-Column- Knock, knock. A fellow volunteer from Cameroon knocks on the door of our treatment room and enters. He has a question. I have a moment and walk over to him. He says: “It’s not right: that filling you recently made for me”. I try to think about what treatment he’s talking about. Was it a deep restoration? A difficult contact point? Oh, I remember: an occlusal dentin lesion in tooth 36, quite large, not threatening the pulp. Curious, I ask further: “What’s the problem with the tooth?” He tells me that he has a strange, slightly painful feeling in the tooth when he opens a bottle of beer or soft drink. He makes a movement with his hand as if he is opening a bottle sideways with his jaws. I laugh in surprise (inside) and ask seriously: “Does it also hurt at other times? Eating, drinking, sleeping?” It turns out that he only has the complaint when using his molars as a bottle opener.
While working here on the hospital ship in Sierra Leone I see a lot of teeth with severe wear on the teeth. Many teeth have generalized wear (abrasion). This is often caused by the habit of chewing on animal bones. Chicken bones, cow bones and even fish bones; many people in West Africa love to chew on these and this is clearly visible in the teeth.
A lot of other wear and tear comes from using the teeth as a multifunctional tool to open all kinds of things. Plastic bags for example: there is no network of drinking water pipes in this country. In the city, people mainly drink water from plastic bags that are sold on the street. These bags are usually opened with the teeth and emptied on the spot. Most other drinks are sold in glass bottles. People are crazy about sugar and soft drinks. If drinks have to be bought and the price difference between water and soft drinks is not that big, they often choose soft drinks. These bottles are also opened with the teeth. Both with the incisors and with the molars. Very regularly I see an upper front like in this famous beer commercial. Our local employees also have the first reflex to use their teeth when something needs to be opened.
By the way: when teeth are healthy, have no caries or periodontitis, they are quite strong enough to do a lot more work than just eating for about 60-80 years. Sometimes it looks severe, that wear, but the percentage of cases in which that leads to a pain complaint or broken tooth or molar is not very high. Only when there are also cavities or deep pockets, the forces on the teeth become too much and it causes bigger problems. I try to keep these other oral habits in mind when I decide on the choice of restoring or extracting front teeth with endodontic problems.
In the Netherlands, we generally find parafunctions and wear quite severe. I also raised these problems in the Netherlands and tried to motivate the patient to change the harmful behavior. The fact that we find wear so severe in the Netherlands, I think has to do with the high appreciation of the aesthetic function of the teeth.
Here in West Africa I try not to immediately see the ‘extra functions’ of the teeth as bad. Of course, as a true Dutch person, I also try to find the cause here and address it. On the other hand, I know: as soon as different tools become more widely available for these people and aesthetics are valued more highly, these habits will most likely change by themselves.
(Image: Tomas Prochazka, Wikipedia | CC-BY-SA 3.0)
Marijke Westerduin, dentist and volunteer at Mercy Ships, writes a monthly column for the NTVT. Marijke graduated as a dentist from Radboudumc in 2007. After that, she worked as a dentist in a general practice and in a pediatric dental clinic. Marijke worked for 7 years as a lecturer at the Radboudumc dentistry program. In the past, she also worked for short periods as a dentist in Togo, Zambia and Guinea. She is currently working as a Lead Dentist in West Africa for the third year, from a Mercy Ships hospital ship. Marijke will work on her dream there: improving access to oral care in West Africa. She also does this through her foundation: Stichting Improve. In her columns, she takes you along in her experiences and her thoughts on the matter.
