Dentistry Through The Ages

The dental profession is an ancient and noble profession. The earliest known person referred to as a dental practitioner was an African. Unlike the current allusion to dentists as “detoothers”, Hesy-Re, an Egyptian scribe who died in 2600 BC, was called “Chief of the Toothers”.

An inscription on his tomb includes the title “the greatest of those who deal with teeth, and of physicians”. It should be noted that ancient Egyptian civilization was African and not Arabic; the Arabs only moved into North Africa during the three Islamic invasions that occurred in the 7th century AD. The world’s oldest known recipe for toothpaste was African: 400 AD in Egypt – more than 1,500 years before Colgate began marketing the first commercial brand in 1873. The formula included mint, salt, grains of pepper and dried iris flower.

The Greek philosopher Aristotle, who studied in North Africa for a number of years  (Egypt was the centre of world learning at the time), mistakenly stated that men had 32 teeth and women had only 30. From this came the use of the term “wisdom teeth,” which only men supposedly had. Hippocrates the Father of clinical medicine also wrote about dentistry.

By 2000 AD, the Chinese were practicing dentistry. Around 700 AD, the Chinese developed a silver paste similar to amalgam for fillings more than 1000 years before dentists in the West.

The Romans had a high regard for oral hygiene. Like our African ancestors, the Romans used “chew sticks” that were actually small branches, with one frayed end which they rubbed on teeth to clean off deposits. Several Roman physicians wrote extensively about dentistry.

The Italian Leonardo Da Vinci (April 15, 1452 – May 2, 1519), who studied human anatomy and sketched every part of the human body, was the first to differentiate between molars and premolars.

In Europe, dentistry only emerged as a licensed profession at the end of the 19th century. Previous to that, monks provided dental care but after a series of papal edicts in the 12th century banning monks from drawing blood, barbers took over. For little cost and a lot of pain, it was not unusual to have one’s hair cut and a tooth pulled out on the same visit. Before then, dentists learnt their profession by apprenticeship, where a practicing dentist trained another dentist on the job.

The world’s first dental college, Baltimore College of Dental Surgery, was opened in 1840 in the USA, making the United States the world leader in dentistry. Today, it is known as the School of Dentistry at the University of Maryland.

People of ancient (and not so ancient) times believed that a tooth demon or tooth worm caused toothaches. They thought the worm ate its way into a tooth. If the tooth pain was severe, it meant that the worm was moving around. If the aching stopped, then the worm was resting. This concept of worms causing dental decay was accepted without question for centuries until successfully attacked in 1728 by the French physician, Pierre Fauchard, regarded as the father of modern dentistry. He developed dentistry as an independent profession from medicine and came up with the title of “surgeon dentist”.

In pre-colonial Uganda dental treatment was largely done by the local medicine man. Charcoal, chew sticks, lemon juice, lemon grass, ashes, or even a mixture of tobacco and honey were used to clean teeth. Globally, It was only about 100 years ago that a minty cream was created to clean teeth.

In 1896, Albert Cook came to Uganda under Church Missionary Society mission. Three months after his arrival, Cook set up the first hospital in East Africa: a grass-thatched, reed-walled structure, with 12 wooden beds and straw for mattresses. Established in 1897, he named it Mengo Hospital after the Kabaka’s royal enclosure nearby. Sir Albert Cook is outstanding among medical missionaries for his efforts to train Africans to become skilled medical workers. He and his wife pioneered the training of midwives, medical assistants, and played a foundational role in the establishment of Mulago Hospital and Makerere Medical School.

In 1946, Musa Settimba, now an octogenarian, began training on the job as a dental practitioner. At the time, there were only two European dentists in Uganda. 
 After a year of training, Musa Settimba started extracting teeth under supervision in Mulago Hospital.

In the 1950s, Dr. Martin Aliker left Makerere to study in the United States; he later set up the first Ugandan owned private dental practice in East Africa. In the late 1950s there was an influx of Asian doctors and by Independence, Uganda had about 450 practicing doctors of whom only 90 were Ugandans. Asian dentists dominated private medical and dental practice.

In the 1960s a number of Ugandans were sent to the UK for training as dentists and dental technologists. The pioneer dental technologists were Mr. Aloysius Kabunga, Mr. Nathan Buwule, and Mr. Peter Emorut.  Among those who trained as dentists were Dr. Arnold Bisase who became the first Ugandan oral maxillofacial surgeon and the first Ugandan head of the oral surgery department at Mulago Hospital, Dr. William Nganwa who later replaced him as head in Mulago; Dr. Gava who became the first Ugandan Chief Dental Officer in the Ministry of Health, and Dr. Amooti Nkurukenda (RIP).

Formal training of dental workers was not done within the country until 1972 when the Mulago School for Public Health Dental Assistants was set up with the help of the Danish government. Starting with an initial intake of 25 students, the school has since produced over 800 dental assistants. This cadre of dental staff is trained utilizing a three-year curriculum to do extractions, basic fillings, management of gum disease, and public health dental education.

The tyranny of the Idi Amin years in the 1970s created a terrible dilemma for the health profession. There was a mass exodus of health care professionals. Of the 55 doctors who died between 1964 and 1986, at least 15 (27%) died from violence including very prominent dentists of the time, Dr. Jack Barlow and Dr. Kizito. Dentists who kept the flag of dentistry flying high in those dark times included Dr. William Nganwa, Dr. Tirwomwe, Dr. George Ssamula, Dr. Irene Gimugu (RIP), and Dr. Gava (RIP).

Soon after the ouster of Idi Amin, a missionary dentist, Dr. Ken Chapman set up a dental clinic in Mengo Hospital. This clinic was destined to play a key role in the training of newly qualified dental surgeons in the years to come.

I982 was a landmark year for dentistry in Uganda.  Makerere University started the Bachelor of Dental Surgery (BDS) degree course. Of the pioneering intake of ten students, only two graduated in January 1988: Dr. James Magara (currently in private practice in Kampala), and Dr. Paul Wamala (currently in private practice in Swaziland). The dental school has since graduated over 200 dentists and currently offers postgraduate studies as well.

This year 2014, another milestone was achieved: Makerere University graduated the first locally trained dental technologists under a program supported by the Italian government. This brings to three the cadres of dental staff trained in the country: dental surgeons, public health dental officers and dental laboratory technologists.

There are currently about 300 registered dentists in Uganda (compared to 72 in 2006); over 50% are urban based in private practice or institution employment.  The dentist: population ratio is 1:168,000 compared to WHO’s recommended ratio of 1:1,000. Every district should employ a dental surgeon, but not all districts have implemented this. On average the government allocates Ministry of Health 9% of the national budget. Oral health gets less than 1% of the Health ministry budget.

While basic oral health services are free in government, public health facilities, secondary and tertiary services are provided at a fee. Limited funding has led to shortage of materials, supplies, equipment and manpower. Patients often have to seek and pay for the basic dental treatment elsewhere.

Dentistry has come along way in Uganda. The country now has specialists in restorative dentistry, orthodontics, prosthodontics, periodontics, oral and maxillofacial surgery, implantology, and dental radiology. Today one can get state-of-the-art treatment in the country and it is unnecessary to travel abroad for dental treatment as some people did even just 20 years ago.

Can Uganda lead Africa in reclaiming the fame of the first known dentist, Hensy – Re who after all was an African? That very much depends on a number of factors: increased funding for oral health programs, better coordinated training of dental workers, improved dental public health training to curb the increase of lifestyle dental diseases, fostering a hunger for research and the strengthening of private public partnerships.

 

%d bloggers like this: