160 Where There Is No Dentist 2012
five PROBLEMS TO WATCH FOR
1. A person who bleeds a lot must know how to prevent bleeding afterward.
Explain very carefully the steps given on page 167. You may also want to
place a suture (pages 167-168) to hold the gums tightly together.
2. Persons with heart disease often take aspirin or medicines called
anticoagulants that do not allow the blood to clot normally. Ask what
medicine the person takes. Heparin and warfarin are examples of
anticoagulants. Another heart medicine, digitalis, is not an anticoagulant. If
the medicine is not an anticoagulant, you can take out the tooth. But do not
use more than 2 cartridges of local anesthetic. The epinephrine inside
the anesthetic can harm a weak heart. (See page 137, #2).
3. A person with allergies may be allergic to aspirin, penicillin, erythromycin,
or other medicines you often use. Find out which medicine has caused
problems and give a different medicine, one that will not cause a reaction.
4. A diabetic’s wound may become infected. Watch carefully the place where
you took out the tooth and give antibiotics (page 94) if an infection begins.
5. D uring the last month of pregnancy, a woman may be too uncomfortable
to have a tooth taken out. Control the infection with a 5-day course of
penicillin (page 94), and take out the tooth after the baby is born. It is also
better to wait if the woman has high blood pressure, because she may
bleed too much when you take out the tooth. For more information about
treating pregnant women, see page 77, and the story on pages 15 to 16.
Be Patient, Careful, and Considerate
• Inject local anesthetic slowly in the right place, so the tooth becomes
numb and you do not hurt the person when you remove it. If the person
says the tooth still hurts, it is probably true! Inject again.
• Use the correct instrument in the correct way. If you are careful you
can avoid breaking the tooth. When you take out a baby tooth, be extra
careful not to hurt the new tooth growing under it.
• Explain everything to the person. Tell the person if something is going
to hurt, even a little. When you take out the tooth, you can explain, for
example, that there will be a feeling of pressure. Press on the person’s
arm to demonstrate what it will be like. When you finish taking out the
tooth, explain what you have done and what the person can do at home
to help the mouth heal.
THE INSTRUMENTS YOU NEED
Buying instruments can be confusing, because there are so many. Only a few
of them are really necessary. You can take out most teeth with the 4 basic
instruments on page 161.