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Tomas dispenses dental treatment in the bush of South Sudan

Tomas Murray is a 25 year old dentist from Grange in County Waterford who recently spent some time working alongside aid workers from the relief and development agency GOAL in South Sudan.

For the people in the more remote areas Tomas was the first dentist they had seen in their lives. Tomas found that in general the people of South Sudan have low levels of dental decay and gum disease due to their tradition of good brushing using chewed sticks and, more importantly due to the lack of sugar in their diet.

Despite this low level of decay the people do have a high level of pain and infection because any decay present is left untreated and becomes the centre of chronic infection. Antibiotics can deal with the situation in the short term but, unless the offending tooth is extracted, the pain will return.

Tomas' visit to South Sudan was undertaken to assess the dental needs of the population, to carry out routine extractions where necessary, to look at ways of improving dental care and to gain information to facilitate future visits by dentists.

Working in the shade of a tree performing extractions among the Dinka and Neur tribes Tomas was surprised to find that the vast majority of adults had had their front bottom teeth removed. This was done as part of a ritual performed on both male and female children when they get to the age of 14. Ninety-three percent of the patients treated had had this done.

Tomas in Action (GOAL - '99)

This ritual is thought to have originated in the days when the people of South Sudan were regularly taken as slaves. Those captives with teeth missing were seen as unhealthy and certainly less valuable and so were often released. The practice continues today but now the lack of front teeth has come to be seen as a sign of beauty.

It was noted also that women had more dental disease than men. Of the 167 patients treated by Tomas in his two and a half weeks, 104 were females, 59 males and the number of patients under the age of 10 was just 4.

Each day during his stay in South Sudan Tomas would travel to one of the outlying villages, set up a makeshift dentist's chair in the shade of a tree and offer his services to anyone that needed treatment. The range of treatments offered was of necessity limited to extraction of teeth which were causing pain.

"To carry out more complicated procedures such as fillings or root treatments would be very difficult however. It would also be of little use as the majority of teeth that were taken out were in such a broken down state that the only option, even in a western clinic, would have been extraction."

Sterilisation of instruments was of the utmost importance as otherwise fatal diseases could be spread through the population. Following cleaning all instruments were put in boiling water over a wood fire for 30 minutes and then placed in a cold sterilisation fluid for a further 30 minutes.

For continuation of this kind of treatment Tomas says: "The ideal would be for a local person with a medical background to be trained to extract teeth with a local anaesthetic".

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Tomas dispenses dental treatment in the bush of South Sudan. Field Exchange 8, November 1999. p29. www.ennonline.net/fex/8/tomas

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