Having a toothache in Swaziland can be a lot more painful than it is in many other places. Most Swazis have never visited a dentist, because in a country where 70 percent of the population lives in absolute poverty, oral hygiene is considered a luxury.
Swaziland's 1.2 million people are served by only nine private dentists: five are in the capital, Mbabane, four are doing business in the central commercial hub, Manzini, and one is located in the up-scale Mbabane suburb of Ezulwini.
A further 15 dental practitioners are employed by the Ministry of Health, including nurses and dental hygienists, but none are specialists who can perform such procedures as root canal work or the fitting of false teeth.
Even getting a filling for a tooth is almost impossible at either of the two government hospitals in Mbabane, or at the facility in Siteki, the eastern provincial capital. The public hospital in Manzini does not currently have any dental practitioners assigned to it.
"In the morning you find a queue of thirty to forty people, and it is the same in the afternoon. For that number a dentist can extract thirty for forty teeth, but he has no time for fillings or anything else more sophisticated than tooth pulling," a private dentist told IRIN.
"People think you go to the dentist to get a nice smile, and nobody ever dies of a toothache," said Pauline Dube, a mother of three who says she cannot afford to give her children regular dental checkups. While she works in Manzini, her children stay in a rural part of the southern Shiselweni Province, a region with no dental practitioners at all. Rural areas are not provided with any sort of dental service.
As diets change and Swazis consume more processed foods, the need for dental care has become even more pressing.
"Our teeth have not adapted yet to soft sugary foods. What we now find are Swazi teeth with cavities like in the developed world. For Swazi young people, no tooth fillings are available except from expensive dentists, who are less than ten in the whole country and they work far from most people,” the dentist told IRIN. “So, the tooth is extracted. Most Swazis go to traditional doctors, but these healers can only offer pain suppressants for tooth pain."
Having a toothache can be a lot more serious in Swaziland. The commonly held belief that dental problems may be painful but are not fatal has changed due to HIV/AIDS. Gum disease can lead to infections that can lead to the death of a person whose immune system has been decimated by HIV, the dentist noted. However, knowledge about gum infections is virtually nonexistent amongst Swazis, who have the world's highest rate of HIV infection.
"I tell all my patients to test for HIV. The danger at government hospitals where they extract teeth is when a person with AIDS cannot produce the white blood cells to cause the blood to coagulate, and the bleeding cannot be stopped. If a patient with AIDS develops oral shingles, this can be a precursor to a more serious life-threatening disease. But the doctors don't know enough about what goes on inside the mouth to detect this," the dentist said.
Despite the need, no public awareness campaigns promoting dental knowledge and oral hygiene have so far been run. Yet tooth decay and gum disease can be prevented with a simple daily regimen of tooth brushing and flossing.
Swaziland is not the only country on the continent with tooth troubles. "The state of dental research in Africa is lamentable when compared to the other continents,” the African Journal of Oral Health (AJOH) noted in an editorial. “While this situation is unacceptable, it is not surprising because oral health personnel on the continent are not yet strategically placed to be able to influence health policy and decisions on funding."