5 Simple Ways to Prevent Tooth Decay

By Godsgift Igbinai

 Today, I am sharing this blog with a guest. Godsgift Igbinai is a Public Health and General Dental Practitioner based in Kaduna, North-West Nigeria. Enjoy!

Dr Godsgift Igbinai

Tooth decay is a common but often unrecognized problem in adults and children. Many times, patients present to the dental clinic when it is practically impossible to save the tooth. To avoid that dreaded visit to the dental chair for tooth extraction, here are 5 simple and proven ways to prevent tooth decay and other dental problems.

Ø  Regular dental visit. Make a habit of going to the dental clinic every six (6) month or less for a routine dental check.

                                                                   

Ø  Diet control; Avoid snacking (i.e eating between meals) and reduce the consumption of refined sugars like cakes, chocolates, and sweets. Rinsing the mouth immediately if and when these are eaten, helps to reduce debris and will leave very little substrate for the oral bacteria.

           

Ø  Eat fresh fruits regularly like oranges, water melon, pineapple, apples, etc. these fruits have a “cleansing effect” and have a way of keeping the teeth and mouth clean.

                         

Ø  Ensure good oral hygiene; Brush your teeth and tongue regularly using the appropriate toothpaste and toothbrush.

                                                                         

Ø  Floss your teeth after brushing to clean the places that toothbrush cannot reach. The use of a dentist recommended mouth wash may also be helpful.

                      
Carrying out these simple steps will keep your teeth and oral cavity in good health.

Nepal Needs Our Help

Credit: Krish Dulal

I will like to highlight the recent 7.8 magnitude earthquake in Nepal. I am quite sure you are aware of the details. I will not focus on the fact that presently over 3700 people are dead,7000 injured and millions of dollars worth of infrastructure destroyed. The death toll is rising by the minute.

Rather, my focus is on what we can do to help. Nepal needs relief materials, food, water, sanitation materials, medical assistance and a lot of other things. The country has just one major airport with one runway. Getting materials in has been a difficult task.

However, several organizations are already in Nepal and you can send your donations to them. I will list some of them below.

Please, lets be our brothers' keepers and send what we can. Click on the links below to go to the donation sites of the various organizations already in Nepal.

The Salvation Army: Click here

Mercy Corps: Click here

Handicap International: Click here

Doctors Without Borders: Click Here

American Jewish World Service: Click here

Oxfam: Click here

International Medical Corps: Click here

Red Cross: Click here

UNICEF: Click here

Save The Children: Click here

Canadian Medical Assistance Teams: Click here

World Vision: Click here

Catholic Relief Services: Click here

Thank you for your kindness.

My post on 'Using Checklists to reduce Medical Errors' will be coming up soon...

Using Algorithms to Reduce Waste in the Hospital

The issue of waste is a perennial problem in any organization. Waste is the failure and inability to use something wisely. It is the failure to maximize the potentials and value of a thing or activity.

I have previously written on excessive waiting time,re-work and poor ergonomics as sources of waste. Today, I will identify excessive processing/over-processing as a source of waste. I will also explain the role of algorithms in reducing this waste.

An algorithm is a logical step-by-step procedure for solving problems. When used in healthcare, it helps to set guidelines for critical activities in the hospital.

 Excessive Processing

Excessive processing is like placing a bucket under a running tap to fill it, yet refusing to turn off the tap when the bucket is full. The extra water added and the extra time spent is wasted in the long run. Examples of over processing could be excessive and indiscriminate use of antibiotics, sending patients for laboratory investigations that are irrelevant etc. Consider Jummai’s case:

Jummai is a 5 year old girl who was admitted for anemia secondary to severe malaria. On admission, her PCV was 17%. She was placed on an antimalarial drug and also received a unit of compatible blood. Her PCV rose to 20%. She became clinically stable and was even playing around the pediatric ward. She was scheduled for discharge. But Dr. James who just returned from his annual leave felt that she shouldn’t go home with a PCV of 20%. He decided to transfuse another unit of compatible blood. Unfortunately, she developed a transfusion reaction and spent an additional 6 days in the hospital consuming resources that should have been used on other patients!

We can deduce 3 reasons for excessive processing from Jummai’s story.

• ·        The employee may not really know what the exact standard of his work is going to be. For example, when is the right time to discharge a patient? Sometimes, doctors working in the same facility may disagree on the discharge date for patients under their care.
• ·        The internal standards used to determine quality may not reflect the true patient requirements. From the above case, Jummai’s PCV level alone was not a good indicator to determine her fitness for discharge or continual hospital stay.
• ·        Over processing may be a re-bound effect of rework (re-admission). Dr James may have had a previous experience where he had to re-admit a similar patient after discharge. Therefore to prevent re-work, he may have ended up over-processing.

An algorithm can be used to eliminate over processing. Here’s how it works:

• ·        Set clear standards (for any process) that reflect the actual patient requirement e.g. set parameters that if achieved by the patient will lead to discharge. The setting of standards involves the development of algorithms or protocols for certain situations.
• ·        Involve operational staff, unit leaders and top management in the development of algorithms.
• ·        Review every aspect of your hospital process to identify areas of excessive processing and remove such activities.
• ·        Ensure regular supervision of hospital personnel to ensure that they adhere to the hospital standards of performance.

Teamwork is a Problem in Healthcare: So, What next?

I have tried to resist the temptation to write on teamwork for some time now. I realize that I may ruffle a few feathers with this post so I am already bracing up for any possible backlash.

It is common knowledge that there is a lot of in-fighting among healthcare professionals. This problem is endemic worldwide; physicians vs. nurses, laboratory scientists vs. physicians, pharmacists vs. physicians, and the strife is endless. One recurring decimal seems to be that other healthcare professionals are at peace with themselves but have issues to grind with physicians. I don’t have a high-tech solution for this problem. I think it probably just comes down to simple things like interpersonal skills, prejudices and stereotyping.

Let us consider some of the factors associated with this problem.

Ego and Arrogance

A classmate of mine had his mum on the staff of the Teaching Hospital while we were still students. She was a matron in one of the units. All her colleagues were nice and treated us like their own children. Imagine the gross reversal of roles when the ‘children’ qualified as physicians and the nurses had to take ‘instructions’ from them!

Medical professionals typically have large egos. For example:

Many physicians feel they possess all the knowledge in the world. Maybe, they feel that way because they are always ‘inside’ the human body. This feeling may also be reinforced by patients. Sometime back, after seeing a patient wheeled out of the operating theater, someone remarked that ‘doctors are next to God in knowledge and ability’. Really???

Many nurses on their own part feel that they are indispensable. They seem to have an exaggerated opinion of their abilities. This ego is reflective on their relationships with other team members.

Some pharmacists believe they are the ‘gurus’ of medicines. It is quite common for them to ‘query’ a physician’s prescription just to show that they have more knowledge about drugs.

Large egos in hospitals are often manifested as arrogance. Ego and arrogance are offensive to everyone and are major causes of in-fighting in the medical team.

Lack of Mutual Respect

Furthermore, healthcare professionals do not show enough respect for others on the medical team. Unfortunately, until there is mutual respect exhibited in words and actions, disharmony and disunity may continue.

In a male soccer team, there can only be one captain. However, the captain alone cannot be a midfielder, goalkeeper, striker and defender all at once. He needs others to make the team victorious. He may not be the most talented though, but he is the captain and deserves respect. He must respect others too. He must not be condescending in speech or conduct towards teammates. They are actually teammates and not subordinates. They are also endowed with skills, talents and knowledge.

If other healthcare professionals were inconsequential, society would not have placed them together with physicians in the health sector. Teammates must each recognize their role on the team, fulfill their responsibilities and respect their captain.

Fight for Resources

The leader of any team usually controls the allocation of resources. It is therefore little wonder that every member of the medical team wants to lead the team. If the leader allocates resources unfairly or unjustly, there will be in-fighting. This fight is actually a fight for prominence and relevance. Team Leaders therefore should be just and fair in their leadership roles to reduce the incidences of discontent among team members.

Did a ‘deity’ Actually Kill the ‘Ondo 18’?

Map of Nigeria showing Ondo State (see arrow)

Recently 18 Okada Riders (Commercial Motor Cyclists) died from a ‘mysterious’ illness in Irele, Ondo State, Southwest Nigeria. 5 others are in a hospital receiving treatment for the presently unknown disease. The locals claimed the dead men were killed by a deity. An in-depth analysis of the story will reveal 3 ‘deities’ that may have been responsible for their deaths.

‘deity’ #1- Malokun Shrine

The people of the community claimed that the 18 young men who died were punished for stealing sacred objects from the Malokun shrine. It is generally believed in Africa that mystic gods and goddesses can mete out punishment to criminals.  I really can’t prove this story so let’s move on to the next possible deity.

‘deity’ #2- Herbicide Poisoning

The initial hypothesis from the World Health Organization (WHO) was herbicide poisoning as the cause of death. This may be corroborated by the fact that the men all drank an herbal substance shortly before their deaths. Herbicide poisoning is actually quite lethal so this ‘deity’ may have had a hand in their death.

 Dr A.G Iyagbe, a Nigerian Scientist who studied herbicide use in South-South Nigeria in 2013 noted that many farmers who used herbicides bought them from the open market. His study also noted that the farmers did not use accurate measurements in preparing spray mixtures. In addition, they disposed left over spray mixture in local rivers and streams and had limited knowledge of the dangers of herbicide use.

Another Nigeria scientist, Dr. John Gushit in his 2012 Study noted the presence of herbicide residues in Fadama and Upland soils in North- Central Nigeria months after their use.

The unregulated availability, improper use and careless disposal of herbicides by farmers can lead to the contamination of crops and the environment. It is possible therefore that the 18 dead men somehow ingested an herbal mixture that was contaminated by herbicides. Toxicology may prove this.

 ‘deity’ #3- Methanol Poisoning

According to the Ondo State Government Spokesman this ‘deity’ likely caused the deaths of these 18 men and the illness of the remaining 5. The 23 men were said to have consumed a local brew known as Ogogoro. As is the practice with millions of Nigerians (even my Auto Mechanic is a consumer), Ogogoro is frequently mixed with roots and local herbs before consumption. There is a myth that this mixture treats malaria, makes people healthy and also ‘charges’ the brain. These men were alleged to have taken this Ogogoro-Herbs Mixture. Ogogoro is akin to Moonshine, an illicit brew made popular in America by the Appalachian distillers in the 1700s and 1800s.

Ogogoro also known as Sapele Water is a common Nigerian spirit made by distilling Raffia Palm wine. It contains 30-60% alcohol and is a source of income for many economically disadvantaged Nigerians who brew it in their homes. Sometimes, cheap methanol is added to increase the alcohol concentration of the drink.

However, it seems plausible that the methanol contaminant came from the roots and wood (local herbs) added to the mixture by the sellers. It is well known that methanol is the simplest alcohol which is produced by distilling wood. That is why it is also called wood alcohol.

How Poor Ergonomics Can Lead to Waste in the Hospital

Taiichi Ono, the former chief engineer of Toyota wrote that “moving is not necessarily working”. Your workers may appear busy but they may not be productive (i.e. no added value from their activities). Ergonomics is the study of workplace design. It has to do with the working conditions of an organization, especially the design of the work space, equipment and furniture in order to help workers work more efficiently, effectively, comfortably and safely. This results in being more productive. Poor ergonomics therefore means poor work conditions and poor design of the workplace.

Unnecessary movement of machines or manpower within your hospital process is counterproductive. This usually happens when your work space is poorly designed. To fully understand poor ergonomics as a source of waste, let us consider a clinical scenario.

Dr. Kola is in the OR performing a C-section. He has already extracted a 4.5 kg male neonate. In the process, there was a deep tear extending from the anterior part of the lower uterine segment towards the posterior surface of the urinary bladder. In an attempt to close the uterus beginning at the “angle of sorrow”, the suture snaps. The scrub nurse is so jittery that he drops the replacement on the floor. That happens to be the last Chromic 2 suture available in the OR. (Dr. Kola’s practice is to keep all materials and drugs in his office to reduce pilferage. He only supplies what is needed per time. His office is a fair distance from the OR). So, the circulating nurse has to get the office keys from Dr. Kola’s pocket, runs to his office, and fumbles at the lock before gaining access to the office-cum-store. The nurse returns 7 minutes later with a pack of the coveted Chromic 2 sutures. In the process, the patient losses a considerable amount of blood and have to be transfused on the ward.

This is a poor design of the workplace and work conditions. It is quite fortunate that the patient did not lose her life in the process.

Dr. Kola’s problem can be easily resolved by decentralizing his storage system and securing the items with locks. He could situate a mini-store in the immediate theater vicinity. This is a better design and will reduce the incidences of unnecessary motion without jeopardizing the safety of hospital materials (and patients, of course!). 

Other examples of poor ergonomics are situating the Out Patient Department (OPD) far from the laboratory or placing the pharmacy at the hospital entrance while the OPD is at the middle of the complex.

To reduce wastage from unnecessary motion, carefully and economically design your work space. Manpower, machines and materials should be arranged in such a way as to minimize motion. This will save time and energy. Plan and constantly re-plan your hospital layout to achieve better ergonomics. Having workers run around in an uncoordinated manner during emergencies because of poor workplace design does not portray order and efficiency. Rather, it reflects hysteria and panic resulting from poor planning.

See you soon.....