Dentistry in Nepal

A patient who represents majority, in Nepal’s oral hygiene/Dental Health condition.

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(This is a write up by Dr Dinesh Karki, A dentist/blogger based in Kathmandu. )

A fifty year old lady walks in my practice with her ill fitting denture.

“What happens to your natural teeth which otherwise are supposed to be here instead of this full mouth artificial denture?” I could not stop myself asking her after seeing complete artificial denture by this early age of fifty.

She starts recounting her dental health story:

“……….When I started having small holes in my teeth, I gave no attention. Food started lodging in and those holes and I was used to gargling and tooth picking to remove them. When these small holes started becoming larger ones, they started troubling me: Pain during food, pain during drinking cold/hot water and pain even during middle of my sleep. Finally, yet unfortunately, I started having my sleepless nights. So I started visiting dental hospitals and clinics to pluck out my teeth to get relieved from pains emanating from here and there.   This tooth plucking activity continued for quite some time and finally, I was left only with 14-16 sound teeth inside my mouth …… “

(This is a write up by Dr Dinesh Karki, A dentist/blogger based in Kathmandu. )

She goes on :

“……..After being left only with half the number of natural teeth inside my mouth, I started having difficulty to chew any food properly. So, I felt like having artificial teeth. I ,again, took out all my remaining sound teeth and got this artificial denture. After I started wearing this denture, problems of not staying properly to its place, poking and hurting inside started. So, I want these problems be fixed here………Dr sab!”

This kind of story, told above, is just a tip of the iceberg regarding the dental health in our community, in Nepal. There could be different kinds of stories regarding their poor oral health: poor oral hygiene, generalized painful mouth, foul smelling of mouth, no teeth in early age of adulthood and list goes on. Here, the questions arise: why people do not take their tooth as one of the important parts of their body to save and tend? Why do we neglect the natural teeth and opt for artificial ones even if it could maintained/treated in its natural state? And, another unanswered question since long: Who should be responsible for the neglected oral health of the community?

(This is a write up by Dr Dinesh Karki, A dentist/blogger based in Kathmandu. )

As a dentist, my points here are:

1. There are (supposed to be ) thirty two teeth in the oral cavity, including four wisdom teeth (many a time these wisdom teeth are taken as eccentric ones for their size, position, eruption time, absence in some cases and by their trouble making nature so are advised to be plucked out if need be).
2. If somebody brushes his or her teeth properly after square meals and teaches children to clean their teeth after each sticky food, most of the gum related and caries related dental problems may not show up. If any problem looms, it could be managed with small amount of fillings and basic cleanings.
3. Lets say, if some kind of big cavity is formed, it could easily be filled and regained its original form and function of tooth by using tooth-filling cements.
4. Worst come worst! If some couple of teeth are taken out by mistake or by lack of knowledge or by unmanageable severe pain (but, dental pain of any kind must be managed by every dental doctors! And management of pain is possible without taking out the tooth), remaining healthy teeth could be used as abutments for the upcoming partial dentures (fixed or removable). And, this kind of denture would be way better than complete dentures in terms of esthetics, functions and comfort.   (This is a write up by Dr Dinesh Karki, A dentist/blogger based in Kathmandu. )

Hearsay is that “Professional cleaning of teeth(which is popularly known as scaling ) weakens gums and teeth itself” which is wrong. Visiting the maladroit and less knowledgeable person with substandard qualification would be different thing otherwise cleaning of teeth means taking away of debris and tartars from the interface of gums and tooth surface. Cleaning would not damage tooth or gums. It would rather improve the blood flow, increase flexibility of the gums and stops foul smell coming out of mouth.

What could be the eventuation of poor oral health?

Gum disease might lead to heart disease.

Inadequately crushed food (due to painful teeth or no teeth) leads to indigestion, abdominal discomfort and ulceration in the food pipes.

Untimely falling/taking out of teeth may end up with battered look of the face, drift in voice intonation, social discomfort.

(This is a write up by Dr Dinesh Karki, A dentist/blogger based in Kathmandu. )

Foul smell emanating from mouth may repel partners, colleagues and clients away.

School going children with tooth pain may not focus on their studies. Difficulty in his/her study and academic regression would be inevitable due to lack of concentration in their regular studies due to pain.

Then, who is supposed to better the oral health of the community? What could be the affordable solution for the same?

First and foremost, government should disseminate some information for the best interest of its common people.

Famous slogan from radio or TV: “ Wash your hands before eating your food” should be tailgated by “Don’t forget to brush your teeth after your square meals.” Government should make an effort to educate its people on oral health issues as well.

Plenty of up and coming dental doctors are graduating by the day . They have immense energy to serve the community. Their invigorating fresh knowledge could be implemented for the national oral health campaign. Every district hospital should create a post or two for the dental surgeons. So that, they can teach at least all VDC workers and health assistants about “Basic oral health needs” in the first place and they can manage severe cases in district hospital’s outpatient departments (OPDs) which would be affordable cum accessible for the villagers.

(This is a write up by Dr Dinesh Karki, A dentist/blogger based in Kathmandu. )

Finally, a person with good oral health may ultimately possess sound overall health: Personally and socially. Healthy persons can be a part of healthy society. Only healthy society can work for the betterment of the nation. That is the reason why oral health should fall under public health priority.

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