‘Clean mouth protects from heart attack’

Dental problems such as tooth loss and infected gums are on the rise in Nigeria and its consequences are tremendous. Unfortunately, so many of these dental problems can be prevented. Dr Sunny Okeigbemen, Chairman, Nigerian Dental Association, Edo state Chapter, in this interview with Sade Oguntola, explains the importance of a clean mouth from childhood and how implementation of the National Oral Health Policy will contribute to healthy teeth.

How serious is the problem of tooth loss, as its incidence is on the rise in Nigeria and does the problem cut across all age groups?
Tooth loss is loss of teeth and it mainly affects the middle age and elderly people. It is hardly seen in children, except with those with conditions such as juvenile peridontitis. We do not have a national study to give a national picture of whether cases of tooth loss are on the rise or not. But if you look at the causes of tooth loss like dental caries, periodontal disease and trauma, if these cases are on the rise you will expect that cases of tooth loss will also be on the rise. But mainly, it affects the elderly.

What are the consequences of losing your teeth?
The consequences can be derived from the uses for the teeth. The teeth have functions and if these teeth are lost, those functions of mastication and speech will be affected. The affected person, for instance, will not be able to speak well. Of course the face will collapse and then you have an aged look and you will not be able to eat well. The oral health profile, as well as the quality of life, will be reduced. So it has great consequences and it is more than we can imagine.

Are there diseases that are associated with tooth loss?
Yes, the commonest ones are dental caries which refers to holes in the tooth. If it is allowed to run its full course, it will lead to tooth loss. Also, gum diseases that lead to periodontal diseases and subsequently shaking teeth also accounts for some cases of tooth loss. A tooth that continues to shake over time can fall off. In addition, juvenile peridontitis can cause tooth loss in children. Cases of trauma, whether from vehicular accidents or home injury, can lead to a tooth being knocked off.

Do diseases such as diabetes and heart problems contribute to loss of tooth? Studies also say that people with tooth problems stand a higher risk of developing health conditions such as heart problems?
Recently, it was scientifically proven that there is a link between oral diseases and diseases like diabetes, heart disease and low birth weight in babies. But more work is ongoing to substantiate the link between poor oral health and diseases such as diabetes and heart disease.

Most of these studies were done outside the country, but still need to be domesticated in the African region because there are some of these findings that are yet to be verified whether they are true in the African setting.

But is tooth loss synonymous with ageing?
Tooth loss is not synonymous with ageing, but when we allow the ravages of dental diseases to run their course, then the consequence is tooth loss. Now, if you take care of your teeth on a regular basis, you will have your complement of teeth throughout old age. So it is when people do not take care of their teeth that we have tooth loss and now say people will lose their teeth when they are old. If you take care of your teeth regularly, even at age 90 or 100, you will not lose them. It is because we do not have dental services, that is why we allow diseases to run their course. How many people have regular dental care from when they were young till they were old? How many people have dental checks every six months? So these are the things we should be looking at rather than focusing on the disease.

Can people that lose their teeth be helped?
There are options that we can use to help them. They could have dentures, bridges, implants and other forms of restorations that will replace the teeth artificially.

You will hardly know that they are having tooth loss. But the options are dependent on what they can afford as well. Virtually all these options are available because Nigeria is well matured in dentistry. If you need bridges, if you need implants and dentures of various kinds, they are all available in Nigeria.

Is it true that those implants might help improve productivity? How will it do this?
 Implants will improve quality of life but that it will save cost is another issue. Generally anywhere in the world, implants are more expensive than other forms of artificial tooth replacement.  As at now, implants are very expensive and not too many Nigerians on the average can afford it. But as more and more dentists get trained on artificial tooth replacement, probably cost of implants will come down.

How can Nigeria as a country help to ensure artificial tooth replacement is within the reach of the common man?
This can be possible through implementation of the Oral Health Policy which was launched November, 2012. This covers at least 50 per cent of all citizens. When a policy like that is in place, there will be some form of improvement and inclusion of oral health in the National Health Insurance Scheme.  Due to this, people can access oral health care without any money in their pockets to pay and doctors will be able to treat patients without having to demand for money. So let Nigeria implement the National Health Insurance Scheme and the Oral Health Policy so that people can be helped. This will go a long way in reducing dental problems.

Many myths abound in the community on tooth loss, tooth decay and dental health issues. In fact some people believe that a toothbrush must be used for a whole year before it is thrown away. Some believe that all toothpastes are same. Some say that one’s toothbrush should be thrown away after having a sore throat. What are the most prevalent ones in Nigeria?
From a professional point of view, the toothbrush should be used for maybe about three months. By that time, you will see the tuft had started to flatten out and are no longer effective in cleaning the teeth.  In fact, any time the tuft starts to flatten out, you should know that it is time to throw away that toothbrush.

On toothpaste, what is recommended is one that contains fluoride, which is its active ingredient.  Any toothpaste that contains fluoride is good. It is the fluoride that helps to prevent tooth decay. Other things such as the taste and the colour are not determinants of ideal toothpaste.

With regards to keeping the toothbrush, it should be kept dry. After brushing, it should be rinsed and kept such that it can remain dry, not damp, to prevent it accumulating germs. Also, when you have sore throat or dental infection in your mouth, it does not mean that after the infection is gone, your toothbrush cannot be used. You only need to continue to clean your toothbrush after each use and keep it dry. That a toothbrush be thrown away after a sore throat is cured is a myth, it has no scientific basis.

What other myths or practices do you see in the community on dental care and problems?
It is a common thing to see people that want to file their teeth to create a space between their front teeth. This is dental mutilation and it is wrong to start filling one’s teeth. Some also use things like sand, charcoal, petrol and kerosene in the mouth, claiming that it will kill the worms that are believed to cause tooth ache and tooth loss. This is a myth, it does not work.

Some also put a substance called “touch and go”, a chemical which distracts one’s attention from the real pain, so therefore increase the time spent before seeking dental care.

I have seen patients that applied “touch and go” when experiencing tooth ache but who ended up with burnt gums. Afterwards, they still end up coming to the dentist who will now be treating two things instead of one.  So, the best option is to visit the dentist at least twice a year, clean your teeth twice daily, eat nutritious foods and avoid things that have refined sugar in them.

Will the use of mouthwash help?
The use of mouthwash, when combined with brushing, is very beneficial and the mouthwash is always recommended as an adjunct to tooth brushing. The mouthwash helps to freshen one’s breath. But what is most important is tooth brushing; you cannot just use a mouthwash and stop tooth brushing.

Are there food items in our community that supports healthy teeth?
We have good and natural foods all over Nigeria that support good oral health. Our normal diets are okay for good oral health but the pattern of eating matters a lot. We should eat three square meals, no in-between meals, especially snacking on sugary substances. If you must take them do so during meal times and if you need snacks, eat fruits that can help to clean the mouth, which does not contain simple sugar. Simple sugar can be easily digested by the organisms in the mouth that converts them to acids which dissolves the tooth.