teeth

Brush them.  That's all I have to say about that.

Okay, so I do have more to say about teeth, but just remember that "brush them" is the take-away point of what follows.

Since the Eye Team is without a surgeon this week, I took the opportunity to spend a day with the Dental Team.  It was a lot fun, if for nothing else because they start at 8am as opposed to my usual 7am start.  The Dental Team has their own scrubs, so after donning the light blue uniform, I accompanied my dental assistant friend, Sandra, on the short walk (in the rain!) to the Hope Center.  The Hope Center is just up the road from the port (about a 7 minute walk) and is home to both the Dental Clinic and accommodations for out-of-town patients who do not need daily nursing care but who need to be nearby for follow-up appointments.

After a short devotion, we began our day.  The Dental Team screens on Mondays and Thursdays and assigns appointments from there.  The majority of the work involves extractions of rotted/infected/damaged teeth, but they also do fillings, cleanings, and care of other oral maladies (osteomyelitis, abscesses, Ludwig's angina, etc.).  (What's Ludwig's angina, you ask? Check out Ludwig's angina.  It's basically a nasty infection, but more on this later.)

The dental clinic is a large room with four dental stations with two tables each, and one hygiene station for the hygienist.  Right now there are four dentists and each is paired with a dental assistant.

My first job was to assist the hygienist with suction on a patient who had extractions a few weeks ago and was back for a cleaning. After that, I headed over to Sandra's station and worked there for the rest of the day, assisting Joan, a dentist from Arizona.  More suction followed.  It is funny to think back to when I was a little kid and the hygienist always called the suction "Mr. Thirsty."  I'm sure the patients here call the suction "Mr. Is This Over Yet?" or something along those lines.

Assisting Joan with suction.

When a patient comes to the chair, he or she explains which tooth is hurting them and after a quick exam, the area is numbed and the extraction begins.  Many patients have only roots left behind after years of decay.  Some teeth have the pulp exposed, and others may reveal exposed bone.  Very few patients have only one tooth removed.  One of today's patients was a 19 year-old girl with severe tooth decay.  We ended up extracting all but three of her upper teeth.  Click on the photos for a closer look.

After all the teeth were extracted, Joan placed a few sutures at the former home of her molars and then offered me the opportunity to throw a suture closer to the front of her mouth.  I gladly picked up the needle-driver!  If you look closely, you can see the open sockets where her teeth used to be.  

It is funny to see the dental patients after their procedure.  If I had to have several teeth pulled, I would be less than thrilled.  But when our patients leave, they are smiling the best they can with gauze-filled mouths.  Their toothaches are gone and the chance of a life-threatening infection from rotted teeth has just been erased.

And don't get me wrong.  There are a fair share of squealers.  Like this guy, who had a large abscess on the roof of his mouth.

He moaned and squirmed as the dentists worked on him.  Part of the aftermath:

Some of the trays look like something out of a horror film by the time the dentists are finished.

Another patient I worked on, with a dentist named Mona, had the aforementioned Ludwig's angina.  She had been in the clinic yesterday with a very large abscess on her lower jaw.  According to stories, not much pus was coming out, but after a bit of poking and prodding, Mona had to literally jump back as pus shot from this woman's mouth!  Yes, gross, I know.  They inserted four drains in her jaw, which are basically pieces of rubber that are sown into place to allow the pus to drain.  So when I first saw this patient today, the first thing I noticed where the little bits of rubber poking out of her jaw/neck.  When Mona began irrigating in her mouth, the fluid would run out of the tubing and down the patient's neck!  It was a challenge to suction all the drains at once--you never knew where the blood/pus would come from!  

During our short lunch break, we ate on the terrace of the building (formerly the Seafarer's Building).  Sandra and I both had cheese toasties.

Before getting back to the teeth-pulling and the pus-suctioning, we ran over to the main side of the building to visit with patients stay here at the Hope Center.  I was happy to find my friend Tamba!  Tamba is Mr. Personality himself.  

I got to know Tamba during his stay in the ship's hospital. He spent over two months on the ward!  He is from the village of Njagbwema (which is coincidentally where the Eye Team went on our upcountry trip in April!) and when he first came to us, his feet were formed backwards.  He was in casts for several weeks that were up to his mid-thighs with knees at 90 degree angles and feet pointed straight.  After a series of surgeries and more casts, his feet are finally properly positioned!  He is staying at the Hope Center while he undergoes physical therapy and more cast changes.  When he was wheelchair-bound, he would come visit my eye room and we would color and decorate his wheelchair with balloons.  He is very funny and will talk your ear off.  Needless to say, I love this kid!

After seeing some more patients in the afternoon, we cleaned up and headed back to the ship.  On my way out, I noticed something familiar on one of the sheets used to cover up a table.

You just never know what you'll find here!

As of July 9, 2011, the Mercy Ships Dental team has extracted just shy of 18,000 teeth from around 5,500 patients here in Sierra Leone!  If you are not thinking "Whoa!" right now, well, you should be!

So boys and girls, what did we learn today?  BRUSH YOUR TEETH!