Both Lamvitu and Nilota were twins. They were born in Arusha in 1995. Having spent the formative years of their life in the North they had ingested water that had contained copious amount of fluorine. Like most of the youthful population their teeth had been systemically affected with the intake of fluoride.
The most conspicuous aspect of the face happened to be teeth which had turned brownish black with mottled enamel in the front providing the unesthetic feature to majoriy of youngsters who had been the inhabitants of the Arusha-Kilimanjaro-Moshi corridor.
Lamvitu and Nilota’s parents had University education and with time their father had qualified as a professor after his thesis for a PhD had been lauded for its research base by the appointed referees.
Prof. Rishala and Mrs. Rishala were pro- active. They were forefront in matters related to the well being of the community they were serving. As parents they took adequate safeguards to see that Nilota and Lamvitu had the best of health care and education.
Last year Prof. Rishola had a total clearance of all his teeth carried out. With a gum disease that changed its course from periodontitis simplex to periodontitis complex and then to periodontosis, no matter how hard he tried to conserve his natural teeth, they underwent a gradual third degree movement.
With an extremely poor nutritional status since the primary school going age, the health of gums and alveolar bone supporting the teeth had been compromised. With resorption of bone the teeth had become extremely mobile.
In Morogoro, he had established a rapport with a herbalist who had claimed that his herbal potions would prove very beneficial in bringing about a ‘firmness or tightening’ of teeth around their sockets. Despite the application of salves around the gums there was no amelioration of the condition of the structures in the mouth.
Finally better sense had prevailed. After having sought the professional advice of the Dental Surgeon, Professor had ultimately resorted to the use of a complete removable upper and lower dentures after removal of the remaining twenty-four ‘lose-limbed’ teeth.
Prof. Rishola had made a pact with his wife that in matters of health both of them would not vacillate in providing quality care to their children.
The Professor had recently brought his family to the Dental Clinic. His main concern was the unesthetic surfaces of anterior teeth of both of his sons which needed cosmetic repair and restoration.
It was a coincidence that the two boys had brownish discoloration in conjunction with the upper anterior teeth viz. Central incisor, lateral incisor and canine on either side of the midline of the face indicated by the frenum.
Lamvitu had four of his teeth fluorosed whereas Nilota had six teeth, three on the either side of centre-grotesquely tainted. Out of these six, both the central incisors had exposed nerves. Labially, from outside, there were window- like cavities which clearly laid bare the pulp within the teeth.
The ‘fenestration’ of the upper central incisors with dark spotch of fluoride stain around it made the incisors slovenly. All other teeth had intact enamel except for the ‘offensive’ mismatch of dark brown in the presence of milk white teeth. The majority of remaining teeth including the lower anterior teeth were comparatively more clearer and whiter.
With peri-apical x-ray pictures of all anterior teeth on the viewer it was decided to have the root canals of central incisors of Nilota opened.
Pulp was live. The nerve filaments of the two teeth were removed. Nilota had a total of four sittings during which the pulp was extirpated and root-canal treatment (RCT) concluded with gutta-percha points placed within the lumen of the canals completely sealing the peri-apical ends.
With the final X-ray picture indicating that RCT had been successful all six of the upper front teeth were cut into shape under the effect of local anesthesia. Impressions were taken of both upper and lower teeth. Temporary shells of methylmethacrylate were placed on the cut surfaces of teeth. These were adyusted for shape and bite. This was a stop-gap measure.
For Lamvitu the peri-apical view did not indicate the need for RCT. Four of his anterior teeth, two on either side of the centre were trimmed with the help of a tapered fissure diamond bur under local anesthetic effect. He was also similarly ‘capped’ with four thin temporary acrylic crowns.
When the brothers beheld themselves in the mirror that was fastened on the knob of one of the drawers they looked at their parents with a sense of glee. Professor Rishola had a close look at the temporary crowns which had been cemented in place. He said, “The front teeth are certainly looking good. At least there is no more of that crude and harsh brown color”.
The Dental Surgeon said, “These are temporary crowns. They will be there in the mouth for about two to three weeks. These will be all removed and replaced with porcelain crowns.
Lamvitu will have four separate porcelain caps. Nilota will have his six porcelain crowns placed in the shape of two bridges from the centre, each bridge having a span of three teeth, namely central incisor, lateral incisor and canine”.
The twins have returned to Morogoro with their parents. They are anxiously awaiting the outcome of the ‘face-lifting’ cosmetic venture.
(All names of patients and parents in this feature are fictitious. The description however is based on actual clinical events. Dr. K.S Gupta is a private dental practitioner.