Where There Is No Dentist 2012 191
More serious gum infection
(gangrene of the face, Noma, Cancrum Oris)
In the most severe gum infection, the jaw bone will
become infected and this can spread through the cheek
to the face. This will be very easy to see, as parts of the
face and jaw rot away and smell bad. It happens mainly
to very sick children (usually one to four years old), but
can also happen to adults with HIV infection.
Get medical help as quickly as you can—in a hospital if possible.
In the meantime, use the information on pages 122 to 124 for cleaning and
treating the gangrene.
The medicines (antibiotics) listed on page 123 are for children. For an adult,
give the following:
For an adult who is able to swallow:
• give 400 mg of
metronidazole by mouth,
3 times a day for 10 days,
• OR if you cannot get
metronidazole give 450 mg of
clindamycin by mouth, 4 times a
day, for 5 days.
• OR if clindamycin is not available give 500 mg of erythromycin
by mouth, 4 times a day, for 10 days.
Note: Clindamycin, erythromycin, and metronidazole are OK to use
for women who are pregnant or breastfeeding.
For an adult who cannot swallow:
• inject 2,000,000 (2 million) Units of penicillin G into a large muscle,
3 times a day, for 7 days.
For an adult who is allergic to penicillin,
• inject 600 mg of clindamycin into a large muscle, 4 times a day,
for 5 days.
If you give the medicines by injection, change to medicines by mouth
once the person starts to feel better. But do not stop giving the medicines
until the 7 to 10 days have passed.