When was the last time you visited a dentist?
I thought as much.
Dental Care is one medical field that’s under appreciated in sub-Saharan Africa. In some places, the only time most people get to see the dentist is when they have tooth ache, with or without associated swelling (even when some do, they go first to a physician, even an optometrist before been referred to the dentist).
There’s a lot to be gained by going to see a dentist, even when there’s no pain, but just for a routine dental check up.
The importance of a routine dental check up cannot be overemphasized, as pathologies of the oral variety can be nipped in the bud in the early stages before they aggravate to difficult to manage levels that may require invasive procedures to smell ameliorate.
Simple procedures that can be performed when patients pay routine visits to the dentist include ‘Scaling & Polishing’ for patients of all ages (as long as they have teeth) and ‘Fluoride Therapy’ especially for Children.
Scaling & Polishing involves the removal of deposits attached to the teeth commonly known as ‘PLAQUE’ and ‘CALCULUS’. These deposits cannot be removed by the normal brushing we do in the mornings (and evenings for some people who do the ideal).
Fluoride therapy is meant to augment FLOURIDATION for Children who may have lacked Flouride by other sources, such as in the public water supplies. In many African countries, this is important as many communities lack access to clean potable water talk more of one that’s Fluoridated. Residents in Towns and Cities have also abandoned the pipe borne water where they exist, for bottled water (or sachet water as you’ll find everywhere in Nigeria), hence Flouride therapy for kids become imperative in this case.
Besides the above prophylactic treatments, Atraumatic Restorative Treatments (ART) can also be procured at the dentists, where shallow cavities can be filed without Local Anaesthetic (which is widely responsible for the phobia most people have for visiting dentists). Also deep fissures (*posterior teeth like molars have elevated and depressed aspects on the surfaces, especially in the early years of eruption before the elevated areas are worn down by chewing activity, it’s the depressed aspect of the surface of molars which look like Valleys, that’rê referred to as ‘Fissures’) on the surfaces of molars and some premolars maybe filled with ‘FISSURE SEALANTS’. The Fissure Sealants reduce the predisposition of such teeth to develop cavities or holes, and their placement on the surface of teeth does not require Local Anaesthetic.
Now, the typical tooth has three layers above gum namely the ENAMEL, DENTINE and PULP. The Enamel is the outer protective layer that’s some shade of white in some people.
The Dentine is the Yellower second layer which when the Enamel is breached, gives rise to DENTINAL HYPERSENSITIVITY, the presentation which includes the feeling of a ‘shocking sensation’ when one takes cold drinks and or sweet things, when there’s no hole on the tooth.
The third layer is the Pulp Chamber, which houses the Nerves and Blood Vessels. Once this level is breached (by a cavity/hole, a fracture of the tooth passing through the Pulp etc) there’s pain.
If there’s sensitivity, or Hypersensitivity, then a DESENSITIZING PASTE could help a great deal in reducing the sensitivity on the tooth when it’s applied directly on the tooth for a short period of time before one brushes the teeth with it.
If there’s a hole or cavity on the tooth, that’s restricted to the first and second layer of the tooth, a FILLING (white or tooth-coloured filings like GLASS IONOMER CEMENT or COMPOSITE filings for anterior teeth, while the stronger metal alloy, AMALGAM filling for posterior which can bear ‘Masticatory Stress’ better) could be placed on the tooth, when the pulp isn’t involved.
When the Pulp is involved, the options available to the dentist include to perform a ROOT CANAL TREATMENT/THERAPY on the tooth, which involves the removal of the blood vessels and nerves in the Pulp Chamber and Root Canals emanating from the Pulp.
This Procedure will ‘Kill’ the tooth but keep it in the mouth, and can be used to chew though it will not be able to respond to stimuli from temperature changes. Consequently, the tooth will be weak and won’t be strong as it used to be, hence will require a crown to protect it from fracturing, and in the case of the anterior teeth, cover it such that people won’t see the tooth becoming darker in shade.
Alternatively, the patient may decide to opt for an EXTRACTION, if (s)he cannot afford the cost of an RCT or if the tooth has become so badly broken down that not even an RCT could suffice.
After an extraction, the patient may decide to do a replacement for the missing tooth. There are two types of replacements namely the Removable and Fixed Types. The Removable Replacements include Non-Flexible Partial Dentures and the Flexible Partial Denture aka Valplast.
The Fixed Replacements include BRIDGES and IMPLANTS.
Apart from the fear of administration of Local Anaesthesia, many dental patients who’ve had unsavoury experiences with dental visits (especially on their first visit) usually stay away afterwards for fear of a repeat experience.
When filings fail, the wise thing to do is to go have them redone. If one isn’t confident in a particular dentist one could seek a second opinion, but to refuse to see a dentist ever again is a no-brainer.
Even when RCT’s fail, remedies like an APICECTOMY could be procured at the dentists before an extraction is considered as an option.
Besides all the dentist can do to better the lot of your teeth (including the arrangement of same by ORTHODONTISTS), many systemic diseases which have oral presentations and manifestations can be detected by the dentists during such routine dental check-ups.
Today, in most parts of Africa, Dental Care has become more accessible though still restricted to major towns and cities in terms of concentration. Many people have also become introduced to Dental Care through their Health Management Organizations, HMO.
In Nigeria, most HMO’s allocate very little to Dental Care, hence patients or clients seeking specialist treatments have to bear the cost themselves even when they have Health Insurance.
Dental Care is expensive the world over, and in some places it’s considered quite elitist (especially in sub-Saharan Africa where most, if not all of the equipments and consumables are sourced from abroad), however simple Dental Prophylaxis which is far less expensive makes the maxim ‘Prevention is Better than Cure’, all the more apt if we all can find some time to pay the dentist that visit for a routine Dental Check Up, which should ideally be twice a year (or once a year as your HMO will recommend).