DENTAL SPEAK : Will Aidan succeed in moving to the fast track?

Aidan Nkoloshi (AN) worked in a mitumba shop. He would be seen sitting amidst bales. He would wait for a customer to dish out instructions to him with regard to the type, weight and contents of a particular bale. Enclosed in thick hessian cloth and strapped, the bales were of South Korean and Canadian makes. The smaller bale weighed 45 kilos while the larger one scaled about 100 kilos.

AN was the only worker his employer had hired. A few months back there had been three more assistants working with him. However, due to the prevailing economic scenario with a “tight money market”, AN’s employer had decided to retain him but to terminate the services of three of his co-helpers.

AN was solely the “mechanical arm” of the shop sliding, shoving, pushing and lifting the second hand cloth bundles from the rear of the store to the front. Out of those who frequented the mitumba shop many had told AN very bluntly that his front teeth “looked black and rotten”. AN’s employer was also chastised for not taking interest in AN. AN had become the butt of banter of his friends as well as customers. “It would be good for you to see daktari wa meno and have your black front teeth repaired,” was the daily chorus.

The employer who was being recriminated finally decided to rectify the matter once and for all. On a Saturday, which was a half-holiday, AN sought the appointment of the dental surgeon (DS).

The DS told AN: “You have upper two central incisors and two lateral incisors. All these are grossly abraded. The abrasion has caused marked concavities. The enamel is worn out, the dentine is very close to the nerve centre of every tooth. The lateral incisors look like pegs. The roots are intact. All these teeth are firmly anchored. You have four options to consider.

“All these teeth can undergo root-canal treatment (RCT). The pulp containing the nerve can be extirpated. All the canals in the roots can be filled and sealed. This will thus prevent infection from the crown end or the root end of each tooth. The procedure will be aided by peri-apical X-ray pictures. After the RCT is complete the structure of all teeth will be cut to shape them up. Subsequently four ceramic crowns will be prepared in form of a bridge. The colour of bridge will match the rest of the teeth. To cut down the cost you can have the four crowns made in acrylic. While a ceramic bridge can have a life of more than ten years without any effect in its hue the acrylic bridge will wear out, become discoloured and will need to be changed every two or three years.

“The second option, if RCT is not carried out, is to remove all four incisors and prepare a removable upper partial denture. This will require regular cleaning after every meal, which means this will need to be removed and replaced every now and often. This is the least expensive choice. The third alternative is to have a fixed bridgework carried out with canines on both sides acting as two supports. The two canines will carry with them the four incisors. The bridge thereby will consist of six teeth. This will cover the cost of six ceramic crowns. This will be another line of treatment that can prove costly”.

AN seemed to be downcast. He was lost for words. Gathering his composure he said meekly, “How on earth will I be able to have bridgework made in ceramic? It will cost a fortune.” DS: “You can at least talk to your employer.”

A week later AN returned. “My boss told me to have the four grossly spoiled teeth removed and replaced by a removable partial denture.” DS: “What is it that you prefer to carry out in your mouth?” AN: “If I had the money I would go by the first option – RCT followed by a ceramic bridge”. AN is now wearing a removable partial denture. There is nobody joking about his black incisors. His friends believe that he has pearl white teeth which have been fixed for life.

In terms of economic reality if there are 10 patients with a similar predicament as AN, two or three patients only will opt for the first option. About six to seven patients will go the way of AN. The financial burden of patients can be telling, taxing and testing. There are compromises galore. AN is hoping that his boss will turn generous and put him on “fast track” soon. That would be tantamount to moving from economy class to extravagance.