Where There Is No Dentist 2012 123
3. Start antibiotics.
Metronidazole is the best medicine to use. Give 200 mg by mouth 3 times a
day for 10 days. You can also use clindamycin. To decide how much to give,
weigh the child. For adults, see the medicines and doses on page 191.
5 to 10 kg
10 to 17 kg
17 to 25 kg
over 25 kg
Dose for clindamycin (give 3 times a day for 5 days)
50 mg by mouth or 60 mg by injection
100 mg by mouth or 130 mg by injection
150 mg by mouth or 225 mg by injection
250 mg by mouth or 333 mg by injection
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, pages
364 to 367).
Look for any other illnesses and treat them, too, especially measles and
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. See page 8.) Then put in a wet dressing. (You can also
clean the sore with an iodine solution.)
• Soak cotton gauze in salt water. Squeeze out the extra water so that
it is damp but not wet.
• Put it in the hole and cover it with a dry bandage.
• Every day, remove the bandage, wash the hole with hydrogen
peroxide, and put in a new dressing. Do this until the hole does not
smell anymore and there is no more dark dead skin.
6. Remove the loose teeth and dead bone.
You can use a local anesthetic (Chapter 9). Usually there is not much
bleeding. If gums are loose, join them with a suture (see pages 167 to 169).