Oral diseases are the most common and preventable non-communicable diseases (NCDs) worldwide, according to the World Health Organisation (WHO). However, many people, especially in developing countries, pay little attention to oral hygiene or still use rudimentary methods to ensure dental health.

According to Prof. Joseph Mucumbisti, a paediatrician, cardiologist and president of Rwanda Heart Federation, oral health has always been neglected, especially in poor countries, where the majority of the population do not use tooth paste for brushing their teeth because of the high cost as well as poor awareness on the importance of maintaining good oral hygiene.

Worldwide, he says, the biggest problem in oral health is considered to be dental caries and periodontal diseases such as chronic gingivitis and others. He notes that if people don’t adapt new lifestyle and embrace the culture of brushing their teeth and visiting dentists more often, prevalence of NCDs will go higher with time.

"The risk is higher among poor communities because people don’t brush their teeth. However, dental caries are more prevalent in developed countries,” he adds.

Gonzalue Niyigaba, a dentist at University Teaching Hospital, Kigali (CHUK), explains that dental diseases in developed countries occur because people are more exposed to bad nutrition habits like sugary products. He says, in developing countries, dental caries is less prevalent due to the general lifestyle and genetic factors.

Another important aspect about oral health, Niyigaba says, is the high cost of dental care services, which makes a lot of people shun these services.

Although developing countries are experiencing less severe dental problems, Mucumbisti says the challenge is increasing at a high speed because of the changing lifestyles, where many people are trying to copy western habits.

"The life Africans are living now is more westernised; our children are consuming more sugarly stuff, which increases the problem of oral health. To make it worse, most people don’t use tooth paste or have access to any dental services,” he says.

According to Moses Kamugisha, a dentist at La Nouvelle Clinic in Remera, Kigali, one of the main risk factors for poor oral health is dietary habits, which influence the development of NCDs and dental caries. It’s also linked to development of cancers of oral cavities, he says.

Kamugisha notes that 90 per cent of cases of cancers in the mouth are related to tobacco use.

How poor oral health is linked to NCDs

Mucumbisti explains that, poor oral hygiene, especially when one experiences bleeding during brushing or when they are going through different dental procedures, can result into an infection of the heart known as endocarditic. This is an infection of the inner lining of the heart. This happens when bacteria from the mouth travel to the valves of the heart.

"Endocarditic normally occurs when bacteria or other germs from another part of the body, such as the mouth, spread through the bloodstream and damage areas in the heart, especially the valves,” he says.

Mucumbisti further explains that this is more common if one has presiding conditions such as congenital inflammation of the heart or a hole between the two cavities.

"Endocarditic is considered as a non-communicable disease as it cannot be transmitted from one person to another. Most of the time it’s a silent infection and kills very fast when contracted,” he says.

Several studies have shown that people with periodontal disease may be more likely to have coronary artery disease than people with healthy mouths.

Currently, scientists have two possible explanations for this association. One is that the bacteria that cause periodontal disease can release toxins into or travel through the bloodstream and help to form fatty plaques in the arteries. These plaque deposits can lead to serious problems, such as blood clots, which can block blood flow. The other explanation is that these bacteria cause the liver to make high levels of certain proteins, which inflame the blood vessels. Inflammation eventually could lead to a heart attack or stroke.

For patients with dental problems, Kamugisha says there are protocols and guidelines for preventing endocarditic whenever they visit a dentist.

He notes that they include giving antibiotics before carrying out root canal treatment, implanting of teeth as well as cleaning of the teeth, especially for those with heart defect or rheumatic valve disease problems and yet have dental problems.

Why we need to maintain good oral hygiene

Dr Kristine Mae T Ferrer, a dentist at Deva medical Consultancy in Nyarutarama, Kigali, says many people think they don’t have dental problems until the situation gets out of the hand. She points out that in order to maintain good oral hygiene, one should at least visit a dentist every six months.

She notes that the most common problem people stay with for a long time without noticing is dental plaque, which results in root decay or gum diseases.

"Although plaque can be removed while brushing, the problem crops in when it hardens due to poor brushing and not visiting the dentists often. This causes it to harden and become a calculus deposit,” Ferrer says.

She explains that this calculus deposit is leftover food particles and saliva that mixes in the mouth and begins to form and build up on the teeth. Normally, it’s very difficult for someone to know what it is.

Ferrer, however points out that this does not necessarily result from bad brushing as the plaque is normally brought about by the type of saliva we have in our mouths.

"We usually have three different types of saliva; acidic, basic and neutral. Depending on which one has, this can either accelerate or reduce the formation of the plaque,” she says.

Ferrer adds that it is disadvantageous to have either basic or acidic saliva; the one which is ideal is neutral.

She says if someone’s saliva is acidic, they are more likely to have dental caries, while for those with basic, the plague hardens very fast.

"This is why it’s important for everyone to go for check-up every six months, so that the dentists can rule out any dental problem resulting from the type of saliva,” Ferrer says.

How to ensure neutral saliva

Brushing the teeth two times per day including at night when going to sleep is essential. This, Ferrer explains, is because when sleeping the saliva with bacteria (good bacteria) moves in every part of the mouth, but it becomes bad when our teeth are not brushed, which can later lead to tooth decay.

With basic saliva, she says, foods such as milk and peanut should be avoided as they create more problems for people with basic saliva.

Ferrer says, for acidic saliva, anything acidic that can worsen the situation should be avoided.

"In case of dental problems, such as sensitivity or pain, X-rays are important to find out the exact cause of the pain. This also helps in finding out if the pain is from the teeth or the bone, which makes treatment easier,” she says.

Experts share tips

Joseph Uwiragiye, head nutritionist at University Teaching Hospital Kigali

Consuming foods that are rich in vitamins and calcium such as leafy greens is essential.

Also, foods containing phosphorous like meat, eggs and fish ensure that the enamel is strong, as well as help maintain general dental health.

Besides, avoiding sugary stuff prevents dental problems.

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Pacifique Nkusi, dentist at King Faisal Hospital, Kigali

People should floss their teeth as it’s an essential component of tooth care as it cleans between teeth and the gum line, where brush bristles cannot.

Ideally, flossing should be done after every meal, but before going to bed is the most ideal.

It’s also advisable to rinse the mouth thoroughly after flossing.

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Celestine Karangwa, medic at TCM technology Clinic

Generally, the entire community needs to be educated on the importance of maintaining good oral hygiene.

Parents should also try to maintain good eating habits for their children.

They should give them foods that don’t interfere with their dental health.

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Eric Musengimana, nutritionist

Some drinks, such as soda and processed juices with high sugar content, when taken for a long time, are not healthy for the teeth.

This is because bacteria in the mouth feed on sugars and produce acids which attack the enamel.

So, avoiding such foods is important.