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Sunday, November 15, 2015

MEDICAL ADVISORY : Diabetic Tooth Extraction In A Tropical Environment

From experience

THE 5TH ESTATE
By Robert S. Finnegan
11/15/2015

Diabetic expatriates and visitors from the West and especially the United States experience unique medical challenges in ASEAN countries. Most are easily surmounted.


There are however circumstances that require careful consideration, pro-active treatment and monitoring by the patient.

Dental surgery is one of these areas.

While some ASEAN countries such as Malaysia and Singapore are on par with Western dentistry, in others such as Indonesia extreme caution must be exercised when undergoing tooth extraction, especially diabetic patients.


Choose Your Dentist Well

The U.S. embassy Jakarta cannot be relied upon for referrals, the fact is their representatives have stated that they simply do not care about American expats regardless of the circumstances, military veterans included. Never utilise or expect anything from them except your passport and visa services.

Short-stay (60 days or less) visitors should not undergo elective dental surgery here as the logistics alone are a nightmare. Indonesia is not an English speaking country, and by the time a patient secures a dentist they can communicate with (an absolute necessity) their time here - including recovery - will most likely be near expiration. 

Should a visitor require an emergency extraction and does not have any in-country contacts to assist with a referral and translation services if required, the best option is to request assistance from your hotel in-house doctor or the management. They will be more than glad to assist once they become aware of your situation.

Extraction

Dentists in Indonesia extract a lot of teeth, so the majority are experts at it. All have access to Novocaine and Lidocaine and provide painless extraction. 

However, diabetic patients must take charge of their own post-op surgery and recovery in order to insure there are no bleeding issues or other complications.

Infection

Pre-extraction antibiotic prophylaxis is a requirement, beginning at least 72 hours in advance. It is optimal that patients coordinate with their dentists in their countries of origin. A ten day regimen following surgery is recommended and antibiotics are readily available in Indonesia.

Pain Remediation

Current drug laws in Indonesia prohibit the sale and use of any narcotic drug, including codine. Your choice will be over the counter analgesics and cloves, there simply are no other options available. This must be carefully considered before undertaking any extractions in Indonesia. It is guaranteed to be a very painful experience, especially for diabetics.

Monitoring BGL

Precise control over blood glucose levels must be maintained post-op, as higher levels will lead to an increased possibility of infection and compromised healing. Patients must assure they have a test kit and 30 day supply of strips prior to surgery in addition to a 30 day supply of insulin, also readily available.




Summary

All diabetic dental work in tropical environments is a risky business that requires a completely pro-active stance on the part of the patient and should be avoided whenever possible by visitors.

Never assume, always confirm. Have a plan, work the plan. Have a back-up plan in the event the first goes South. This is one area where a mistake leading to infection can put you in the ground.

Utilize the hotel staff whenever possible, they will gladly assist you through your ordeal.


Robert S. Finnegan is a retired investigative journalist and journalism professor. He resides with his spouse Imas Kurniawati-Finnegan in Indonesia and may be reached at rsfinnegan@gmail.com.



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