Dentistry in Liberia

"Steve"

Steve presented to the clinic complaining of a painful swelling on the left side of his jaw, worsening over the last seven days.Extraorally he is a fit 21year old man, rather subdued, but obviously in otherwise good shape. He has a large swelling on the right side of his mandible spreading down his neck and into his chest. The right breast is swollen to three to four times the size of the left. The swelling is very fluid, pressure on the chest causes his cheek to bulge. There is skin breakdown over the mandibular part of the swelling with an obviously long established extraorally draining sinus in about 46,47 area.Intraoral examination was virtually impossible due to severe trismus but no obvious caries was visible.I made a provisional diagnosis of pericoronitis associated with an partially erupted , but invisible 48. I was able to get a second opinion from the only other dentist in Liberia, because he works less than 10 feet away from me! Bob is also from the UK and is here for three weeks. We both decided he needed urgent IV antibiotics and sent a referral “letter” to the ship. The letter consists of a scrap of paper with as much history as I can get on it. It turns out my three lines of hand written scrawl save a young man’s life.By the time he arrives at the ship, after walking the 2-3miles from the dental clinic, he is pyretic and tachycardic. The surgeons see him and put him on the urgent list for treatment  as soon as a table comes available.

By 7pm Steve is given a GA and needs forty (40) drain tubes inserted around his face, neck and chest. By 10pm his temperature is coming down and tomorrow or the next day I need to try to go in and fix the originating dental cause. The consensus of opinion is that he had under 24 hours left to live before his airway was closed or he succumbed to the sepsis.

Clinical debriefing & peer review come from chatting the case over and praying for Steve with his anaesthesiologist, my roommate John.

Not all the patients are like this but the ship has had two life threatening dental complications today. The other was a cardiac arrest under GA for a deciduous extraction on a four year old boy. Both survived. Otherwise the dental workforce of Liberia, 2 dentists, 4 nurses, 1 hygienist and our clerical & CSSD staff have seen 40 or so patients today and extracted about 100 teeth. I placed 2 fillings; Bob did one.

So, is it dental school dentistry? – no

Is it NEBDN standards of cross infection control? - no

Is it the sort of treatment my Denplan patients would accept? – no

Does it save lives? – yes

Does it test my skills to the very limit? – yes

Can I cope? -  Dunno yet – ask me when it's all over.

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"Tom"