Prevent dental diseases with good hygiene, diet

Taking good care of your teeth is a good way to avoid toothaches, expensive trips to the dentist and tooth loss. But poor oral hygiene, health and care can affect the health of your whole body.

For some, it has caused oral cancers and others, bad breath.

Sarah Nassozi’s journey through tooth decay is a tale to tell. Over the years, two premolars on her left side of the mouth became brown and their enamels (hard outer layer of the teeth) started chipping off.

Then once, while having dinner, her food got stuck in a hole between her teeth, large enough for the tip of her tongue to reach. This was the beginning of her nightmare. Soon, her teeth hurt so bad that it brought her fever.

“I was hospitalized and could not eat anything for three days until my tooth was gouged out,” she recalls.

Dr Muwazi at his job

Nevertheless, the teeth trauma did not end at that. Two years after removing her first tooth as an adult, Nassozi, 26, is back at Mulago hospital’s dental unit, removing yet another decaying tooth.

Although tooth decay or cavities are largely preventable, Dr Isaac Okullo, dean of the Makerere University school of Health Sciences, says they remain the most common chronic disease of those who present with tooth problems.

They are commonly among children aged six to 11 years and adolescents aged 12 to 19 years.

“When sugar sticks onto or between teeth, it holds bacteria which break down foods and produce acid that destroys tooth enamel. This causes tooth decay,” Okullo says.

He advises people not to eat sugary foods in between meals because it is unlikely that one will clean his or her mouth. Snacking should also be limited.

Additionally, excessive intake of soft and energy drinks such as sodas and red bull respectively should be avoided as these contain acids and artificial sugars which are harmful to the teeth.

PREVENTING

GUM DISEASE

Associated with the sugar and bacteria action on teeth is gum disease.  It occurs when the gums holding the teeth are affected by dental plaque: a colorless substance that sticks on the teeth which will hold bacteria and sugars to the teeth.

Dr Okullo says if this plaque is left unchecked it causes redness and inflammation of the gums.  As a result of this irritation, the gums can begin to pull away from the teeth and the gaps which have been created become infected.

“If gum disease is not treated quickly, the bone which supports the teeth can be destroyed and teeth can be lost. Gum disease is a major factor in tooth loss as we age,” says Okullo.

Also, some teeth end up being held by the gum around them which means that a small force and take the tooth out.

Inside Mulago's dental clinic 

Dr Louis Muwazi, a dental surgeon at Makerere University, says one is at risk of gum disease if he or she is a smoker, has diabetes, crooked teeth as they are harder to clean. Muwazi says important signs and symptoms for one to look out for in regard to gum disease include gums that are red and tender, gums that have pulled away from your teeth, pus coming from between your teeth and gums and teeth which look longer than before because of gum recession.

To avoid gum disease, Dr Muwazi advises people to daily brush their teeth at least twice a day (morning and when going to bed) using fluoride toothpaste in order to remove plaque.

If the plaque is not eliminated, it can continue to build up, which will then feed on the food fragments left behind and can cause tooth decay and gum disease.

However, ‘over-brushing’ the teeth may cause gums to bleed.

“It is vital to change your toothbrush every two to three months or sooner if the filaments become worn. When the bristles become weak, they no longer clean properly and may even damage your gums,” Dr Muwazi notes.

Dental visits every six months are recommended for oral examinations and professional cleaning of teeth. Mulago hospital’s dental unit charges Shs 20,000 for teeth cleaning.

Coping, dealing with acid attacks

On June 2, 2010, Charles Ssebowa, experienced a most horrendous crime. It was as permanent as it was cruel. The accompanying scars, psychological trauma and stigma are hard to fathom. Ssebowa, 37, is an acid survivor.

It was a Wednesday; at around 9pm. Ssebowa, his wife, and two children were riding home from work when someone doused them with acid.

A great fall and sharp shrills followed. They could not see. Their bodies were burnt. The children writhed in pain. 

“When the acid was thrown on us, I felt a burning sensation on my face and did not discover that it was acid. However, my wife shouted and alerted me that acid had been poured on us,” recalls Ssebowa, whose right side of the face is scared.

Luckily, the gathering crowd hurriedly poured water onto them, partly easing the stinging pain.

Ssebowa in his current state

Many would wonder of what use water is against acid; but according to Dr Ben Khingi, a plastic and reconstructive surgeon at Mulago Hospital, water helps to dilute the acid on one’s skin and is recommended as first aid.

After the administration of first aid, the family was driven to Mulago Hospital for treatment. Their tormentor is still out there, the torment a constant thorn in Ssebowa’s flesh.

“After two months in hospital, my first born child, aged five, died. And two weeks later, the one aged two died,” says Ssebowa, peering on the floor, still hurting that he did not bury his children.

That September, his wife also died.

Dr Khingi says it is important for acid burn patients to get first aid as soon as possible. Otherwise, the acid penetrates further into the skin, affecting the bones and nerves.

“Such patients heal with worse disfigurement, for example thick scars compared to those who received first aid promptly,” he says.

In Uganda, acid is easily accessible at service stations, laboratory stores that supply schools and people that deal with car batteries.

Since its establishment in 1985 the Acid Survivors Foundation Uganda (ASFU) has registered 429 acid attack victims.

“According to our statistics, about 40 acid attacks occur annually with many more going unreported and the attempt of the attacker is to kill or at the very least, leave their victims with severe skin deformities,” says Hilda Wanaha, ASFU’s program manager.

ASFU is a nongovernmental organisation that supports victims of acid violence through legal aid, direct survivor support such as medical support and campaigns against acid violence.

Majority of these attacks are attributable to love-turned-sour, business and conflict wrangles and 56 per cent of victims are women.

ABOUT ACID BURNS:

An acid burn is usually considered a deep second degree or third degree chemical burn as it burns not only the skin but penetrates to the fourth layer of skin and damages the tissue. The chemical usually affects the nerve endings.

Dr Khingi says an acid burn takes an average of four to five months for an acid burn to heal properly.

“For one to heal completely, one usually undergoes about 10 surgeries aimed at getting the dead skin out, letting the skin heal and to enable to free movement of the affected muscles in the affected area,” he explains.

For the six months that Ssebowa spent in Mulago, he underwent 10 operations and these are what helped him regain his sight.

At Mulago Hospital, a single operation costs between Shs 3m and 5m and one will need about Shs 50m for the entire course of treatment and recovery. The hospital receives between six and 40 cases of acid burn patients annually, with 13 per cent dying.

Some of the acid survivors being taken care of by ASFU

RECOMMENDED FIRST AID:

After acid gets into contact with any body part, mostly the face, the immediate first aid is to pour a lot of clean water on the person for 20 to 30 minutes. Dr Khingi says dirty water should not be used as this may expose the person to infections.

Take off all clothes, jewelry and shoes stained with acid and continue to flush with water until the burning sensation starts to fade.

Wrap the affected area in clean sheets or sterilised gauze to prevent dirt from getting into contact with the affected area.

Get the patient medical attention as soon as possible.

 TREATMENT AT FIRST HEALTH FACILITY:

More irrigation of the eyes should be done.

Thereafter, pain control using strong pain killers such as Tramadol should be administered. Ritah Sanyu, an acid survivor and peer counsellor at ASFU, says an average of Shs 350,000 may be spent on pain killers per cycle of treatment.

The patient may now be referred to a surgeon who uses saline water to clean the open wounds.

“Saline water further dilutes the acid, ensures that affected cells do not swell and reverses the acid effect,” Khingi expounds.

WOUND TREATMENT

Hygiene is one of the most vital elements to remember during wound treatment as infection is the commonest cause of death among these patients. In Ssebowa’s scenario, the acid caused dents in his children, exposing them to infections.

The room and washroom used by patients should be thoroughly cleaned with disinfectant two or three times a day.

Skin grafting, where a part of the skin is taken from an unaffected area and used to cover the open skin and surgery to cut out the dead skin may also done during treatment.

“After the wound/burn heals, a series of reconstructive surgery is then done to correct the contracted skin,” Dr Khingi notes, adding that regular sessions of physiotherapy are required to ensure that the affected nerves gain their mobility to prevent physical handicap.

Sanyu advises that patients should eat a lot of protein and carbohydrate-rich food, such as beans, peas, cassava and potatoes, for quick recovery of damaged tissues.

Nevertheless, challenges of costly and long periods of treatment and inadequate man power remain. Currently, there are only four plastic and reconstructive surgeons at Mulago.

LONG TERM CARE

After the wounds have healed, Sanyu says it is important for a patient to keep the skin moisturised by applying petroleum jelly.

In many instances, acid burn patients are stigmatised by the public and hence need constant counseling.

“This stigma greatly demoralises them, [blunts] their self-esteem and it is common that many contemplate suicide,” Sanyu says, adding that social reintegration is also necessary for their families and communities to accept them.

Wanaha says that training patients to engage in self-sustenance projects such as agriculture is also important in boosting self esteem.

Currently, Ssebowa, who has completely healed, sells charcoal and vegetables for a living.