Tanzania: Poor Oral Health - A Nationwide Problem

MZEE Ramadhani, 42, lies in a bed at Muhimbili National Hospital (MNH). Medical bandages cover his left eye and his throat. What started as a toothache led to an infection which spread to his left eye down to his throat and finally to his chest. "At first one of my teeth started paining. It looked rotten.
So, I took pain-killers but as time rolled on the pain got worse," he says. Mr

Ramadhan ignored oral health, although he says he used to brush his teeth twice a day. He is currently complaining of chest pain and a persistent cough. But medical doctors doubt whether he was really brushing his teeth twice a day. Another patient admitted in the same hospital is Furaha Ali, 26, a mother of twins who is also a victim of poor oral health.

Her throat is infected. She was admitted early this week. She says she had a rotten tooth but ignored it until it was too late. Dr Owibingire of MNH, says there is an established relationship between poor oral health and poor general health. The micro-organisms causing oral diseases can affect the heart and cause a condition called bacterial endocarditis.

An estimated 60 per cent of Tanzanians have poor oral health habits, which the doctor says, is a high-risk factor for heart diseases and other health complications. He says the problem is critical and nationwide. A former Chief Medical Officer, Dr Ali Mzige, said quoting a recent study that people who fail to brush their teeth twice a day are at risk of contracting heart diseases and even brain abscess.
"It is known that inflammation in the human body, including mouth and gums, has an important role in the build up of clogged arteries, which can lead to heart attack. Also poor oral health can cause brain abscess and poor quality of life," he explained. Oral and Maxillofacial Surgeon of MNH, Dr Sira Owibingire, agrees that there is enough evidence that poor oral hygiene can lead to heart disease and brain abscess.

He pointed out the major diseases affecting the mouth which include dental caries and periodontal diseases. Dental caries, which is essentially the destruction of the tooth caused by acid produced by bacteria do feed on the sugary food we eat. The progression of this destruction can reach the tooth central portion with nerves and blood vessels which is called the pulp. "The patient will at first complain of the mild to moderate pain which is caused by intake of foods and drinks especially those which are hot or cold.
This indicates that the destruction has reached the middle layer which is the dentine but probably not the pulp. At the advanced stage the patient will have toothache not elicited by any activity. Pain will be severe and may radiate to the head. The patient may even fail to sleep and the intake of simple pain-killer drugs like Paracetamol may not help or help just for few minutes," he elaborates.

The infection can further progress to the terminal portion of the root of the tooth, spread into the jaw bone and eventually the tissues around causing swelling and accumulation of pus that is what is called dental abscess. "Periodontal diseases can also lead to formation of periodontal abscess and eventually dental abscess as for the dental caries," he says. Most of the periodontal diseases are caused by the inadequate oral hygiene leading to gum diseases which on the initial stage will be called gingivitis and in advanced stage periodontitis.

Gingivitis will present with gum bleeding especially during brushing and even on touch. The airway obstruction due to the swelling on the floor of the mouth and the throat just from the progression of dental abscess can be the cause of early death due to dental infection. Overwhelming infection spreading to the blood stream (septicaemia) may be so much severe to the extent that multiple body systems are affected. In most cases this is the cause of death.

Dr Omondi, an intern dentist at MNH from Kenya says there is a lack of education on oral health. He is referring to Mzee who she says might be brushing his teeth but does it wrongly. There are people who brush their teeth for less than two minutes. The ideal time is not less than five minutes, she said. A patient with diabetes mellitus is prone to having periodontal diseases and the management of periodontal diseases in such patient is as simple as in a normal patient.

Likewise, all patients with systemic diseases affecting other body organs like liver and kidneys, patients with leukemia, sickle cell and other blood related diseases and all patients with decreased immunity in one or another are at risk of having poor oral health or the prevailing poor oral health may affect the progression and management of such systemic diseases. "The delay of presentation of patients for treatment of the advanced stage dental caries is the cause of formation of dental abscess," he said.

A dental technologist of MNH, Andrew Mdoe, says the cause of tooth decay or oral hygiene is a combination of bacteria and food. A clear, sticky substance called plaque that contains bacteria is always forming on your teeth and gums. As the bacteria feed on the sugars in the food you eat, they make acids. The acids attack te teeth for 20 minutes or more after eating.

Over a period of time, these acids destroy tooth enamel, resulting in tooth decay. Mdoe says "there are basic things that one should do, brushing of the teeth twice a day, replacing your tooth brush at least every three months, flossing (cleaning of your teeth with a special thread) and dental checkups, as recommended by the dentist."

Maintaining good oral health includes keeping teeth free from cavities and preventing gum disease. Poor oral health can affect your appearance and self-esteem. Poor oral health can also affect your ability to chew and digest food properly.


allafrican     Sources