Dental infections have a greater influence on general health and life expectancy than was previously thought.A distinction is made below between the direct and indirect effects leading to potential ill health.In the majority of developing countries, in particular in rural areas, the capacity of the dental medical care is limited.

Dental infections in developing countries account for more absence from work than anaemia, malaria and tuberculosis together (according to a rapport by the WHO).
Although a tooth abscess can cause extreme prolonged pain, people rarely die because of dental infections.

The above-mentioned is the direct (acute) effect of dental infections: the severe pain, high temperature and a general feeling of sickness (malaise) are responsible for long-term absence from work or school and the use of expensive medicines without removing the cause of the symptom.
As a consequence of this, infections in the mouth and jaw have a negative effect on the economy, education and well-being of the population.

The indirect effects of chronic infections in the mouth and jaw leading to potential ill health

These are the latent infections in the mouth and jaw which do not give any pain or other symptoms.
These infections present in the gums and jaw that can go unnoticed for years are a continual strain on the immune system as a result of the continual infiltration of (anaerobic) bacteria and toxins¹.
Part of the immune system of the individual is continually engaged in fighting the infection causing the patient to be more sensitive to all other infections such as malaria, tuberculosis, cholera, HIV, pneumonia, etc.

For example: in a patient whose immune system is weakened because of a chronic tooth abscess, an infection with malaria will take place much sooner and therefore be much more severe.
The first indirect (chronic) effect of dental infections that does not give any symptoms is the depletion of the immune system of the body.
The second indirect effect is caused by the bacteria that are present in chronic infections in the gums and jaw. In particular, the aggressive anaerobic bacteria that penetrate the bloodstream every day and cause, for example, damage to the heart valves and the pancreas.
A baby who is underweight at birth is in many cases caused by a chronic infection in the gums of the mother.
Diabetes in later life can also develop as a result of a chronic gum infection (periodontitis ²).

There are quite a lot of patients who visit a doctor or hospital that have the symptoms of fever and feel unwell as a result of a dental infection; but the infection itself does not give any symptoms.
An infection in the jaw can cause the long-term presence of pathogenic bacteria and their toxins in the bloodstream: a bacteraemia or a septicaemia.
Because the dental diagnosis cannot be determined in hospital, the patient often receives medication³ that treats the symptoms, but does not treat the cause of the infection. After a while, the symptoms return once again.
Moreover, the patient is exposed to the side effects of the medication which often leads to a second prescription.

In the dental clinic "classic" alongside "modern"

It is customary in almost the whole of the medical and dental care sector to respond only to the symptoms of the patient.
If the patient has pain or discomfort, then they are treated, not otherwise.
In addition to this, a patient without any symptoms would not consult a doctor.

Classic

Classic dentistry only treats symptomatically.
If there is no pain then there is no reason for examination and treatment.
In a patient with toothache, the nerve of the tooth concerned is deadened and therefore the pain disappears completely. However, the bacteria responsible for the toothache remain in the tooth and therefore in the body where they are responsible for an indirect effect.
A different case of toothache: if the infected tooth is extracted then the complete source of the infection is eliminated.

Modern

Modern dentistry, just like the classic dentistry makes the treatment of symptoms (pain and swelling) a priority.
But afterwards the whole mouth is examined: are there any latent infections present which can weaken the immune system and from which bacteria can damage the heart valves and other organs?
Modern dentistry is a continuous development of classic dentistry.
Classic dentistry is directed at the direct effects of the infection whereas modern dentistry tracks down infections which do not give any symptoms and therefore limits the indirect effects.

Logically speaking, the diagnostics of chronic infections which cause indirect effects is more complex than the detection of acute infections which give rise to pain and swelling.

Classic + modern in Nyarutarama

In the dental training clinic of the fADA foundation in the capital of Kigali , both forms of dentistry are taught and practised.
After treating the symptoms of pain, the patient is given the advice to also have treated any eventual chronic infections which give no symptoms.
Of course, the patient has to make this decision himself as only he or she has the right to only have the acute symptoms treated.

Policies in the dental training clinic

The training clinic does its best to work together intensively with the Ministry of Health and all dental professionals.
The clinic would like to serve as a post-academic centre for dentists and dental specialists ( techniciens supérieurs and odonto- stomatology).
In addition to this, fADA would like to set up dental practices in the existing health centres which are spread about the rural areas.
FADA is prepared to undertake the task of providing the additional dental training for the work in the peripheral health centres.
As well as this, fADA will work hard to equip the dental practises in the health centres in the rural areas.
To accomplish this, fADA is working together with the WHOCC of the University of Nijmegen in the Netherlands .

Additional information:

• Rudasingwa Longin, clinique detaire ADA , Nyarutarama, Kigali , Rwanda
• Tom van der Colk, dental health practice, Den Haag, The Netherlands

¹
Most of the bacteria, which in a healthy situation are present as a protective layer in the mouth, are dependent on oxygen for their existence.
Bacteria that can survive without oxygen are usually damaging to the health.
The aggressive bacteria in dental infections can usually survive without oxygen (anaerobic) and secrete metabolic products (toxins) which are damaging to the human organism.

²
Parodontitis: is an inflammation of the gums which gives no symptoms. Anaerobic bacteria accumulate underneath the gums where damaging bacteria flora leak continually into the jawbone and bloodstream.

³
Painkillers, a course of (broad- spectrum) antibiotics and /or anti-inflammatory drugs.