Dying from simple dental decay might seem impossible, but on the eve of World Oral Health Day Mark Topley points out that - in some parts of the world - it is all too common.
I run a British dental health NGO out in Tanzania. At a dinner recently on the shores of Lake Victoria, I sat next to an America surgeon visiting the area. As well as working within our local city, Mwanza, she was carrying out surgery in one of the district hospitals where our emergency dental training teams are based. As we chatted, the subject turned to the training we'd been providing in the Lake Zone.
Although I knew that complications from untreated dental disease could cause real problems for people living in this part of the world, the comments my dinner companion made shocked me. Many of her patients, she said, needed major surgery to remove diseased tissue caused by untreated dental infection. When a dental infection fails to 'drain' properly, she explained, the infection can track into the neck and then spread from there into the chest. This leads to tissue necrosis (tissue death) and septicemia (severe infection in the blood), often fatal. Treatment is to cut away the necrotic tissue and give high doses of antibiotics.
Sadly, she reflected, this very rarely works. Once a person has infection tracking into their neck, the prognosis is not good. It was one of the enduring memories, and frustrations, from her visit. She summed it up with a comment at the end of dinner:
"If I had my way, I would train an army of people to take teeth out safely. What people need in the villages round here is someone who can simply remove a diseased tooth, and stop the infection spreading."
Dying from decay
It is 2013 and people are still dying from untreated dental decay. Two of our teams have just returned from the regions of Musoma and Bukoba in Tanzania, where for 10 days they have been training local health workers in emergency dentistry. They will train them in areas without running water or power, or the standard sterilisation kit we are used to here back in the UK (special charcoal-burning sterilisers are used instead). Yet for thousands of people living in distant, rural settlements there are now a dozen locally-qualified people who are able to treat their communities day-in, day-out, helping to prevent the sort of hideous conditions that my dinner companion had mentioned.
Sadly, however, the shocking reality is that three-quarters of the world's population have no access to even the most basic of dental services. Dental Caries as the dental profession calls them - or tooth decay - is the world's most common disease. It causes debilitating pain and drastically affects a person's ability to function.
Most developing countries don't have enough dentists: here in Tanzania there is one dentist for approximately every 100,000 people (in the UK the ratio is 1:2,500). In Rwanda, where we are about to launch a new project, there are just 11 dentists for the entire country! To make matters worse, these dentists usually live in cities and large towns, where in these east African nations only a minority of the population is based. This lack of access to pain relief leads to chronic suffering, the loss of ability to work or support the family, withdrawal of children from school (to help support subsistence farming), and complications that can and do lead to death.
So the access to a dentist in every village remains a utopia. What we believe is necessary, and where we feel our partnership with the Tanzanian government is leading the way, is to train medical personnel already deployed to these rural areas to provide a basic, pain-relieving service, combined with oral health education. We're extending that partnership elsewhere in Africa now, backed by the support of many British dental professionals. Above all, though, all of us involved in this field must focus on relieving dental pain through training, so that local medics can carry out safe tooth extractions. Otherwise, literally, a toothache can kill.
World Oral Health Day: Wednesday 20 March 2013
Mark Topley is CEO of Bridge2Aid, a British dental health NGO operating in East Africa www.bridge2id.org | @mark_topley