn how to give injections from an experienced health worker. The injections described on this page are not like the anesthetic injections in Chapter 9 of this book — you must inject these medicines into a large muscle in the buttocks or arm. For more instructions on this kind of injection, see Chapter 9 (pages 65-74) of Where There Is No Doctor.

For severe infection: There are 2 kinds of penicillin to inject.

Procaine Penicillin		Crystalline Penicillin

300,000 units in 1 ml		1,000,000 units in 1 ml
You will usually use aqueous procaine penicillin. Give only 1 injection per day.		For very severe infections, give crystalline penicillin every 6 hours for the first day. It acts quickly and for a short time only.

INJECTABLE MEDICINES
	SUPPLIES			DOSE
Proper Name	Amount you need in 3 months	Amount to keep in kit	Adult (over 40 kg)	Child 6–12 years old (22–39 kg)	Child 1–6 years old (10–22 kg)
1. procaine penicillin, bottle with 300,000 Units per ml	200 bottles	4 bottles	4 ml 2 times/ day	2 ml 2 times/day	1 ml 2 times/day
2. crystalline penicillin, bottle with 1,000,000 Units per ml	50 bottles	1 bottle	3 ml 4 times/ day	1.5ml 4 times/ day	1 ml 4 times/ day

SUPPLIES
Use	Proper Name	Local name (write in here)	Amount you need in 3 months	Amount to keep in kit
To make dressings	1. clean cotton gauze	___________________________	8 packages of 100	20 pieces
	2. clean cotton rolls	___________________________	10 packages of 50	8 rolls
To fill cavities	3. oil of cloves (eugenol)	___________________________	50 ml	1 small bottle
	4. zinc oxide powder	___________________________	500 grams	1 small bottle
To treat sensitive teeth	5. fluoride toothpaste	___________________________	1 tube	1 tube
To give injections of local anesthetic	6. lidocaine 2% 1.8 ml cartridge	___________________________	8 boxes of 100 cartridges	10 cartridges
To give injections of local anesthetic	7. disposable needles, 27 gauge long	___________________________	8 boxes of 100 needles	10 needles
	8. lidocaine topical anesthetic	___________________________	5 small tubes	1 tube

Fluoride

You can use a special solution of fluoride (if available) or any fluoride toothpaste, which is much cheaper and more common (see above, number 5), in 2 ways:

To treat a sensitive tooth: Put cotton rolls between the lip and gum on each side of the bad tooth. Dry the bad tooth with cotton and look for the small groove that is causing the pain. Cover the groove with a smear of fluoride toothpaste and tell the patient not to spit or rinse it out for several minutes. One week later, give the same treatment again, or have the patient do it himself.

To help prevent cavities, in children who do not clean their teeth with fluoride toothpaste, once a week have children bring their toothbrushes or toothsticks to school. Put some fluoride toothpaste on each child’s brush or stick and have them brush and coat their teeth, leaving the paste in their mouths for at least one minute. Then they can spit it out. Do not eat or drink for 30 minutes.

In Chapter 3, children are shown using a twice‑yearly application of a special paste, a topical fluoride gel. This is good, but the weekly treatment with fluoride paste is even better for the teeth.

Weight (how heavy something is)			Volume (how full something is)

1 kilogram (kg)	= (equals)	10 x 100 grams (g)	1 liter	1 cup	1 teaspoon
1 kilogram = 1000 grams			1000 ml = 1 liter 236.5 ml = 1cup
1 gram = 1000 mg			5 ml = 1 teaspoon
			1 ml = 1 cubic centimeter (cc)

Use	Proper Name	local name (write in here)	Amount you need in 3 months	Amount to keep in kit
To make rinses	1. salt	___________________________	2 kilograms	100 grams
	2. Hydrogen peroxide	___________________________	3 liters	500 ml
To keep instruments clean	1. 95% alcohol disinfectant solution	___________________________	18 liters	1.5 liters
	2. bleach for disinfectant solution	___________________________	2.5 liters	125 ml(1/2 cup)
To keep instruments sharp	Arkansas sharpening stone	___________________________	1 stone	1 stone
For examing	wooden tongue depressors	___________________________	8 boxes of 50 per box	10