Part 37 - - Offline

Part 37 - - Offline
A project of Volunteers in Asia
Where There Is No Dentist
by Murray Dickson
Published by:
Hesperian Foundation
P.O. Box 1692
Palo Alto, California
Available from:
same as above
Reproduced by pemission.
Reproduction of this microfiche document in any
form is subject to the same restrictions as those
of the original document.
Where T
Is No Dentist
by Murray Dickson
with an introduction by David Werner,
author of Where. There Is No Doctor
Library of Congress Cataloging in Publication
Catalog card No. 82-84067
Dickson, Murray
Where there is no dentist.
Includes index.
Palo Alto, CA: Hesperian Foundation
ISEN : o-942364-05-8
First edition,
The Hesperian Foundation
P-0. Box 1692
Palo Alto, California 94302
U. S. A.
by The Hesperian Foundation
This book is certainly not intended to te the last word in community
dental care. It is only a beginning. The author hopes to rewrite and
improve the book with suggestions from readers.
Note on the use, adaptation,
and translation
of this book:
Each country is special, with its own
particular customs, health needs, and
ways of caring for people.
This book, therefore, must be adapted
by dental workers in each country, using
the language that is common to the local
health workers there.
The author would be pleased to assist
in any way with those who would translate
or adapt the book.
We encourage persons or programs to use this book, or portions of it,
in preparing their own manuals for villagers or health workers. Permission
from the author or publisher is not needed-provided the parts reproduced
are distributed free or at cost, not for profit. To avoid duplication of
efforts, before beginning any translation, please write to The Hesperian
We would like to rewrite this book and incorporate many of your ideas.
If you have a suggestion, please write to Murray Dickson at The Hesperian
Foundation. Better yet, if you write your own manual, please set aside
two copies and send one to The !-lesperian Foundation, Box 1692, Palo
Alto, California 94302, USA. Send the other to AHRTAG (Appropriate
Health, Resources and Technologies Action Group), 85 Marylebone High
Street, London WIM 3DE, England. Both organizations would like to
help pass along your ideas to others.
Where There Is No Dentist is here to fill a need. To many people, it has seemed that
the existing books about dental care were either too incomplete or too comp’;;ated.
If this book fills that need, it is only because a number of people worked ti 3rd to make
it happen. Tc them I owe my sincere thanks.
Much has happened since that day in Papua New Guinea when David Werner’s
letter arrived. His challenge was simple: “Since no one else has written a dental manual
like this, why don’t you?” With David’s encouragement and constant support, I was
,;ble to take teaching notes and produce a suitable draft that was the basis for this
book. To you, David, for your patience in helping me learn, my heartfelt thanks.
Thqnks also to Trude Bock and Bill Bower for the home, food, direction, and support,
during a short visit to The Hesperian Foundation in which -the book took a definite
turrl for the better.
Michael Blske deserves speciat mention. As editor of Where There Is No Dentist,
was he who took the manuscript and nursed it along to completion. Michael’s
commitment to finishing the book was vital, and I sincerely appreciate it.
My thanks go to Maggie Leung for typing the final draft, and to those dedicated
persons who helped get the book into final form: Annaloy Nickum (page design);
Hal Lockwooa (typesetting and paste-up); Paul Chandler, Serena Clayton, and Elaine
Rossi (proofreading); Pat Bernier (typing); and Howard Uno (photostats).
For their outstanding drawings, I am exceedingly grateful to: June Mehra, Janet
Elliott de Jacques, Michael Marzolla, Joan Thompson, Mindy Mead, Arlene UstinCartagena, and Lynn Gordon. My own drawings in the manual appear amateurish in
I want to thank the many persons who reviewed the manuscript and offered
valuable suggestions: Ken Cripweil, Bill Bower, Jeff Vore, Aaron Yaschine, Rosalie
Warpeha, Norma Francisco, Mike Muller, Marcia Anderson, Phil Haskett, Bert Ball,
Tom Coles, Sunil Mehra, and John Rogers. In particular, thanks to Chris Lennox who,
faced with stressful times in Papua New Guinea, found time to read through two
drafts; and to David Morley for his ideas for improving the book and his assistance
with its eventual public&ion.
For their financial help, I am grateful to the Ella Lyman Cabot Trust, Muttart
Foundation, the Canadian Organization for Development through Education, and the
James C. Penney Foundation
I thank the C.V. Mosby Company and Dr. Kenneth Snawder for permission to
adapt several drawings from the Handbook of Clinical Pedodontics.
This book is based upon several years of practical experience, made possible by
the Canadian Organization CUSO. For this opportunity,
and for CUSO’s active interest
and involvement in this book, I most gratefully say thanks,
Finally, I want to acknowledge my family’s contribution.
For weeks
wife, Gerri faithfully read and discussed with me each part of the book
and was rewritten. She did this cheerfully, at a time when she was fully
graduate study program. For much longer than I had anticipated, Gerri
boys, hliCh&
and Brennan, had to roierate my preoccupatrons.
on end, my
as it changed
occupied in a
and our two
My parents endurnd my wanderings and search for answers to human problems
with love and a growrng sense of understanding. It is my only disappointment
they did not live to see this book in its final form.
by David Werner
Part 0r.e: Learning and Teaching about Teeth and Gums
Your O.wn Teeth and
Teaching Family dnd
Teaching Children At
School Activities for
Taking Care of Teeth
Part Two: Treating
Gums . . . . _
. . . . . . . . .
Friends In Your Community
. .
School. . . . . _ . . . . . . . . . .
Learning About Teeth and Gums.
and Gums . . . . . . . . . . . . . .
. ,
. .
. . .
. . .
. .
REFERENCE PAGES ._......................
The Dental KI:
Records, Reports, and Surveys
Story Telling
Dental Healit TFachfng Materials
. 1
. 9
DeFtal Problems
6: Examination and Diagnosis . . . .
7. Treating Some Commcn Problems
8: Scaling Teeth .
. . . .
9: Injecting Inside the Mouth . . .
10: Cement Fillings
. . .
. . .
11: Taking Out a Tooth
. . .
. . . .
. . . .
. .
. . .
. . . . . .
. . . . . . . . .
. . . . .
. .
. .
. .
. . . 71
. . 81
. . 121
. . 137
. . 147
. . . . . . . . . . . . . . 163
. .
. . . . . . . . . . . . .._._.........._...................
. . . . . ..
by David Werner
A healthy tooth
‘tife-tines’ of blood
the tooth from the
death to the tooth.
is a living part of the bodv. It is connected
and nerve to a person’s hear? and brain. To
body, or even to interrupt
those ‘life-lines’,
It also means pain and injury to the body,
to the
Let us look at it another way. The health of the teeth and gums is
related to the health of the whole person, just as the well-being of a
person relates to the health of the entire community.
Because of this, the usual separation between dentistry
and general
health care is neither reasonable nor healthy. Basic care of the teeth and
preventive and curative-should
be part of the ‘know-how’
ail primary health care workers. Ideally, perhaps, Where There 1s No
Dentist should be a part of Where There fs No Doctor. Think of it as a
voiume, both to Where There Is No Doctor and Helping Health
Workers Learn.
Murray Dickson has taken care to write this book in a way that will
help the readers see dental care as part of community
health and
The approach is what we call ‘people centered.’
Where There /s No Dentist is a book about what people cando
and each other
village and neighborhood
about dental
to health;
It is written
health workers who want to learn more
care as part of a complete
school teachers, mothers, fathers, and anyone
to care for their gums and teeth.
in their children
concerned with
and their community;
those dentists and dental technicians who are looking
share their skills, to help people
for ways to
more self-reliant
at lower
Just as with the rest of health care, there is a strong need to
provide nrdinary people and community
workers with more skills to prevent and cure problems in the mouth.
After all, early care is what makes the dentist’s work unnecessary-and
this is the care that each person gives to’his or her own teeth, or what a
mother does to protect her children’s teeth.
While dental disease is decreasing in richer countries, it is oil the increase
in most poor countries. One reason for this is that people are eating fewer
foods and more pre-packaged commercial
often sweetened with refined sugar.
Even as the need for denral care is growing, there are still far too few
clentists in poor countries. Most of those few work only in the cities,
where they serve mostly those who can afford their expensive services,
People in many countries cannot afford to pay for costly professional
dental care. Even in rich countries, persons who do not have dental
insurance often do not get the artention they need-or
go into debt to
get it.
Two things can greatly reduce the cost of adequate dental care: pooular
education about dental health, and the training of primary health workers
as ‘dental health promo.ters’.
In addition,
numbers o-f ‘community
technicians’ can be trained-in
2 to 3 months plus a period of
cut-e for up to 90% of the people who have problems
of pain and infection.
Dentists’ training usually includes complicated
oral surgery, root canal
work, orthodontics
teeth), and other complex skills. Yet
most dentists rarely do more than pull, drill, and fill teeth-skills
require a fraction of the training they have received. The simpler, more
common dental problems should be the work of community
technicians who are on the ‘front lines’ (the villages), with secondary
help from dentists for more difficult
Would this reduce quality of service? Not necessarily. Studies have
shown that dental technicians often can treat problems as well as or better
than professional dentists. In Boston (U.S.A.), for example, a study
showed many of the basic treatments commonly
given by dentists to be
done just as well, and often better, by dental technicians with much
shorter training.
in some countries skilled dental technicians have managed
to become the major providers of the most needed dental services. In
India, there are still ‘street-corner’
dental technicians with foot-pedal
drills, who drill and fill teeth at remarkably
low cost.
In Honduras, technicians
(who learn largely from each other,
starting as helpers) have formed their own union. Their political strength
recently was tested when, in the town of Trujillo, a dentist tried to put a
technician out of business. The local technician had removed an infected
root left mistakenly
by the dentist. The technician had commented
the dentist’s carelessness, and the dentist heard about it. The dentist sent
a policeman who shut down the technician’s
office and took away his
tools. However, the dental technicians’
union took this to court. They
argued their rights to practice dentistry,
because they are the only persons
working in marginal communitres
wllere dentists prices are too high for
the people. The court decided in favor- of the technicians,
and ordered the
dentist to return the technician’s
tools and pay him for work lost.
In other countries dentists and community
dental workers work in
closer harmony.
In Guatemala, Ecuador, Papua New Guinea, and
dental technicians are now recognized by the Ministries of
Health. In Papua New Guinea and Ecuador, professional
dentists train and
supervise them to provide dental care to school children. In Ecuador, they
work mostly as dentist assistants, bringing high quality services to more
people while decreastng costs. The ‘dental therapists’
in Papua New Guinea
are trained .to extract, drill, and fill teeth, as well as to work on prevention
of dental probletns in school children.
In Guatemala and Mozambique,
dentists from the dental
trained village health promoters as dental workers who work
o-f all ages. Their training includes community
dental health
cleaning of teeth, extractions,
and drilling and filling. These
workers are provided with the few basic instruments
these services.
school have
with people
to provide
In Project Piaxtla, Mexico (with which I and the Hesperian Foundation
have worked for many years), visiting dentists have also helped train
village ‘dentics’. They, in turn, now teach basic dental skills to the parttime village health workers. Thesl, villcgc dentics, some of whom have had
only 3 to 6 years of primary school, now practice-and
teach-a wider
range of dental skills than the average dentist. Their activities include
dental health campaigns with school children, community
puppet shows
about low-cost dental self-care, cleaning of teeth, extractions,
drilling and
filling, and the making of dentures (false teeth). Several of the dental
workers can now do root canal work-a
special treatment
to remove the
central nerve in order to save an infected tooth. One of the village dentics,
what he had seen a dentist do, taught himself how to do
root canals when his girlfriend
had an infected front tooth that he did not
want to pull. (He had also learned to check the tooth from time to time
afterward to make sure this treatment
had been successful.)
We still have much to learn akJout dental health. Dentists need to learn
from the knowledge of the local people, as well as the people from the
We have learned that villagers with little formal education often can
learn skills with their hands-such
as tooth extractions,
faster than university students (who have never learned to
use ,their hands for much more than pushing pencils). We aiso have
observed that the best way to learn dentistry
is not -through school but
through practice, helping someone with more experience who is willing
to teach.
Where There /s No Dentist has 2 parts. The first part (Chaplers l-5)
and learning about preventilJ? cars. It begins by
encouraging the health worker to examine herself and ner family. To be
a good example is the best way to teach.
discusses teaching
The second part (Chapters 6-l I) talks about diagnosing and treating
common dental problems. It is especially for those who live where they
cannot reach or afford a dentist. A poor neighborhood in the city can be
as distant and neglected as a far-off village. This second part is intended
mainly for health workers who have helped organize people to meet their
own needs.
Murray Dickson-a Canadian with primary care experience in Northern
Canada, Nigeria, Papua New Guinea, and Mozambique-has written this
book in clear, simple language. He takes care to use popular names instead
of unfamiliar scientific words. For example, instead of speaking of ‘dental
plaque’ the author speaks of the ‘coating of germs on the teeth.’ Such
simple language does not weaken the message. The message is stronger
because everyone understands.
The author has said:
I am sure some dentists will disagree with parts of this book. Some
points of disagreement may be small, like the failure to use accepted
dental terminology. Other ideas, particularly the suggestion that nondental people can be trained to provide many kinds of treatments, may
make some dentists angry.
The book is meant to be a source for argument and discussion. This
way, it may stimulate others to write the kind of manual that is really
needed in their countries.
We hope that this will be only the first volume of Where There 1s No
Dentist. It takes the reader as far as simple extraction (pulling) of teeth
and placement of temporary fillings. As we have seen, village workers can
also learn a wide range of more difficult dental skills. We hope that later
volumes of Where There /s No Dentist will include permanent fillings,
homemade portable drilling equipment (many kinds have been developed),
the making of false teeth, and root canal treatment. There is no reason
why village workers cannot learn all of these skills and practice them at
low cost to serve the millions who are unserved today.
The people must answer to the people’s needs. The health of teeth and
gums, along with general health, will improve only when people take the
lead in caring ,for themselves. The challenge for dentists and other health
professionals is to allow and encourage this to happen,
Yaur Own Teeth
and Gums
Next time you look in a mirror, look at your teeth ancl the skin (gums)
aroclnd them. Look in your children’s mouths, too. Look at both gums
and teeth, because the health of one often depends on the health of the
ot.her. To be strong, teeth need healthy gums. Healthy gums need clean
What can good
teeth give you?
And when you think of your teeth, think of your gums. Gums are
important for holding each tooth in place.
You need strong teeth to eat different
kinds of foods. Different foods
are important
for health. Nuts, maize, fruits, and meat are some of the
best foods-but
they are difficult
to bite and chew if your teeth are loose
and hurting!
You can
the pictures
If ycru find
look for its
usually tell if
on pages 71
a problem in
your teeth and gums are healthy or not. Look dt
and 72 and compare them with your own mouth.
your mouth, look for its name in Chapter 6 and
Chapter 7.
If you notice a problem ear!y, often you can stop it from getting worse.
It is even better to prevent the problem from starting. You can do this
if you know how to keep your teeth and gums healthy.
Learn to take care of your own teeth and gums before you try to teach
others. A good example is one of your best teaching tools, People will
see that you are healthy, and they will want to know why. When you tell
people ways to care for their teeth, they will believe you if they know
that you do these things yourself. First take care of your own teeth and
gums. Then teach your family what you have learned. They, too, will be
good examples for others to see.
The best food is food that you grow or raise yourself. Mix different
kinds of food together and eat several times a day. This helps your body
as well as your teeth and gums to stay strong and healthy. Traditional
food is usually good food.
Sweet food, especially the kind you buy from the store, can mix with
germs and make cavities-holes
in the teeth. Soft food sticks to the teeth
easily and it, too, can make a coating of germs and food on the teeth that
starts an infection in the gums-gum
Soft and sweet food and drinks with a
lot of sugar are bad for both teeth and gums.
Breast feed to help a child’s teeth
grow and stay strong. An older child
can drink from a CUD.
Do not give a baby anything to drink
from a bottle. Sweet tea, sugar water
or fruit juice can easily make holes
in the child’s teeth.
Even milk has sugar that can wash over the baby’s teeth and cause cavities when
it comes from a bottle.
I! you do not clean properly,
the food that is left on your teeth can
hurt the teeth as well as the gums near them.
Bits of food stay longer in places that are
This is where both tooth and
gum problems start.
To prevent problems you must take special
care to keep these protected places clean.
‘near the gums
It is better to clean your teeth carefully
once every day than to clean poorly many
times a day.
Here are 3 places where problems start.
Use a soft brush to clean your teeth. Buy one from the store (be sure it
says soft on the package), or make a brush yourself. To make a brush:
1. Ube ,I x nal! branch,
your.: ixmboo, strong
grass or the skin from
sugar cane or betel nut.
2. Cut a piece that is still
green and soft.
3. Chew one end to make
it stringy like a
4, Sharpen the other end so
it can clean between the
teeth (see pages 69-70).
YOIJ can twist the .flber from Inside a coconut husk into a kind of brush.
First rub it and shake away the loose bits. Then use thp end to <lean your
Whatever kind of brush you use, be sure to clean your back teeth as
well as your front teeth. Scrub the tops and sides where the grooves are.
Then push the hairs between the teeth and scrub (page 67).
Toothpaste is not necessary.
Charcoal or even just water is
enough. When your teeth are
clean, rinse away the loose
pieces of food.
are holes in teeth. Cavities are made by the Infection
tooth decay. If you have d black spot on your t.ooth, it might be a cavity.
If that tooth hurts some of the time, such as when ~OLI eat, drink,
breathe cold air, it probably has a cavity in it.
You will get cavities in your teeth if you eat sweet food and then do
not clean your teeth. If you see a cavity starting in your mouth or feel a
tooth hurting you, get help right away. A dental worker knows how to
fill the cavity so you can keep that tooth. Do this before the pain gets
‘When decay touches
the nerve inside,
the tooth aches,
even when you try
to sleep.
If you do
not fill a cavity,
it grows bigger.
It also grows
When infection
reacrles the inside
of a tooth, it
is called a tooth
A tooth with an abscess needs treatment at once, before the infection
can go into the bone (page 87). In most cases the tooth must be taken out.
If i-t is not possible ‘to do this right away, you can stop the problem
getting any worse if you follow these steps:
1. Wash the inside of your mouth with warm
\nlater. This removes any bits of food
caught inside the cavity
2. Take aspirin
for pain. See page 88 for
3. Reduce the swelling:
hold warm water
the bad tooth.
inside your
Wet a cloth with hot water and hold it
against your face. Do not use water hot
enough to burn yourself!
A tooth abscess can cause
swelling like this.
Healthy gums fit tightly around the teeth. Gums are infected if thq/
are loose, sore, and red, and if they bleed when the teeth are cleaned.
Infection in the gums is called gum disease.
Gum disease, like tooth decay, tlappens when acid touches the teeth
and gums. This acid is made wheti sweet and soft foods mix with germs
Infection from gum disease can spread into the root llbers and bone (see
page 40). But you can stop gum disease and prevent it from coming back.
There are two things to do: clean your teeth better and strengthen your gums.
1. Even if your gums are sore and they bleed, you must still clean the
teeth beside them. If more food collects on the teeth, the gum
infection will get even worse. Get a soft brush (see p. 4) and use it
gently. This way you will not hurt the gums when you clean.
2. To make your gums stronger and more able to fight the infection:
Eat more fresh fruits and yreen leafy vegetables, and fewer soft
sticky foods from tt-,e store.
Rinse your mouth with warm salt water. Do this every day, even
after your glrms feel better.
(‘I ) Mix some salt with a cup of warm water. (2) Take a
mouthful and rinse. (3) Spit it out. Repcat until dll of the sdt
water is finished.
Painful gums that bleed at the slightest touch need special treatment.
If you have this problem, ask for help. A dental worker can explain what
is happening and what needs to be done. A dental worker can also scrape
the teeth and remove the tartar that is poking the gums, making them sore.
At home, you can do some things to help.
I, Clean your teeth near the gums with a soft brush. Gently push “he
brush between the tooth and the gum. It may bleed at first, but
as the gums toughen, the bleeding will stop.
2. Make your food soft, so it is easier to chew. Pobnded
are good examples.
3. Eat plenty of fresh fruits and vegetables. If it is difficult
bite into fruit, squeeze it and drink the juice.
yam and soup
for you to
4. Start rinsing your mouth with a mixture of hydrogen peroxide and
water. You can get hydrogen peroxide from your clinic or your
pharmacy (chemist).
The strength of hydrogen peroxide is important.
and mix it evenly with water-that
with l/2 cup of water.
Ask for a 3%
is, l/2 cup of hydrogen
Read the label to be sure the solution is 3%. A
mixture with more than 3% hydrogen peroxide can burn
the mouth.
Take some into your mou’
there for about 2 minutes. Then spit it
out and repear. Do this every hour you
are awake.
Use hydrogen peroxide for only 3 days.
Then change and start rinsing with salt
waler (page 7).
you take care, you can keep your
I If~~~
teeth for a lifetime, I
Teaching Family and Friends
In Your ommunity
Old people can remember when there were fewer problems with teeth
and gums. Children’s teeth were stronger and adults kept their teeth
Times are changing. Today there are more tooth and gum problems than
ever before. In many countries, tooth decay and gum disease are two of
the fastest growing health problems.
This unhealthy situation is getting worse, for two reasons: changes in
the kind of food people now are eating, and not enough cleaning after
they eat.
BEFORE, the food people ate was
their own, grown and prepared by
NOW, more people are buying
softer and sweeter food from the
store. This kind of food sticks to
the teeth more easily so it has
more time to attack the teeth
Even sugar cane was not JS bad as
the sticky candy children eat l?day.
The sugar was bad for the teeth, but
the fiber in the cane helped rub
them clean.
Everyone must be more careful
to clean away soft, sweet food.
But many people do not know
how. Some, especially chiidren,
do not even try.
Many people do not understand
that tooth and gum problems are
caused by certain kinds of food, and poor cleaning of the teeth. In fact,
some have a completely
Do not attack a belief because it is traditional.
Many traditions
are more
healthy than ‘modern’ things. Often, instead of telling people that their
belief is wrong, you can remind them of a different tradition
that is
heal thy.
Other people like to watch what you do before they try something
First show members of your family and then they will be an
example to others in your community.
For example:
1. Instead of buying
all your foods from the store, buy fresh fruits and
vegetables from the market. It is even
better to grow food in your own
Learn to use several
foods in each meal.
healthy idea. Invite
your meals and see
different foods you
kinds of
Mixing foods is a
friends to share
the number of
have at each meal.
2. Do not buy fizzy drinks like Coca-Cola or Fanta.
They have a lot of added sugar which quickly
makes children’s teeth rotten.
do not sweeten
your child’s
milk or tea.
When she is young she can learn to enjoy drinks
that are not sweet.
Clean, cool water, tea with little sugar, milk, or
water from a young coconut are best to drink.
Fresh fruits are delicious when you are thirsty.
Most important: do not give your child a feeding bottle, especially
one with a sweet drink inside. (See page 3.)
3. Keep
your children’s teeth clean.
friends will notice clean
or teeth that are dirty or
cavities. Remember, clean
teeth are healthy teeth.
An older child can clean his own
teeth if you show him how.
A younger child cannot. He needs
help. Each day someone older
should clean his teeth for him
(page 16).
When you teach, remember that as others learn,
they too become teachers. Each person can teach another.
Encourage people to pass along v:hat you have taught.
teach family and friends. Students can talk at home with
and older family members.
. . . TO
Mothers can
brothers, sisters,
If all learners become teachers, a simple message can begin in the health clinic or school
and reach many more people at home,
Deciding what to teach is impor tant but just as important
is how to
Learning cannot take place when
you use words that people do not
understand. They will learn
something only when they see how
it is related to their lives.
Remember this when you teach about eating good food and keeping
teeth clean. Design your own health messages, but be ready to change
them if people are not understanding or accepting what you say.
Here are five suggestions for teaching well.
1. Learn First From the People
Get involved in your community’s activities. Learn about people’s
problems, and then offer to help solve them. People will listen to you
when they know that you care about them and want to help.
z Sit and talk with people. Learn
about their customs, traditions
and beliefs. Respect them.
Learn about their health habits.
Improving health may require
changing some habits and V
strengthening others.,
Learn also about tooth decay
and gum disease in your community.
4 2\
0 - A
i-q ‘7
Make people smile-then
look into their mouths.
Find out how many children and adu!ts are having
problems with their teeth and gums. Do a survey such
as the one on p. 176.
2. Build New Ideas Onto Old Ones
People find their own ways to stay healthy. Many traditions
helpful, and worth keeping. But some are not.
are good,
When you teach, start with what people already
doing themselves. Then add new idc
and are
This method of teaching is callec
,sociation of ideas’. It helps people
to understand new ideas because they can compare them with what they
already are doing.
In this way people can more easily accept,
you suggest.
and do what
builds -
Just as sweeping the
makes it a clean
and healthy place to live.
in the
same way
the teeth and gums
keeps them clean and
healthv. A
A small child cannot find his
own lice. Mother knows she
must help him.
in the
same wa7
A small child cannot see the
food on his teeth. He needs
help with that also.
Different vegetables when
planted together-like
and yams-help
each other
to grow.
in the
same waj7
Eating different kinds of
food helps people to grow.
Eating them several times a
day makes your teeth and
gums, as well as your whole
body, grow stronger.
3. Keep Your Messages Short and Simple
Instead of partially
few things well. After
greatest, decide what
Then think of how to
Use simple words (see page 13). If you must use a big word,
time to explain
take the
Teach people when they are ready to learn. A sick person, for
teaching too many things, it is better to discuss a
learning what health problems the people feel are
will help them solve these problems.
share the information.
Try to:
usually wants to know how to prevent
He will remember what you tell him.
Repeat the most important
his sickness from
message many times. Whenever you teach
about staying healthy, remember to emphasize eating good food and
keeping teeth clean. Repetition helps people remember.
Let people see what you mean. See pages 24 to 32 for ways to use
and plays.
4. Teach Wherever People Get Together
Knowing where to teach is sometimes as important
as how you teach.
Instead of asking people to come to a class you have organized, go to
them. Look for ways to fit into their way of living. You both will gain
from the experience. They will ask more questions, and you will learn how
to work with people to solve problems.
Talk with people where they
gather near their homes.
Talk to men as they
sit together and
discuss important
issues. Also go to
their business and
farming meetings.
Talk to women at
health clinics, in the
market, and at their
church meetings,
Teach men and women
at reading groups.
5. Teach Something
People Can Do Right Away
It is good to tell a mother to keep her child’s teeth clean, but it is better
to show her how to do it. She will remember how if she actually watches
you clean her child’s teeth.
An even better way for a mother to learn is to let her clean her child’s
teeth while you watch. A person discovers something for herself when she
does it herself.
Pick out a child and clean his teeth yourself.
his mother watch,
Use a soft brush (or for a baby, a clean cloth).
Gently but quickly brush or wipe his teeth. Do the
best you can even if he cries.
If mothers make this into a habit, the ch Id will
expect to have his teeth cleaned and will soon
the way he does to have I ice
removed from his hair.
Now let each mother clean her own
child’s teeth, Teach her to clean on
top and on both sides of every
Ask her to do the same at home
each day. At the next clinic, look at
the children’s teeth and see how
well the mothers are doing. Give
further help when needed. Always
praise and encourage those who are
doing well.
Teaching Children
At School
Children want to learn. They want to know more about things that are
real to them. Family, friends, and teachers are all important
sources of
new knowledge for the children.
It is important
to keep alive their desire to learn, so
that children can continue tcJ ask questions, discover,
at td learn more for themselves.
When children arc interested rn something,
hard to learn all they can about it.
they will work
I I you relate your teaching to children’s interests and needs, they will
learn more easily. New information
added to what they already know
helps children to understand your lesson better. As a result, they will want
to learn more because the information
is both interesting and worthwhile.
Teaching about teeth and gums is important.
You must do it well if
you want children to pay attention,
learn, and finally act to take care of
their own teeth and gums,
As school children continue to learn, they can share their new ideas and
at home with brothers, sisters, mothers, fathers, and grandparents. In this way, the circle of teaching and learning described on page
12 comes back into the family and is complete.
This chapter has two parts. Part 1 gives seven guidelines for assuring
that learning takes place. Part 2 suggests ways to have fun while learningwith stories, games, and pictures. In Chapter 4 there are nine questions on
teeth and gums with specific activities for learning how to answer them.
More children
having problems
than ever before are
with their teeth and their
What is the
You are not
A tooth that hurts or gums that are sore
can affect a student’s ability to pay
in school and learn.
Treating the problem makes the child
feel better, and that is important.
It is
equally important
to prevent the same
problem from returning later.
Working together, teachers and school children
can do much to prevent both tooth decay
and gum disease.
Keeping the mouth healthy involves learning about eating good food
and keeping teeth clean, Just giving information
is not enough, though. To
truly learn, children need a chance to find out things for themselves.
a person simply
to accept what you say does not work
very well.
A student learns not to question. What you
teach may have no relation to his own
experiences and needs.
As a result,
he may end up not doing what
you teach-not
eating good foods, and
not cleaning his teeth.
Learning happens when a student with a
question or Jn idea is able to discover more
about it himself.
lt also happens when he has a chance to do
whatever is necessary to take better care of
himself and his ,familv.
He can learn by doing, Give him a chance to
cat good food and clean his teeth at school.
Learning about teeth and gums can be fun. When the teaching
and practical, students love to learn. Here are some ideas:
is real
Teaching so that learning can take place
Teach and learn together with your school children.
Start with what the students already know.
Let students
Let children help each other.
Teach about teeth and gums together
Be a good example.
Make the community
see and then do.
A discussion draws
out information
It helps you to learn
more about the
school children,
what they already
know and believe to
be true.
But it also allows
you to introduce
that is
related to the d iscussion.
other subjects.
part of your classroom.
1. Teach and Learn Together
with School
Share ideas
instead of always
giving information.
Children learn more
when they are
A lecture transfers
your own notes to
the children’s
notebooks without
ever passing through
their minds,
2. Start with What the Students
To have meaning, learning should be a part of daily living. Talk with
your students. Find out what they know about teeth and gums, and what
questions they might have.
Add information
by building upon
Do not use big words. Scientific names and textbook
confusing, and you usually do not need them. Talk about teeth and gums
using words that a school child can understand and use later at home.
This way makes students feel stupid.
This way lets the students feel good,
because it makes sense and they know
something about it.
When you can understand new information,
you look forward to learning more.
you gain confidence
3. Let Students
See and Do.
Students learn best when they can take part and find out for themselves
about something new.
1 I
- ' IF I DO17
A lecture about
II r
teeth is usually
Learning is more interesting when students
brush and how to clean teeth properly.
not interesting
at all.
can see how to make a
If students can actually make their own brushes and clean their own
teeth, it is not only interesting but fun.
A student who takes part will not forget.
becomes part of himself.
What he learns by doing
4. Let Children
Help Each Other.*
In most families, older children have important
work to do-taking
of their younger brothers and sisters. These older children can do much to
teach the younger ones about care of teeth and gltms. For example:
(1) When they feed their younger
and sisters they can encourage them
to eat good food, like fruit instead of
(2) They can do a play or puppet show
about care of teeth and gums.
(3 They can check the teeth and gums of
the younger children and ‘score’ them
on how healthy they are (see p. 58).
(4 ) Best
of all, they can actually clean the
of the younger ones, and show
how to clean their own teeth
they are able.
Here a group of school children
in Ajoya, Mexico is putting a
high-fluoride paste (see p. 167)
on the teeth of the younger
5. Teach About Teeth and Gums
Together with Other Subjects.
Teeth and gums are part of a bigger health
in class at the same time.
Eating good food can be part of a discussion
and the politics
Teach about
on nutrition,
of who owns the lands.
Cleaning the teeth can be part of a
discussion on hygiene, clean water,
and traditions and customs.
A good way for school children to
learn about using numbers ig to do a
survey in the community.
The results will tell the children
something about health problems in
their community.
For an example of
a survey of health problems, see page
3-l 4 of Helping Health Workers Learn.
*For more ideas on how school children can help each other, write to CHILD-to-child
Institute of Child Health, 30 Guilford Street, London WC1 N 1 EH, England.
6. Be a Good Example.
Children watch people around
do, as well as to what you say.
them. They pay attention
Be a good example.
to what
. c-w
Take care to do
yourself what you are
teaching to your
Your family can be
a good example for
Clean your teeth carefully
their teeth clean.
every day. Also, help your children
Make a garden near your house and plant a variety
fruits in it.
Buy only good, healthy food from the store. Do not buy sweet foods
and drinks for yourself or your children.
7. Make the Community
of vegetables
Part of Your Classroom.
A child’s home and his community
are really more important
to him
than his school. Learning will be more interesting for a student if the
day-to-day needs of his home and his community
are part of school
Let students find out more
about problems at home and in
their community.
For example:
How many small children
have cavities or red, bleeding
How many stores have
mostly sweet snack foods
on their shelves?
Why do the people not grow
and eat more loca! food?
Back in the classroom, students can record what they find. Ask the
children to think of ways to solve the problems they found. If they can
think of a program to help solve a health problem, let them go back into
their community
and try it,
Here are some ideas to help students see what you are teaching, and to
have fun while they learn. Students can also show these things to others.
Teaching others is an excellent way to learn.
Tell a story about food or teeth. For example,
wild cat’s teeth are different in shape from
are an excellent way to learn, both for the
listening. Leave time at the end to discuss
See the example of storytelling
tell a story about why a
a goat’s teeth (page 38). Stories
and for those
the story and to introduce new
on pages 177-I 79.
Make up a play or drama about good food or clean teeth. Show it later to
the community.
The play should be about looking for an answer to a real problem. If
the children invent the play, they will have to think, plan, and solve
problems. A play also helps children learn how to talk with and teach
These school children in Nicaragua are doing a play about cavities. On the left, germs
and sweet food are combining and trying to make a hole in the ‘tooth’, But a giant
toothbrush (right) beats them away!
Do a demonstration
using local resources,
Try, for example, the ‘tooth
in the Coca-Cola’ test on
page 46.
Puzzles can help school children
discover answers for themselves. You can
make your own. The best puzzles are with words that the students know
and can use easily.
(for younger children just learning to read)
Try to find these words:
As you find each wor *d, put a 4 beside it.
An older child can try to find important
words that are more difficult.
green leaf
gum disease
Spell some of the words
It will make the puzzle
You can use pictures on posters, flip charts, and on flannel-boards.
Pictures that school children draw themselves are best. They learn
simply by drawing them. Also, school children will draw local people and
local experiences, and the people will understand ttleir pictures better than
the ones sent from a central office far away.
Photographs of local people and events are also good. If there is a
photography club in a local secondary school, have them take some
pictures for you. They may even print the photographs larger so that you
can use them as posters.
Ask the children to make pictures big enough so that a person can
stand far away and see them easily.
Let each child carry her poster home
to show her family and friends.
Hang up other posters in the store,
church, or other places where people
will see them.
Pictures can be made to stick to cloth and then used to tell a story.
Cover a board with a piece of flannel cloth or a soft blanket, to make a
Mix some flour and water to make
glue. Then glue a strip of sandpaper to
the back of each picture. The sandpaper sticks to the cloth and lets you
place the picture where you want on
the cloth.
Let the child use her pictures and
cloth outside of the school, to show
her story to family and friends.
*For more ideas on flannel-boards,
see pages 1 l-l 5 to 11-19 of Helping
Flip charts are excellent for telling a story with pictures. Often, people
can guess what the story is about just from the pictures. When showing
the pictures on a flip chart, ask as many questions as you can, to get the
people to tell you the story.
Here a health worker from
Mozambique is holding a flip chart
with pictures about care of teeth
and gums. There are no words with
the pictures.
But he can read a short message
written on the back of the page
before. There are also examples of
questions to ask.
This way, anyone
who can read can
tell the ‘flip chart
story‘ to others.
This is part of a flip chart presentation on
mothers’ and children’s health. Notice the
rings at the top that hold the flip chart
together. They are made from old
electrical cords.
There is also s
small copy of the
big picture on the
back of the page
Find a way to attach the sheets of heavy paper. Here are twu ways
with 2 thin pieces of wood
with metal or wire rings
Dental workers
chart presentation
in Mozambique
created this flip
for teaching in schools.
1) Here is a healthy, happy schoolboy.
In the
circle you see the inside of his mouth. His
teeth are white and clean. Look at his gums.
What color are they? Are they tight or loose?
Between the teeth, are the gums pointed or
This is an unhappy, sick boy. What color are
his teeth? Not only are they yellow, there are
black spots. These are cavities.
What color are his gums? Are they pointed?
Loose, red, swollen gums are signs of gum
Both cavities and gum disease can be treated.
3) What happens if tooth and gum
problems are not treated?
a) The black hole grows bigger on the
tooth and a sore forms on the gums
near the root. The tooth hurts
whenever you touch it.
b) The
red, loose gums pull away from
tooth. Infection gets to the bone
eats it. The tooth loses the bone
the gum around it.
The first problem is a tooth abscess. The second is advanced gum disease.
If either of these things happens, the tooth must be taken out.
4) Why does the boy have cavities and gum
disease? There are 2 reasons.
a) He eats too many sweet foods.
What foods do you see here?
What other foods hurt the teeth?
b) He does not clean his teeth regularly.
The germs in his mouth eat sugar from
food and make acid. Acid causes both
cavities and gum disease.
5) What foods can the boy eat to keep his teeth
and gums healthy? What do you see in this
Natural foods,
best. The foods
foods from the
foods from the
with no sugar added, are the
you grow yourself and local
market are better than sweet
6) How can we clean our teeth? Carefully is the
word to remember. Clean your
teeth at least once a day, carefully brushing
every part of every tooth-outside,
and top. Be very careful to push your brush
between your teeth. That is where the germs
arid food collect to make acid.
If you do not have a toothbrush,
you can
make one from a stick. Toothpaste
is not
necessary. Clean water is enough.
Chapter 12 in Helping Health Workers Learn is full of ideas on how to
make and use pictures effectively.
have a good original, you do
not need to be an artist to make a good copy. Here is an easy method that
can involve every student.
Place thin see-through
paper over the original
Now place the copy on a new sheet of heavy paper. Pressing firmly
a pencil, retrace all of the lines on the thin copy paper.
trace a
Remove the
tracing paper.
Pressure from the
pencil has made
lines on the poster
paper. Redraw
them with a
pencil so they
stand out clearly.
Your copy is now
ready for coloring.
And you can use
your copy paper
again to make
another copy.
Use puppet shows to ac:t out the messages
of eating good%%
and keeping
teeth clean.
Mr. Lyam, you
Feel shame Car
Students can make their own
puppets to look like people or
Using puppets, it is often easier
to say things that peo;3le themselves cannot. For example,
they can talk openly about the
bad food sold at the village store.
Children can make puppets easily from paper bags. They are good for
showing teeth because you can make a wide-open mouth.
Open and close your
hand to make it
eat or speak.
To make a
bigger puppet,
attach a
cardboard face
to the bag.
A puppet
made from a sock looks
1. Fit the sock over your hand.
2. Make the mouth by pushing in the
cloth between your thumb and
3. Add eyes, nose and hair to the
sock or to a box that fits over it.
Loosely fill a cloth bag with old cotton or paper. Put the end of a stick
inside, and tie the bag to it with tape or string. Make a sad or happy face
to fit the story. Dress the puppet with an old piece of cloth.
Above, school children in Ajoya, Mexico are holding puppets they made
ttwrnselves. On ttw left, yot~ see \hc?m in front of the stage and at right, the
(:liil(lren s11c)w IIC.IW they h(.~Id the plrppets behind the stage.
1) They r:aIled their puppet show “Rotten
A Friend’s Advice.”
2) Pedro, a schoolboy,
is sad. His friends
looked irlto his mouth and saw two
teeth with big holes in them. He tells
his brother he wants to walk horIte
3) On the way, Pedro meets Maria, a
friend who is a dental worker. “I’m
rlljt sad b~ca~~sc! tl\e others iire
says Pedro. “I know tht:
rc!al problf?ln. The holes in my teeth
w10 get I)iggc:r. My tc:otl\ will rot md
fall exit, arjcl rllaybc rr~y I)errnanenl
tr:i!ltl c:orniny in will rot, too.”
M;lria ttlinks she knows what
“We wilt talk to your father,”
1Ij 27 39 01 Helping
,I tHJ1)pf‘t
;tnd rnc1w suqqestions
Workers Learn.
to do.
she says.
4) One day later.
(Note how the scene behind the
puppets changes. It is a flipchart with
pictures to show the different places
the puppets ‘go’.)
5) “I am a poor farmer,” Pedro’s father
tells Maria. “I only go to the city two
times a year to sell my crops. I cannot
ttiks the boy to the city and pay for
fillings in his teeth.”
Maria answers, “But we can save his
teeth with a temporary cement filling.”
6) “Then, when you have time and
money, you can go to the city. I know
a dental worker who will put in a
permanent filling. I trust him. I will
send a note with you, and it will not
cost much.”
says the father.
“Come on, Pedro,” says Maria, “I’ll
put some cement in those holes!”
7) Four months later, Pedro visits the
dental worker in the city. “Maria’s
good fillings saved your teeth,” he
says, “These permanent fillings will
last for years.”
says Pedro.
8) After the show, the puppets played a
game. Throwing a ball into the
audience, they asked questions Ii ke
“How do you keep cavities from
happening?” Each child who caught
the ball answered the question and
threw it back, Then the children in
the audience began asking questions
for the puppets to answer, “Why did
you get rotten teeth?” one child asked
Pedro, The puppet looked down and
said, “Too much candy!”
‘To learn how to make a temporary filling, see Ct lap’ter IO.
School Activities for Learning
About Teeth and Gums
We can help school children in two ways. First, they need treatment
now for problems they already have. Second, they need to learn how to
prevent problems from hurting them (and their families) later.
Treatment and prevention go together.
prevention and to forget about treatment.
It is a mistake
to emphasize
In fact, early treatment is the
first step to prevention because it usually meets a person’s most strongly
felt, immediate need.
As a community
dental worker, you can visit a school and find out
what the felt needs are. Begin with the teacher. Examine for cavities,
bleeding gums, or other problems. Then look at the students.
Chapter 6 tells you how to examine a person.
what treatment to give, and who should give it.
It also helps you decide
Then teach how to prevent dental problems. Give the teacher ideas to
help students learn why they have problems, and how to keep the
problems from returning. The best way to learn is by doing-through
activities, not lectures. This chapter has many suggesl’ions for activities.
The best health practice is to prevent cavities and gum disease from
even starting. With these activities, children can do something to guard
their health.
Teacher, each day
at school:
Suggest ways for your
students to eat good
healthy kinds of food.
Give your students time
to clean their teeth.
A Note To Teachers:
Do not wait for a dental worker. This book, and especially this chapter,
is written to help you learn and do things yourself. But do ask your dental
worker to work with you, He probably has suggestions that would fit your
situation. After examining the children, he can help you follow their
progress. You can then find out how much they are learning and how
healthy they are becoming.
To begin, talk with your students to find out what they think and
what they already know. What are their traditional beliefs? Some may be
helpful, and others may need changing. At first it is best simply to discuss.
Ask the kind of questions that get students talking.
part in discussions more easily.
Later they will take
Add new information as you go along, changing some ideas but usually
building upon what the students already know.
This chapter asks nine questions:
1. Why do we need teeth and gums?
2. Whv, do some teeth look different?
3. What holds the teeth?
4. How often do teeth grow in?
5. What makes teeth hurt?
6. How do germs make holes in the teeth?
7. What makes the gums feel sore?
8. What does it mean if a tooth is loose?
9. How can we prevent cavities and sore gums?
For each question, there is an activity to help students discover answers
for themselves. The questions are not in any particular order, nor are they
written for any particular grade level, Make your own lesson plan, using
the main idea to help you. Shorten the lesson and make it easier for
younger children, Add more information for older students and Ict them
do more activities,
Why Do We Need Teeth and Gums?
Your teeth and the gums around them help ‘+ou in many ways.
Teeth are important
Good Health. Infection from a
bad tooth can spread to other parts
of your body.
Good Looks. Healthy teeth that
look good help you feel good.
Good Speech. Your tongue and
lips touching the teeth help you
make many sounds.
Good Eating. Your teeth break
food into small pieces so that you
can swallow and digest it better.
Good Breath. If you leave food around your teeth, your breath will
smell bad.
Your gums are important too.
They fit tightly around the teeth, and
help to keep them strong. Without strong
gums, your teeth are of no use. Most old
people lose teeth because of bad gums,
not bad teeth.
1. Draw or cut pictures of people from magazines. Make posters to
show that healthy teeth make a person happy, while bad teeth make a
person sad. Use the posters for discussion.
Hang up a picture of a person the students
know and like. Put black on one of her front
teeth. Talk about it.
Leave the picture for a few days. Then put
black on some of her teeth before the
students come to school. See who notices
When someone sees the difference, talk about
how the person looks, how teeth can be lost,
how to prevent that, and what she can do now.
Make a picture of a person who has lost all of his
teeth. He looks old.
Talk about how hard it is for him to eat properly
or speak clearly.
2. Have the students say words that use teeth to make sounds.
“v” and “f” - friend, fever
I “/
“s” -sun
goes between the teeth.
Now, try saying the same words again, but
do not let the tongue or lips touch the
3. Have students draw pictures of good foods we use our teeth to eat.
Then draw foods that we can eat if we lose our teeth.
Need Teeth
No Teeth Needed
Many More!
Much More!
Talk about this together. Try to eat a mango or some maize without
using your teeth, or using only your front teeth.
Why Do Some Teeth Look Different?
We need two different
kinds of teeth to help us eat our food.
Front teeth. Another name for
them is incisors. Their sharp
edge cuts food into pieces.
Back teeth are called molars.
They chew and grind pieces of
food into bits small enough
to swallow.
The outside of a tooth is the hardest and strongest part of your body.
When a tooth is healthy, it can chew hard food, even bone. The shape of
a tooth allows us to swallow food when the small pieces can slide down its
smooth sides,
Small bits of food
often get caught
inside deep lines, or
grooves, in a tooth.
Look for them on the
top and the sides of
back teeth,
Food that is not
cleaned away from
the grooves can make
a cavity (hole) in
A tooth with a cavity
is weak and often
_I,, il. ,I,,
_ :
, “
1. Ask the students to bring different
kinds of food to class. Bring some
Eat the food using first the front and then
the back teeth.
Bite a guava using only the back teeth.
Chew completely a mango or piece of maize,
using only the front teeth.
2. Collect teeth from different animals. Let the students discover from
the shape of an animal’s teeth the kind of food it usually eats. For
instance, a wild cat needs sharp pointed teeth to tear meat, but a goat
needs flat teeth to chew grass.
Make a poster to show the animal, its teeth, and the kind of food it
likes to eat,
3. Have each student take a partner. Let each look at the shape of the
front and back teeth in the other’s mouth.
Talk about the many different kinds of food we need to stay healthy.
Discuss which teeth we use to chew meat, fish, mango, and other good
foods in your area. (For most foods, the answer is both front and back
What Holds the Teeth?
When you look inside someone’s mouth, you see only the top part of
each tooth, The bottom part, its root, is inside the bone under the gum.
The roots of the
tooth hold it in
the bone just
Ii ke the roots of
a tree hold it
firmly in the
The roots of the
tooth do not
actually touch
the bone. Root
fibers connect the root and bone, holding the tooth in place.
The gums do not hold the teeth, but healthy gums will keep harmful
germs from getting to the bone and root fibers. When the gums are not
healthy, they form deep ‘pockets’ which collect germs. Soon, these germs
will reach the root fibers and bone. The bone pulls away from -the tooth
in order to get away from the germs. With no bone to hold it, the tooth is
lost. This is the most common reason why teeth fall out,
1. Have the students look for
an old jaw bone from a dog or
other animal. Notice that bone
goes around every root of every
tooth and holds it tightly,
Break away some of the bone
and look at the roots of the
Front teeth need only one root
because they are used for biting.
Back teeth have 2, 3, or even 4
roots, That makes them strong
enough to chew tough meat and
even break hard bone.
2. Show your students how infected gums can cause teeth to fall out.
A. When gum disease is beginning, a small red ‘pocket’ forms where the tooth meets
the gum. Germs and food collect in the gum and make acid. This makes the gums sore.
B. As a result, the gum pulls away and the pocket becomes deeper. C. The bone moves
away from the infection and no longer holds the tooth.
Try to think of other ways to teach how gum disease pushes the bone
away from the tooth. In Jamaica, dental workers ask, “What do you do if
someone attacks you with a machete (long knife)?” “I run away!” most
people answer, “Exactly,” say the dental workers, “and when you have a
lot of germs attacking the root of your tooth, the bone ‘runs away’ and
leaves the tooth with nothing to hold it.”
Tell a story to show how, when the gum moves away from the top of
the tooth, the root and bone are open to attack. For example:
Enrique was sleeping on a cold night when suddenly he had diarrhea.
Still dreaming, he went outside, and afterward, he forgot to close his pants
tightly. Suddenly, he saw an ugly monster coming after him! He ran away
without thinking of his pants. Finally he could not run because his pants
were around his knees, and the monster caught him,
Explain to the children that when the gums are red near a tooth, they
are like Enrique’s pants-not tight enough around the tooth, When germs
come near the tooth, they will go inside and the gums will ‘fall down’ and
show part of the root of the tooth, When this happens, the germs attack
not only the top of the tooth, but also the bone and root.
How Often Do Teeth Grow In?
A child gets two sets of teeth. The first set, baby teeth, starts to grow
when the child is a baby. The second and last set grows in at school age.
They are the permanent teeth. Permanent teeth should last a lifetime.
A child grows his first baby tooth at about 7
months of age. It is usually a front one.
A baby who is poorly nourished, however, may
not grow his first tooth until later. Do not wait for
the first tooth before giving him the extra soft food
he needs to grow and stay healthy.
The remaining baby teeth grow in over the next 24
months. By the time the child is 30 months old,
there will be a total of 20 baby teeth in his mouth,
10 on too and 10 on the bottom.
Most permanent teeth form under the baby teeth. When the child is
between 6 and 12 years old, the permanent teeth push against the roots of
the baby teeth, making them fall out. Not all of the baby teeth fall out
at once. One tooth at a time becomes loose, falls out, and then is replaced
with a permanent tooth. The new tooth may not grow in immediately.
Sometimes 2 or 3 months pass before the new tooth grows into the space.
In the 6 years between ages 6 and 12, the 20 permanent teeth replace
the 26 baby teeth. In addition, 8 other teeth grow in behind the baby
At 6 years the four 1st permanent
molars start to grow in at the back
of the mouth. This means an 8-yearold child should have 24 teeth, or
spaces for them.
At 12 years, the four 2nd permanent
molars grow in behind the 1st
molars?This means a 14.year-old
child should have 28 teeth, or
spaces for them.
Between 16 and 22 years, the four
3rd permanent molars grow in. This
means that an adult should have a
total of 32 permanent teeth: 16 on
top and 16 on the bottom?
*(Note: the third molars often do not grow in correctly, This is a very common cause of tooth
pain. See page 64.
Have the students examine each other.” Help them learn which are
baby teeth and which are permanent teeth. Look for the important 1st
permanent molars at the back.
Show the students
how to count the
teeth and the spaces
that are ready for
new teeth to grow
0A0Y Tom4
PACE Fok NEW -mom
Then have them
count their friends’
teeth, to find out
how many teeth should be growing in different age groups. Later, they
can do this with their brothers and sisters at home.
Wash your hands.
Count the teeth.
Count the spaces where new teeth have not yet grown in.
TOTAL = teeth + spaces
Find out the person’s age.
Have the students first write their totals on the blackboard. Then make
a chart for the children to remember and discuss the results.
a$ rem+4
Tom L = +edh now
* Here the children are only counting the teeth, They can also learn to check for cavities and gum
disease (sac p. 47).
Discuss the number of teeth children have at different ages. Young
children 6 to 12 years old, for example, have 24 teeth; older students, 28
teeth; and adults, 32 teeth.
At home, students can count brothers’ and sisters’ teeth to learn how
many teeth small children have. Count only the teeth and not the spaces.
t 7cae I I-Z
2-3 yew.
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yews old
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Ask the students what other things they saw inside someone else’s
mouth. This is a good time for students to discover important tilings about
good health practices. Encourage them to learn as much as they can from
what they see, and then show them how to use a book like this to answer
their own questions. For example, if students see cavities and red bleeding
gums, you can start a discussion on tooth decay and gum disease. Use
some of the activities on pages 53 to 58.
For another example, if the students see a baby who has only a few
teeth, they may have some interesting questions. Show them this book
and invite them to read pages 61 to 63 to find answers to questions like
Can Chenia, who is six months old and has no teeth, eat soft foods?
Should she have more than just breast milk?
When Chenia’s teeth grow in, will they give her diarrhea and fever?
Will a 2-year-old girl get more baby teeth?
Why do we care for baby teeth, when we only need them for a few
What Makes Teeth Hurt?
A tooth will hurt if it is broken, loose, or if it has a cavity. Cavities are
the usual cause of toothaches.
I Healthy
teeth are alive. I
Two thin strings enter each tooth. One, the nerve, comes from the brain
and carries the message of pain. The other is the blood vessel. It comes
from the heart and carries blood to the tooth.
If you could peel away the
gum and look inside the bone,
you would see that a nerve
and a blood vessel go into
each one of a tooth’s roots.
They give the tooth life
and feel ink.
The hard cover of the tooth protects the nerve and blood vessel inside
it. But when tooth decay eats through that cover, the nerve and blood
vessel are unprotected. A cavity lets food, water and air get closer to the
nerve, and that can make the tooth hurt.
The sugar in food makes tooth decay possible. Sweet food that is also
sticky is the worst of all because it glues itself to the teeth. Germs inside
your mouth use the sugar to grow and to work harder at making cavities.
See the next section for more discussion of how germs and sugar
combine to cause cavities.
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c I
A cavity may look small on the outside, but it is much bigger inside.
Decay spreads more easily in the soft part under the hard cover of the
A tooth with a cavity may hurt, but it usually does not hurt all the
time. This is because the bottom of the cavity is close, but not yet on
the nerve inside the tooth.
Fill a small cavity and save a tooth.
A small cavity that is not treated grows bigger and gets deeper. When
the cavity finally touches the nerve, it causes a tooth. abscess. Infection
from the tooth decay going inside the tooth causes the tooth to ache all
the time, even when you try to sleep.
Infection can pass from the tooth to the bone. As it spreads under the
skin, there will be swelling of your face.
A tooth with an abscess must either be taken out
or have its nerve treated.
An abscessed tooth is dying. When it dies the tooth changes color from
white to dark yellow, grey, or even black. Pus from the end of its root can
pass to the gum, making a sore called a gum bubble,
A tooth is like a light bulb.
When the bulb is alive from power inside, it
is bright and useful.
The little wires inside the bulb are like the
nerves inside the tooth. When the bulb burns
out, it is dark and not useful any more.
3. Look inside a tooth for the space where the nerve and blood vessel
used to be. See how close they were to the tooth’s hard outer cover. Look
for a small hole at the end of the root. That is the place where the nerve
and blood vessel enter the tooth.
Ask your dental worker to find an old
tooth with a cavity and grind it for you.
1. Take a hammer.
2. Gently break open a tooth.
3. Look inside.
See how much bigger the cavity is on
the inside. It spreads under the hard
Cut through a rotten yam. See how
the rotten part spreads under its skin
in the same way.
4. Do a project in class.
Count the number of students with cavities.
Count the number of teeth having cavities. Show the students how
to look for them on the tops, sides and between the teeth.
0 Find out the person’s age.
Have the students write on the blackboard what they counted. Then
make a chart or graph.
Numlcn OF SfUmNn nr SCl4OOL
1 1 fuum86a oFsruo6~rs wi+rl cnvrrrcr
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Decide if tooth decay is a serious problem in your school. Ask your
dental worker to look at your results and to come and treat the
students, and help you prevent the problem from returning.
Do the same with brothers and sisters at home. Find out if tooth
decay is a problem with these young children. Tell your dental
worker what you find.
How Do Germs Make Holes in the Teeth?
makes holes in the teeth. The acid is made when sweet foods mix
with germs in your mouth.
It is not possible to prevent cavities or gum problems by trying to kill
all of the germs in your mouth. There are too many-and some germs are
good for you, The important thing is to keep the germs from getting
together and making a film or coating on your teeth.
This film on the teeth is called plaque, but you do not need to use this
word. Every morning we can all feel a ‘furry film’ on our teeth. This film
must not be allowed to stay on the teeth! It will mix with sugar and make
acid. Worse, if it stays in a group (or ‘colony’) for more than 24 hours, it
will mix with saliva, harden, and make tartar (see page 50).
The main reason for cleaning teeth is to break up these colonies so they
cannot make acid. Also, if you forget to clean your teeth, tartar will form,
and you will need a dental worker to scrape it off. This is why it is
important to clean your teeth at least every 24 hours, so the tartar can
never form on your teeth.
Here is a game called “Scatter! ” that students can play outside.
You need:
The Game:
Children in Jocuixtita, Mexico, beginning a
game of “Scatter.. 1 ” The ‘decoloniter’ is the
girl in the center with the broom.
20 students called
‘colonizers’ stand facing the
decolonizer. When the decolonizer says “go!” they try to ‘form colonies’
around the bases before the decolonizer can touch them with the broom.
The colonizers win if they make
a colony. There are two kinds of
colony: (I) 15 people touching
one monitor at a base, or (2) a
chain of 12 people holding
hands, touching two monitors,
The ‘decoionizer’ (with broom) has lost the
game. The children behind him have formed
a ‘colony’.
Here the decoionizer
completing a chain.
stops a boy from
Play two games: one with
children trying to form the first
kind of colony, one with the
second kind. These photos are
from the second game.
The decolonizer tries ‘to stop
the others by touching them
with the broom. When the
decolonizer touches a colonizer
with the broom, the colonizer
must leave the area for one
minute. (Give that child a task
to do-run around the schoolhouse or lie down and sit up
30 times.)
The decolonizer wins if no
colonies form in 5 minutes.
After The Game:
Talk to the students about
germs in their mouths and how
small they are. Can anyone see
germs? No, but they can feel
them and taste them. Ask the
group what their mouths feel
like in the morning when they
wake up. You may get these
my teeth feel mossy!
my breath is bad.
I feel a coating on my teeth,
but it goes away when I
brush them,
To teach about things too small to see, look at
the suggestion on page 11-29 of Helping Health
Workers Learn,
Tell the students that this coating on the teeth is a ‘colony’ of germs.
They are always trying to group together on the teeth or in spaces between
the teeth-just as the ‘colonizers’ did in the game!
What Makes the Gums Feel Sore?
Healthy gums fit tightly around the teeth and help to hold them
strongly, Healthy gums also cover and protect the bone under them.
Healthy gums are pink in color, or
even blue or dark yellow in some
people. But healthy gums are never
Healthy gums are pointed between
the teeth, This lets food slide away
and be swallowed.
Healthy gums fold under, making a
little pocket around the tooth.
As we saw with the last activity (p. 48), when you have ‘colonies’ of
germs on your teeth, they can make acid that makes holes on your teeth.
The same coating of germs can make a different acid that makes the gums
sore. This also happens when food mixes with the coating on your teeth.
Soft food is the worst kind, because when it mixes with spit it sticks more
and stays longer on your teeth. Juice from tea, betel nut, and meat color
this food, making the tooth look dark.
Healthy gums become sore because of acid. Also, if the coating on the
teeth (p. 48) becomes hard, it is called tartar. Tartar can be very sharp
and hurt the gums. Also, the ‘colonies’ of germs can make a coating on
top of tartar more easily than on a clean tooth. When the colonies are
new, they make more acid to cause tooth and gum problems. After 24
hours, they harden and make a new layer of tartar. The tartar gets bigger
and bigger.
Here is a larger picture of the teeth in the box above:
Sore gums are infected.
Infected gums are red
and bleed easily.
Infected gums are
round and swollen
between the teeth.
They are also loose
instead of tight against
the teeth,
Infected gums have a deep gum pocket which catches even more food.
infection in the gums is called gum disease. It is important to treat gum
disease early, before it can spread to the root fibers and the bone.
If you have sore, bleeding
gums, you can do much to
treat the infection yourself.
1. Clean your teeth with a
soft brush gently and more
often. (see page 69)
2. Eat more fresh fruits and
3. Rinse your mouth with
warm salt water.
,4. Clean between your teeth
with dental floss or string.
At first your gums may
bleed when you do this.
But when the gums are
stronger the bleeding will
1. Have the students look in each other’s mouths.
Can they see the coating on the teeth? Usually they
cannot. They may see food or ‘white stuff’, but
this is not the coating that makes acid. However, if
someone has been chewing betel nut or eating
berries, you will see stains on her teeth and the
stains will be darkest where she has these colonies
of germs on her teeth.
Put something on the teeth to stain the colonies of germs. Try using
food dye, betel nut or berry juices. Remember: first wash your hands!
Older students can rub berries on the teeth of the younger ones. Have
them rinse with a little water and spit it out. After this, the colored areas
on the teeth will show where the colonies of germs are forming. Where
are they? Usually you will see the dark colors:
between the teeth
in the pits or holes in the teeth
on the tops (biting surfaces) of the teeth.
The older students can now show the younger ones the best way to
clean teeth (see pages 67-70). Let the younger ones see in the mirror if
they are getting the colored juice from their teeth. They will learn that it
is most difficult to get rid of the color between their teeth. Give them
some string, dental floss, or even the soft stem from a young palm leaf,
and show them how to use it between their teeth (p. 70). Remind them to
be gentle, or they will hurt their gums. You should clean between your
teeth every day.
What Does It Mean if a Tooth is Loose? ’
Baby teeth become loose when children are between 6 and 12 years old.
This is normal. If a loose baby tooth does not have a cavity, and if the
gums around it are healthy, there is probably a permanent tooth growing
under it.
But a tooth might be loose because it is broken or because it is sick
from an abscess or gum disease. Either can destroy the bone around the
tooth’s roots.
When bone is lost, the tooth
becomes loose. A loose tooth hurts
and usually must be taken out.
There is no medicine to make bone
grow back around the roots of loose
teeth. All you can do is stop the
infection from getting worse.
1. Let the students look into each other’s mouth for loose baby teeth.
Look carefully to see why a tooth is loose.
Touch the gum and bone beside the
loose tooth, You can feel a bump-it is
the new permanent tooth growing.
Save the baby tooth after it has fallen
out. Look to see how the permanent
tooth has eaten away its root by pushing
against it.
2. Look for teeth that have cavities or
gum disease around them. The students
can do this with each other, and then
later at home. (Remember they must
wash their hands!)
A tooth that has some of its root
showing is probably loose.
Using your fingers or the handles
of two spoons, rock the tooth back
and forth gently. See how much it
moves, and ask how much it hurts,
Tell the person what he can do to
prevent other teeth from becoming
loose. (See the next section.)
How Can We Prevent Cavities and Sore Gums?
Eating good food and carefully cleaning the teeth prevents both tooth
decay and gum disease.
Food from your own garden and local food from the market is best.
These foods are good for your body, your teeth, and your gums.
Vegetables, especially
those with dark green
Peas and beans, Ii ke green
beans, soybeans, winged
beans, and mung beans.
Oil, from palm nut
kernels, ground nuts,
and coconut.
Fruits, Ii ke banana,
guava, oranges, and
Fish, meat and eggs.
Clean water, coconut
water, and milk are
best to drink,
Soft foods and sweet foods from
the store are not good for you. Soft
foods stick to your teeth easily. They
can work longer to cause cavities and
infected gums. Sweet foods have
mostly sugar in them, and it is ‘factory
sugar’, not the ‘natural sugar’ that is
in the foods in the pictures above.
This kind of sugar is quick to mix with
germs and make acid. Remember:
natural sugar makes acid slowly;
factory sugar makes acid quickly.
Children who eat a lot of sugar lose
their appetite for other foods-the
foods that help them grow strong,
stay healthy, and learn well in school.
Store foods are also expensive. You
can usually get better food, and more
of it for the same money, from your
garden or in the market.
Cleaning your teeth carefully every day is another important way to
.take care of both teeth and gums. However, cleaning teeth is like building
2 house. To do a good job, you need to work slowly and carefully. Once a
uay is enough, if you clean your teeth well every day.
Buy a brush from the store, or make one yourself (see p. 4). But be sure
the cleaning end of the brush is soft so that it won’t hurt the gums.
Use your brush to clean all the teeth, especially the back ones with the
grooves. Back teeth are harder to reach and so it is easy not to clean them
well enough. Cavities start from sweet food and germs left together inside
the grooves.
1. Scrub the inside,
outside, and top
of each tooth.
2. Push the hairs of
your brush between
two teeth. Sweep
the food away.
3. Wash your mouth
with water, to
remove any loose
bits of food,
Small children are not able to clean their teeth carefully enough by
themselves. They need help. Look at the pictures on the cover and p, 16 to
see how you can do this. Older children can care for younger brothers and
sisters at home.
” -1
One of the best ways to teach is by example,
Students will believe what
their teacher says if they
know he eats good food and
cleans his teeth.
The reverse is also true.
Learning is harder when
students know that their I
teacher does not do those
things himself.
Students can be a good example for their community,
too. They can:
draw pictures of foods that are both good and bad for teeth. Use
them to make posters and flannel-board stories.
make puppets and plays to discuss ways people can become healthier.
There are some other ways to make learning meaningful and fun.
1. Make a garden at schtzol. Divide the ground so that each class has its
own space to plant a garden.
Use some of the garden’s food to prepare a meal for the students,
perhaps once a week, Students can bring food from home if there is not
enough ready in the garden,
2. Organize a school lunch program. Each day the students can bring
some good food from home. Cooked yams, or maize, nuts, fruit and
fresh vegetables are all good. Often the students will exchange food
and talk about the many different foods that can be grown locally.
3. Find the best way to clean teeth. Divide the class into groups. They
will learn more easily in a small group of 4 to 8 students.
Give all the students something to eat that is sweet, sticky and dark in
color, such as sweet chocolate biscuits. Ask the students to look in each
other’s mouth, to see how easily the biscuit sticks to the teeth. One or
two of the students in a group can then try to clean away the pieces of
biscuit, using a different method.
When they are finished, the students can look at the teeth to decide if
they are clean or not. Put your findings on a chart and talk about what
you have learned.
. .
;, * __,^
I ,
4. Make cleaning part of a daily health activity.
Older students can look after younger students. They can first check
their hair for lice, then sores for infection, and teeth for old food or
germs, (To see the coating of germs on the teeth, try the activity on page
51.) One partner can point out to the other where washing and brushing
can be done better.
At school, students can wash their hands before lunch and brush their
teeth afterward. Encourage them to keep a piece of soap and a toothbrush
or brushstick (p. 4). One day a week, the whole class can rinse with
fluoride water (p. 167) to prevent cavities.
The student
can keep the
brush at her
own desk . . ,
A piece of bamboo can hold a brush
nicely. Make two holes near the
top for some grass string, to hang
the barn=7
Let each student look after her
own soap and brush.
. , . or on a
rack at the
back of the
Have the students score each other’s progress. Do not make it hard to
judge, or they will not do it. In the example below, the tooth is either
clean or not clean.
Pick 4 teeth, a back tooth
and a front tooth-two
top and two on the bottom.
Use the same 4 teeth for
each person. Look for food
on each tooth near the gutT 1S.
A clean tooth
A dirty tooth
Total possible
day is 4 teeth
= 2 points
= 0 point
points each
x 2 = 8 poin ts.
In this example
Tooth 1 = 2
Tooth 2 = 0
Tooth 3 = 0
Tooth 4 = 2
the score is:
= 4 points
Have each student put his daily score on a chart. At the end of the
month he can see how much he has improved.
TEETH Se~~e.5
Taking Care of
Teeth and Gums
We can prevent most tooth and gum problems. This chapter gives more
information about how teeth grow in and how to keep teeth and gums
healthy. Share this information and you will prevent problems from
But remember that people are most interested in the problems they
have now. Before listening to what you know about prevention, people
will want treatment for the problems that are already causing them pain
and discomfort.
Early treatment is a form of prevention.
It can prevent a tooth or gum problem
When you treat a person’s problem, it shows that you care about him.
It also shows that you know what treatment he needs. As his confidence
in you grows, he will want to learn from you about preventing tooth or
gum problems.
In order to help a person
it is important to know
what the problem is and
what is the best treatment.
But just as important is
knowing what you are
not able to do, and when
to seek help.
In this chapter, you
will learn more about
teeth, gums, and problems
affecting them, but
you must never be too
proud to get help from
more experienced dental
,_ ..
, ^1,J
A child’s baby teeth are being made before birth while the baby is still
inside the mother’s womb, During the last months of pregnancy and the
first few months after the child is born, the baby teeth take their final
form. Pregnant mothers and young children need good food and good
health in order to have strong baby teeth.
Weak teeth
Strong teeth
are white and their
front surface is smooth.
have yellow marks that
are pitted and rough.
Baby teeth get marks on them when: 1) the pregnant mother is sick or
does not eat good food; 2) the young baby is sick or does not eat good
food; or, sometimes, 3) the baby’s birth was early or the delivery was
The marks are rougher than the rest of
the tooth. Food sticks easily to them
and turns the tooth yellow.
The marks are also soft. They need to be
cleaned well every day (p. 61) to prevent
them from becoming cavities. A tooth with
a cavity hurts. When children’s teeth
hurt, they do not want to eat as much.
Cavities in baby teeth can make a child’s malnutrition worse. Remember
this whenever you see a weak, poorly nourished child. When you examine
a child at the health clinic, lift his lip and look at his teeth. Do this as part
of your routine examination.
You can fill cavities with cement (Chapter
IO). Cement prevents food and air from
going inside the cavity and hurting the
A sore on the gums may be a gum bubble.
If so, it means the tooth has an abscess
(page 78). That cavity should not be
filled with cement. Instead, the tooth needs
to be taken out (Chapter 11) before the
infection can get worse.
For baby teeth to growstrong, mother and baby must stay healthy.”
Help her to understand how important this is. A pregnant mother should:
I. Eat enough good kinds of foods, both for herself and her baby
growing inside (page 66; also see Where There /s No Doctor, Chapter
11, and Helping Health Workers Learn, pages 25-39 to 25-44.)
2. Attend health clinic each month, so the health workers can examine
her regularly and she can receive important ,nedicines (see Where
There Is No Doctor, page 250).
3. Not use the medicine tetracycline, because it can cause the teeth to
turn dark. You, the health worker, must remember-do not give
tetracycline to a pregnantwoman or to a young child. If she needs
an antibiotic, use a different one.
For baby teeth to stay strong, and to prevent marks from turning into
cavities, mother should:
1. Continue to breast feed and never feed her child juice or sweet tea
from a bottle. Start adding soft foods, mashed banana or papaya
when the child is 4 months old.
2. Wipe her baby’s teeth with a clean cloth afi ter
the baby eats. This cleans the baby’s teeth, and
helps the baby get used to teeth cleaning. Later
he wi II be happy with a brush.
Around 1 year of age, there wil’l be several baby
teeth. At that time, mother should start using waternot toothpaste--on a soft brush or brushstick. (With
toothpaste, you cannot see the child’s teeth clearly because of the bubbles
it makes.) She should scrub the sides and tops of each baby tooth as well
as she can (page 67).
The child can also try to clean his own teeth. That should be
encouraged. However, since he is too young to clean properly, mother (or
father, or older brother, sister) must clean his teeth once a day for him.
Continue helping in this way until the child is old enough to go to school.
You can make a large brush
smaller, to fit more easily into
or cut them with scissors,
*See the story about pregnancy and dental care on pages 177-l 79.
Why Baby Teeth Are Important
Baby teeth are just as important to children as permanent teeth are to
adults. They help a child to eat, talk, and look good.
However, many people feel that it is not worth the effort to look after
baby teeth. Nor is it worth fixing them. After all, parents think, the
permanent teeth will take their place.
This kind of thinking is understandable. The problem is that we are
forgetting one other useful purpose of baby teeth. Baby teeth keep space
in the mouth for the permanent teeth to grow in. If there is not enough
space, the new teeth will grow in crooked, and cavities grow faster around
crooked teeth.
Under each baby tooth a new permanent
tooth. is grow,ing.
At the same time, extra permanent
molars are forming at the back of the
mouth, inside the bone (page 41).
Permanent mol.ars (PM) come in
behind the baby molars (BM).
Front baby teeth become loose and fall
out (usually 6-7 years, but sometimes as
young as 5 years) ahead of back baby
teeth (10-l 2 years). This is because the
front permanent teeth are formed and
ready to grow in first.
The permanent molar (1 PM) is often the first of the permanent teeth to
grow into the mouth. That happens at 6 years of age.
The first permanent molar grows into
the mouth by sliding against the
back of the second baby molar (2BM).
Slowly but steadily the upper and
lower permanent molars grow until
they meet and fit tightly together.
Between the ages of 6 and 11, a child needs healthy baby molars to
guide the first permanent molars into position and then to hold them
there. When the first permanent molars grow into the right place, this is a
good sign. It means the other permanent teeth will also grow in properly,
because they will have enough space.
Some people are born without enough space. But most people
are not born with this problem-they
lose the spaces when they
remove baby teeth instead of fixing them.
10 years
10 years
to make-
Tell mothers why baby teeth are important. Good food and regular
cleaning keeps them healthy, They should know that new teeth coming
in do not cause diarrhea and fever, but that a child may have diarrhea or
fever at the same time.
If there is a cavity, fix it so the tooth can be kept in the mouth to do
its important work (see Chapter IO).
‘( j, ‘,‘,
3,. _I,“(>,
,,,, >,_
;I I ,)
,; ,‘d
We often notice front teeth growing in, but not the back ones. Back
not so obvious. Swelling on the face can be either a
new molar growing in or an abscess. So, to help you to decide, look at
the tooth for a cavity and at the gums beside it for a gum bubble.
When you see a swollen face, look for the two signs of an abscess.
But if the person is young (16-22 years), it often is not an abscess, The
third permanent molar tooth may be growing in at the back of her mouth.
As the tooth grows, it cuts through the skin, Just as a dirty cut on a
person’s hand can get infected, the cut gum around her new tooth also
can get infected, causing a swollen face,
Look behind her back teeth.
See the red swollen skin on
top of the new tooth.
If there is enough space for the tooth, it will grow in by itself
needs time, Before acting, decide how serious the problem is.
It only
If there is no swelling and she can open her mouth, explain to he:
what is happening and what she can do herself to reduce infection and
toughen the gums, The best medicine is to rinse warm salt water over the
sore area, A good home remedy is to rinse until the tooth grows all the
way into the mouth.
If it does appear serious (severe pain, swelling, not able to open the
mouth), see page 88 for further treatment,
This book often repeats an important message: eat good food and clean
your teeth. It is repeated because this is the most important thing you
can learn from this book. Later chapters will discuss what to do when
problems occur, but if you follow these two suggestions, you will almost
never have problems with your teeth and gums. This is true because good
food keeps your whole body healthy, including your teeth. Also, with no
‘colonies’ of germs (page 48) or harmful factory sugar (p. 53) on your
teeth, your mouth cannot make the acids that cause both tooth and gum
problems. So, remember :
1. Eat Good Food
An easy-to-remember rule is the same foods that are good for the body
are good for the teeth. A healthy body is the best protection against
Good nutrition
at the center of
every meal.
(eating well) means two things:
One, eat a mixture of different kinds of foods
every time you eat. Look at the pictures on page
53. There are several groups of foods. Every time
you eat, try to eat one or two foods from each of
the groups. This way, you will get three important
kinds of food: GROW FOOD (body-building food)
to give you the protein you need; GLOW FOOD
(protective food) to give you vitamins and
minerals; and GO FOOD (concentrated energy
food) to give you calories to be active all day.
Two, be sure you eat enough food
to give your body the energy it needs.
This is even more important than the
first suggestion. We get half or more
of our energy from our MAIN FOOD.
In most parts of the world, people eat
one low-cost energy food with almost
every meal. Depending on the area,
this MAIN FOOD may be rice, maize,
millet, wheat, cassava, potato, breadfruit, or banana. The MAIN FOOD is
the central or ‘super’ food in the local
A spoonful of cooking oil added to a
child’s food means he only has to eat
about % as much of the local main food
in order to meet his energy needs. The
added oil helps make sure he gets enough
calories by the time his belly Is full.
Be sure
always to eat
and GLOW
FOODS to get
the vitamins
and protein
you need.
‘Go Foow
Pm cay.
Your energy
foods give
you the most
part of your
Half or more
of our
calories come
from the MAIN
FOOD, and
most of the
other calories
come from GO
GO FOOD gives us the energy
we need, some GO FOODS are worse than others. Honey, molasses and
especially white sugar can be very bad for the teeth, even though they
have the calories we need. Fruits, nuts, and oils all give us energy (calories)
without attacking the teeth.
2. Clean Your Teeth
Cleaning teeth requires time and care. If you hurry, you will leave food
and germs behind, and they continue to make cavities and sore gums.
You may find that different dental workers recommend different ways
of brushing teeth. Some ways are definitely better, but often they are
harder to learn.
Teach a method of cleaning that a person can learn and will do at
home. Let him start by scrubbing his teeth (and his children’s teeth) back
and forth, or round and round. Encourage him to improve his method
only when you think he is ready.
Toothpaste is not necessary. Some people use charcoal or salt instead.
But it is the brush hairs that do the cleaning, so water on the brush is
Scrub the outside, inside, and top of each tooth carefully.
When you finish, feel the tooth with your tongue to make sure it is
smooth and clean.
Finally, push the hairs of the brush
between the teeth and sweep away any bits
of food caught there. Do this for both upper
and lower teeth.
Sweep away in the direction the tooth
grows: sweep upper teeth down and lower
teeth up.
Explain how important it is to use a brush with soft hairs. A brush that
is stiff and hard will hurt the gums, not help them.
You can make a hard brush softer by
putting the hairs into hot water for a
few minutes.
Do not put the plastic handle into the
hot water, or it will melt.
If your store has only hard brushes, tell the storekeeper that hard
toothbrushes do not help the people in the community. Ask him to order
and sell only soft toothbrushes.
/Vote.- Another important way to reduce cavities is by adding
fluoride to teeth. Fluoride is a substance which, like calcium,
makes teeth harder and stronger.
Fluoride in drinking water, toothpaste, vitamins, and mouth rinses,
helps to prevent cavities. These methods are sometimes expensive.
Perhaps the most ei!eciive and inexpensive method is the weekly
rinse at school, desci-i bed on page 167.
Fluoride can also be found naturally in food and water. For
example, tea leaves and most foods from the sea contain a large
amount of fluoride,
So, your source of fluoride can be either:
Here are three ways to clean between the teeth:
1. Push the hairs of a toothbrush
of food away.
between the teeth, and sweep the bits
2. Remove the stem from a palm leaf. Use the thinner end and move it
gently in and out between the teeth.
Rub the stem
against one tooth
and then the other.
This way, you clean
the sides of both
3. Use some thin but strong thread or string. String can be the best
method of all-but you must be careful with it.
Get some thin cotton rope
used for fishing nets. Unwind
and use one strand of it.
Buy and use Dental Floss.
This is a special kind of
string for cleaning
between the teeth.
Be carefull
The string can hurt your gums if you do not use it correctly.
The next page shows how to use the string, but the best way to learn how
to ‘floss’ your teeth is to have someone show you. Ask a dental worker
who has experience.
Wrap the ends of the string around the middle finger of each hand.
Use the thumb and finger to guide the string, Go back and forth to
slide the string between two teeth. Be careful not to let it snap down and
hurt the gums.
Upper teeth
Lower teeth
With your fingers pull the string against the side of one tooth. Now
move the string up and down. Do not pull the string back and forth or
it will cut the gum.
Lift the string over the pointed gum and clean the other tooth.
When you have cleaned both teeth, release the string from one finger
and pull it out from between the teeth. Then wrap it around your two
middle fingers once again, and clean between the next two teeth.
Remember: clean teeth and good food
will prevent almost all dental problems. I
and Diagnosis
Whenever you do an examination,
remember to examine the mouth.
You can prevent much suffering and serious
sickness when you notice and treat problems
early, Whenever you hold a health clinic, try
to find out how healthy each p.erson’s mouth
Ask if she is having a problem now, or has
had a problem recently.
When you look inside
someone’s mouth, ask
yourself three questions.
Always write down what you find out, so you
remember what treatment that person needs.
1. Are the teeth healthy?
Look for:
1. A New Tooth
Tell the person what
is happening and how
to keep the skin
around it healthy
1 (page 64).
should be filled
3. A Loose
Tell the person what
teeth (page 52).
4. A Dark
A tooth that is dark is dead.
Infection from its root can
go into the bone (p. 45).
This can make a sore on the
gums (p. 72).
2. Are the gums healthy?
Look at page 50 and compare the pictures of healthy and unhealthy
gums. Unhealthy gums often are red and they bleed when you touch them.
A bubble on the gums below the tooth is a clear sign
that the person has an abscess. The abscess may be
from the tooth, or it may be from the gums. To
decide, look carefully at both the tooth and the gum
around it.
A bubble beside a healthy tooth is a sign of infected
gums. Scale the tooth carefully. See Chapter 8.
A bubble beside a decayed tooth is a sign of a tooth
abscess. See page 87.
A sore on the gums from a badly decayed tooth
appears when a gum bubble breaks open and lets out
the pus from inside.
3. Are there any sores?
Look for sores under the smooth skin on the inside of the lips and
cheeks. Look also under the tongue and along its sides.
1. A sore on the gums
may be from an
infected tooth
(P. 87).
2. Sores on the inside
of the lip or cheek
may be from a virus
(p. 98).
3. Sores on the lips
or tongue may be
cancer (p. 119):
After your examination, tell the person what you have found. If you
notice a problem starting, explain what to do to prevent it from getting
worse. If there are no problems and the mouth is healthy, congratulate
the person,
Share your knowledge-explain
things to people.
Help them learn how they can prevent and
even manage their own problems with their teeth.
Examine people in a light and bright place. It is dark inside a person’s
mouth, so you need light to see the teeth and gums.
Use the sun. Examine outside, or inside a room facing the window. With
sunlight alone, you will be able to see most places in the mouth well
enough. If you cannot, set up a lamp or have someone hold a lamp for
you. Reflect the light off a small mouth mirror onto the tooth or gum.
If you have a low chair, lift up the person’s chin so that you do not
have to bend over as far when you look into the mouth. An even better
way is to have the person sit on some books. The person’s head can lean
back on a piece of cloth.
Usean old chair with a strong back,
Attach two flat sticks to the chair. Then tie a
strip of clean cloth to the sticks. Tie it strong
enough to support the head, but loose enough
to let the head lean back.
Three instruments are really enough:
1. A wooden tongue blade to hold back the
cheek, lips, and tongue.
2. A small mirror to let you look more
closely at a tooth and the gums around it.
3. A sharp probe to feel for cavities and to
check for tartar under the gum.
If you have many people to examine, it is helpful to have more than one
of each instrument. But be sure they are clean.
Dirty instruments easily can pass infection
from one person to another. After you finish an
examination, clean your instruments in soap
and water and then leave them in a germ-killing
solution like the ones described on page 85.
Examine people in a light and bright place. It is dark inside a person’s
mouth, so you need light to see the teeth and gums.
Use the sun. Examine outside, or inside a room facing the window.
sunlight alone, you will be able to see most places in the mouth well
enough. If you cannot, set up a lamp or have someone hold a lamp for
you, Reflect the light off a small mouth mirror onto the tooth or gum.
If you have a low chair, lift up the person’s chin so that you do not
have to bend over as far when you look into the mouth. An even better
way is to have the person sit on some books, The person’s head can lean
back on a piece of cloth.
Use an old chair with a strong back,
Attach two flat sticks to the chair. Then tie a
strip of clean cloth to the sticks. Tie it strong
enough to support the head, but loose enough
to let the head lean back.
Three instruments are really enough:
1. A wooden tongue blade to hold back the
cheek, lips, and tongue.
2. A small mirror to let you look more
closely at a tooth and the gums around it.
3. A sharp probe to feel for cavities and to
check for tartar under the gum.
If you have many people to examine, it is helpful to have more than one
of each instrument. But be sure they are clean,
Dirty instruments easily can pass infection
from one person to another. After you finish an
examination, clean your instruments in soap
and water and then leave them in a germ-killing
solution like the ones described on page 85.
When you talk to a woman, find out if she is pregnant. A pregnant
woman’s gums can easily become infected. The gums may bleed and she
may have more tooth decay. But this is not necessary. If a pregnant woman
takes extra care of her teeth and gums, she can prevent most dental
problems. But if she already has a problem, do not wait for the baby’s
birth before you help her. You can treat a pregnant woman’s mouth
problems now. In fact, this may be an important way of protecting her
baby as well, See pages 177-179.
2. Look at the person.
People have some problems more often at certain ages. When a person
first comes in to see you, notice his age. Then, before you ask him to open
his mouth, look at his face for a sore or swollen area.
Swelling can come from
. mumps
l an infection
in the spit
gland (p. 113)
l a tooth abscess
(P. 87)
Swelling can come from
l a new tooth
growing in
(P* 94
l a tooth
(P- 87)
Swelling can come from
a tooth abscess
(P. 87)
l a broken jaw
(P+ 107)
-a tumor (p. 119)
A sore can come from
. impetigo
(P- 96)
A sore can come from
. fever blisters
(P- 98)
. a tooth abscess
(P# 87)
A sore can come from
a tooth abscess
(P- 87)
a bone infection
3. Examine inside the mouth.
Remember what the person said, the person’s age, and what you saw,
Now look more closely at the problem area.
Look at the teeth:
Is a new one growing in?
Is a tooth loose?
Is there a dark (dead) tooth?
Look at the gums:
Are they red?
Is there any swelling?
Do they bleed?
Are the gums eaten away between the teeth?
Look also for sores on the inside of the cheek or lips, and on the tongue,
4. Touch the sore place.
Touching is a good way to find out how serious the problem is. This
will help you decide which treatment to give.
Push gently against each tooth in the area of pain to see if a tooth is
loose. Rock the loose tooth backward and forward between your fingers,
to see if it hurts when you move it.
Using the end of
your mirror, tap
against several
teeth, including
the one you
There is probably
an abscess on a
tooth that hurts
when you tap it.
Press against the gums with cotton gauze. Wait a moment, andthen
look closely to see if they start bleeding. Then use your probe gently to
feel under the gum for tartar. Carefully scrape some away. Wait and look
again to see if the gums bleed. When gums bleed, it is a sign of gum disease.
If a person comes to you with a toothache or a
sore or a loose tooth, there are many possible
causes for each problem. The first thing you
notice-the toothache; sore or loose tooth-is your
first step to a diagnosis, To this you must add more
information before you can point to the most
probable cause.
Put together what you have found with what
you already know about teeth and gums. You can
make a good diagnosis of a problem without
knowing a special name for it.
Usually it is easy to make a diagnosis. However,
sometimes you will not be sure, and these are the
times to seek the advice of a more experienced dental worker. Never
pretend to know something you do not. Only treat problems that you
are sure about and have supplies to treat properly. See Where There /s No
Doctor, p. w4.
Use the charts beginning here to help you make the diagnosis. For more
practice using charts to tell problems apart, see Chapter 21 of He/ping
Health Workers Learn.
It hurt8 only after rating ’
or drinking. Theo i8 a
cavity, but the tooth do.8
not hurt wkn you tap it,
Part of the filling has fallan
out, or i8 cracked and ready
to fall out. Eatinp and
drinking make the tooth hurt.
a cavity under
an old filling
Tha tooth hurt8 when chewing
food. It may hurt when tapprd,
but thora b no avity and
the tooth loolu ho&thy.
tartar between
the teeth
It hurt8 all the tima-rum
whrn porron trio8 to aImp,
thr tooth hurt8 whrn you tep
it and it fHl8 a bit toola,
an ab8ca88
It hurn when penon breather
in cold air. The tooth wa8
hit rrcantly,
a crecked or
broken tooth
Ho cannot opan hi8 mouth
properly. Stradv pain and
a bad taste are comltig from
thr baak of thr mouth.
a naw tooth
growing in
Slvwrl top t#ath hurt, rvrn
when you trp thrm, Shr hod
I hrrd cold and can only
braathr through hrr mouth,
en infrctod
a tooth abtceu
She i8 Young, about 18 years
old, and her troubla opening
a broken bona
Food and tartar are
attached to the tooth,
The gums around it are
loose and swollen,
There Wa8pain in the tooth
before, but it doe8 not hurt
80 much anymore. It ha8 a
cevitv, and there may be
a lore on the gum8 near it.
infection in8ide
the root f ibmfrom gum disease
, ,,#
The tooth wa8 hit Borne
time ago.
infection in the
bone-from an
old tooth sbrclu
a root broken
under the gum
When the loose tooth moves,
the bone around it and the
tooth beside it alto move.
a broken bone
around the
tooth’s roots
When you ask the perron to
8lowly close hir teeth, one
tooth hit8 another, before
the other teeth come together.
1 a
infection inridr
the bone from
a tooth i8 out of
position and
biting too hard
against anothrr
The gum8 are red and 8wollen.
They bleed when the teeth are
Between two teeth the gum8
are sore and swollen, like
a rmell tumor.
caught under
the gum
The gum8 between the teeth
have died and are no longer
pointed. Pus and blood
around the teeth make the
mouth small bad.
Ia more rerioub
gum infection)
fever blister8 on
the gum8-from
Herpes Viru8
The gum8 are bright red and
8orb, but between the teeth
thev are ctill pointad.
skin around it bright red.
Food touching it make8 the
sore hurt more.
from a
A Bore 8pOt around or
under a denture hurts
when you touch it,
a denture, or an
old denture that
The sore is near the root
of e bad tooth.
A dark sore ir sating through
the cheek. Her gums are badly
infected. A bad smell is coming
from the dyinp skin on the face,
and from inside the mouth.
a condition called
from Vincent’8
Infection of the
A 1monthold sore
on the lips is not heeling
wlth medicine.
He ir young, between 16-24
years, with some swelling
behind his jaw.
abscessed tooth
draining pus to
the outside of
the face
Inside his mouth, he has
a tooth abscess or a
broken tooth near the sore.
a new tooth
growin in
He recently hed en accident.
a broken jewprobebly in front
He had a toothache before
in a back tooth with some
en abscess in a
back tooth
Whrn rho tries to open her
mouth, tharr is e clicking
sound from in front of her
ear. It also hurt: in thet
plea whenever tho trier to
open her mouth or chew food,
pain in the joint
-where the
jawbone join8
the hrad
Swallowing ia difficult, and -o”l” ‘u+x.
thr jaw grows stiff. Germ8
have gono into thr body from
dirty instrumontr or an
infected wound.
After opening widr to oat or
yawn, his mouth became stuck
thrrr. Ho has many missing
back teeth.
a dirlocated jaw
Ho had an accident, and now
somrthinp is rtopping the
t&h from coming together.
a brokrn jaw
Treating Some
Common Problems
You must make a good diagnosis to treat a problem so it finishes and
does not return. Why treat a sore on the face by cleaning it when the sore
is from pus draining from a tooth with an abscess? You need to know
the cause of the sore to give the best kind of treatment.
After you make the diagnosis, you must decide whether you or a more
experienced dental worker should provide the treatment.
In the following pages, we describe the kinds of problems you as a
health worker may see, and we also give the treatment for each problem.
Use the table below to help you find the right page.
Before you touch the inside of anyone’s mouth, learn how to keep
clean. See the next 4 pages.
Cavities . . . . . . . , . , . , . . . page 86
lost filling. . . . . . . . . . . . page 86
broken filling. . , . . . , , , , page 86
Abscess . . . . . . . . . . . . . . . page 87
Infected sinus . . . , . . . . , . . page 89
Tooth injury
1, broken tooth . , , . . . , , page 90
2. tooth knocked out . . . , . page 91
Loose tooth . . . . . , , . , . . . page 93
New tooth growing in, , , , , , , page 94
babies’ teething , , , , . . , , page 95
Sore gums
gum disease starting . . . . . page 95
something caught under
the gums lepulisl
. . page 95, 127
Vincent’s Infection . , . . . . page96
fever blusters (from
Herpes virus), , . . . . . . page 98
Thrush . . . . . . . . . . . . . . . page99
Other sores in the mouth
canker sores . , . . . . . . . . page 100
from a denture. . . . . . . . . page 100
at the corners of the mouth . page 101
Broken bone.
. . . . . . . , . . . page 102
. . . . . . . . . . . . ..page112
Dislocated jaw . . . . . . . . . . . page 107
Pain in the joint . . . . , . . . . , page 108
in the spit gland . . . . page 113
Swollen gums and epilepsy , . . , page 109
Bleeding from the mouth.
, . , , page 110
After you take out a tooth
swelling of the face . . . . . . page 110
pain from the socket , , , , , page 111
bleeding from the socket . , . page 112
Sores on the face
from a tooth abscess . . , . . page 114
Noma (cancrum oris), a
complication of Vincent’s
infection . . . . , . . . . . page 115
. . . . , . . . . . . . . . .page1;9
Cancer . . . . . . . . . . . . . . . page 119
No matter what problem you are treating, be sure that your workplace,
your instruments, and you are always clean. For example, prevent
infection by always washing your hands before you examine or treat
Wash your hands in front of the
person, in the same room. You
will show that you are a careful
and caring health worker. Also,
you will demonstrate just how
important cleanliness really is.
The mouth is a natural home for germs. They usually do not cause
problems because the body is used to them. In fact, many germs are
helpful. For example, when we eat, some germs break down chewed food
into parts small enough for the body to use.
There are problems when the number of these ordinary germs increases
greatly, or when strange, harmful germs come into a healthy body from
outside. Fever and swelling follow. It is an infection.
When we regularly clean the mouth, the number of germs stays normal.
You can teach others to clean teeth and gums, but cleaning is each
person’s responsi bi Ii ty.
However, dental workers have one serious responsibility, You must
not spread germs from a sick person to a healthy person. You must do
everything you can to make sure your instruments are clean.
Germs hide inside bits of old food, cement, or
blood on an instrument. There they can continue
to live, even in boiling water.
This is why you must be sure to scrub the working
end of each instrument carefully with soap and
water. Rinse, and then look carefully to see that
it is clean and shiny.
Remember that ‘clean looking’ is not necessarily ‘clean’. Truly ‘clean’
means free of germs. Unless you sterilite, that instrument may still have
germs, the kind that cause infection in the next person that it touches.
Sterilizing means killing germs. The best way to sterilize is with heat.
High heat kills almost all harmful germs-especially those that cause
hepatitis, tetanus, and mouth infections. Wet heat (steam) is always more
effective than dry heat from an oven.
Here is a simple rule to use in deciding
when to sterilize:
Boil any instrument that
has touched blood.
That means always sterilize with
steam all syringes, needles, and
instruments you use when scaling
teeth (Chapter 8) or when taking
out a tooth (Chapter 11).
Be safe: When in doubt, sterilize!
Instruments left in boiling water need 30 minutes to become sterile. A
pot with a cover to trap the steam can act faster. The inside becomes
hotter and 20 minutes is enough. But remember that water can rust metal
instruments. To prevent rust:
Add 5 spoonfuls (20 ml.) of oil to every liter of water you boil.
Then lay the hot instruments on a dry, clean (sterile, if possible)
cloth, so the water can evaporate.
Never put an instrument
away while it is wet.
Sterilizing with steam under pressure is the fastest and surest method.
It kills harmful germs in 15 minutes. You need a strong pot with a tight
fitting I id, But be sure to make a small hole in the lid so steam can escape
when the pressure becomes too great.
A special pot called a pressure cooker is perfect for this. It even has a
safety hole on it to release extra steam.
I. PUT2 cups of water and
2 spoonfuls of oil
into the pot.
2. Place the handles together.
Put on high heat until a
loud hissing noise begins.
3. Put on lower heat. Begin
timing now. Leave the hissing
pot on the low flame for 15
4. Cool the pot under water,
open, and lay the instruments
on a clean towel to dry.
The next time you use the pot,
you can use the same water that
was left inside it,
Sterilizing with heat is not necessary for instruments that do not touch
blood. For example, after you examine a person or place a temporary
filling, you can clean your instruments and then soak them in a solution
of alcohol or bleach.
Alcohol solution
I. Mix in a large container each week:
7 parts alcohol (95%)
and 3 parts clean water.
Keep the container tightly covered
to prevent evaporation.
2. Keep a covered pan half filled with
this mixture. You will have to add
some more of the mixture frcm the
large container (WI ) to the pan each
3. Leave your clean
pan, completely covered with the
liquid, for 30 minutes.
Bleach (sodium hypochlorite!
Find the cheapest brand name in your area for
bleach. Examples are Javex, Clorox, P;rrex, and
Cidex. Make 1 liter of solution with a mixture of
l/T cup (100 ml) of bleach and 3 l/2 cups (900 ml)
of clean water.
Unfortunately, bleach rusts
metal instruments. To reduce
rust, add 1 large spoonful of
baking soda (sodium
bicarbonate) to the solution,
and leave your instruments in
the solution for only 30 minutes.
Wipe each instrument with
alcohol to remove the film of
bleach, Then store it dry
inside a clean cloth or in
another covered pan.
Change the solution each week.
A cavity can occur in any tooth. A cavity can also start around an old
filling, especially if it is dirty. The deeper a cavity gets inside the tooth
where the nerve lives, the more the tooth hurts,
pain when drinking water or eating
something sweet
a hole (or black spot) on the tooth, or
between two teeth
pain if food gets caught inside the hole
no pain when you tap the tooth
TREATMENT (when there is no abscess):
Try to remove any loose piece of filling with a probe. Then, following
the steps in Chapter 10, put in a temporary filling.
1. Fill the hole with cement. If you have no cement, put some cotton
into the hole to keep food out.
2. Look for cavities or broken fillings in the other teeth, Fill each one
with cement before it gets worse and starts to hurt.
Soon (within a few months):
3. Arrange for someone to replace the temporary filling with a
permanent one, You will need a person who has experience using
a dental drill (see p. 145).
A groove on the neck of a tooth is a more
difficult cavity to fill. For the temporary
\ _. cement to hold properly, you need to shape
the groove with a drill. To help temporarily,
youcan paint the groove with fluoride water (page 167). Do this once
each week until the inside part of the groove is stronger and the tooth
hurts less. Or, you can paint the inside of the groove with oil of cloves
(eugenol) to reduce the pain,
To avoid making the problem worse, (I) do not use a hard toothbrush;
(2) do not brush back and forth along the gums; and (3) do not chew
betel nut and do not hold it against the teeth.
A cavity that is not filled grows bigger and deeper until it touches the
nerve. Germs travel inside the tooth’s root and start an infection called
an abscess.
Pus forms at the end of the root, inside the bone. As the pus increases,
it causes grc dt pressure. This is why an abscess causes severe pain,
pain all the time, even ,when trying
to sleep
tooth often feels longer, and even a
bit loose
tooth hurts when it is tapped
a sore on the gums near where the
root ends (gum bubble).,
swelling of the gums around the
tooth, or swelling of the face on the
same side as the bad tooth
If there is no swelling, take out the tooth immediately (unless you are
able to give root canal treatment). This allows the pus to escape and
relieves the pain. See Chapter 11.
If there is swelling, treat the swelling first. Take out the tooth only
after the swelling goes down. This is necessary because an anesthetic (see
Chapter 9) will not work if there is swelling. If the anesthetic works, then
it is safe to take out the tooth.
To treat the swelling, give an antibiotic. Penicillin by mouth is best.
Use an injection only when the person is in immediate danger, For
example, inject penicillin when the person has a fever or if the swelling
is pressing against the throat, But remember you can treat most serious
infections with simple penicillin by mouth. For the doses for serious
infections, look below the box on the next page. If you still think an
injection is necessary, look at the section on ‘aqueous procaine penicillin’
on page 166.
Adults and children over 25 kg. (60 pounds) of weight should take the
same amount of oral penicillin. Children under 25 kg. should take l/2 as
much. For most infections, penicillin by mouth is taken 13 times: a very
large first dose and 12 smaller doses every 6 hours for 3 days. The person
should take all of the penicillin, even if the pain or swelling goes down.
For the correct doses, see the next page,
(for those allergic to penicillin)
Penicillin G or V:
1 tablet = 250 mg.
1 tablet (or capsule) = 250 mg.
Give enough tablets for 3 days
Give enough tablets for 3 days
First Dow (take all at once)
First Dose (take all at once)
and children over 25 kg.
Children under 25 kg.
8 tablets
(2000 mg.)
4 tablets
(1000 mg.1
Then every 6 hours for 3 days (12 doses)
and children over 25 kg.
Children under 25 kg.
2 tablets
(500 ma.1
1 tablet
and children over 25 kg.
Children under 25 kg.
Than evary 6 hours for 3 days (12 doses)
and children over 26 kg.
Children under 25 kg.
(260 mg.1
IMPORTANT: to allow It to best fight
infection, take penicillin before eating.
4 tablets
(1000 mg.)
2 tablets
(500 mg.1
2 tablets
(500 mg.)
1 tablet
(260 mg.)
IMPORTANT: to avoid upset stomach,
take erythromycin with meals.
For serious infections, it may be necessary to take the antibiotics for a
longer time. Take the same first dose as above, then take l/2 the first
dose every 6 hours until the condition begins to improve. Then take the
second, smaller dose every 6 hours until the end of five days, or seven
days if it is very serious.” Usually you can take out the tooth 1 or 2 days
before the end of the antibiotic treatment, but the person must continue
to take all of. the tablets, even after you have taken out the tooth.
If the swelling is ‘pointing’, open it with a sharp sterile knife to release
the pus. Cover the wound with a sterile dressing to keep it clean. If you
are not able to do that, explain how to reduce the swelling with heat.
As often as possible until the swelling goes away:
soak a cloth in warm water and hold it against the face.
hold warm water inside the mouth near the swelling. It is not
necessary to add salt to the water.
Finally, give the person medicine for pain. A two-day supply will be
enough, because the penicillin and the heat will reduce the pressure and
that will reduce the pain, The best medicines for pain are aspirin, which
comes in 300 mg. tablets, and acetaminophen (paracetamol), which
comes in 500 mg. tablets. Aspirin is usually cheaper, but acetaminophen
does not cause stomach pain and it is safer than aspirin for children. (To
avoid stomach pain, take aspirin with food, milk, or water.)
Take aspirin or acetaminophen 4 times a day. Every 6 hours, adults
can take 2 tablets, children 8 to 12 years take 1 tablet, and children 3 to
7 take l/2 tablet, Children 1 to 2 years should only take acetaminophen,
l/4 tablet 4 times a day. See page 165.
*If the infection does not heal, penicillin may not be the best antibiotic.
infection and have it tested, to see which antibiotic is best.
Take some pus from the
A sinus is a hollow place inside the bone. There is a sinus under the
eyes, on each side of the nose. Because the sinus is very close to the roots
of the top teeth, these teeth may hurt if the sinus becomes infected.
toothache in several top teeth. The
teeth look healthy, but hurt when
you tap them.
a head cold, and plugged nose. She
can only breathe through her mouth,
hurts when you press against the bone
under her eyes.
Do not take out any teeth. They will feel better after you treat the sinus
1. Give penicillin
for 3 days
2. Explain to the person that she should:
drink lots of water.
breathe steam from boiling waterto clear her nose.
hold a warm wet cloth against her
face, as often as possible.
not try to blow her nose, or else her
ears will hurt. Wiping the nose is
3. See the person again after 3 days, and
examine her teeth closely, tapping them to be sure they are strong
and heal thy.
if she is not better, get help from a more experienced health worker.
1. Broken tooth
It is possible to save a broken tooth, It depends on where the tooth
is broken and whether its nerve is still covered.
pain when breathing air or drinking
blood from the gums around the tooth
tooth moves when you touch it
Take out the broken tooth if:
its nerve is not covered. If no one can give special root canal
treatment, the tooth must come out. Germs from the spit have
already gone inside the tooth and started a small infection.
its root is broken. To see if it is broken, push gently against the
tooth as you feel the bone around its roots. The tooth’s root
probably is broken if the tooth moves but the bone does not. The
root probably is not broken if both the tooth and bone move.
However, the bone around the roots may be broken (page 103).
You can save a broken tooth if the nerve is still covered and the root
is not broken. To do this, use a file on the sharp edges around the break.
This makes them smooth so they do not cut the tongue. Later, an
experienced dental worker who has the equipment can cover the broken
part with a cap or a filling. Until this is possible; tell the person how to
protect the tooth:
Give the tooth a rest. Use other teeth to eat.
Do not drink things that are very hot or cold, and do not eat spicy
Watch the tooth. See if it changes color (gets darker). Also watch
the gums near the root. See if a sore (gum bubble) develops.
A dark tooth and gum bubble are signs that the tooth is dying. Take it
out, unless you can give special nerve treatment.
2. Tooth knocked out
When a tooth is knocked out of the mouth, you should ask two
questions: (I .) Was it a baby tooth? and (2.) How long ago did it happen?
Baby tooth. There is no reason to try to put a baby tooth back into
the socket. Tell the child to bite on some cotton to stop the bleeding,
Then wait for the permanent tooth to replace it. Warn the mother that
the permanent tooth may take more time than usual to grow into the
Similarly, there is no need for
treatment if the baby tooth is pushed
up under the gum.
The tooth may grow back into the
right place later, or it may turn dark
and die. If you see a darkened tooth or
a gum bubble (p. (721, take out the
baby tooth before it hurts the permanent
tooth that is growing under it.
Permanent tooth. A permanent tooth is worth saving. How long ago
was it knocked out? If it was less than 12 hours ago, you can put a
permanent tooth back into the socket. The sooner you do this the better,
so do not wait. If you replace the tooth in the first hour, it has a much
better chance of joining with the gum and bone. In order to heal and to
join the bone, the tooth must be held firmly.
1. Wash the tooth gently
with clean water. There
should not be any bits of
dirt on the root of the
Keep the tooth damp
with wet cotton gauze.
Do not scrape away any
skin from the root or from
the inside of the socket.
2. Gently push the tooth up into the
socket. As you push it up, use a slight
turning movement back and forth.
The biting edge of the loose tooth
should be at the same level as the
teeth beside it.
Hold it in place with your fingers for
about 5 minutes.
3. Soften some beeswax and form it
into 2 thin rolls, Place 1 roll near the
gums on the front side of five teeth:
the loose tooth and the two teeth on
each side of it. Press the wax firmly,
but carefully, against these teeth.
Do the same with the second roll of
wax on the back side of the same
teeth, again near the gums.
It is good if the wax on the back side
is touching the wax on the front
side. This helps the wax hold the
teeth more firmly. To do this, you
can push the wax between the teeth
with the end of your cotton tweezers.
Keep the wax in its position for at
least 3 weeks.
Tell the person with the injured tooth to return to see you several
times. The tooth may die several months or even several years later (see
page 45). If that happens, you must take out the tooth, unless you can
do root canal treatment.
If it is possible, take an X-ray of the tooth 6 months later and then
again each year. Look at the X-ray picture of the root to be sure an
infection is not eating it away. To do this, compare the root with the
roots of the teeth beside it.
A tooth may be loose for one of several reasons. Decide the reason
before giving the treatment.
a new permanent tooth is
growing under it.
1. tell the mother and child what is
2, pull out the loose baby tooth, if it is
hurting the child.
gum disease or an old abscess
has eaten the bone around its
1. take out the tooth, especially if it
also hurts,
2. explain to the person what to do to
prevent this problem in other teeth,
(See Chapter 5).
its root has been broken,
take out both parts of the tooth. If you
have trouble taking out the broken root,
leave it and try again a week later.
the bone around its root is
cracked. (The bone moves when
you push against the tooth.)
Do not take out the tooth. If you do,
the bone will come out with it. Instead,
hold the tooth with wires (page 1041.
A tooth may also be loose because
another tooth is biting too
hard against it.
you can feel the tooth move
when the upper and lower teeth
that tooth hurts.
You need to remove a bit of each of the teeth that are biting too hard.
Use either a dental worker’s drill, a small file, or a hard stone.
1. Smooth the inside edge of the upper tooth.
2. Smooth the outside edge of the lower tooth.
A new tooth cuts through the gums when it grows into the mouth,
Germs can easily go under the gums in that place and cause an infectio:i.
When the opposite tooth bites against the sore gum it can make an
infection worse.
toothache at the back of the jaw
mouth cannot open properly
a bad taste coming from the back of
the mouth
sore throat
skin over the new tooth is sore and
hurts when you touch it
the age of the person is the right age
for growing a new molar tooth
(page 64.
infection in the gums and
pressure from the new tooth are
painful, Notice the ‘flap’
of skin over the new tooth.
Do not take out a new tooth while there is still infection and pain. Wait
for the infection to finish, Then decide if there is room for the tooth to
grow in. A dental X-ray can help you make that decision. New molar
teeth are often difficult to take out. Ask an experienced dental worker to
take out the tooth, if it must be done.
What you can do
First, treat the infection. Then wait for the new tooth to grow more
into the mouth, Tell the person what is happening. Tell him what he can
do to keep the gums healthy while the tooth grows in:
Rinse the area with warm salt water (page 7). Make 4 cups each day
until the mouth opens normally again. Then make 1 cup each day
to prevent the problem from returning. Keep rinsing this way until
the tooth grows all the way in.
Hold a warm wet cloth against the jaw as often as possible each day.
Take aspirin for pain (page 88).
Give penicillin (page 87) if there is fever, a swelling, or if he is only able
to open his mouth a little,
When babies and small children first get their teeth, it is called teething.
This can make the child unhappy, because his gums are sore.
Teething does not cause fever, head
colds, or cough.
But a child can have any of these
problems at the same time as he gets a
new tooth.
If the child has another sickness, do not blame it on teething. Look for
another cause and treat it separately. Also, do not cut the gum-over the
new tooth. Let the tooth grow through the gum by itself.
1. Give acetaminophen or aspirin for pain and fever (page 88).
2. Give the child something hard to bite against. This will help the tooth
to grow through the gums faster. For example, let him chew on a dry
hard biscuit,
Infection can start in the gums whenever the teeth near them are not
clean. For example, there may be swelling (called an epulis) between
only 2 teeth or between many teeth. In addition, gums that are weak
from poor nutrition are not able to resist the infection. This is why a
pregnant woman must take special care to eat well and clean her teeth
Gums are red instead of pink.
Gums are loose instead of
tight against the tooth.
Between the teeth, gums are
round instead of pointed.
Gums bleed when you press
against them, or when you
scrape away food from under
The person has bad breath
and a bad taste inside the mouth,
Feel for tartar under the gumor even a piece of fishbone.
Explain to the person the cause of her gum problem and what she can do
to help herself.
I, Show her how to clean her teeth better near the gums (page 67).
2. Tell her to rinse her mouth with warm salt water (page 7). Make 4
cups each day until the bleeding stops. Then make 1 cup each day to
keep the gums strong and tough.
3. Tell her to eat fresh fruits and vegetables. Guavas, oranges, pineapples,
papayas, tomatoes, peas, and green leaves give strength to gums.
4. Gently reach under the gums and remove tartar (or loose piece of
fishbone) that is caught there (see Chapter 8).
Vincent’s Infection of the gums, also called trench mouth, affects both
adults and children, In its worst form, it can eat a hole through the cheek
of a weak child (page 115).
A person with Vincent’s Infection may not want to eat because his
teeth hurt when he chews food. That can make a child’s malnutrition
You must prevent this problem from starting, especially in a child who
is weak from sickness, Teach mothers to clean their children’s teeth and
to get their children to rinse their mouths with warm salt water.
gums between the teeth are dying
and turning gray.
pus and old blood collect
around the teeth.
burning pain from the gums.
bleeding from the gums.
the mouth smells bad.
You will need to see the person over a two-week period. Start some
treatment NOW;
I, If the person is already sick, give penicillin
for 3 days (page 88).
2. Clean away the pus, old food, and big pieces of tartar. Then:
Tell the person to rinse his mouth with warm water.
Wipe his gums with cotton soaked in a 5% solution of hydrogen
peroxide. Rinse with warm water. For a child, use a weaker solution.
Mix 1 part hydrogen peroxide with 5 parts water and wipe the
child’s gums with it.
Scrape away the bigger pieces of tartar. Do not try to remove all of
it. You can do that later. Put topical anesthetic on the gums if you
have some (first dry the area with cotton so the topical anesthetic
will stay longer). Rinse away any loose bits of tartar with warm water,
3. Give Vitamin C (ascorbic acid), 2 tablets a day for 7 days.
(1 tablet = 500 mg.)
4. Teach the person how to care for the gums at home:
Rinse at home for 3 days with a weak solution of hydrogen peroxide
(page 8). Try to hold the solution in the mouth for several minutes.
The longer the solution touches the gums, the better it is for the
gums. Rinse once every hour. After 3 days, change to salt water,
4 cups a day. If you have no hydrogen peroxide, rinse with salt
water from the beginnirq.
For a young child who is not able to rinse, Mother or
Father can wipe his gums with the weak solution of
hydrogen peroxide 4 times a day.
Show parents how to do this, Give them some cotton
gauze and hydrogen peroxide to take home.
Clean the teeth with a soft brush. Parents can clean children’s teeth.
Show them how (page 16), and ask them to do it even if the gums
* Cook food that is soft (like pounded yam) and not spicy (no pepper).
Eat fresh fruits and vegetables that give strength to the gums (page
Stop smoking and stop chewing betel nut.
One week later, scrape away the rest of the tartar from the teeth. Then
use the person’s own brush and show him how to do a better job of
cleaning his teeth,
Herpes virus causes fever blisters. Herpes virus is a kind of germ. Fever
blisters are sores that can form either inside the mouth on the gums, or
outside on the lips.
When the sores are inside the mouth, it is a serious problem. It usually
affects children between 1 and 5 years old. A child with fever blisters in
his mouth can become very sick. He will not be able to eat properly. If
he does not drink enough fluids, he can become dehydrated (lose his body
water). This is dangerous!
sore throat
crying, stops sucking 2-3
days before sores appear
spit spills from the mouth
because it hurts to swallow
painful swefling under the jaw.
bright red blisters on the gums,
but not between the teeth.
inside the mouth
Blisters also may be on the roof
of the mouth.
Medicine cannot kill the Herpes virus. The sores will go away by themselves in about 10 days. The treatment is to help the person feel more
comfortable and to be sure he gets enough to eat and drink.
1, Give aspirin or acetaminophen for fever (page 88).
2. Wipe milk or yogurt over the sores to protect them before eating. Wash
your hands before touching the inside of someone’s mouth! (See page
82.) Then give food that is soft and not spicy. If he cannot eat, prepare
a special milk-oil drink for him, as on page 105.
3. Give lots of fluids to drink.
Sores on the lips usually occur after the age
of 5. They often appear when the person is
weak and sick (for example, with diarrhea or
pneumonia.) Usually there is no fever. The
blisters soon break open and release water.
When they dry, a crust forms. The blisters often
On the lips
These sores go away in about 1 week, To prevent them from becoming
infected, paint the sores with gentian violet, tincture of benzoin, or
petroleum jelly. If you hold ice against the sores for several minutes each
day, it may help them heal faster.
Thrush is a kind of infection. It often appears when a person is weak
and poorly nourished, or sick and taking medicine like tetracycline or
ampicillin. In a baby, thrush usually appears on the tongue or top of the
mouth. It can stop the baby from sucking. In an adult, thrush often occurs
under a denture.
White patches on the tongue,
cheek, or top of the mouth.
Wipe the white area:
If there is no bleeding it
is old milk.
If there is bleeding, it
is thrush.
the child may not want to suck or eat.
There is usually something else present which is helping thrush to grow.
Try to find what it is and deal with it. For example, treat the malnutrition,
change or stop the antrbiotic medicine, or leave the denture out of the
mouth for a while. Then:
I. Put some nystatin creme on top of
children 5-12 years:
children up to 5 years old:
patch with
on 4 times
on 3 times
on 2 times
a bit of cotton.
a day
a day
a day
Show the mother how she can do this in her child’s mouth at home. If
you have no nystatin creme, paint gentian violet on the white area. The
mother should paint the child’s mouth 2 times a day,
Do not use penicillin or any other antibiotic unless you need to treat
something different. Thrush can get worse when a person uses an
for a long time.
2. Continue breast feeding. For older persons, make their food soft and
easy to chew.
IMPORTANT: Sometimes white lines appear on the inside of an adult’s
cheek or on the roof of the mouth. If these lines become sore, they can
change into a cancer (page 119). To prevent this cancer, ask the person to
stop smoking (especially pipes), stop chewing betel nut, and get dentures
adjusted if they do not fit properly.
A virus can cause canker sores, as with fever blisters. Unlike fever
blisters, canker sores usually affect adults rather than children.
One or more sores can appear at any time. These sores hurt, especially
when pieces of food touch them.
A sore can appear on the tongue,
roof of the mouth, or below the
gums on the smooth skin.
The sore is white or yellow with the
skin around it bright red.
The person may have had a similar
kind of sore before. It tends to
come back.
Note; a sharp edge of a denture rubbing against the gums can make
a similar kind of sore.
A canker sore goes away by itself in about 10 days. Medicine does not
make that happen any faster. (However, smoothing a denture does help.)
The treatment is simple. Tell the person how to feel more comfortable
while waiting for the 10 days to pass:
Eat foods that are soft and not likely to hurt the sore. Do not eat food
with a lot of pepper. Drink lots of water. Chew food on the other side of
the mouth, away from the sore.
A denture which does not
fit should be remade.
In the meantime, leave
the denture out of the
mouth for 2-3 days.
Ask the person to rinse
with warm salt water,
4 cups each day until
the sore is better.
If the sore continues after 10 days, it may be infected. Give penicillin
(page 87).
A sore that does not heal after antibiotic treatment may be cancer.
See a doctor immediately,
Teeth support the lips. When they come together for chewing, the teeth
stop the person’s chin from moving any closer to the nose.
A person without many teeth looks old. A person with a poor fitting
denture also looks old.
The distance from his chin to
his nose is shorter than
He must close his jaw further
to eat. That causes lines to
form at the corners of his
Poor health can make lines at
the corners of the mouth crack
and become sore.
A person with missing teeth needs dentures. Dentures will help him
chew more food and make him look younger. They support his lips and
open his mouth more.
Note: Making dentures is not easy. We hope to write a book
in the future that will tell more about dentures.
A child who has had a fever or measles often has dry lips. The corners
of her mouth can crack and become sore.
Cracks and sores appearing
at the corners of a child’s
mouth are signs of dehydration
and malnutrition.
The child needs to eat the kind of foods that give strength, energy, and
protection. Feed her beans, milk, eggs, fish, oils, fruits, and green leafy
vegetables (see page 65).
(when sores occur) :
I. Wash the sores with soap and hot water
2. Mix 1 part sulfur with IO parts of petroleum jelly (Vaseline).
3. Smear some on the sores 3-4 times a day.
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.
Three main bones form the face and lower jaw.
- 1. cheek bone ‘2. upper jaw bol
3. lower jaw bor
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.
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.
MWtR tooT,r
SIGNS of a cracked bone around
the tooth 3 roots:
When you move one tooth, the
tooth beside it also moves.
When you move the loose tooth,
the bone moves with them.
Blood is coming from under
the gums.
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.
Emergency care (pages 103-I 04) :
Be sure the person can breathe.
Stop the bleeding.
Put a bandage on the person’s head.
Give penicillin to stop infection.
Give aspirin for pain.
1. Be sure the person can breathe.
Lie 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 (p. 175). They will remove the root
when they put on the final wires.
2. 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 /s No Doctor, p. 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 two 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 8. You must twist
the wire tight enough to hold the broken parts
Bend the end of the twisted wire toward the teeth. Now it cannot poke
the person’s lips or cheek.
3. 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,
4. Give penicillin by injection (page 166) for 5 days to stop infection
inside the bone,
5. Give something for pain, Aspirin (p. 88) 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.
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.
1. Give liquid foods for strength and energy:,
Prepare food in two ways: (1) First, a milk-oil drink to build strength;
and then (2) 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
l/2 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:
0 l/2 tin of fish, or a handful of dried fish
0 4 small spoonfuls of peanut oil or palm oil
6 sweet potatoes or small yams
1 large handful of green (e&es
0’ 1 small
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.
2. Keep the teeth clean and the gums tough.
The person must learn to clean teeth and gums or the gums can quick IY
become infected and the mouth will feel sore. So:
Scrub both the wires and the teeth with a soft brush after drinking
Rinse with warm salt water (page 7), 2 cups every day.
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.
1. With your thumb and finger, gently move the
loose teeth and bone back into normal
2. 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.
3. Tie each tooth to the needle. Use short pieces
of 0.20 gauge ligature wire (page 104).
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 HEMOSTAT OR
twist the ends together. Tighten the wire
around each one of the 6 teeth.
4. Cut the ends of the ligature wire. Turn them
toward the teeth, so they will not cut the lip.
5. Tighten the wires the next day, and then once each week. But bo
careful. Only l/2 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.
6. 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 (p. 8).
return to have the wires tightened every week.
7. 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.
If a person opens her mouth wide and then is unable to close it, we say
her jaw is dislocated. It is stuck in the open position. This problem often
happens to a person who does not have several of her back teeth. When
she opens wide to yawn or shout, the part of her jaw that joins her head
moves too far forward inside the joint. It is then unable to return to its
normal position.
She is unable to close her teeth
She cannot close her lips easily.
Her lower jaw looks long and
It hurts when you press on the
joint in front of her ear.
She cannot speak clearly.
The treatment is to try to move the lower jaw back where it belongs.
Then hold it in that position until the muscles can relax.
I. Find a way to support the person’s head. For example, have the
person sit on the floor with her head against a wall.
2. Kneel in front of her. Put your fingers under her jaw, outside the
mouth. Put your thumbs beside her last molar tooth on each side.
Do not put your thumbs on the molars. The person may bite them!
Press down hard with the ends of
your thumbs. Force the jaw to move
quickly down and back into position.
Be sure to press down before you
press back.
If the jaw will not move, perhaps the
muscles are too tight. A doctor or
dentist can put the person to sleep,
which will relax the muscles.
3. Support the jaw with a head-andchin bandage for 3 to 4 days
(page 104).
4. Give aspirin for pain (page 88).
5. Explain the proble? to the person and tell her how to care for her
jaw: (1) eat mostly;soft foods for 2 weeks; (2) hold a warm wet
cloth against the jaw; (3) remember not to open the mouth wide
anymore. If possible, replace the missing back teeth with dentures
(page 101).
A joint is the place where one bone joins another. The jawbone has
two joints, for it joins the head in front of each ear.
The mouth opens and closes because:
muscles pull the jawbone; and
the jawbone slides against the head
bone, inside the joints.
Pain in these joints may be because:
(I) The muscles are tight because the
the person is tense or nervous.
(2) The jawbone is fractured in the area
of the joint.
(3) The teeth do not fit together
Before you treat, decide what is causing the pain. We will discuss the
three causes mentioned above.
1. Tension.
Talk with the person and help, if you can, to find a solution to her
personal problems. This can do much to help her and her muscles relax.
In addition, explain how to care for the sore joint:
(a) Eat only soft foods until it no longer hurts to chew.
(b) Hold a hot, wet cloth against the jaw, to help relax the muscle. Do
this as often as possible, but be careful not to burn the skin.
(c) Take aspirin (page 88) to reduce the pain.
2. Fracture.
If an X-ray shows a fracture, the person needs expert help. A dentist
can wire the teeth in a way that will allow the bone to heal.
3. Teeth do not fit together properly.
Imagine a line that passes between the two middle upper teeth and the
two middle lower teeth in the person’s closed mouth (see the next page).
When the person opens the mouth, this line becomes longer, but it is still
a straight line. If it is not, this condition can, after a long time, cause pain
in the joint,
These teeth are normal. The line formed between the two ‘middle teeth does not shift
when the mouth opens.
When you see teeth that do
not fit properly:
(a) Warn the person not to open
his mouth wide. Suggest,
for example, that he take
his food in small bites.
(b) Tell the person what can
be done to help. Often
a dentist can grind the teeth
in a special way and this
can end the pain.
These teeth do not fit properly.
Because the line shifts, this means
the jaw is also shifting. This
shift can cause pain in the joint.
Many persons who suffer from epilepsy
(see Where There Is No Doctor, page
78) have a problem with swollen gums.
In severe cases, the teeth are moved
out of position. This problem is caused
not by epilepsy but by diphenylhydantoin
(Dilantinl, a drug used to control
When you see swollen gums, find out what medicines the person is
taking. If possible, change to a different drug. If the person must
continue using diphenylhydantoin,
explain how to prevent this swelling
of the gums. Show the person this book, especially pages 67 to 70. Persons
who take this drug can prevent this swelling of the gums, but they must
brush even more often than most people-and they must clean carefully
between the teeth several times a day.
Use wet cotton gauze to wipe away the old blood from inside the
mouth. Then you can see where it is coming from. Treat the cause of the
a large red clot growing
out of a socket where you
have taken out a tooth
1. Remove the clot with cotton
2. Ask the person to bite on a
piece of cotton.
sore and bleeding gums
and the mouth smells bad
(Vincent’s infection)
‘I. Rinse with a mixture of
hydrogen peroxide and water.
2. Remove as much tartar as you can.
a red, bleeding growth inside
the cavity in a tooth
Take out the tooth; it has an
a loose tooth with bleeding
gums around it
Hold the tooth with wires,
or if the root is broken,
take out the tooth.
1. With wire, hold the broken
p?,rts of the bone together.
2. Send the person to an
experienced dental worker.
torn gums with broken bone
and bleeding
Problems like swelling, severe pain, and bleeding can occur after you
take out a tooth. Tetanus (p. 112), a more serious problem, can also occur,
especially if your instruments were not clean.
Swelling of the face
You can expect some swelling after you
take out a tooth. But if the swelling
continues to grow, and it is painful, this
is not normal. Probably an infection has
started. The treatment is the same as for
a tooth abscess: penicillin for 3 days to
fight infection, heat to reduce the swelling,
and aspirin for pain. See page 88 for the
proper doses.
Pain from the Socket
There is always some pain after a tooth is taken out. Aspirin is usually
enough to help.
However, sometimes a severe kind of pain starts inside the tooth’s
‘socket’ (the wound) 2 to 3 days after you take out the tooth. This
problem is called dry socket and it needs special care.
1. Place a dressing inside the socket. Change it each day until the pain
First, clean out the socket.
Squirt warm water inside the socket with
a clean syringe. After the person spits out
the water, squirt water inside once more.
Use a blunt needle so that it does not hurt
the gums or bone if it touches them.
Third, place the d’&Zng gently
inside the socket.
Second, prepare the dressing.
Soak 1-2 small pieces of cotton
in eugenol (oil of cloves).
Squeeze each piece so that it
is damp but not wet.
Note: There may be a local
medicine in your area that
relieves pain, Use it instead of
2. Give aspirin for pain (page 88).
Place one piece of dressing into
each root space. Push it down into
the root space gently.
Cover the socket with plain cotton
gauze, and send the person home
biting against it, He can remove
the plain cotton in an hour. The
dressing should remain inside the
Bleeding from the socket
When you take out a tooth it leaves a wound, so you can expect some
blood. However, if the person bites firmly against a piece of cotton, it
usually controls the bleeding. To help the wound heal (from a clot), tell
the person not to rinse with salt water or spit for 1 or 2 days after you
take out the tooth.
When the first bleeding occurs, put a new piece of cotton on top of
the wound and ask the person to close her teeth against it for an hour.
Keep her there with you, to be sure she continues to bite on the cotton,
(If it is too painful, you may want to inject anesthetic. See Chapter 9.)
Change the cotton if it becomes soaked with blood.
(if the bleeding continues):
1. Take her blood pressure (see He/ping Health
Workers Learn, page 19-13). If it is high,
you may need medicine to bring it down.
That can help slow the bleeding.
2. Look carefully at the wound. If the gum
is torn or loose, put in a suture (pages 155157).
3. Wrap tea leaves in cotton gauze. Soak the
bundle in water and then put it on the socket. Have the person bite
against it. Or, have her bite against cotton gauze soaked with cactus juice.
Let the person go home only when the bleeding stops. Give her some
clean cotton to use in case the bleeding starts again later (see page 157).
also be
a tooth.
is a very serious infection. Tetanus germs enter the body when a
like a wound on the bottom of the foot, gets dirty. Germs can
carried to the socket when you use a dirty instrument to take out
To avoid this, carefully read pages 82 to 85.
the jaw becomes stiff and tight
it is hard to swallow
0 the whole body becomes tight, with sudden
A person with signs of tetanus requires immediate medical help. See
Where There /s No Doctor, page 182, if you cannot get help immediately.
Spit glands are places where the spit is made. They are located in front
of the ear and under the jaw, ori each side of the head. If there is an
infection inside a spit gland, the face will become swollen and the area
will hurt.
Spit is sent from the gland to t?e mouth through a thin pipe called a
duct. Ducts open into the mouth in two places: on the inside ot each
cheek, and under the tongue.
A small stone can often block a duct and cause an infection in the spit
gland and swelling of the face. You may be able to feel the stone near
where the duct enters the mouth.
swelling in the area of the spit gland.
pain which gets worse when the person is hungry, and when he sees
or smells $ood.
the opening of the duct is red, swollen, and hurts when you touch it.
Reduce the infection and swelling first. Later try to remove the
I. Give penicillin for 3 days (page 88). If the swelling is large and the
infection serious, start with short-acting crystalline penicillin (see
p* 166).
2. Give aspirin for pain (page 88).
3. Apply a wet hot cloth to the swelling as often as possible.
4. Give enough soft food to prevent the person from feeling hungry.
The pain will be less then.
5. When the person feels better, a dentist or doctor can remove the
stone that is blocking the duct.
Whenever you see a sore on a person’s cheek or under his chin,
remember there may be a tooth or gum problem. If it is a gum problem,
it may be Noma. See p. II 5.
A bad tooth:
Ask him to open his mouth.
Look for an infected tooth in
the area of the sore.
There may be a large cavity and
the tooth may be loose.
Or the tooth may be darker
in color than the others. This
is because it is dead.
The pus is draining onto the
skin, so the pressure is reduced
and the person does not
complain of pain.
1. Take
2. Give
3. After
is no
out the tooth (see Chapter II),
penicillin for 5 days (see page 88).
the penicillin treatment, check the sore. If it has healed, there
longer infection inside. The treatment is finished.
But if the sore is still open and you can squeeze out pus, you will need
the help of experienced health workers who can:
test the pus to see if it is resistant to penicillin,
The person may
need to take a different’antibiotic.
take an X-ray to see if there are dead pieces of bone which are
keeping the infection alive. If there are, they must be removed.
If infected gums (and not a bad tooth) are the cause of a sore on the
cheek or chin, the problem is more serious. See the next 4 pages.
When a child is sick, a simple gum infection can get out of control and
spread through the cheek to the face. When that happens the condition is
called Noma or Cancrum Oris. Noma is a complication of Vincent’s
Infection of the gums (page 96).
You will usually see noma in children. It will only develop if these 3
things are true:
(1) The child’s general resistance is low. Usually, he
is undernourished and anemic (lacks iron). He
may have tuberculosis.
(2) The child has Vincent’s
(3) The child has recently had a serious illness like
measles or n malaria.
The infection starts in the mouth.
Then it passesto the gums.
1. Sore mouth with itching gums.
2. Swollen, sore gums.
3. Gums bleed when eating or when
teeth are cleaned.
4. Bad breath, spits a lot.
Then it reaches the jaw.
5. Loose teeth.
6. Loose pieces of bone around the
Finally, it affects the cheek.
7. Skin is tight with dark red swelling.
8. Black spot on the cheek breaks open,
leaving a hole into the mouth.
9. A I ine separates dead tissue from
heal thy tissue.
You must start treatment for noma immediately in order to prevent the
hole from getting bigger. The bigger the hole, the tighter the scar that
forms after you close the hole. A tight scar will prevent the child from
opening his mouth and chewing the food he needs to grow stronger.
1. Give fluids.
The child needs to overcome
both the lack of body water
(dehydration) and his lack of
resistance to disease.
Start giving the Milk-oil drink
described on p. 105.
If he cannot drink by himself,
help him. Use a spoon or
Place the fluid on the inside
of the healthy cheek and ask
the child to swallow.
2. Treat the anemia.
Start giving iron now. The chi Id should continue taking the tablets or
mixture for 3 months.
over 6 years:
3-6 years:
under 3 years:
Ferric Ammonium
Citrate Mixture
Ferrous Sulfate
Tablets (200 mg.)
1 l/2 ml. (30 drops) daily
1 ml. (20 drops) daily
l/2 ml. (10 drops) daily
200 mg. (1 tab) 3 times a day
100 mg. (l/2 tab) 3 times a day
50 mg. (l/4 tab) 3 times a day
Also give food rich in iron: meat, fish, eggs, dark green leafy vegetables,
peas and beans.
Note: a child may have anemia because he has hookworm. It is wise not
to wait for a test for hookworm. Begin now giving hookworm medicine such
as thiabendazole and folic acid (see Where There /s No Doctor, pages 142,
363, and 376).
3, Start antibiotics.
Penicillin is the best antibiotic to use. As the child may not be able to
swallow pills easily, it is best to start with penicillin injections (page 166).
If you do not have penicillin, you can give sulfadimidine 4 times a day.
It comes in 500 mg. tablets or in syrup that has 500 mg. in 5 ml. To
decide how much to give, weigh the child.
Dose (give 4 times a day)
5 to 10 kg.
10 to 17 kg.
over 25 kg.
l/2 tablet or l/2 teaspoon of syrup
1 tablet or 1 teaspoon of syrup
I l/2 tablet or 1 l/2 teaspoon of syrup
2 tablets or 2 teaspoons of syrup
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 /s No Doctor, pages 357 and
Look for any other illnesses and treat them, too.
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.
The dressing:
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 155-I 57).
7. Keep the mouth clean.
Use a soft brush gently to clean the remaining teeth. Do this 3 times
a day for the child.
Wipe the gums with a weak solution of hydrogen peroxide. Use
cotton gauze that is damp with the solution. Do this every 2 hours
for 5 days.
Then after 5 days, start rinsing with warm salt water 3 cups a day.
8. Get advice on whether surgery is needed.
Unfortunately, the child will probably need surgery, to release the scar.
Without this surgery, the child will not be able to open his mouth
Send the child for medical help when the
infection is finished and the wound starts to
You may also need a dentist’s help at this time.
The child’s jaws may need to be wired. The
wires are put on the healthy teeth in a way that
holds the mouth open while the tight scar is
forming, When the wires are removed, the child
will be able to open and close his mouth to
chew food.
of Noma:
Noma need not occur. We can prevent it. Always give special attention
to the mouth of a sick child, to be sure to keep his teeth clean,
Whenever someone is nursing or caring for a sick child, that person
should clean the child’s teeth as a normial activity. This is especially true
for a child who is weak, undernourished, and with little body water
Such a child should always:
(1) have his teeth carefully cleaned each
day with a soft brush.
(2) rinse his mouth with a warm salt
water solution. (page 7), 2 times a
(3) eat fresh fruits and
especially the kind
C-guavas, oranges,
papayas, tomatoes,
green leaves.
that have Vitamin
peas, and dark
A tumor is a lump that grows under the skin or inside the bone . It
grows slowly but steadily, usually without
If the swelling does not get better after 5 days of antibiotics and
heat treatment (page 88), it may be a tumor.
Do not waste any more medicine or any more time. A tumor may be
cancer. Send for medical help. Surgery is needed to remove a tumor.
Any sore that does not heal may be
cancer. The lips and tongue are the
two places in the mouth where
cancer starts most often.
Cancer is deadly.
Medicine cannot help.
It wastes time to use it.
Cancer can spread quickly to the inside of the person’s body where
you cannot see it. This can lead to the person’s death.
Whenever you treat a sore and it does not get better, send the person
for medical help immediately. A doctor can cut out a piece from the sore,
look at it under a microscope, and decide if it is cancer.
Scaling Teeth
Scaling means ‘scraping away’. You can scale old food, tartar, or even a
fish bone caught under the gum. You usually scale teeth to rem&e tartar.
We get tartar when the coating
of germs on our teeth (p, 48)
becomes hard.
Gums that pressagainst
tartar become sore and infected.
Clean teeth keep our gums healthy. Scaling a person’s teeth gives
infected gums a chance to become normal again.
However, gums remain healthy only when we keep the teeth beside
them clean. If we are not careful about cleaning our teeth after they are
scaled, tartar will soon return. Instead of being healthy, the gums will
become sore and infected again.
Scale a person’s teeth, but
also teach how to keep teeth clean.
You must remove something caught under the gums (page 127) before
it causes more pain and swelling. Remove a piece of fish bone or piece of
mango string now.
If the person has a mild gum problem (gums that bleed), wait a week or
so before scaling, If the person uses this time to clean his teeth better and
to rinse with warm salt water (page 71, the gums will improve. The
person’s teeth will be easier for you to scale, and he will learn that he can
do much by himself to care for the gums.
Use a n’lirror to show the person gum infection inside his own mouth.
Later he can see the improvement he has made. He can learn about how
to keep gums healthy as he follows his own progress.
Scale a person’s teeth only when he really wants to try to keep them
clean. If he does not want to clean his, the tartar will soon return.
Do not waste your time scaling the teeth bf a person who does not want
to learn.
We scale teeth with special instruments called scalers. There are many
different kinds of scalers for different teeth, to make scaling easier. It can
be a problem to know which ones to buy.
Scalers are expensive instruments. For that reason, it is better to order
only a few instruments that you can use to clean most teeth.
You need only 2 double-ended scalers, or 4 single-ended scalers.
For instance:
1. One with two pointed tips-to
near the gum.
remove tartar from the part of the tooth
Its proper name is
Ivory C-l scaler.
2. Another with two blunt, rounded ends-to remove tartar from the part
of the tooth under the gum.
Its proper name is
G-l 7 and 72 curette.
The ends of the scaler are the important parts. One end is bent to the
left and the other end is bent to the right, so you can reach more easily
around all sides of the tooth.
The blade at each end of the scaler is sharp. You must keep the blade
sharp. A sharp blade can break more of the tartar away than a blunt blade.
You also need these:
(cotton pliers)
Sharpening stone
(Arkansas stone)
Note: When you order an instrument, use both its common and proper
name. Then you have a better chance of receiving the instrument
you want. You can also make some of your own instruments. See
pages 170-l 72.
Keep everything in a Scaling Kit.
Tartar starts to form inside the gum pocket. There it builds up, because
the gums protect it. So you often must feel rather than see the tartar when
you scale a tooth.
You must remove all of the tartar so the gums can heal. New tartar
grows faster when there is old tartar left behind for it to build upon.
Lay out what you need ahead of time.
your instruments:
scalers, mirror, probe, tweezers
sharpening stone
cotton gauze
Your light must be good enough to see the tooth and gums around it
clearly. Scaling teeth requires time and practice. Make yourself and the
person comfortable. You can sit next to a special chair that lets the person
lean back (see page 73).
The steps in scaling teeth are these (pages 123-l 27) :
Explain to the person what you are going to do.
Feel under the gum for rough spots (tartar).
Place the scaler under the tartar.
Pull the scaler against the side of the tooth.
Check to be sure the tooth is smooth.
Explain what you have done and what the
person should now do.
1. Explain what you are going to do. Tell the person what to expect. There
will be some bleeding and possibly some pain. However, you can stop
and rest, or inject local anesthetic, if it is painful. Remember: first wash
your hands and your instruments! (See pages 82-85.)
2. Feel under the gum for tartar. Tartar feels like a rough spot on the root
of the tooth. Since tartar can form anywhere inside the gum pocket, feel
for it on all sides of the tooth.
You can check for tartar two ways.
1. Use your probe. Slide the point up and down along the
root surface under the gum. Feel for places that are
rough. Teeth without tartar are smooth.
2. Use cotton gauze. Twist a corner and press it between
the teeth. The gauze lowers the gum and soaks up the
spit. You can then see more tartar.
3. Plsce the scaler under the tartar. You must learn two important
how to hold tne scaler and how IO slide the scaler into the gum pocket.
Hold the scaler
almost as you would
hold a pen, You can
then pull it against
the tartar with both
power and controi.
Control is very important, The
ends of the scalers are sharp.
If you are not careful, the blades
can cut the gums. Be gently and do
not hurry. Always hold the tip of
the scaler on the tooth to avoid
poking the gums.
Rest your 3rd finger against a
tooth. This will steady your hand
and let you slide the sharp scaler
under the gum with care.
The edge of the gum, near the tooth, folds under to form a pocket. This
around each tooth. The gum pocket can be
shallow or deep. A deep pocket means there has been an infection for a
gum pocket goes completely
First, use the pointed-tip
scaler to remove the tartar
that you can see.
Tartar starts forming deep
inside the gum pocket. If
you remove tartar that you
can see above the gum, it
is helpful, tut not good
enough. You must remove
the rest of the tartar, or
the infection will continue.
If part of the tartar
stays on the tooth, the
infection will continue.
Then, go back with your roundedtip scaler and scrape away the
remaining tartar.
Be careful when you place the rounded end of the scaler inside the gum
1B Put the sharp face of the
blade against the tooth,
Slide it along the tooth
down into the gum pocket,
2. You can feel the edge as it
goes over the rough tartar,
Stop when you feel the
bottom of the gum pocket.
4. Hold the end tight against the side of the tooth and pull the scaler. Try
to break free as much tartar as possible at once. It is u bad idea to remove
the tartar a bit at a time, because the remaining tartar becomes smooth
and harder to scrape away.
1. Tighten your fingers
on the scaler.
2. Pull the scaler with
a firm short stroke.
3. Wipe the end of the
scaler with cotton gauze.
4. Press against the gums
to stop the bleeding.
5. Check to be sure the tooth is smooth.
With your probe, feel under the gum for
any place that is still rough.
When all the sides of the tooth feel
smooth, move to the next tooth.
Do not hurry. It is more important to take your time and carefully
remove all the tartar. If the person has a lot of tartar, scale only half the
mouth now. Do the other half on another day, as soon as the person can
Finally, make the tooth look clean. Use the sharp edge of either scaler.
Scrape away the dark material on the front and back sides of the tooth.
The tooth itself has not turned dark. It
is just a stain. People most often get
these stain’, when they eat meat, drink
tea or smoke tobacco.
You czri scrape away this old food and
uncover the white tooth. But remember:
the teeth will turn dark again if not
cleaned carefully every day.
6. Talk to the person about what you have done and what to expect. The
gums will be sore for the next few days. That is normal.
Then explain to the person what to do to make the gums strong and
tough again.
A. Clean your teeth better with a soft brush. Reach with the brush into
the gum pocket, and behind your front teeth. That is where tartar
collects most often (page 67).
B. Clean between your teeth. Use your brush, the stem from a palm
leaf, or a piece of strong, thin thread (page 69).
C. Rinse your mouth with warm salt water. Start with 4 cups a day,
to make the gums strong. Then use 1 cup a day to keep them strong
(page 7h
D. Eat local foods that give strength to gums. Fresh fruits Ii ke guava
and oranges, and fresh vegetables with dark green leaves are good
for the gums.
If the gum between two teeth is red and swollen, something may be
caught inside the gum pocket. Ask what the person has been eating. The
object may be a fish bone, mango string, or a sharp piece of tartar.
First try to feel the object with your probe. Then remove it using a
scaler or a piece of strong thread.
Use the ,,ounded-tip
scaler in the same way
as you would to remove
Feel the object, go
under it gently, and
then lift it out.
Tie a knot in a piece of
thread. Then slide the thread
between 2 teeth (page 69).
However, do not move the
thread up and down. Instead,
pull it and the knot out
;he side. The knot can pull
the object out with it.*
*If the gum has grown into a kind of tumor (epulis), an experienced dental worker should cut
it away.
A sharp scaler bites into tartar better than a blunt one. Sharpen the
edge whenever you feel it sliding over the tartar.
From time to time, feel the cutting edge to be sure
it is sharp.
Scrape it against your fingernail. If the cutting edge
is not able to cut your nail, it will not be sharp
enough to break the tartar free.
Sharpen the cutting edge of the scaler on a fine-grain stone (Arkansas
stone). Put a few drops of oil or water on the stone first, so the scaler can
slide against it more easily.
Rest your 2nd or 3rd finger against the side of the
stone. This is for control.
Rub the cutting edge against the stone. Move it back
and forth.
Turn the round scaler as you sharpen it. This helps
to keep the scaler’s round shape.
Scalers must be more than clean-they must be sterile. This is because
there may be spots of blood on them. Hepatitis (Where There /s No
Doctor, page 172) can pass from the blood of one person to the blood of
another person. To learn how to sterilize, see pages 83 and 84.
Your mirror, probe, and cotton tweezers do not need sterilization. A
disinfectant (see page 85) will clean them. Dry all the instruments with a
towel, Then wrap them inside a clean cloth and put them in your scaling
kit. They are now ready for use whenever you need them again.
Remind each persoi.1: scaling is not
a cure, Rather it is a way of giving
her a new start, Only she can give
herself the care she needs to keep her
gums healthy. You have removed the
hard material from her teeth, and if
she brushes carefully, the tartar will
not return!
Injecting Inside
the Mouth
It is possible to treat a tooth without pain. You do this with an
injection of local anesthetic. You must inject near the nerve, so to give
good injections, you must know where the nerves are.
Injecting is a skill that develops with experience. The best way to learn
is not from a book, but from a person who has experience giving injections.
Watch an experienced dental worker give injections. That person
can then watch you and show you how to inject carefully and safely.
Local anesthetic is an injectable medicine. When it touches a nerve, the
tooth joined to that nerve feels numb or dead for about an hour. This
usually gives you enough,time to take out a strong tooth or to put a
cement filling into a deep cavity.
There are two kinds of syringes for injecting local anesthetic inside the
mouth. One is made of metal and the other is made of glass. The metal
syringe uses local anesthetic in a cartridge. The glass syringe uses local
anesthetic from a bottle.
This is a dental syringe, It uses special needles,
and the local anesthetic is sealed inside a
glass cartridge. You must throw away both
needle and cartridge after injecting.
This kind of syringe is for injections of
medicine like penicillin, but you Lan use it in
the mouth. Boil the syringe and needles !p. 9°C
before and after each use. When sterile, the
needles are ready for another person.
) before you inject,
be sure the local
anesthetic is able to
come out of the needlti:,
Use a new nmdle and a new cartridge of local
anesthetic for oaoh pmon.
Be careful! Do not touch the needle.
Your choice of which syringe to use depends on the local anesthetic you
can get. Order needles to fit your particular kind of syringe.
1. syringe: aspirating dental cartridge syringe,
1.8 ml. (lml=lcc)
2. needles: disposable needles for dental
cartridge syringe (27 gauge, long)
One box contains 100 needles, each one
inside a plastic cover
3. local anesthetic: local anesthetic cartridges
for a dental syringe
1. syringe: standard glass syringe that holds
around 3 ml (1 ml=1 cc)
2. needles: 24 gauge, long (40 mm x.56 mm
or similar)
3. local anesthetic: 20 ml bottle of lidocaine
(lignocaine) 2%
Or, if not available: order 2 ml ampules
of procaine hydrochloride 1%
One sealed tin contains 50 cartridges
of lidocaine (lignocaine) 2%
NOTE: Lidocaine will keep the tcc?:h numb longer if there is epinephrine
in it. But this is more expensive, and you should not use it on
persons with heart problems (see the bottom of the next page).
You can deaden a nerve with an injection of local anesthetic:
1. near the small nerve branch going inside the root of a tooth.
2. near the main nerve trunk before it divides into small branches.
Smaller nerves ‘branch’ off
from the main nerve-much
branches of a tree leave its
main trunk.
One small nerve then goes to
each root of every tooth.
Inject an upper tooth near its roots.
Bone in the upper jaw is soft and
Local anesthetic placed near the root
of an upper tooth can go inside the
bone and reach its nerve easily.
The same injection also makes the
gums around that side of the tooth
It is more difficult to injeit the lower teeth.
The lower jaw bone is thicker. When you inject near the roots of a
lower tooth, the anesthetic is not able to reach its nerve as easily.
Note: You can inject lower
front teeth in young children,
or very loose lower front
teeth in adults, near their roots.
To make a lower tooth
completely numb, you must
block the main nerve (a)
before it goes inside the ja\rd
These two injections also make the gums
around the teeth numb.
If you are treating a back tooth, you must give a second injection for
nerve (b). See page 134.
Inject local anesthetic whenever the treatment you give may hurt the
person. If, after you inject, the person says the tooth still hurts, be kind.
Stop and inject again.
Inject local anesthetic slowly and carefully.
You can then treat a bad tooth and not hurt the person.
For a good, safe injection, remember these 5 things!
1. Do not inject local anesthetic into an area
that is swollen. This can spread the infection.
Also, pus inside the swelling stops the local
anesihetic from working properly.
Instead, treat the swelling first (page 88) ‘and
take out the tooth later.
2. If the person has a heart problem, do not
inject more than 2 times in (Jne visit. Also,
it is best not to use an anesthetic with epinephrine on persons with heart
problems. Use Iidocaine only, or mepivacaine 3%.
*Local anesthetics are the only injections given in tly mouth, To learn about injecting antibiotics,
3. Before you push the needle under the skin, be sure its pointed end is
facing in the correct direction.
The local anesthetic
must come out against
the bone, where the
nerve is.
4. Before you inject the local anesthetic, wait a moment to see if any
blood enters the syringe. (Note: only an aspirating syringe will do this.)
Pull back on the plunger. It blood comes inside,
it means you have poked a blood vessel.
Pull the needle part way out and gently move it
over to a different place.
If ycu inject local anesthetic into the blood ,:essel, there will be more
swelling afterward, and the person may faint. If thF person faints:
Lie him on his back.
Loosen his sh’i*t collar.
Lift his legs q. d:‘sy are higher th....ll his head.
5. Be sure YOUI-syringe and needles are clean and sterile (see pages 82 to
85). Do not pass an infection from one person to another by using dirty
Boil the syringe and needle in water (page 84)
for 20 minutes in a covered pot. Although it is
not as important, it is also a good practiceto
boil your metal syringe,
Use a new cartridge for each person who
needs an injection. Do not use local anesthetic from a cartfidge that
you have used on another person.
Break the disposable needle after using it. Then cover the poimt with
its plastic top and throw the needle into the trash.
Injecting the Upper Teeth
Inject local anesthetic near the root
of the tooth you want to treat.
Front teeth have one root. Back teeth
have more than one.
For a tooth to become completely
numb, the local anesthetic must
touch the small nerve going to each one of its roots.
1, First decide where to inject.
Lift the lip or cheek. See the
line that forms when it joins the
The needle enters at the line
where the lip or cheek meets the
2. Push the needle in, aiming at the
root of the tooth. Stop when the
needle hits bone, Inject about 1 ml.
of local anesthetic (l/2 of a
Pull the needle part way out and
move it over to the next root.
Inject again.
If the tooth is to be taken out, leave l/4 ml. for the next step.
3. If you are taking out a tooth, also inject the gums on the inside.
Ask the person to open
wide, Inject the remaining
anesthetic (l/4 ml) directly
behind the back tooth that
must come out.
One injection can numb the
gum behind the 6 front
tfjeth. Inject into the lump
of gum behind the middle
front teeth. (Note: This
injection hurts! It may help
to use ‘pressure anesthesia’.
See p. 135,)
4. Wait 5 minutes for the tooth to become numb.
lnjectinq . the Lower Teeth
When you block the nerve, it affects all of the teeth as well as gums on
that side. However, it takes practice to do this successfully. Ask an
experienced dental worker to help you learn how to give this injection
Stand in such a way that you can see clearly where you need to inject.
Ask the person to open wide.
1. First feel for the place to be injected.
Put your thumb beside the last molar tooth. (Wash your hands first!
See p. 82.) Feel the jawbone as it turns up towards the head. Rest your
thumb in the depression there.
2. Pressagainst the skin with the end of your thumb.
The skin forms a ‘v’ shape. Your needle must go into the ‘v’.
Hold the syringe on top of tooth
number 4 and aim the needle at the
Push the needle in until it hits the
jawbone, (about 3/4 of the length of
a long needle). Pull back on the
plunger of the aspirating syringe to
check for blood (page 132).
Inject 1% ml of local anesthet :ic (3/4 of a cartridge).
Try to feel your way: If you hit bone too early, pull the needle part way
out and move it over so that it points more toward the back of the mouth.
Try again.
If you do not hit bone, the needle is too far back. Pull it part way out,
and point it more toward the front. Push it in again.
3. Give a second injection BESIDE the back teeth.
If you are going to fill or remove a back
tooth, inject beside that tooth, where the cheel,
joins the gum.
Inject l/2 ml of local anesthetic (l/4 of a
This injection is not needed for front teeth.
It is enough to block the main nerve.
4. Wait 5 minutes for the tooth to become numb.
Take time with children
1. Put some topical anesthetic on the gum before you inject. But be
sure the gums are dry in that place. If you wipe the gum with cotton,
the topical anesthetic will stay on longer. Give the anesthetic time to
work: wait a minute before injecting.
If you do not have topical anesthetic, try
using pressure. You can use ‘pressure
anesthesia’ whenever you have to give an
injection in a sensitive place, like the roof
of the mouth.
Wind some cotton around the end of a matchstick. Press firmly for a minute behind the bad
tooth. Then inject quickly into the depression
that formed where you pressed.
2. Be sure the anesthetic is warm when you inject it. Hold the cartridge
or bottle in your hands for a few minutes before you use it.
3. Use a new, sharp needle.
4. Have someone pass you the syringe out of sight of the child. Then
the child will not have to look at it and be frightened.
5. Be ready to stop the child from grabbing the syringe.
6. Inject the anesthetic slowly. Do not hurry, A too-quick injection can
cause sudden pressure, which hurts and frightens the child.
Before you begin treatment, test the tooth and gums to be sure that
they are numb. Wait 5 minutes for the anesthetic to start working. Ask
the person how his lips feel-they should feel ‘heavy’ or numb. Then test
the area.
Poke the gums between the teeth with a
clean probe.
Watch the person’s eyes-you will see if
you are hurting. If the person still feels
pain, stop. Think about your injection
technique, and inject again.
After you fkish treatment, always talk to the person about what you
have done. Tell the person what to expect, and how to be careful with the
numb area of the mouth:
The area will feel normal again in about 1 hour.
0 Do not bite or scratch the area *while there is no feeling.
Do not drink anything hot. It can burn the skin inside the mouth.
With a child, always place a ball of cotton between the teeth on the
side where you injected. The child should leave it there for 2 hours, until
the area feels normal again. Tell Mother that, and give her a bit of extra
cotton to take home. It is much better for the child to chew cotton
instead of the numb lip or cheek!
Try not to hurt anyone. You can treat a
bad tooth easier, faster, and with&t pain
if you inject loyal anesthetic slqwly and
carefully ikto the right place.
Cement Fillings
When someone’s tooth hurts, you do not always need to take it out.
There may be a way to treat it and keep it. Always ask yourself whether
a bad tooth really needs to come out.
This chapter is about filling cavities.
Cavities are the holes that tooth decay
makes in the teeth.
From this chapter, you can learn:
When to fill the cavity, or when to
take out the tooth
How to place a temporary
Do not fill a cavity if you think there is an abscess
in the tooth. Look for these signs of an abscess:
The face is swollen.
0 There is a gum bubble (p. 72) near the root of
the tooth.
The tooth hurts constantly,
person tries to sleep.
even when the
The tooth hurts sharply when you tap it.
An abscess occurs when germs from tooth decay start an infection on
the inside of the tooth, If you cover up an abscess with filling material,
it will make the problem worse. Pressure builds up inside the filled tooth,
causing even more pain and swelling.
If a tooth has an abscess, take it out (see the next chapter), unless you
can give special nerve treatment (root canal treatment).
You can fill a cavity if the tooth does not have an abscess.There is not
yet an abscess if:
there is no swelling of the face or gums
near the bad tooth.
the tooth hurts only once in a while-for
example, if it hurts only after f )od or
drink, or when breathing cold air.
probably no abscess.
the tooth feels the same as the others
when you tap against it.
The decay is deep enough for the nerve to
feel temperature changes, but not near enough
to the nerve to be infected. So there is not an abscess.You can save the
tooth by filling the cavity as soon as possible.
What a Filling Can Do
A filling can help a person in three ways:
It stops food, air, and water from entering the cavity. This will stop
much discomfort and pain.
It stops the decay from growing deeper. This can prevent a tooth
It can save the tooth, so the person can use it for many more years.
A permanent filling is made to last for many years. To place one requires
special equipment and skills. An ,experienced dental worker can shape the
cavity with a dental drill so it can hold the filling material better (see
pages 145-146).
A cement filling is a temporary filling. It is meant to last only for a few
months. It helps the person feel more comfortable until it is possible to
get a permanent filling.
Replace a temporary filling with
a permanent filling as soon as possible.
This chapter shows how to place cement fillings only, for most readers
do not have the expensive equipment needed to make permanent fillings.
But remember that many people can benefit from the extra time that a
temporary filling gives them before they get a permanent filling.
A cement filling is often the first step to saving a tooth.
In many places, government medical stores can provide most of the
instruments as well as cement filling material. If this is not possible, a
dentist may be able to help you to order what you need.
Most dental instruments look alike, but the small 2nd of each instrument
is shaped to do a special task. Try to get instruments similar JO these and
keep them in a kit.
(explorer .)
(cotton pliers)
(spoon excavator ,)
filling tool
(filling instrument)
mixing tool
(cement spatula)
Some instruments have more than one name. The second one, in ( ),
is the proper name. Use the proper name when you order.
Cement Filling Material
Many companies make temporary filling material. The names on the
packages are different. This makes it hard to know which one to order.
However, the basic material of each product is the same-zinc oxide and
oil of cloves (eugenol). To save money, order these two main ingredients
in bulk, instead of an expensive kind of cement filling material.
Oil of cloves is a liquid.
Zinc oxide is a powder.
You may be able to buy a special kind of zinc oxide powder called
I.R.M. (Intermediate Restorative Material). Fillings with I.R.M. are stronger
and harder, so they last longer. But it is more expensive than zinc oxide.
your syringe, needle,
and local anesthetic
(in case a tooth hurts)
oil of cloves
(eugenol) and
zinc oxide
Your instruments:,
mirror, probe,
tweezers, spoon,
filling tool,
mixing tool
lots of
smooth glass to
mix cement
a cement filling, follow these 6 steps (pages 140-I 44) :
1. Keep the cavity dry.
2. Lift out some, but not all, of the soft decay. (If the tooth hurts,
inject local anesthetic.)
3. Mix the cement.
4. Press the cement into the cavity.
5. Remove the extra cement from around the cavity and the tooth.
6. Explain things to the person.
1. Keep the cavity dry. The cavity and the area around it must be dry so
you can see what you are doing. Just as Important, cement stays longer
inside a dry cavity.
Place cotton between the cheek
and gums to keep the area dry.
Put some cotton under the tongue
when you work on a lower tooth.
Use whatever kind of cotton you
have: gauze, wool, or even rolls.
Change the cotton whenever it
becomes wet.
Keep the cavity dry while you work.
Wipe the inside of it every now and
then with a bit of cotton.
Then leave a piece of cotton inside
the cavity while you mix the
2. Lift out some of the decay. You do not need to remove all of the decay
on the bottom of the cavity. You can leave some, as long as you cover it
with cement. If you try to dig out all of the decay, you might touch the
nerve. Try to cover the decay so it stops growing.
However, you must remove all of the decay from the edge of the cavity.
Otherwise, germs and food can go between the cement and the cavity and
keep the decay growing inside.
Scrape clean the walls and the edge of the cavit;. If you find that the
edge is thin and weak, break it deliberately with the end of your
instrument. That makes for stronger sides to hold onto the cement.
Use the spoon tool and lift out soft decay from inside the cavity. 90 not
go too deep. Make the cavity just deep enough to give thickness and
strength to the cement. If the tooth hurts when you do this, stop and
inject some local anesthetic. Use cotton gauze to collect the bits of decay
so that the person does not swallow them.
Use your mirror and look closely around the edges of the cavity for
decay that you may have missed. Put some cotton inside the cavity and
leave it there while you mix the cement.
3. Mix the cement on a piece of smooth glass. Place separately onto the
glass a pile of zinc oxide powder and a few drops of eugenol liquid.
Pull a small amount of the powder to the liquid with the mixing tool
and mix them together. Add more powder in this way, until the cement
mixture becomes thick.
Suggest/on: Practice with the cement ahead of time. You can then find out the time
it takes to become hard.
Cement is much easier to use when it is dhick and not
too sticky. Roll a bit between your fingers. If the
cement sticks, it is not yet ready. Add more powder
and then test again.
Now take the cotton out of the cavity. Check to be sure the cavity is
dry. If the cotton around the tooth is wet, change it.
4. Presssome cement into the cavity. Put a small ball of cement on the end
of your filling tool. Carry it to the cavity. Spread it over the floor of the
cavity and into the corners.
Then add another ball of cement, pressing it against the other cement
and against the sides of the cavity.
Decay stops growing only when the
cement covers it completely and tightly.
Keep adding cement until the cavity is over-filled. Smooth the extra
cement against the edge of the cavity.
If a cavity goes down between two teeth, one other step is necessary.
You need to take care that the cement does not squeeze and hurt the gum.
Before you spread
the cement, place
something thin
between the teeth.
You can use the soft stem
from a p.slm leaf, a toothpick,
or a tooth from a comb. Be
sure it has a rounded end to
prevent damage to the gums.
6. RemovI~the extra cement before it g@tstoo hard. Pressthe flat side of
the filling tool against the cement and smooth it towards the edge of the
As you smooth the cement, shape it to look like
the top of a normal tooth.
This way, the tooth above or below it can fit
against the filling without breaking it.
After you take out the stem or toothpick
(p. 1421, smooth the cement. Gums stay healthier
when the cement beside them is smooth.
Cement that sticks out and is not smooth can hurt
the gums. It can also later break off. When that
happens, spit and germs are able to go inside and start the decay growing again.
It is also important to look closely around the tooth for loose pieces of
cement and to remove them before they make the gums sore.
Use the end of your probe. Gently reach
into the gum pdcket’and lift out any pieces
of cement caught there.
Wipe off your probe with cotton gauze
each time.
Now remove all the cotton and ask the
person to gently close the teeth. The teeth
should come together normally and not hit first against the cement filling.
Too much pressure against the cement filling will crack and break it.
Always check to see if part of the filling is high:
(1) If the cement is still wet, you can see the smooth place where the
opposite tooth bit into it. Scrape the
cement away from th$ place.
(2) If the cement is dry, have the person
bite on a piece of carbon paper. If there
is too much cement, the carbon paper
will darken the cement. Scrape away
If you have no carbon paper,
that extra cement.
darken some paper with a pencil.
The person must not leave your clinic until the
filled tooth fits properly against the other teeth,
6. Explain things to the person. Explain how to look after the filling so it
will not break:
Do not eat anything for 1 hour-let
the cement get hard and strong.
Try not to use that tooth for biting or chewing. Until there is a
permanent filling, the cement and sides of the cavity are weak. They
cannot take much pressure.
If the tooth hurts more after you place the cement filling, there is
probably an abscess.Take out the tooth. If you cannot take out the tooth
immediately because of swelling, take out the filling to relieve the pressure,
and take out the tooth after you treat the swelling (p. 87).
You do not need to boil your cement filling instruments.
boiling can weaken the small pointed ends.
In fact,
First scrape the dried cement from the filling ano mixing tools. Then,
after you scrub them with soap and water, leave them for 20 minutes in
disinfectant (see page 85), Finally wrap the instruments together in a clean
cloth so they are ready for use when you need them again.
A cement filling is only a temporary measure. A good one
can last up to 6 months, During this time, the person must
see a dental worker who has the equipment to put in a
permanent filling, For this, the person may have to travel
to the city, or wait for the dental worker to visit your area.
This chapter has shown how to place a temporary filling. Remember that
within a few months, the person needs to replace this filling with a
permanent one. This book does not give full instructions for placing
permanent fillings, because most readers,of the book cannot buy the
dental drill needed to make them. In a later book, we hope to give not
only instructions for placing a permanent filling, but also ideas for
constructing simple dental drills using low-cost local resources.
Some Simple Dental Drills
We use a dental drill to remove
all decay from a cavity and to
change the shape of the hole in the
tooth so it can firmly hold the
permanent filling material. The
most expensive drills use electricity,
but some dril Is are powered by
people instead of electricity.
Village dental workers in the mountains
of western Mexico use bicycle power to
make compressed air, which runs a highspeed diill.
Local young people or family members
volunteer to pump the air while they
wait to have their own teeth fixed.
In India and Guatemala, health workers
use a foot treadle to power a drill, the
same way they operate a sewing
machine. This kind of drill is slower
than a compressed-air drill, and the
grinding produces a lot of heat, so one
must take care not to let the tooth get
so hot that it kills the nerves (see p.
146). Still, this is one of the simplest
and cheapest ways to place a permanent
There are many other excellent ideas for simple, low-cost dental drills.
Some are lightweight, so you can carry them to remote areas, Please write
to the Hesperian Foundation if you know of a design for a low-cost drill.
We will use these ideas in the next book. We also will answer letters from
those interested in ways to make or buy inexpensive drilling equipment.*
*Some simple but strong portable equipment has been made for use in remote areas by the
National School of Dental Therapy, 710 . 15th Ave. E., Prince Albert, Saskatchewan S6V 7A4,
!iow a Dental Drill Works
it is essential that you learn how to
make permanent fillings from a person who has experience using a dental
Even if you have the equipment,
The drill is sharp. The ones powered
by compressed air move at high
speed, which makes it easier to dig
out all of the decay and shape the
hole. Some drills spray water Jn the
tooth to keep it cool. Cooling is
especially important with a slower,
treadle-powered drill, An assistant
can spray water on the tooth if the
dri I I does not have a sprayer.
As the drill moves slowly back and forth,
it opens the cavity further. This makes
it easier to see all of the decay. The
decay is later removed with a spoon
instrument (p. 139).
The drill also changes the shape of the
cavity. The hole in the tooth is shaped
so that it will keep the permanent
filling material in place.
When all of the decay is removed, the
dental worker will place a paste
containing calcium hydroxide into the
deepest part of the cavity. This paste helps to separate the final filling
from the nerve, so the filling will not cause pain.
The filling material, which is
made of metal or plastic,
must be very strong. It must
not break apart when the
person chews food or when
saliva washes over it.
Unfortunately, the best kinds
of filling material often
require special instruments
to prepare
and place them
in the cavity.
1 Taking Out a Tooth
Not every painful tooth needs to come out. Sometimes it is possible to
prevent such a final step. You must decide how serious the problem is,
and then decide iF you can treat and save the tooth. Some problems-such
as root canal treatment for a tooth with an abscess, or wiring for a loose
the skills of an experienced dental worker. Even if you
cannot treat every person, a more experienced worker can help you by
taking care of the more difficult tooth problems.
Remove a tooth only when it is necessary. Here are three reasons to
take out a tooth:
It hurts all the time (or if the pain starts by itself, often waking the
person at night)
It is loose and hurts when you move it.
It has a broken root (p. 90) or a broken top with an exposed nerve.
It is important
to learn from another person, not just from a book. Find
an experienced dental worker who can show you how to take out a tooth
and who can then watch you as you try it yourself.
Before You Begin: Ask Questions!
Before you take out a tooth, you need to learn about the person’s
health. Tell the person what to expect, and then ask:
Do you bleed a lot when your skin is cut? (If so, you may bleed a
lot when your tooth comes out.)
Do you have swollen feet and difficulty breathing? (You may have
heart disease.)
Do you have any allergies? (You may be allergic to some medicines
we give when we take out a tooth.)
Are you a diabetic? (If you have diabetes, your wound will take a
long time to heal.)
If the person answers “yes” to any of these questions, you must take
special precautions. See the next page.
A person who bleeds a lot must know how to prevent bleeding
afterward. Explain very carefully the steps given on page 155. You may
also want to place a suture (p. 155) to hold the gums tightly together.
Persons with heart disease often take medicine called anticoagulants
that do not allow the blood to clot normally. Ask what medicine the
person takes. Heparin is an example of an anticoagulant. 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 (3.6~~) of local anesthetic. The epinephrine inside the anesthetic
can harm a weak heart. (Set! p. 131, #2).
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.
A diabetic’s wound may become infected. Watch carefully the place
where you took out the tooth and give antibiotics (page 88) if an
infection begins.
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.
l 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.
l 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.
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 the top of page 149.
When you order, use the proper name. Many companies use numbers to
describe the instruments, but a different company may use a different
number. If you use the proper name along with the number given here,
most companies will understand what you want.*
*All of the instruments in this chapter are available at low cost from: ECHO, 4 West Street,
Ewell Surrey KT17, llJL, England. (See p. 173.)
The Four Basic Instruments
You can take out most teeth with these 4 instruments:
A spoon
or probe , . .
. . . an
elevator . . .
. . . and two forceps
upper universal
Use this to
separate the
gum from the
An elevator
will loosen
a tooth, or
lift out a
broken root.
lower bicuspid
Use forceps to pull out the tooth.
There is one for upper teeth and
one for lower teeth.
Other forceps can be useful, especially for taking out a strong back
tooth. They have pointed beaks that are made to fit between the roots
of a back molar. As a result, you can hold onto the larger tooth better.
lower molar
‘hawk’s bill’
17 right
18 left
upper molar
Curved elevators are good for taking out broken roots. You can force
their pointed ends more easily between the root and the bone that is
holding it.
Crycrs elcvJors
Unfortunatel,y, forceps and elevators are expensive. If you want to
order more than the 4 basic instruments (p. 149), remember the cost.
Work wherever it is light and bright. You must be able to see what
needs to be done. Sunlight or light from a lamp is usually enough. Use a
dental mirror (p, 139) to direct more light into the mouth.
Use a chair that has a back high enough to support the person’s head.
Think about how you can stand and work the most easily:
To take out a Ic wer tooth,
you need to push down and
then pull up.
To take out an upper tooth,
you need to push up and
then pull down.
So the person should be
sitting down low.
So the person should be
sitting up high.
If you stand on a box,
he will be lower,
If he sits on cushions,
he will be higher.
Once you are certain which tooth must come out, decide which
instruments you will need. Lay them out ahead of time on a clean cloth:
a syringe,
needle, and
local anesthetic --/+f
an elevator -db
spoon instrument
Before you touch your instruments, be sure your hands are clean. Wash
with soap and water. Be sure, also, that your instruments are clean. See
pages 82 to 85. Prevent infection-keep clean!
To take out a tooth, follow these 8 steps
Explain what you are going to do.
Inject local anesthetic.
Separate the gum from the tooth,
Loosen the tooth.
Take out the tooth.
Stop the bleeding.
Explain to the person what to do at
home to look after the wound.
8. Help the person to replace the
tooth with a false tooth.
1. Always begin by talking to the person. Explain why you must take out
a tooth (or teeth) and tell how many teeth you will take out, Begin
working only when the person understands and agrees,
2. Inject some local anesthetic slowly, in the right place. Remember from
Chapter 9 that the injection for a lower tooth is different
injection for an upper tooth.
from the
Wait 5 minutes for the anesthetic to work, and then test to be sure the
tooth is numb. Be kind-always test before you start. If the persbn still
feels pain, give another injection,
3. Separate the gum from the tooth. The gum is attached to the tooth
inside the gum pocket. Separate the gum and tooth before you take out
the tooth. If you do not, the gum may tear when the tooth comes out.
Torn gums bleed more and take longer to heal.
Use this
or this
Slide the end of the instrument along the side
of the tooth into the gum pocket. At the deepest
part of the pocket, you can feel the place where
the gum attaches to the tooth.
Push the instrument between this attached part
and the tooth. Then separate the tooth from the
gum by moving the instrument back and forth.
Front Side
Do this on both the cheek side (outside) and
the tongue side (inside) of the tooth.
The attached gum is strong, but it is also thin.
Control your instrument carefully so that it only
cuts through the part that is attached to the tooth.
Do not go any deeper.
Back Side
4. Loosen the tooth. A loose tooth is less Ii kely to break when you take it
out. Before you take out a strong tooth, always loosen it first with a
straight elevator,
Caution: if you do not use it properly, a straight
elevator can cause more harm than good.
It is important to hold a
straight elevator properly.
Place your first finger against
the next tooth while you turn the
handle. This will control it.
Remember that the sharp blade can
slip and hurt the gums or tongue.
The blade goes between the bad
tooth and the good one in front of
it. Put the curved face of the blade
against the tooth you are removing.
Slide the blade down the side of the
tooth, as far as possible under the
Turn the handle so that the blade
moves the top of the bad tooth
bat kward.
Put pressure on the bone, not the tooth
beside it. Do not loosen the good tooth!
5. Now, take out the tooth. Push your forceps as far up the tooth as
possible. The beaks of the forceps must hold onto the root under the
Use your other hand to support the bone around the tooth. Your
fingers will feel the bone expanding a little at a time as the tooth comes
free. With practice, you will be able to decide how much movement the
tooth can take without breaking.
To decide which way to move a tooth, think about how many roots it has.
If a tooth has 1 root, you can turn it.
If a tooth has 2 or 3 roots, you need to
tip it back and forth.
/ -I’
Take your time. If you hurry and squeeze your
forceps too tightly, you can break a tooth.
Removing a tooth is
like pulling a post
out of the ground,
When you move it back and forth a
little more each time, it soon
becomes loose enough to come out.
Back teeth usually come
out toward the cheek:
Front teeth come
straight out:
When you remove lower molars with the lower molar ‘cow-horn’ forcep,
you use it in a different way:
Fit the points under the gum, between
the tooth’s roots.
Squeeze the handles gently and move
them up and down, then side to side.
This will force the points of the forcep
further between the roots and lifts the
tooth up and out.
Note: some lower molars come out
toward the tongue,
Warning: Do not use the
‘cowhorn’ forcep to take
out a baby molar. Its points
can damage the permanent
tooth growing under it.
When the tooth comes out, look carefully at its roots to see if you have
broken any part off and left it behind. Whenever possible, take out broken
roots so that they do not cause infection later inside the bone.
6. Stop the bleeding. Squeeze the sides of the socket (the hole that is left
after you take out the tooth) back into place. Then cover the socket with
cotton gauze and ask the person to bite firmly against it for 30 minutes.
A child should bite firmly on the gauze for 2 hours. See p. 136.
Whenever the gums are loose, join them together. To stop the bleeding
and heal the wound, you must hold the gums tightly against the bone
under them.
When you remove two or more teeth in a row, it is a good idea to join
the gums with a suture (needle and thread). If you need more than one
suture, place the first one nearest the front of the mouth and work toward
the back.
The needle and thread you use must be sterile.
Boil both for twenty minutes. See page 64.
You will need an instrument
scissors to cut the thread.
to hold the needle firmly
(hemostat) and
A. Pass the needle through ,the loose gum-the one you can move most
easily. Then pass it through the more firmly attached gum.
If the looser gum is on the outside, you will
bring the needle toward the tongue. Protect the
tongue with a tongue blade or your dental
You must suture both the upper and the lower
gums in this way.
After this you must tie two knots and cut the
thread. See the next page.
B. Pull the thread until about 4 cm. of thread is left loose on the starting
Wrap the longer end of thread 2 times around the
beaks of the needle holder.
Then grab the shorter free end of the thread with
the tip of the needle holder. With the needle in
your fingers, pull the needle holder in the opposite
direction. The thread will slide off the beaks and
form the first knot.
Tighten the knot onto the side of the wound, not on top of it.
C. Tie a second knot, to keep the first one tight.
Wrap the thread once around the beaks of the
needle holder.
Grab the free end with the tip of the needle holder
as you did before. Pull the two ends in opposites
directions. The second knot will form over the
first knot.
D. Cut the threads so that about l/2 cm. is left free. If the ends are too
long, they will bother the person’s tongue. If they are too short, the
knot may come open,
Then cover the area with cotton gauze. Tell
the person to:
bite against the cotton for 1 hour to stop
the bleeding
return in 1 week for you to remove the
There is a special kind of suture material that disappears by itself, which
is good to use because the person does not have to return for you to
remove sutures. Unfortunately, it is expensive. If you cannot afford it,
use sewing thread and remove it 1 week later.
7. Explain to the parson what you have done, and what to do at home to
look after the wound. Remember that her mouth is numb, so she cannot
feel what is happening.
Taking out a tooth is like a small operation. There will be bleeding and
later some pain and swelling. This is normal and should be expected. Tell
the person this. Then give the following advice:
Bite firmly on cotton gauze for an hour, and again later if blood
comes from the socket.
Always give the person some extra cotton gauze to carry
home, in case bleeding starts again later.
Show her how to use the cotton gauze.
Take an aspirin for pain as soon as you need it, and then one every
3 or 4 hours. See page 88.
Keep your head up when you rest. This
reduces bleeding because it is harder for blood
to flow uphill. It also hurts less.
Do not rinse your mouth. In some places
people believe they should immediately rinse
with salt water and spit a lot after a tooth comes out, but this is
harmful! It is important for the blood clot to stay inside the socket
and not wash away.
Do not drink hot liquids Ii ke tea or coffee, because they encourage
bleeding. However, cool liquids are good for you. Drink a lot of water.
Continue to eat, but be sure the food is soft and easy to chew. Try to
chew food on the side opposite the wound.
Keep your mouth clean. Start on the second day and continue until
the socket is well. To do this, rinse your mouth with warm salt water
(p. 7) and keep your teeth clean (pages 67-701, especially the teeth
near the socket.
False Teeth
After a tooth comes out, it is a good idea
to replace it with a false tooth. If you do
not, the other teeth soon start to shift
into the open space.
This weakens the bone around their
roots. After some years, they too become
loose and sore, and they have to be taken out.
When you take out a tooth, it is like removing a brick from the center
of a wall. The area around the space becomes weaker and begins to
To prevent this, a plastic tooth can fit into the space. This tooth is not
for chewing food but to hold the remaining teeth in their normal, healthy
A full set of teeth allows a person to chew the foods needed to stay
healthy and feel good. Moreover, teeth help you look good!
A person without
many teeth looks
With a new set
of plastic ‘false
teeth’, the same
person looks and
feels much younger.
This book does not show how to make false teeth. In a later book, we
hope to give instructions for false teeth, dentures, and permanent fillings
(see page 145). If possible, after you take out a tooth, encourage the
person to replace the tooth with a plastic tooth. Find out where they are
made and how much they cost. Then explain:
how to clean the remaining teeth to prevent them from going bad
(pages 67-701, and
* how it is possible to get a replacement plastic tooth.
Sometimes a problem develops even though you have tried to becareful.
Give help whenever you can. If you are not able to help, refer the person
to a doctor or dentist as soon as possible.
Broken Roots
If you can see the root, try to remove it. If you leave a broken root
inside the bone, it can start an infection.
Removing a broken UPPER root. Use your straight elevator. Slide the
blade along the wall of the socket until it meets the broken root.
1. Force the blade between
the root and the socket.
: I
4 t
3. Move the root ,further
until it is loose.
2, Move the root away
from the socket wall.
4. Grab the loose root and
pull it out.
Use a straight elevator (or a curved
elevator if you have one). If the broken root is from a molar tooth, slide
the blade into the socket beside the broken root.
Removing a broken LOWER root.
the root and the socket.
3. Move the root away
from the socket wall.
4. Grab the loose root and
It is better to leave a small broken root inside
week or so, it will Ioosen itself and be easier to
Root Pushed Into the Sinus
An upper root that seems to disappear may have gone into the sinus
(p, 89). Do not try to find it. Instead, cover the socket with cotton gauze
and send the person to the hospital. A special operation is needed to open
the sinus, find the root,.and take it out.
Ask the person not to blow his nose. That forces air through the
opening and prevents it from healing.
Bone Chips and Tags of Flesh
Small pieces of bone that Ii
and delay healing.
Gently reach into the socket with the end of an
elevator or spoon instrument. Feel for the
piece of bone and carefully lift it out.
Give local anesthetic if needed.
When you are finished, ask the pers
bleeding stops.
Small tags of flesh are not s
y bother the person. Hold the
le scissors carefully to cut the
Rinsing with warm
do not rinse for th
Hold a cloth wet with cold water against the face. This helps to prevent
swelling. This is a good thing to do if the tooth was hard to take out, or
if it took a long time.
If there already is swelling, heat against the face will help to reduce
swelling, Hold a cloth wet with hot water against the swollen area, 30
minutes on and 30 minutes off, Be careful not to burn the skin!
A large swelling usually means there is an infection, The person needs
additional treatment, See page 110.
, ,,:,,
/ ‘,,,$,,‘2
-1,’ ;.: 5, ,, /f
-/j/I./ The
socket area often hurts for a day or so after the tooth has been
removed. Aspirin (p. 88) is usually enough to relieve the pain.
A strong, steady pain that lasts for several days is a sign that the person
is having a problem called dry socket. The treatment for this special kind
of problem is given on page 111.
Dislocated Jaw
When you press against a person’s jaw while taking out a tooth you can
sometimes dislocate it. The jaw has been pushed out of position and it is
not able to go back again.
We describe the care for a dislocated jaw on page 107.
Most important:
Be sure to tell each person you treat:
“If your problem gets worse,
you can come back to see me immediately!”
If your instruments are dirty, they can pass on germs that cause tetanus
(page 112) or hepatitis (see page 172 in Where There /s No Doctor).
Germs on dirty instruments can also go into the socket and start an
Dental instruments must be not only clean, but also sterile. This means
they need to be hot!, scrubbed and then boiled before they can be used
again. See pages 82 to 85.
Use a brush and clean each
instrument with soap and
Be careful to scrub away
all bits of old dried blood.
Then kill the germs
by placing the
instruments into a
coveredpot of
boiling water for
20 minutes.
Keep your sterile instruments together in a clean place.
Wrap them in a
Mark with tape the names
of the instruments inside.
Leave them in dXnfectant
(See p. 85)
Before you use any instrument
again, wash it with clean
water-to remove the taste
of the disinfectant.
Germs living in dirty cotton can easily go inside the socket and start an
infection. It is important, therefore, to keep the cut pieces in a container
that is clean and has a cover. Use clean tweezers to remove the cotton
gauze when you need some.
Also, keep your room and work area clean. Sweep the floor every day,
and wipe down the chair and tables as often as possible.
1 Staying clean is a part of staying healthy. 1
After you have read Chapters l-l 1, you will want to use pages 163195 for reference-to return to later and read when you want to find
information quickly.
Pages 163-l 73:
The Dental Kit
Medicines. . . . . . . . . . . . . . . . . . . . . . . .164-165
Instruments . . , . . . , . . . . . . . . . . . . . . . 166-171
Supplies. . . . . . . . . . . , . . . . . . . . . . . , 172-173
Pages 174-l 76:
Records, Reports, and Surveys
Pages 177-l 79:
Story Telling: An example about pregnancy
Story about pregnancy and dental care . . . . 177-l 78
Dental care for pregnant women . . . . . . . . . . 179
Pages 180-l 81:
Dental Health Teaching Materials
Pages 182-l 86 :
Pages 187- 192:
In the next 10 pages, 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 wil! 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.
On pages 164 to 169 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
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.
Proper Name
Local name
(write in here)
Amount you need Amount to
in 3 months
keep in kit
1. aspirin,
300 mg tablets
2. acetaminophen
500 mg tat lets
1. penicillin,
250 mg tablets
2. erythromycin,
250 mg tablets
smal I tubes
or bottles
small tubes
or bottles
3. nystatin,
creme or
Another antibiotic, tetracycline, is not recommended for any of the
treatments in this book because it is a broad-spectrum antibiotic. Narrowspectrum antibiotics (see ‘antibiotics’, p. 182) are usually safer and just as
effective for most dental problems. If you do use tetracycline, read page
353 of Where There Is No Doctor and remember, do not give tetracycline
to a pregnant woman or to a young child. Tetracycline can make a young,
developing tooth turn yellow.
1. Compare prices before you buy medicines. Often the same medicine
has many different names. The generic name (the name we use on this
page) usually is cheapest, and the medicine is just as good as the ‘brandname medicines’, Use the generic name to order and buy, not the brand
2. 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.
3, Be careful to give the correct dose. Read the next two pages
carefully, as well as the ‘Treatment’ section of each problem in Chapter 7.
If pages 165 and 166 are not clear to you, read Chapter 8 (pages 59 to 64)
of Where There /s No Doctor.
4. For serious infections or serious pain, see page 166.
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 like aspirin (300 mg tablets) or acetaminophen (500 mg tablets)
can be broken up into smaller tablets:
Four times a day:
Adults take
2 tablets
Children 8-l 2
take 1 tablet
Children 3-7
take l/2 tablet
Babies take
only, l/4 tablet
Notes: 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 a 30 mg tablet
of codeine.
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 (p. 186) 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 iniections. 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 , . .
difficulty breathing
cool, moist, pale, gray skin (cold sweat)
loss of consciousness
weak, rapid pulse (heartbeat)
. . 1 immediately inject epinephrine: l/2 ml for adults or l/4 ml for
children, For more information on allergic shock, see Where There 1s No
Doctor, pages 68 to 72.
Always give the full dose of penicillin or any antibiotic, even if the
person feels better. See page 88 for the correct dose of penicillin or
erythromycin in 250 mg tablets. Erythromycin also comes in liquid form.
It has 125 mg in 5 ml, so 10 ml of liquid (about two large teaspoons) is
the same as one tablet.
It is important to take a strong first dose of penicillin or erythromycin,
and then smaller doses four times a day for 3 to 5 days after that.
Carefully read the instructions on page 88.
It is always safer to take medicine by mouth.
Sometimes, however, an infection is so bad that
// II \’
’ / 1 \ \ ‘\
you need to give medicine by injection. Learn
) I 1; ’\ ‘\ A ‘\
how to give injections from an experienced
&r’ 1 IL 2 2& 3
health worker. The injections described on this
page are not like the anesthetic injections in
3 ml syringe
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 two kinds of penicillin to inject.
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.
Amount you need
in 3 2xO
Amount to
keepin kit
Child 6-12
years old
Child l-6
years old
bottle with
300,000 units
per ml
2. crystalline
bottle with
units per ml
3 ml
1 l/2 ml
II2 ml
Local name
(write in here)
Amount you need
in 3 months
Amount to
keepin kit
6 packages
of 100
20 pieces
10 packages
of 50
a roils
50 ml
1 small
4. zinc oxide
500 grams
1 small
To harden
5. fluoride
50 ml
1 small
To give
of local
6. lidocaine 2%
1.8 ml cartridge
8 boxes
of 100
8 boxes
of 100
need ies
Pro er Name
-+--1. clean
cotton gauze
2. clean
cotton rolls
3. oil of
7. disposable
needles, 27
gauge, long
8. lidocaine
You can use a solution
of fluoride
and water (above, number 5) in two ways:
To treat a sensitive tooth, make
To help prevent cavities, especially in
this concentrated
above). Mix:
children, make a solution of fluoride and
water using sodium fluoride powder. Mix 2
grams of the powder with 1 liter of water.
Then, once a week, take a mouthful and rinse
for 60 seconds with teeth closed together,
‘washing’ every surface of every tooth. Then
spit it out-do not swallow the fluoride water,
Also, do not eat or drink for 30 minutes,
(see box
500 tablets sodium fluoride
(1.1 mg each) in 59 ml of water
1 gram of sodium fluoride
powder with 50 ml of water.
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. Wet
some cotton with the fluoride
water and rub it on the tooth. Keep
the tooth wet with fluoride water
for 1 minute. One week later, give
the same treatment again.
School is a good place to do a weekly fluoride
rinse. Students can brush each day at school
(page 571, and then on the same day each
week, they can each take a mouthful from
the liter bottle of fluoride water, On page 22
of this book, children are shown using a
twice-yearly application of a special paste, a
‘topical fluoride gel’. This is good, but the
weekly rinse is even better,for the teeth.
Weight (how heavy something is)
Volume (how full something is)
1 liter
1 cup
1 teaspoon
1000 ml = 1 liter
236.5 ml = 1 cup
1 kilogram = 1000 grams
5 ml = 1 teaspoon
1 gram = 1000 mg
1 ml = 1 cubic
centimeter (cc)
1 grain = 65 mg
To make
2. hydrogen
To keep
Local name
(write in here)
Proper Name
1. salt
Amount you need Amount to
in 3 months
keep in kit
3 liters
500 ml
12 small
1 small
Note: You can clean instruments with a homemade solution. See page 85.
To keep
8 boxes
of 50
per box
If you order your supplies in bulk long before you need them, you
probably will pay lower prices. If you have a place to store supplies that
is clean, dry, and free from cockroaches and rats, consider ordering enough
for one year instead of only 3 months.
When you are treating several people on the same day, you will
clean some instruments (see pages 82 to 85) at the same time that
are using others. Therefore, it is necessary to have several of each
instrument, to be sure that the instrument you need will be ready
or sterile) when you need it.
need to
kind of
There are three instruments you will need for each person who comes
to you, no matter which treatment is needed. They are: a mirror, probe,
and cotton pliers. Keep them together. Below we recommend that you
have 15 of each of these, so you can keep one in each treatment kit. You
do not need to buy all of these instruments. Yc u can make several of
them-see pages 170-I 72. If you like, buy only one example of each of
the instruments below, and use them as models to copy when you make
your own extra instruments.*
To examine
or to
give any
1. dental mouth
Local name
(write in here)
Pa e
3. cotton pliers
To inject
Aspirating dental
syringe (to use with
1.8 ml cartridges)
To scale
1. Ivory C-l scaler
2. Gracey 11-12
1. spoon excavator
2. filling instrument
3. cement spatula
1. spoon excavator
2. straight elevator
(no. 34)
3. upper universal
forcep (no. 150)
4. lower universal
forcep (no. 751
To place
To remove
2. explorer
Number to
Note: See pages 149-150 for recommendations
to have if you can afford them.
*If yo
#ant the help of a charitable organization
of other elevators and forceps that are good
in buying instruments, see page 173.
Here are a few ideas for making instruments at low cost. Try to use
materials that are available where you live.
Can you think of any other materials you can use?
Each instrument has two parts: a handle and a working piece at the
end. Join them together:
. . . with wire:
. . . with glue or even wax:
If you make the end flat, it can prevent the working piece from turning.
Pound the working piece with a hammer and make a flat slot in the handle
so the working piece cannot turn.
bottom of
goes in
“I am grateful to Aaron Yaschine for the ideas in this section.
Making the Three Instruments You Use Most
Mirror: Use old pieces of mirror or a shiny piece of tin. You even can use
a polished silver coin. A tongue depressor is the handle.
Probe: Use the end of a paper clip, pin or needle for the working piece.
Rub it against a smooth stone to sharpen it. Bend it so it can reach
around to the back of a tooth. Attach the working piece to a smooth
stick handle (p. 170).
Tweezers: Draw the shape on a piece of tin and then cut it out with
strong scissors. Use a file or a smooth stone to make the edges smooth.
Bend in half to make the tweezers.
Making Other Instruments and Supplies
Spoon: Bend a paper clip or needle. Flatten the end. Then pound a small
stone against the end, to make it hollow. Make 2 bends and attach to a
stick handle.
Filling Tool: Remove the heads from 2 long screws.
With a
file and
make the
end of
one screw
flat and
the end
of the other
screw round.
pieces to
a small
the face)
of the
flat side.
Dental Floss: When using string to clean between your teeth (pages 69-701,
you may have trouble getting this string down in between your teeth.
Sometimes, also, the string gets caught there,
forming a kind of ‘bird’s nest’. Three things
can cause problems with dental floss:
1. An incorrectly made filling-flat
and rough
instead of round and smooth. Replace it.
2. Teeth too tight together. Use the floss on a
tooth. Then pull the string out from between
the teeth as you press the free end down
against the gum with the fingers of your other
hand. If there is a sharp filling on a tooth, the
string will stay under it as it comes free.
3. String that is too thick, Make thinner but
stronger floss by waxing as in this picture.
The wax also will make the floss easier to
slide between your teeth.
(1) Soak thin string in hot
wax. (2) To remove the extra
wax, pull the string between
your fingers.
Buying Dental Instruments
When you do not have much money, you must spend wisely. Dental
instruments are very expensive, especially when you buy them at
commercial prices. You may want help to find the lowest prices available
to you.
The Dental Health Services Unit of AHRTAG (AHRTAG means
Appropriate Health Resources and Technologies Action Group Ltd.) may
be able to help. Write to them and tell them what you are doing and what
you need. AHRTAG can use the information to develop the right kind of
projects in other countries. In return, AHRTAG possibly can give you
good advice to help you buy or make your own low-cost dental
equipment. Their address is:
85 Marylebone High Street
London WI M 3DE
There are many organizations that collect health supplies, including
dental instruments. Some prefer to help church-sponsored health projects,
but others will provide instruments at reduced cost to whoever needs them.
One of the best of these organizations is ECHO. They can provide any of
the instruments mentioned in this book, They also sell at lower than
commercial prices. For example, for the four instruments at the bottom
of page 169 for removing teeth (excavator, elevator, upper forcep, and
lower forcep), ECHO’s 1983 price is E17.98, or about 28 U.S. dollars.
Write to them with a list of the instruments you need:
4 West Street
Ewell Surrey KTI 7 1 UL
Other organizations who may be able to help are:
MAP International
P.O. Box 50
Wheaton, I L 60187
International Human Assistance
360 Park Avenue, South
New York, NY 10010
Operation California
336 Foothill Road
Beverly Hills, CA 90210
Direct Relief Foundation
P.O. Box 30820
Santa Barbara, CA 93105
For record keeping, you can divide the
mouth into 4 parts:
Upper Right (UR)
Upper Left (U L)
Lower Left ( L L)
Lower Right (LR)
In each part there are 8 teeth (fewer in
children-see p. 41).
Here are the short names of 4 teeth,
Can YOU find the tooth named LLS?
You can call each tooth by its short name,
U R3.
Keep a record of each
person you see. Write
some brief information
about the person and the
problem. This way, if the
person returns, you
remember what you did
to help.
When a person needs to come more than once to take care of a problem,
it is better to keep a special record for that person. With all the treatments
on one page, you can follow that person’s progress more easily. Below is
an example for a person named Yupere. Yupere has a bad tooth that has
hurt from time to time for 2 months. One day when he woke up, his face
was swollen. Yupere decided to wait a day to see if the swelling would go
away, The next day it was worse, so he went to the medical post for
You need to write a report whenever you send a person for medical
help. Give as much information as possible so that your treatment can
continue and new treatment starts as quickly as possible. If you cannot
go along, always send a report with a sick person.
The sf6ry of Naime: After drinking for several hours, Naime’s husband
returned home asking for money. She had none and told him so. He did
not believe Naime, so he beat her with his hands and then a knife, Naime’s
friends carried her, unconscious and bleeding, to the aid post. The front
part of her lower jaw was hanging out of position.
It is a good idea to know how many persons in your community have
,’ ,/.*‘,
cavities and gum disease. Look in the mouths of children and adults and
,/’, ‘/ ,“,
make a record of what you see. Here is an example that is used in
, ,‘,(,‘,S I ,
, ;,r/,.+:’ ’
‘, ,$,‘;
.’,:‘A;4 ’ ’
/’,, .‘p”
Put a line through the circle for each person with:
red, swollen gums
./ ’ “,p ’
,./-t ,/,
, i;’ q
The dental workers ~,C;?!&~$~b,que do a
quick survey in 2 F~*!~~~~>?~‘*
;llothe;-andchild health cliI,‘I’~:,~~,~~:-“~~operatives or
50 persons.
They make a paper for each age
group. Each paper has 3 sections.
They make a mark for each person
they see, until all 50 circles have
marks in them. They make extra
marks if they see a tooth and/or gum
f,’ , , ’ i, ,.
/ / _I ‘,‘//
p/k,*4, q’$s
I ‘+
In this example, you can see that
children have more problems with
cavities, while adults suffer more from
gum disease. This is often true.
This survey helps the dental worker in three
ways :
(1) it shows h ow serious tooth decay and gum
disease are in the community.
(2) it shows which age group is suffering the
most. To these people the dental worker
must plan to give the most attention.
(3) it gives the dental worker something to
show the people when they are discussing
why to change sCme old habits and adapt
some new ideas.
Pregnancy and Dental care-an example
People everywhere have a tradition of teaching with stories. Many of
the things we believe, we learned through stories we heard from parents,
friends, and teachers. This is good, except when a story teaches something
that isn’t true! When a woman gets pregnant, for example, she hears many
stories, and she wants to learn whatever she can from these stories.
Unfortunately, some traditional beliefs about pregnancy are partly wrong.
An example is the belief that one must always have dental problems
during pregnancy.
Here is a story you can tell to help people see that they are partly right
about pregnancy and dental problems, but that there is more to
A Story: Bertine’s teeth
Bertine was the dental worker in her village. She was a young woman,
but the villagers respected her because she was such a careful worker, and
because she knew how to fill cavities and pull teeth without hurting
people. She also spent a lot of time teaching people how to avoid dental
problems. “Clean your teeth every day!” she often said, at her clinic, at
the schools, at vi Il;jge meetings. “Eat a mixture of foods, especially a lot
of fruits and vegetables! Avoid candy and sweet, sticky foods!”
When Bertine was 23 years old, she got
married and became pregnant. She also began to
have some tooth problems of her own. She saw
that her gums were bleeding when she cleaned
her teeth, and she had small cavities in two of
her teeth. As the dental worker, she was
embarrassed to have tooth problems, but an
older woman told her, “It’s natural to lose teeth
when you have babies, Bertine. As we say, ‘For
each child, a tooth’,”
One day Lucie, a dental worker from a nearby village, came to see her
friend Bertine. Lucie had a young baby, and Bertine asked her a lot of
questions about babies and about pregnancy. Then Bertine said, “Of
course, I’m having lots of problems with my teeth.” “Why do you say
‘of course’?” asked Lucie. “Well,” Bertine replied, “For each child, a
“But that’s not true!” Lucie cried, “You think you are having tooth
and gum problems because you are pregnant, but I bet you are having
these problems for all the usual reasons.”
“The usual reasons?” asked Bertine.
“Well, a
you still
said Lucie. “How often do you eat now that you are pregnant?”
lot more than I used to-l have two persons to feed!” “And do
eat sweet foods sometimes?” Lucie asked. “I guess I do,” said
“and more sweets than before, because I eat more often.”
“How about teeth cleaning?” asked Lucie. “Do you clean as often as
you did before you were pregnant? ” “No,” Bertine admitted, “I heard
I was going to have tooth problems anyway, and I have been so tired
lately . . . . Oh! Do you suppose that these are the only reasons I am
having these problems? How do you know so much about this, Lucie?”
“Because I had the same problems, Bertine. I learned the truth the hard
way. I had an infected tooth, and the infection passed to my kidneys. At
the health clinic, they told me it is not necessary to have tooth problems
during pregnancy-and it is even dangerous. I am lucky I did not lose my
baby! That can happen, you know, when a tooth problem is not treated.
We must fill your cavities right now.”
“You mean I can be treated now, before I have my baby?”
“Yes, and you should!” said Lucie. “And you can
:.,ke better care of your teeth. It is true that
because of the pregnancy, your gums are weaker,
and they can get infected. But this means you
should take even more care than usual to: (1) clean
regularly and (2) eat the right foods. You need to
have strength when you are pregnant. An infection
in your mouth does not help that. Because your
gums are weak, it is also good to (3) rinse your
mouth every day with warm salt water*, and if you
cannot get fresh fruits and vegetables, then (4) take
a tablet of Vitamin C every day.”
Lucie then offered to clean Bertine’s teeth and to fill her cavities. When
she touched Bertine’s gums, they bled, and Lucie said, “They will bleed at
first, but after you clean them regularly for a while, they will be stronger.
Bleeding gums are dangerous to a pregnant woman. The bleeding can
increase anemia, which is a serious problem,”
“If a pregnant woman’s tooth has an abscess, is it safe to pull it before
she has the baby?” asked Bertine. “Yes,” said Lucie, “you just must be
gentle, A woman gets tired sitting in a dental chair for a long time, and
sometimes you must give some extra anesthetic so she does not feel any
*S00page 7.
As we see from the story of Bertine and Lucie, it is possible-and good
-to treat a pregnant woman’s dental problems before she has her baby.
In two situations,
it is sometimes better to wait for the baby:
(1) Sometimes the woman’s gums become
swollen and the swelling does not go
down even after cleaning with a soft
brush and rinsing with salt water.
These swellings must bt cut away. She
should have this small operation after the
baby is born,
Train midwives to examine women’s
mouths. When they send them to you
for dental care, they can give you any
information you need.
(2) During the last month of pregnancy,
a woman may be too uncomfortable to
have her tooth taken out. Control the
infection with a 5-day course of penicillin
(p. 881, 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.
Caring for a pregnant woman-a guide for dental workers
1. Ask her how many months she has been pregnant, and find out if
she has high blood pressure. Any person with blood pressure over
15O/lOO may bleed excessively after an extraction. To get this
information, encourage all women to use the Mother and Child
2. Do not take X-rays of teeth unless absolutely necessary. X-rays
are dangerous to the unborn baby inside. Before an X-ray, always
cover the mother’s midsection with an apron lined with lead.
3. Always give a careful and complete mouth examination. Tell her
what treatment she needs and how to prevent tooth problems.
4, Be gentle. Show the woman that you care, that you want her to
be comfortable, and that you can treat her without hurting her.
In many different countries, teachers and dental workers have made
their own materials to help them teach better. Below is a list of some of
the materials we know about. We would like to improve this list. Please
write us and let us know what you are doing. We will pass along your
good ideas to others.
To receive the materials in this list, write to the addresses on the right.
A. Manuals and Noter
Available from:
1. Common Oral Diseases. A manual for
All regional offices of the World Health
health teachers about common diseases
and etnergency treatments. Now available
in English and French, Soon available in
Arabic and Spanish,
2. Dental Therapist Program. This book
outlines the content of an existing 2-year
basic dental care program for Native
people living in isolated areas of Canada,
English only.
Dr. Keith W. Davey
National School of Dental Therapy
710 - 15th Ave. E.
Prince Albert, Saskatchewan S6V 7A4
3. S&de Dendria-0
Direccgo Provincial de Salide de Sofala
lnstituto de CiGncias de SalSde da Beira
C.P. 583
Beira, Provincia da Sofala
Povo Moqambicano.
A manual for health workers, adapted
from Where There Is No Dentist, now
being field tested in Mozambique, In
4. The Good Teeth Book-How to Take
Care of Your Mouth. A manual of ideas,
especially for school teachers, In English.
5. School Health Manual. Health lessons
for primary-school teachers, IYith a
prominent section on dental health. In
6, Dental Health: A Teacher’s Guide K-12
Lesson plans for teaching dental health
in Canadian schools, from kindergarten
to Grade 12. In French and English.
The Good Teeth Book
Box 395
Wewak, East Sepik Province
Papua New Guinea
Gutnius Lutheran Church
P.O. Box 111
Wabag, Enga Province
Papua New Guinea
Health & Welfare Canada
Room 1970, Jean Mance Building
Tunney’s Pasture
Ottawa, Ontario KlA OL3
6. Slides
Teaching Aids at Low Cost
P.0, Box 49
St, Albans, Herts. AL1 4AX
2. ‘How to Take Care of Your Teeth’,
slides of the puppet show shown on
pages 27-37 and 27-38 of Helping Health
The Hesperian Foundation
P.O. Box 1692
Palo Alto, California 94302
1, Two slide sets to accompany
Oral Di#ee8ea, Script in English.
Workers Learn,
C. Flannel-baards
Available from:
‘Happiness is Healthy Teeth’. Presentation
on dental health of children-a series of
pictures to show the importance of
brushing and healthy food.
Council on Dental Health
Indian Dental Association, Audio
Visual Unit
CMC Hospital, Vellove, 630 004
‘Taking Care of Your Teeth, and Those
of Your Children’. Large drawings
showing local foods and possible ways of
cleaning the teeth. Portuguese script
DireccBo National Medicina Preventiva
Sec$o Educa@o Sanittiria
Ministerio de Satide
Maputo, Mozambique
D. Flip&arts
1. ‘Taking Care of a Small Child’s Teeth’
and ‘Improving Your Dental Health’ are
two separate poster-size sets, using
enlarged photographs. Script, in English
and Melanesian Pidgin, can be attached
to the back of each poster.
I mmanuel Hospi tat
P.O. Box 181
Wapenamanda, Enga Province
Papua New Guinea
2. Nutrition/Dental
size flipcharts using
in both English and
printed on the back
Ministry of Health
Dental Section
P.O. Box 1881, Boroko
Papua New Guinea
Flipchart. Posterphotographs. Script,
Melanesian Pidgin, is
of each poster.
3. Flipchart on dental health, in the
form of a manual (approx 35 cm x 20 cm),
for use in small groups, Discusses food
and hygiene for adults and children,
Explanation in Portuguese on the back
of each picture.
DireccBo National Medicina Preventiva
SeccZo Educac%o Sanitaria
Ministerio de Saljde
4. Dental flipcharts for mothers and
children in rural areas. Text in both
English and Bengali on back of each
chart. A booklet with further explanations
is also included,
Swedish Free Mission Dental Clinic
House 45A Road 16
Dhanmondi, Dhaka 9
Write also to these organizations-they
have a special interest in teaching aids:
1, Appropriate Health Resources and
Technologies Action Group (AHRTAG)
Dental Health Services Unit
85 Marylebone High Street
London Wl M 3DE
2, Teaching Aids at Low Cost
P-0. Box 49
St. Al bans,
Herts. AL1 4AX
3. Medical Education Unit
Faculty of Medicine
Peradeniya, Sri Lanka
4. Health Education Bureau
Kynsey Road, Colombo
Sri Lanka
5. World Health Organization
Oral Health
1211 Geneva 27
This vocabulary is listed in the order of the alphabet:
Most names of sicknesses are not in this vocabulary.
the Index and read about it in the book.
Find the name of a sickness in
There are many words in this vocabulary that are not in the rest of the book, but
you may see them in other books or hear dentists use them.
Different from what is usual,
natural, or average. Not normal.
Abscess A sac of pus caused by an infection.
For example, a boil.
Acid A strong liquid that is produced from
certain foods left in the mouth. Acid causes
both tooth decay and gum disease.
Acute Sudden and short-lived, An acute
illness is one that starts suddenly and lasts a
short time. The opposite of ‘chronic’.
Baby teeth The first set of teeth. There are 20
baby teeth, which are also called milk teeth
or primary teeth.
Bacteria Tiny germs that you can only see
with a microscope and that cause many
different infectious diseases.
Beeswax Wax made by honey bees.
The teeth between the canine teeth
and the molars; premolars.
Bite (I 1 To cut with the teeth. (2) The way
the upper and lower teeth fit together when
they close.
Blood pressure The force, or pressure, of the
blood flowing through the blood vessels
(veins and arteries).
Blood vessels Tubes that carry blood through
the body. Veins and arteries.
Also called epinephrine. A drug
which stimulates the heart, used for severe
allergic shock.
Adult teeth See Permanent teeth.
A bad reaction after breathing in,
eating, touching, or being injected with
something. The reaction may be itching,
sneezing, or difficult breathing.
Analgesic Medicine to calm pain. Aspirin,
acetaminophen (paracetamol), and codeine
all are analgesics.
A special metal used in permanent
A disease in which the blood gets
thin. Signs include tiredness, pale skin, and
lack of energy.
A drug that causes the mouth or
other part of the body to feel numb.
Medicine that fights infections
caused by bacteria. A broad-spectrum
antibiotic such as tetracycline kills many
kinds of bacteria, while a narrow.spectrum
antibiotic like penicillin kills only a few
kinds of bacteria.
Something that ;:: the easiest,
safest, and most likely to work in a
particular situation or conditior,.
Arkansas stone A special stone used to
sharpen dental instruments.
To breathe, An ‘aspirating syringe’
is one that can ‘breathe’, or allow liquid to
go both in and out of the needle tip.
(I 1 To heat water until it bubbles. (2) A
swollen, inflamed lump with a pocket of pus
under the skin. A kind of abscess.
Brand name Trade name, the name a company
gives to its product. A brand-name medicine
is sold under a special name and is often
more expensive than the same generic
Bridge False teeth that are glued onto several
nearby healthy teeth.
Buccal Of the cheek. The buccal face of a
tooth is the side facing the cheek.
Large quantity
or amount.
A nutritional element which makes
teeth strong and hard.
Calories Units of heat found in food, giving
energy for the body to use.
Canine teeth Also called cuspids, dog teeth,
and eye teeth. These teeth have the longest
roots of any tooth.
Cancer A tumor or lump that grows and may
keep growing until it causes death.
Starches and sugars-foods
that give energy. In this book they are called
GO foods.
Caries Cavities; tooth decay.
A hole in a tooth where bacteria have
Cement filling
A temporary filling, which may
protect a tooth for up to 6 months. Also see
Cementum The outer covering of the tooth’s
Long-term or frequently recurring
(compare witil ‘acute’). A chronic disease is
one that lasts for a long time.
A new place where a group of people
start a community, This book speaks of
‘colonies’ of germs-where germs group
together in a new place.
A group of people living in the
same village or area who have similar living
conditions, interests, and problems.
Comparative diagnosis A way of looking at
symptoms and deciding which of several
similar illnesses is causing the svmptoms.
Touch. Contagious diseases can be
spread by a sick person who makes contact
with (touches or is close to) another person.
Contagious disease A sickness that can be
spread easily from one person to another.
A situation or condition
when a particular medicine should not be
taken, or a certain treatment not given. For
example, many medicines are contraindicated
during pregnancy.
Crown The top l/3 of the tooth, the part
that is protected with hard enamel.
A scaling instrument.
Cuspids Canine teeth,
Cyst An abnormal, sac-like growth in the body
which is often filled with water,
Decay See Tooth Decay,
A whole set of teeth.
Dental floss See Floss.
Dental worker
A health worker who works
for healthy teeth and gums,
A professional who has advanced
formal education in care of teeth and gums,
False teeth.
Diagnosis A decision made by a health worker
about what a person’s illness is. Also see
Comparative diagnosis,
Frequent runny or liquid stools.
Diet The kinds and amounts of foods that a
person should eat or avoid eating.
Bones that have slipped out of
place at a joint.
Distal The side of the tooth that faces the
back of the mouth. The opposite side from
the ‘meslal’ side.
An instrument used to change the shape
of a cavjty before placing a filling.
Duct A tube that carries liquid. For example,
ducts carry spit from the spit gland to the
An instrument used to loosen a
tooth before you take it out.
A sudden sickness or injury that
needs immedia,te attention.
Enamel The protective layer that covers the
crown (top part) of a tooth. The enamel is
the hardest part of the body.
Epulis A tumor of the gums, usually found
between the teeth.
The moment when a new tooth cuts
through the gums and becomes visible in
the mouth,
A study to find out the value of
something, or to find out what has been
accomplished. Evaluations often compare
different conditions before and after a
new activity begins.
A careful look at something;
an investigation,
Expiration date The month and year marked
on a medicine that tells when it will no
longer be good. Throw away most medicines
after this date.
See Probe.
Taking out a tooth.
A ‘tooth’ made of plastic or other
False tooth
material, used to replace a tooth that has
been taken out.
Feces Stools; shit; the waste from the body
that is moved out through the bowels in a
‘bowel movement’,
Fever A body temperature higher than
Fiber A fine, threadlike piece. A fibrous food
like coconut contains a lot of fiber.
Material put into the cavity in a tooth
to prevent further decay.
First aid Emergency care or treatment for
someone who is sick or injured,
Floss Special string used to clean between the
A chemical which strengthens the
teeth. Painted on the teeth or added to
water for drinking or rinsing, fluoride enters
and hardens the enamel. It is especially good
for children’s teeth.
Instruments used to pull teeth.
A broken bone.
Gauze A material made of cotton, woven into
an open mesh.
Generic name The scientific name of a
medicine. Usually different from the brand
names given it by the different companies
that make it.
Germs Very small organisms that can grow
in the body and cause some infectious
diseases; bacteria.
Gram A metric unit of weight. There are
about 28 grams in an ounce. A paper clip
weighs about 1 gram.
Groove A long, narrow cut on the surface of
back teeth. Grooves are ‘protected areas’
because food and germs can hide and remain
in them longer.
Gum bubble Also called a gum boil. A small
abscess on the gums.
Gum disease Illness that causes gums to
become loose, red, and swollen, and to
bleed when the teeth are cleaned.
Gum pocket The space between the tooth
and the flap of gums around it, forming a
small pocket.
Gums The skin around the teeth.
High blood pressure.
Immunizations (vaccinations)
Medicines that
give protection against specific diseases. For
example, there are immunizations against
diptheria, tetanus, polio, tuberculosis, and
Incisors The four front teeth on the top and
A sickness caused by bacteria or
other germs. Infections may affect part of
the body only (such as a sinus infection) or
all of it (such as measles).
Infectious disease A disease that is easily
passed from one person to another;
contagious disease.
An area that is red, hot, and
painful, often because it is infected.
Inject To give a medicine such as an
immunization or anesthetic, using a syringe,
Injure, injury
Harm; hurt.
Tools that a dental worker uses
to examine, clean, fill, or pull teeth.
Joint The place where two bones meet. When
this book talks about the ‘pain in the joint’, it
means the joint (called the ‘temporomandibular
joint’) where the cheek and jaw bones meet.
Kilogram (kg) One thousand grams. A ‘kilo’
weighs a little more than 2 pounds.
Health worker
A person who takes part in
making the community a healthier place to
A needle holder, used for putting
in sutures.
Herb A jlant, especially one valued for its
medicinal or healing qualities.
History (medical history)
What you can learn
through asking questions about a person’s
sickness-how it began, when it gets better
or worse, what seems to help, whether
others in the village or family have it, etc.
Hydrogen peroxide
A liquid used to clean
wounds and kill certain bacteria.
Actions or practices of personal
cleanliness that lead to good health.
Labial Of the lips. The labial side of a tooth is
the face of the tooth nearest the lips,
Ligature wire A thin, strong wire that bends
easrly, used to attach a loose tooth to a
strong tooth.
Of the tongue. The lingual side of a
tooth is the face of the tooth nearest the
Health problems caused bv not
eating enough of the foods that the body
The lower jaw bone.
The upper jaw bone.
Mesial The side of the tooth that faces the
front of the mouth; the opposite of ‘distal’.
Milligram (mg) One thousandth of a gram.
Molar The back tegth, used for grinding.
Molars are the largest teeth in the mouth,
with 2 or even 3 roots each.
Nerves Thin threads or strings that run from
the brain to every part of the body and
carry messages for feeling, pain or
movement, There is a nerve, along with a
blood vessel, in every root of every tooth,
Usual, natural, or average, Something
that is normal has nothing wrong with it.
Numb Without feeling; anesthetized. When
teeth and the gums around them are numb,
they cannot feel pain.
The mixture of foods the body
needs to grow, he healthy, and fight off
Occluoel The biting surface, or top, of the
Oral Of the mouth, An oral medicine is one
taken by mouth.
Organisms Living things (animals or plants).
Palate The roof
Permanent filling
metal material
Permanent teeth
grow into the
or top part of the mouth.
A filling using a special
which lasts for years.
The 32 adult teeth which
mouth to replace the baby
Petroleum jelly (petrolatum, Vaseline) A
grease-like jelly used in preparing skin
A store that sells medicines and
health care supplies.
A film or coating of germs that can
on the teeth, mix with food and make
You cannot see plaque unless you
Plats A set of false teeth.
Care taken in advance to prevent
harm or prepare for emergencies before
they happen.
Pregnancy The period (normally 9 months)
when a woman carries a child inside her.
Premolars The teeth between the molars and
the canine teeth; bicuspids.
Prenatal Before birth.
Action taken to stop sickness
before it starts.
Probe An instrument for examining teeth for
tartar or other problems.
Foods that are rich in
Protective foods
vitamins and minerals. They help build
healthy bodies and make people more able
to resist or fight diseases. In this book they
are called GLOW foods.
Body-building foods necessary for
proper growth and strength. In this book
they are called GROW foods.
Pus A yellow-white liquid found inside
Records, reports Written information about
sick persons and the treatment they receive.
Records are for the personal use of the
health worker, reports are written by one
health worker to another to describe an
illness and ask for further treatment.
Resistance The ability of somerhing to defend
itself against something that would normally
harm or kill it. Many bacteria tiecome
resistant to the effects of certain antibiotics.
Rinse To hold a liquid in the mouth, moving
it around inside the mouth.
Risk The possibility of injury, loss, or harm.
Root The lower part of the tooth, under the
gum, connected to the bone.
Root canal The hollow part of every root of
a tooth, which has a blood vessel and a
nerve inside.
A special operation on
Root canal treatment
a dead tooth to remove material from the
root canat and replace it with filling
Root fibers Tiny fibers which hold the root
of the tooth to the jaw bone.
Rotten teeth Teeth with a lot of cavities.
Saliva Spit. Saliva helps us to swallow our
Public cleanliness, Community
sanitation efforts include disease prevention,
hygiene, and keeping public places free of
Scab The crust of dry blood that forms over
a wound.
Scale To scrape the tartar off the teeth. A
scaler is an instrument for scaling,
Scientific method
A way of learning
something. It begins with information, then
an idea, and then the idea is tested against
the information available,
Side effects Problems caused by using a
Signs The things or conditions to look for
when you examine a sick person, to find
out what sickness the person has. In this
book the symptoms (the problems a person
feels) are included with signs.
Sinus A hollow place inside the bone.
Soaket The wound left after you take out a
Fizzy, carbonated drinks like
Soft drinks
Spatula An instrument used for mixing
cement for fillings.
Starches Energy foods like maize, rice, wheat,
cassava, potatoes, and squash.
Completely clean and free from living
micro-organisms, Things usually are not
sterile until you boil them or steam them.
To make things sterile by boiling or
steaming for 20 minutes.
See Feces.
Sweet foods like honey, sugar, or
that give energy but ofterl’cause tooth
gum problems.
Survey A collection of facts about a small
group of persons or things in the community,
If the small group is not unusual, the survey
results will describe the whole community.
Suture A stitch made with needle and thread
to sew up an opening or wound.
An area of the skin that is
abnormally large, puffed up. A swollen
area is one that has swelling.
The feelings or conditions that
sick persons report about their sickness. In
this book, symptoms are included with
An instrument with a small sharp
needle, for giving injections,
Teaspoon A measuring spoon that holds 5
ml. Three teaspoons equal one tablespoon.
The action of new teeth cutting
through the gums. Also see Eruption.
The degree of heat of something,
such as the air or a person’s body.
Temporary filling
A filling meant only to last
until a permanent filling can be placed.
T.M.J. The temporomandibular joint. See
Tooth abecess See Abrcclu
Tooth decay Damage to the tooth caused by
acid; cavities.
Pain in a tooth.
A paste for cleaning teeth.
Tongue depnwor
A tongue blade; a piece of
wood used to keep the tongue out of the
way when examining or treating the teeth,
Top of the tooth
The part of the tooth that
bites on food. For both upper and lower
teeth, the biting surface is the ‘top’ and the
root is at the ‘bottom’.
On top of the skin. A topical
medicine is put on the skin.
Practices, beliefs, or customs
handed down from one generation to
another by example or word of mouth.
Care given bv a health worker to
fight an illness, attend to an injury, or
prevent a new problem.
Having to do with the tropics-the
hot regions of the world.
An abnormal mass of tissue without
inflammation. Some tumors are due to
Tweezers Small metal instrument for picking
up cotton or small objects. Some persons
use the word forceps for tweezers, but in
this book, forceps are instruments for
taking out a tooth.
Ulcer A break in the skin or mucus membrane;
a chronic open sore that can appear on the
skin, gums, or gut.
A measuring spoon that holds 3
teaspoons or I6 ml.
A hard, rocky coating on the tooth
near the gums, also called calculus or
toothstone. Tartar forms when old plaque
mixes with calcium in the spit.
See Immunlrationa.
Sse Petrobum jelly.
See Blood vrrk.
Germs smaller than bacteria, which
cause some infectious diseases, like measles
or the common cold.
Protective foods that our bodies
need to work properly.
The amount of space a thing
occupies. We measure volume in liters, ml,
gallons, etc.
Wisdom teeth The 3rd molars, which grow
into the mouth when a person is 16-22
years old.
Weight The heaviness or lightness of a thing.
We measure weight in kilograms, mg,
pounds, etc.
X-ray picture
A special photograph that
allows you to see bone, roots of teeth, etc.,
under the skin.
Index A-B-C
Absce~rt, 87,183
and gum bubble, 72
begins with a cavity, 6,45
diagnosis and treatment, 87
flip chart presentation, 28-29
treat at once before infection reaches the
bone, 6
treat pregnant women now, 178-l 79
Acataminophen fparacetamol)
dental kit supply, 164
dose for pain, 88
causes tooth decay and gum disease, 7,
some sugars make acid more easily, 53
Adrenaline (epinephrine), 130, 165
Alcohol, for disinfecting without heat, 65
Allergies to medicines
and extractions, 147-148
penicillin warning, 165
Anemia, 176,178, 183
Anesthetics, local, 130-l 31
dental kit supply, 167
Antibiotics, 88, 183
dental kit supply, 165
doses for tooth abscesses and other
problems, 88
injections, 166
precautions, 165
sulfadimidine, 117
warning on tetracycline, 61
Arkansas stone, 122
Aspirating syringe, 172, 169, 183
Aspirin, 88
correct dose for pain, 88, 165
dental kit supply, 164
do not hold against teeth, 165
Baby teeth, 66-63
ages when baby teeth come in, 41,62
begin forming before birth, 60
do not cause diarrhea and fever, 63
how baby teeth grow and stay stron’y, 61
knocked out: diagnosis and treatment, 91
loose, 52
make space in mouth for permanent teeth,
marks on baby teeth, 60
why baby teeth are important, 62
Bacteria (See Germs)
Bandage, head, for a broken jaw, 104
Barry juice
used to show coating of germs on teeth, 51
Bicycla.powered dental drill, 145
and extractions, 147, 179
from socket: diagnosis and treatment, 112
how to place a suture, 155-l 56
in the mouth: possible causes (chart), 110
Bleach, for disinfecting without heat, 85
boil any instrument that has touched blood,
(Also see Bleeding)
Blood pressure, 112, 179
Blood vessel, 44
bone chips inside tooth socket, 160
broken: diagnosis and treatment, 102106
damage from gum disease, 40
three main bones in the face, 102
Bones of animals, 39
Books on dental care, 180
Bottle feeding, 3,61
Breat feeding, good for teeth, 3
Broken bone, 102-I 06
Broken root, 159
Broken tooth, 90
Brmhing teeth (See Cleantng teeth)
Brushstick (homemade toothbrush), 4
Bubble (See Gum bubble)
Cancer, 1 IQ, 184
can begin with white lines inside mouth, 99
diagnosis, 119
look for a sore that does not heal, 100
Candy, 9
(Also see Sweet foods)
Cancrum oris (noma)
diagnosis and treatment, 115-l 18
Canker sores, diagnosis and treatment, 700
Cartridges of injectable anesthetic, 129-l 30,
Cavities (caries), 184
can begin as marks an baby teeth, 69
can become abscesses, 45
can make teeth hurt, 44
caused sometimes by baby bottles, 3
diagnosis and treatment, 86
Index C-D-E
Cavities (continued)
fill cavities before abscess forms, 6
flip chart presentation, 28-29
on neck of tooth, 86,167
puppet show about, 31-32
school survey, 47
Cement fiilingr (See Fillings)
Chair for examinations and extractions, 73,150
Cheek bone, 102
program, 22
as health workers, 22
can clean their own teeth, 54
cannot learn well if their teeth hurt, 18
want to learn, 17
young children should not take aspirin, 88,
Cleaning instruments, 73,828s
after extractions, 161-162
after filling a tooth, 144
after scaling, 128
disinfecting without heat, 85
how to sterilize syringes, 132
pressure cooker, 84
sterilizing with steam, 8384
wash your hands, too, 82
Cleaning teeth, 54,87-70
can help sore gums, 7
CHILD-to-child activities, 22, 51
especially important for persons who take
certain medicines, 109
experiment to find the best way, 56
flip chart presentation, 29
how to clean a baby’s teeth, 61
how to clean between teeth, 69-70
how to make a brushstick, 4
how to make a child’s toothbrush, 61
how to make waxed floss, 172
make it part of a daily school activity, 57
parents should clean children’s teeth, 11,
pregnant women must take special care, 178
‘protected areas’ that are hard to clean, 4
soft toothbrush is best, 4,68
(Also see Gum disease, Scaling teeth)
Coating of germs on the teeth, 48
Cola drink, in experiment on decay, 46
Cold sores (fever blisters)
diagnosis and treatment, 98
‘Colonies’ of germs on the teeth, 48, 185
Comparative diagnosis (telling similar problems
apart), 77
Cotton rolls, 140, 167
‘Cowhorn’ forceps, 149
do not use on baby teeth, 154
Curette (for scaling teeth), 122
Demonstration, 24,46
Dental floss, 69-70, 172
Dental kit, supplies for, 163-l 73
Dental mirror, 73, 171
Dental tools (See Instruments)
Dental workers, can visit schools, 33
Dentures, 167-158
bad dentures cause sore mouth, 101
sores under, diagnosis and treatment, 100
Diabetes, and extractions, 147-l 48
Diagnosis (See Examination and diagnosis)
Diagnosis charts, 77-80
loose tooth, 78
sore mouth, 79
sores, 79-80
swelling, 78
toothache, 77
trouble opening or closing mouth, 80
(Also see Comparative diagnosis)
Diet (See Nutrition)
Dilantin (diphenylhydentoin),
Dislocated jaw
after extraction, 161
diagnosis and treatment, 107
Disinfectant, cold
for cleaning certain instruments, 85, 168
Drama, for teaching about tooth problems, 24
Drawing pictures, 29
Drill, dental, 145-I 46
Dry socket, diagnosis and treatment, 111
Elevators for extractions, 149-150, 169
how to use, 152
and swollen gums: diagnosis and treatment,
Epinephrine (adrenaline), 130, 165
Epulis, 127
Erythromycin, 88
,: ,“/:
dental kit supply, 104
‘I I
Eugenol foil of clovesj, 139,167
, /,
Ewaminetion and diagnosis, Chapter 8, 180 ’ ’ ;*,< :‘lj
; .k;.--$.
bleeding in the mouth (chart), 110
different problems come at diffe;p;l-i$$<
I’// ‘
;/I, 4,.
examining inside the mou th,l F.!: !
four steps to a good dilt!r&&,‘~‘I-(
how to check the gc.rnr.iZYe?,> “’
look for sores, 72 ,,;‘$c’
questions tt,qr,~~~-~!~~f?:,i,,
‘snake a diagnosis,
,: L’“/:
71,74 ;, ,,,0
,z’ ,
,,“, *,/ ,
, ; ;/ ,/
‘, ‘,;.,* I_
1” +, ..’
Examihation and diagnosis (continuerl,
telling similar problems apart, 77
tetanus, 112
touch the sore place, 76
where to examine, 73
(Airs see Diagnosis charts)
Excavator, 139
Expiration date, 164
Extractions, Chapter 11
before you begin-ask questions! 1 : 7
four problems to watch for, 148
how to take out a tooth, 151-l 58
instructions: what to do afterwar
i 57-162
instruments needed, 148.150
pregnant women need not wait, 1 ,‘:L179
problems afterward, 110, 159-l 6
three reasons to take out a tooth, 147
Germs, 185
discussion about, 49
health workers must not spread germs,
impossible to kill all germs in mouth, 46
where they hide, 83
Gingivae, QingiVitiS
(See Gums, Gum
‘Go foods’ (energy foods), 65.68
warning about, 66
Groovas on teeth, 86, 167
Gum boil (See Gum
Gum bubble, 45,72
activity about, 51
and treatment,
False teeth, 157-l 58
(Also see Dentures)
Fever blisters, diagnosis and treatm~i~i,,$~ .‘L?
Filing teeth to correct a bad bite,:?,$fy(:/’
Filling tool, 139, 152
‘, <+,,,/
Fillings, Chapter 10
./ ,‘(.,“,
filling material, 139;,$+
how to place. !+?;;!,$;,P ,’
place a filling, 144
‘,,‘,f’; 1 L,
lost (Y ‘:I::~<.~$ ,!&rlosis and treatment, 86
pr; I;r,~,l~~l~~,,;;,,gs,
, “i:‘~~~~;;kt.~!;;,~~
ab0ut, 31.32
/‘f~‘~~t.;~<, a filling can do 138
I’ ’
,, I;<,, H, *s.vhen not to place a ;illing. 137
/r:x /.’ ’ when to place a filling, 138
Fish bone
.y=/A ;,
can get caught under gum;, 127
Flannel-boards, 26, 18 1
Flash, left inside socket after extraction, 160
Flip charts, 27-29, 181
example, 28-29
Flossing (cleaning between teeth), 69-70, 172,
Fluoride, 22,68, 185
on neck of tooth, 86, 167
rinse and paste to prevent cavities, 167
Food (See Nutrition)
Forceps for extractions, 149, 169
Fracture (See Broken bone, tooth, root)
possible cause of a sore mouth, 79
prevent gum disease during pregnancy, 178
serious gum disease: diagnosis and
treatment, 8,95-97, 115-I 18
Gum pocket, 50, 125, 185
definition, 185
importance of, 1,35
if Fected gums (noma): diagnosis and
treatment, 115-I 18
t~~:althy and unhealthy gums: description, 50
Is3w to examine, 72
U.,gollen gums and epilepsy medicine, 109
swollen gums and pregnancy, 178-179
why gums can feel sore, 7,50
wash before you touch someone’s mouth,
Head bandage for a broken jaw, 104
Heart disease, and extractions, 147-148
Heat, can lower swelling, 88
Hemorrhage, and extractions, 147-148
Hemostat, 155
Herpes virus, can cause fever blisters, 98
Hydrogen peroxide, 8
warning: do not use too much, 8
Hygiene (keeping clean), 82-85
Game (‘Scatter-l’), 49
Generic name, 164
115-I 18
Incisors, 37
,?z ‘1ndex I -J-K-L-M-N
Infection, 185
can pass from tooth to bone, 45
dental workers can infect others, 82
description of i,lfected gums, 50
during pregnancy, 177-179
in sinus: diagnosis and treatment, 89
in spit gland: diagnosis and treatment, 113
Injections, Chapter 9, 166, 185
how to give injections to children, 135
injections of antibiotics, 166
sterilization of syringes, 132
two types of syringe, 129-I 30
use an aspirating syringe, 132
instructions for after you give an injection,
what to do after extracting, 157-I 62
what to do after injecting, 136
what to do after placing a :emporary
filling, 144
what to do after scaling, 127
Instruments, 169-l 73, 185
boil any instrument that has touched blood,
buying instruments, 173
for examination, 73
for extractions, 148-150
for filling teeth, 139
for scaling, 122
making your own instruments, 170-I 72
(Also see Cleaning instruments)
I.R.M. (Intermediate Restorative Material), 139
dental workers’ description of gum disease,
Jaw bone, 39
broken: diagnosis and treatment, 102-106
dislocated: after an extraction, 161-162
dislocated: diagnosis and treatment, 107
three main bones in face, 102
Joint, 185
pain in: diagnosis and t:eatment, 108-109
Learning (See Teaching)
Lidocaine (lignocaine), 130
dental kit supply, 167
Ligature wire, 104, 185
Loose teeth, 52
diagnosis and treat’*rent, 93
possible causes (charts), 78,93
Main food, 65-66
Malaria, can contribute to noma, 115
cavities zan help cause, 60
often made worse by Vincent’: Infection, 96
(Also see Nutrition)
Mango string, can get caught under gums, 127
can cause dry, sore lips, 101
can contribute to noma, 115
Medicines in dental kit, 164-166
Mepivacaine, 131
Milk-oil drink
for persons who cannot eat properly, 105
Mirror, 73, 171
Molars, 37,41, 186
ages when molars grow in, 41
baby molars, 62
first permanent molar is often the first
permanent tooth, 62
infection in new molar: diagnosis and
treatment, 94
new molar can cause face to sweil, 64
often grow in badly, 41
taking care of, 64
trouble opening and closing (chart), 80
white lines inside the mouth can be
cancer, 99
Neck of a tooth, grooves in, 86, 167
Needle, hypodermic
disposable, for oral anesthetic, 167
used to wire a broken jaw, 106
Nerve of a tooth, 44, 186
main trunks and small branches, 130-131
Nerve treatment (See Root canal treatment)
Noma (cancrum orisj
diagnosis and treatment, 115-I 18
prevention, 118
Nutrition, 65-66, 186
eat a mixture of foods, 11,65-66
eat enough food, 65
flip chart presentation, 29
foods for persons who cannot eat properly,
foods that make gums stronger, 7,8
foods that we cannot eat without teeth, 36
good and bad foods, 53
good and bad sweets, 3
grow foods in your own garden, 11
Index N-O-P-R-S
Nutrition (continued)
pregnant women need Vitamin C, 178
tooth pain can interfere with nutrition, 60
Nystatin, 99, 164
prevents rust when sterilizing
Oil of cloves, 139
with hydrogen peroxide, 8
with salt water, 7
Root of the tooth, 39
broken: diagnosis and treatment, 159
count roots before taking out a tooth, 153
has a nerve and blood vessel, 44
pushed into sinus, 160
Root canal (special nerve treatment), 45
Root fibers, 39,186
aspirin or acetaminophen can help, 88
Penicillin, 87-98, 164-166
almost alwlays taken by mouth, 87
dental kit supply, 164
dose taken by mouth, 88, 164
injectable, 166
precautions, 165
take entire dose, 87, 165
Permanent teeth, 4 1,52, 186
knocked out: diagnosis and treatment, 91
need good baby teeth before them, 62
Phenytoin (See Dilantin)
as a teaching aid, 26, 35-36
tracing, 29
Plaque, 48, 186
disclosing solution (berry juice), 51
Plays, 24
Posters, 26, 181
Pregnancy, 177-179
and dental problems, 75, 177-l 79
women must take special care, 95
story about, 177-I 78
Pressure cooker for sterilizing instruments, 84
Prevention, 33, Chapter 5, 186
early treatment is a form of prevention, 59
foods that are good and bad, 53
(Also see Cleaning teeth, Nutrition)
Probe, 73, 17 1
Pronunciation, why teeth are important for, 36
Puppet shows, 30-32
example, 31-32
Puzzles, 25
Records, 174, 186
Reports, 175, 186
Rinsing the mouth
during pregnancy, 178
Salivary gland (spit gland)
infection in: diagnosis and treatment, 113
Salt water rinse, 7
Scalers, 122
Scaling teeth, Chapter 9
instruction for after you scale teeth, 127
instruments for, 122, 169
only scale teeth of someone who will keep
teeth clean, 121
‘Scatter!’ (game), 48-49
cleaning teeth can be a daily health activity,
school lunch program, 55
(Also see Teaching)
Scientific method for making diagnosis, 74
Sewing up a wound (suturing), 155- 156
Sharpening stone, 122
Shots (See Injections)
infected, diagnosis and treatment, 89
root pushed into sinus, 160
Slides for teaching about dental health, 180
Socket, 187
broken root inside, 159
painful (dry socket): diagnosis and
treatment, 111
painful, 161
Soreness in mouth, possible causes (chart), 79
at corners of mouth: diagnosis and
treatment, 101
different problems come at different ages,
from a denture: diagnosis and treatment,
on the face, 114
on lips, cheek, and tongue, 72
types of face sores (chart). 80
types of mouth sores (chart), 79
Spatula, for cement fillings, 139
Spit gland
infection in: diagnosis and treatment, 113
Index S-T
for extractions, 149
for fillings, 139
making your own, 172
Sterilization, 83, 187
with steam, 84
Story telling, 24, 177-179
about pregnancy and dents, . .I ,., ‘I 77-l 78
some kinds make acid more easily, 53
sugar cane is not as bad as candy, 9
(Also see Sweet foods)
Sulfadimidine, 117
Surveys, 176,187
as a way of learning numbers, 22,23
counting cavities, 47, 176
counting teeth, 42-43
to find the best way to clean teeth, 56
Sutures, 155-l 56
Sweet foods, 9,44,53
avoid fizzy drinks, 11
can cause cavities and gum disease, 6-7
learning activities, 46
some are called ‘go foods’, 65-66
and epilepsy medicine, 109
and pregnancy, 178-l 79
after extractions, 110, 160
different problems come at different ages,
from a tooth abscess, 6,45
heat can lower swelling, 88
may be a new molar coming in, 64
possible causes (chart), 78
aspirating, 132, 166, 169
for injections: two kinds, 129-130
(Also see Injections)
Tartar, 50, 187
can be a sign of gum disease, 76
how to scale, 121
makes gums sore, 8
can teach without dental worker’s help, 34
‘association of ideas’, 12
by example, 55
community can be part of classroom, 23
each person can teach another, 12
finding the best way to teach, 13-16
finding the best place to teach, 15
how to scale (scrape away) tartar, 121
learn from the people, 13
let students discover for themselves, 18,21
repetition helps people remember, 15
teach yourself before teaching others, 2
teaching family and friends, Chapter 2
teaching school children, Chapters 3,4
teaching so that learning can happen, 19-23
with demonstrations, 24
with drama, 24
with posters and pictures, 26
with puzzles, 25
with story telling, 177-179
(Also see School)
and gums, 1
broken, 90
four problems to watch for, 71
how many teeth weshould have, 41
importance of, I,35
injuries to: diagnosis and treatment, 90-92
learning about anatomy, 47
loose: diagnosis and treatment, 52, 93
naming teeth with numbers, 174
new tooth coming in:
diagnosis and treatment, 94,95
rotting in cola drink (experiment), 46
what holds teeth, 39
what makes teeth hurt, 44
why some teeth look different, 37
(Also see Baby teeth, Loose teeth)
Teeth, false, 157-I 58
(Also see Dentures)
Teeth, taking out, Chapter 11
(Also see Extractions)
Teething: diagnosis and treatment, 95
can cause pain in joint, 108-109
diagnosis, 112
Tetracycline, can hurt baby teeth, 61, 164
Theater, 24
Thrush: diagnosis and treatment, 99
Tongue blade (tongue depressor), 73, 168
Tools (See Instruments)
Tooth (See Teeth)
Tooth abscess (See Abscess)
possible causes (chart), 77
why teeth hurt, 44
(Also see Abscess)
how to make your own, 4-5,21
how to make a brush smaller for a child, 61
soft is best, 4
Tooth decay
can touch nerve and cause an abscess, 6
flip chart presentation, 28
(Also see Cavities)
Index T-V-W-X-Z
Tooth injuries
broken tooth: diagnosis and treatment, 90
booth knocked out: diagnosis and treatment
Toothpaste, 5,67
Tracing picturas, 29
Traditional beliefs, 10, 13, 187
about pregnancy, 177
building new traditions from old ones, 14
Treadle-powered dental drill, 145
Treatment, Chapter 7
can be given during pregnancy, 177-179
early treatment prevents serious problems, 2
list of treatments, 81
Trench mouth: diagnosis and treatment, 96
Tumor, diagnosis and treatment, 119
Tweezers, how to make, 171
Vincent’s Infection of the gums
can worsen and become noma, 115-l 18
diagnosis and treatment, 96-97
Vitamin C, 178
Wax, to replace a knocked-out tooth, 92
Wire, ligature, 104
Wisdom teeth (3rd Molars) (See Molars)
for knocked-out teeth, 92
to look at new tooth growing in, 94
warning about pregnant women, 179
&getable soup (special drink)
for those who cannot eat properly,
Zephiran, 168
Zinc oxide, 139, 167
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