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Dental Tribune United Kingdom Edition

September 3-9, 20128 Feature United Kingdom Edition Neel Kothari looks at the volunteer work taking place in West Africa Mercy ships: Changing lives I t has now been over two years since the Dental Tribune first reported on the work carried out in West Africa by volunteering health- care professionals for the charity Mercy Ships. Due to extreme levels of poverty in this part of the world the outcomes for those who are sick are very poor and many of the conditions that are considered treatable in developed countries often result in fatalities in the third world. This article tells the sto- ries of three people who have had life changing operations thanks to the work of the all of the volunteers at Mercy Ships and discusses the impact that treatment has had on these patients. The first case is that of Ag- bekanme, a 40-year old lady who presented with severe mandibular osteomyelitis as seen in the accompanying photos. Agbekanme’s case In West Africa, the severity and extent of osteomyelitis is more wide spread and persis- tent than those seen in the UK. Apart from poor nutrition and a compromised immune sys- tem against infection, the lack of basic health care includ- ing dental treatment and an- tibiotic leads to uncontrolled periapical abscesses and sub- sequent extensive osteomy- elitis in West African patients. Acute medullary bone is- chemia and irreversible bony necrosis lead to chronic sup- purative osteomyelitis. Agbekanme was not in ex- treme pain as osteomyelitis it- self is not particularly painful given the lack of nerve end- ings in bone, however she did have mild discomfort due to the mucosal infection. Specialist Oral and Maxil- lofacial surgeon Leo Cheng reports that patients with os- teomylelitis who remain un- treated risk suffering from pathological fracture of the mandible and oro-antral/oro- nasal fistula for maxillary os- teomyelitis. Mr Cheng also re- ports that very often patients presented with facial swelling and pus discharge and some have single and multiple ex- traoral sinuses. Some patients were tested to be HIV positive, sickle cell crisis, Hepatitis B and actinomycosis. Although this is a severe case and rarely seen in the UK, an important message for dentists is to be aware of the increased risk of osteo- myelitis that is posed by mi- nor oral surgery procedures and bisphosphonate usage. Bisphosphonates adversely af- fect osteoclasts, which are the cells responsible for bone re- sorption and thereby act to in- crease bone density. The liter- ature shows that intravenous bisphosphonate usage carries a higher risk of osteomyelitis compared with oral bisphos- phonate usage. The uses of bisphospho- nates include the prevention and treatment of osteoporo- sis, osteitis deformans (“Pa- get’s disease of bone”), bone metastasis (with or without hypercalcaemia), multiple myeloma, primary hyperpar- athyroidism, osteogenesis im- perfecta, and other conditions that feature bone fragility. Guanue’s case (before and after) The second case is that of two- year-old boy Guanue, who presented with a rare bilat- eral facial cleft. Thankfully Guanue was lucky enough to receive treatment that man- aged to close his facial clefts and realign the anatomical structures. In West Africa, people with facial deformities often face a series of social is- sues that can often see them being outcast from the socie- ties. Surgeon, Leo Cheng re- ports that apart from appear- ance there are a number of functional deficits including poor speech and overflowing of tears due to defective drain- age of tears. In Guanue’s case local fa- cial skin flaps (interdigitating and transposition flaps) were used to close the clefts and closure of the lower eyelid conjunctiva was also required. For uneducated village chief and witch doctors, babies with clefting deformities are often treated as devil’s chil- dren. Some villages in West Africa bury babies alive with clefting deformities. They are often rejected by their own parents, relatives and villag- ers because they feel that they are cursed. Some babies with birth deformities are even left in the forest for wild animals. Alimou’s case Our third and final case is that of 22-year old Alimou who presented with a large mul- ticystic ameloblastoma of the mandible. Alimou Camara is from Co- nakry, the capital of Guinea in West Africa. At 16 while in the 11th grade, Alimou had to stop school as the tumour was growing in size and becom- ing an unsightly spectacle. His siblings supported him, but his friends abandoned him. “People laughed at me and re- jected me,” he said. He was unable to work, eat, and began losing weight. Alimou lived with one of his ‘For uneducated village chief and witch doctors, babies with clefting deformities are often treated as devil’s children’