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In a country with 3 licensed dentists serving its population of 3 million, Liberia currently receives negligible attention to oral health. Consequently many suffer for years with dental pain, and complications can even reach a fatal stage, contributing to the nation's low life expectancy, which statistics show is only 40 years of age. Liberia is one of the 10 poorest nations on earth. It is emerging from a 14 year civil war that destroyed the country's infrastructure. The population of Liberia live on average at less than $1 per day. It is currently impossible therefore for each one to cover the cost of their treatment. Even with no dentists' salaries, most dental materials and supplies are only available from and priced by the American and European market, and the lack of electricity in Liberia means high prices for generator fuel. Liberia is still in need of relief concerning dental treatment. Yet the quality and diversity of relief treatment needs to be increased to include surgical care for potentially fatal problems. These otherwise fall in between the spectrums of current local dental and health care. |
Ludwig's Angina-One of the worst ways to die It is said that our will to breathe is one of the strongest that we have, making suffocation one of the worst ways to die. That is exactly what happens to an unknown number of Liberians each year that cannot make it to a dental clinic in time to treat a severe infection. Ludwig's Angina is a condition in which an infection spreads from tooth to tissue and causes the tissue of the floor of the mouth to swell, pushing the tongue up and out. If not treated early enough, the patient's airway is blocked and the patient suffocates. Osteomyelitis: From a single tooth to a serious problem When Dr. Chapman first met nine year old Foday (lower left in above picture), the young boy appeared to have an extremely large piece of tartar (calculus, tooth-stone) on his lower teeth. Dr. Chapman would soon discover that it was actually the right side of his jaw bone, which had lost its vitality and was trying to be expelled by his body. Foday's mother told us he had suffered for three years with the problem. It was all caused (and is often caused) by only one decayed and severely infected baby tooth, causing a condition known as osteomyelitis, a condition practically unheard of in developed nations. This would be the first of many cases that Dr. Chapman would see over the next several years of working in West Africa. Because the infection from the tooth goes untreated for so long, it causes the cells of the bone to swell, cutting off its blood supply. A large piece of dead bone now exists as an even larger source of infection than the original problem. This causes severe swelling, pain, draining outside the face, disrupted jaw function, and, if left untreated, irreversible distortion of the face. In a smaller, more contained case the body might be able to rid itself of or isolate the dead bone, but surgical intervention is necessary for cases like Foday's. In a 45 minute surgery, the bone was removed and healing began. It is extremely common in Liberia for a person to have one or more painful teeth for months or even years before they are treated. The body's immune system can often bring a tooth infection to a manageable state, where it then grows slowly and sometimes painlessly under the tooth for years. It eventually becomes too large for the body to manage, and several severe problems can occur. In a developed country, issues such as these would be addressed very early in their progression. However, in countries such as Liberia, due to the lack of health care professionals, facilities, education and funding, these simple problems can evolve into a dangerous, even fatal stage. In a developed world, a dentist may see a case of osteomyelitis or Ludwig's Angina once in his career. While in Liberia, Dr. Chapman sees at least a case of one of these two conditions about every two weeks, sometimes every week. This does not include other problems requiring surgical intervention such as jaw fractures, cysts, and infectious swellings too complex and painful to treat under a local anesthetic. |