Notes from Africa

My interest in dentistry began early. Running down a bank in our garden, I found myself suspended from an unobserved washing line by the frontal incisors of the upper jaw. After a moment or two, they were wrenched out. My father picked them up from the grass, washed them under the kitchen tap, then replaced them firmly and without fuss. They remained in situ for many years.

Later there were constant tooth problems and I grew to loathe teeth and those associated with them, especially tall, mirthless trainee dentists working for Stirling’s school health service who were prone to seize high-speed drills and embed them unerringly into the inferior dental nerve.

Nowadays I am toothless and walk in paradise – but with sympathy for those still rootbound. In KwaZulu-Natal I was first shown how to loosen crowns and clean out foetid sockets. It has never stopped since but at the first scream or when fingernails begin to gouge tracks on my chest, I cease pussyfooting with local injections and put them under with a short-acting general anaesthetic. I know how they feel; I’ve been there, many times; I’m as big a coward as everyone else.

In east and southern Africa you soon learned to extract only loose or visibly rotten teeth. Many otherwise healthy ones had been broken by the owner’s unrestrained gorging on goat, beef or game when lust blinded them to bits of bone in hurriedly butchered cuts, the result being a splintered tooth; the surviving cusps and roots were like tempered steel and would have needed a North Sea drilling bit to shift them.

Gum boils were not a common feature in Britain, other than in dated newspaper cartoons or seaside postcards, but out here the miserable child or adult with a swollen cheek is a frequent sight. Looking inside their mouths you will see a festering tooth making its last painful stand, pus oozing from several sinuses in the gum. It is only a pleasure to put the soul to sleep, extract the necrotic cause, suck out any attached debris, and deal with other “rotters” in the vicinity as a bonus.

Mandla was an unusual dental case. Ten years old, he kept turning up at one of our mobile clinics with abdominal pain. We couldn’t find anything obvious after some basic tests and eventually took him back to the hospital for an X-ray. To our surprise, the film showed four small teeth clustered in the middle of his abdomen.

Mary Dube, the quiet, tidy and efficient radiographer, asked me very pointedly whether I had been in the X-ray room.

“Why do you ask, Mary?”

“These teeth on that boy’s X-ray?” “Yes?”

“Where did they come from?” Long pause. “Maybe you left something lying about, doctor?”

False teeth were unusual in those days and I may have had the only ones in eastern Swaziland. Mary’s inference was obvious. In reply, I whipped out my upper set and flashed it in front of her horrified gaze. “See, Mary? – 14 on mine, but only four on your film. Sorry, not guilty.”

We opened up Mandla’s tummy the next day and found a large cyst embedded in his intestine. It was removed without problems and found to contain hair and four small bony growths. Our friendly pathologist in far-off Johannesburg explained these cysts developed from misplaced embryonic tissue before birth and have the capacity to form different tissues – nerves, intestine or, as in this case, teeth.

Dr David Vost studied medicine at Glasgow University and is working at a hospital in Swaziland. He and his family live on a small farm in Northern Uganda near the Albert Nile.