Highlights from the past few weeks...

• A young man sat in the dental chair, opened his mouth, and I was perplexed to find what looked like a  lower canine that had erupted at the midline!  He had the correct number of lower anteriors present; however his 3.3 looked tiny, so maybe he had a retained 7.3, and the 3.3 had decided that rather erupt at the curve of the arch, it would take a spot right in the middle.  It had a mind of it's own.
• Gums.  Most of the African patients that I have seen have either pink or brown gums, but I have also seen mottled pink and brown gums, as well as blue gums!  I don't know what causes the blueness - at first I thought that it might be due to decay or infection, but I have since seen blue gums in fairly healthy areas of the mouth.  (Reminiscent to an amalgam tattoo, but all over - especially anterior.)
• So far - I have not seen too many surgical extractions.  Most are routine with luxator, forceps and possibly a handpiece to remove a bit of bone around a stubborn root.  But the other day, we came across a root that was so solidly fused to the bone around it, that we got to see some real dental action!  I almost started to feel queezy, which is saying something.  My dentist pushed/peeled back the gums all around the tooth in question as well as the surrounding 2 teeth on either side to obtain really clear access.  I then had to hold this skin flap back while she drilled the buccal wall bone away from the tooth.  The skin was so creepy, flapping in the breeze of the drill.  I was quite relieved after she placed the sutures and everything was back where it should be!  
• On a similar note, my dentist was doing a relatively simple anterior extraction (anterior clearance)- she had loosened the periosteal ligament from the root, and had loosened the tooth in the socket with the luxator, then went to grab it with the forceps, but apparently, the periodonal ligament hadn't been loosened enough on the buccal surface, and when she began the pull the tooth from the socket, the skin gums began to stretch, being pulled along with the tooth.  Because we were removing many adjacent teeth, this piece of tissue that had covered many teeth was fairly large.  It was like elastic - stretching skin - that gave me a queezy shiver!  In the end, the tooth came out, and the gums were left intact.  

more of the same...

So many abscesses revealing themselves during exos today.

What a treat!

  So at the Mercy Ships dental clinic in Guinea, I have been exposed to so many lovely things that I had never seen in Canada.  My lack of dental gore in Canada had less to do with what country I was in, and more the fact that I worked in a general family dentistry practice who referred the majority of extractions to an oral surgeon, whereas in our Guinea clinic, exo's are the main procedure.

  It is surprising to me how many root tips we remove without finding abscesses present.  In plain English, that means that someone has a tooth that has rotted so badly that the whole crown (visible tooth above the gum-line) had been destroyed, and only a remnant of root of left in the gums.  When there had been that much decay, you would think that there would have been more infection present in the tooth sockets after they have been taken out.  Well today, I got to see a number of lovely, squishy flesh balloons (abscess) emerge from the sockets, attached to the end of the roots.  I personally find this fascinating to actually see in real life.  For years at my dental clinic we would take x-rays of sore teeth and be able to see evidence of infection, but the bone that it destroys at the apex of the root, but back then, if we didn't root canal the tooth, then we referred the patient to have the extraction, so I never got to see what these severely infected teeth looked like when they came out.

  Very often we will do 'clearances' in a specific area of the mouth (which means removing all of the teeth in an area) or extractions of many neighboring teeth, and these prodedures will get quite surgical with bone removal and scalpel use and sutures.  So interesting!  (I know none of you readers agree)

  Some of the molars that we take out have crazy curved roots, or the roots are splayed out at a 90 degree (or more) angle.  The dentist will think that he is about to do a routine extraction, and he struggles and struggles to remove this tooth, and when it finally comes out, roots intact, we can see the reason for all the difficulty, it looks like the tooth was in the middle of doing 'jumping jacks.'  I have heard from the dentists a number of times "I would never have taken that tooth out if I had seen the x-ray."  That's right dental folk, we really don't use x-rays.  We have a portable digital machine that doesn't work half of the time when you do want to use it.  We are doing humanitarian work and do not legally need x-rays, so we just don't.  I have never taken out a tooth, but from watching these guys and gals pop teeth out in a matter of seconds, I don't see why we should need them.  (So Erin B, I guess that I won't have extensive opportunity to improve my paralleling technique...)

   Today, the dentist working at the chair next to mine was grasping the crown of a molar with his forceps, and the tooth exploded and pieces went flying, one piece bounced off my scrub top!
 

If saliva were red... well in Africa it is!

   So we were pulling this guy's teeth today - and they were solidly embedded in his bone.  Elevators and forceps were not enough, had to get out the surgical hand-piece.  The HVE tips here are different looking - exactly like hammer-head sharks.  It is difficult to angle these sharks to properly catch all of the water.  After luxating the root tips for so long, there is a lot of blood flowing, which gets caught up in the spray.  The result is a literal 'splatter zone' of red, landing on the patient's white shirt.  My skin crawls as I can almost feel this bloodbath.  Extractions are so fascinating!