Veteran dentist tips on how to avoid tooth decay

Dr Ken Chapman Kigozi, a dental surgeon, has served as a missionary at Mengo Hospital in Kampala for more than 40 years. The doctor, born in Texas, USA, is dedicated to serving the people of Uganda and fluently speaks Luganda.

When he started working at the hospital in 1979, he recalls children had fewer dental problems than adults but with time, there has been an overwhelming increase in the number of cases of dental decay. He attributes some of this to say cough syrups, which he says lead to teeth decay since many do not brush their teeth or rinse their mouth after taking them.

“Sweets are also more accessible and many people eat foods that contain a lot of sugar. These are the biggest contributors of holes in the teeth for both children and adults. The worst thing you can do to a child’s teeth is to give them something sweet before bed,” he says.
Teeth are our servants that we must take good care of or we will have to forego eating some nutritious foods because we cannot chew them. This can cause deficiency in some nutrients, leading to disease. 

Avoid sweets
If you give your child sweets, juice, milk with sugar before bed, they will stop crying and sleep but whatever they take remains on their teeth and as we sleep, the salivary juices from the food or the drink stays on the teeth. Then, bacteria will start feeding on the sugar and digest it into acids.
The acids slowly soften the enamel and will cause holes with time. Unfortunately, parents bring the children to hospital when they are in a lot of pain and the teeth are damaged beyond repair. The best thing is to prevent such a thing from happening. 
Using toothpaste that contains fluoride to brush your teeth is another way to prevent tooth decay and holes in the teeth, according to Dr Kigozi. 

Beyond prevention
Once one’s teeth develop holes, it is too late to stop them and one must see a dentist as soon as possible. The dentist will carry out a physical examination or even an x-ray to determine the extent of damage, which will also determine the treatment.
If the damage is not extensive, sometimes, you do not have to do anything. I usually tell the patient that their tooth is about to develop a hole but if you reduce the intake of sweets and regularly brush your teeth with fluoride toothpaste and use dental floss, then the hole may stop growing.

In case the damage is extensive, for young children, we paint their teeth with a chemical that is painless.
He says, “It can be applied twice a year and can stop the hole from growing further. Silver diammine Fluoride (SDF) can stop tooth decay by hardening the tooth although it turns the tooth black.”

Another option that does not stain the teeth is called fluoride vanish. It also hardens the teeth but it is not as effective as the SDF. The least expensive and readily available option according to Dr Kigozi is toothpaste that contains fluoride. Even if the hole has started developing, it can be arrested and slowed down with regular, proper care of brushing twice a day with more emphasis to brushing before going to bed. 

Dr Chapman remarks, “Sometimes, the hole is too big and at this point the hole has to be cleaned and filled with a type of dental cement to restore the shape of the tooth. Although some types of cement can last up to 40 years, others only last five years. The larger the hole, the less likely it is for cement to last longer.”

Root canal
A hole in the tooth can cause discomfort and one is unable to sleep or chew because of the pain. Such a hole has reached the nerve and the treatment now becomes more complicated and expensive. 

One may need a nerve treatment and may have to remove part of the nerve or the entire tooth in what is termed as a root canal treatment (RCT). The procedure may cost about Shs300,000 or more, depending on where you have it done. This, however, requires a dentist’s clinical judgment.
“If the hole is large enough, we may have to put a cover on the tooth called a crown done in two hospital visits to restore the tooth to the most natural function. This can cost between Shs600,000 and Shs1m depending on where you do it from. The crown is usually made from ceramic and can last up to 15 years,” says Dr Chapman.

There are incidences where the dentist cannot do anything except remove the tooth. “Sometimes you have to tell the patient, ''bambi nga olabye. Erinnyo lino tulina okuligyamu kubanga ligenze wala nnyo!  (I am sorry. We have to remove this tooth. It is badly damaged).''
When extracted, you can replace the tooth with a removable artificial tooth or one that is fixed and permanent. 
Removable teeth are cheaper but one should always remove it before meals to avoid swallowing it accidentally.

Feeding and diet  
Dr Kigozi warns against artificially sweetened foods and beverages. He says, “If you take sweets, brush your teeth as soon as possible. Also, remember to limit your intake and the  frequency because when you eat sweets, the acidic environment stays in your mouth for more than 30 minutes and the longer the acidic environment, the more time your teeth are likely to develop holes.”

Also, limit the intake of acidic foods. If pineapple causes sensitivity to your teeth, do not take too much of it, avoid taking lemon and hot water frequently because it erodes the enamel. A lot of honey can also cause breeding of bacteria in your mouth.