TREATMENT RISKS
MEDICATION EFFECTS
All medications have side effects. Most of the time these don’t cause a problem or can be tolerated. Potential side effects can be found by looking up the effects of the drug/s in question.
Before you give any medication it is important to check the patient’s general health, such as: might they be pregnant, have they had any illness, are they already taking medication, and are they allergic to any medication?
Many drugs interact with other drugs and some combinations can be severe so it is important to have the full picture before you prescribe anything.
Some drugs can have an increased effect in people with particular illnesses, and should be avoided.
Effects on general health
Side effects can range from minor to major. Common general side effects of medications are: tiredness, nausea, constipation, diarrhoea, vomiting, and skin reactions. A rare but serious allergic reaction is Anaphylaxis, which needs immediate treatment.
Effects on oral health
Common oral side effects of medications are dry mouth which can lead to gum disease and bad breath, oral thrush, gum swelling (gingival over-growth), mouth ulcers, taste changes, and tooth discolouration.
It is important to take a full medical history and be aware of drug side effects and interactions
UNSAFE TREATMENTS
More than 80 percent of Africans rely on traditional medicine and indigenous knowledge to meet their health needs. This is understandable because traditional medicine is usually more accessible, affordable, culturally and socially acceptable and most people prefer it to the ‘expensive’ and less familiar, conventional Western medicine.
Unsafe treatments can result from traditional cultural practices, such as Infant Oral Mutilation (IOM), tooth sharpening engraving and removal. Clinics that provide dental treatments may lack general cross infection knowledge and practice.
Practices that have oral implications vary in different countries and regions so it is important to be aware of any such practice that might impact on your own community.
UNSAFE PRACTICE – INFANT ORAL MUTILATION (IOM)
Teething in children (TRM p 10-11)
Some primary (deciduous) teeth come through with no trouble at all – in other cases, the gum may be sore and red where the tooth is pushing its way out. Explain to parents the importance of keeping their child’s mouth clean: i.e. use a piece of wet cotton wool or a small damp rag to wash food away from the area around erupting teeth.
Traditional practice of removing tooth buds
In some communities, a traditional healer will carry out this practice on infants (usually aged between 1 week – 6 months). It involves cutting the gums and then removing tooth buds, most commonly the canine teeth. The tonsils and adenoids are sometimes removed at the same time. This practice is likely to be carried out using non-sterile instruments e.g. razor blade or weaving hook and it carries a high risk of infection.
Child’s primary canine tooth buds removed
General health conditions associated with IOM
- Fever, diarrhoea, vomiting, shallow rapid breathing and loss of appetite
- Cross infection spread, septicaemia, sometimes leading to death
Oral health conditions associated with IOM
- Damage to the adult tooth buds
- White blisters can appear within the mouth due to dehydration
TEETH SHARPENING, ENGRAVING AND REMOVAL
Tooth sharpening is the practice of manually sharpening the teeth for spiritual or aesthetic purposes. It is commonly seen amongst some African communities, Mayans, Aborigines, Vietnamese, Sudanese and others. In some communities, healthy teeth may be engraved or even removed for cultural reasons.
Every effort should be made to discourage communities from continuing harmful habits and customs
UNSAFE CLINICS
Studies in developing countries indicate serious shortcomings with regard to infection prevention & control and the sharing of knowledge and education in oral health-care facilities. Whilst some local practitioners may be well meaning, inappropriate surgical procedures undertaken with unclean instruments and limited knowledge of cross infection control can have serious consequences for clinical treatments.
Sinus and an infected incision made by a local ‘traditional healer’ at the angle of the mandible to relieve the swelling
General conditions associated with unclean instruments
- Cross infection spread, septicaemia, sometimes leading to death
Oral conditions associated with unclean instruments
- Spread of local infection leading to more complex oral infections, e.g. Ludwig’s angina
- Osteomyelitis
When providing healthcare services it is vital to have good Cross Infection Control & resources & knowledge to provide safe care (TRM p33 or Chapter 4 )
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