A visibly shaken Alex Musyoka, 12, lies in a dental chair at the dental clinic section of Makindu Level 4 Hospital.
On a Wednesday, he could be enjoying a session with a teacher in school, but an aching tooth has changed the schedule and he is, instead, seeing an oral specialist at the hospital.
His mother Florence Mueni sits beside him for moral support as he is scheduled to undergo a tooth extraction.
After a brief interaction to make him comfortable, Joy Achieng, an oral health officer at the facility, puts on gloves, assembles her tools and gets to work.
“You are a man. It won’t even take long… A short moment and the pain will be gone,” Achieng employs her medic-patient art of persuasion to ease the tension and anxiety.
In minutes, the tooth that had cavity is extracted.
“It’s very early to extract a molar in a 12-year old. That means the oral hygiene is poor,” she says.
Musyoka was born in Kizingo on the outskirts of Makindu town, where nearly all households have family members with dented teeth.
Mueni says all her six children have discoloured teeth. She herself has had three teeth extracted in the past due to cavities.
The Star randomly visited three households, all of which had residents with teeth so dented, some teeth had irregular shapes and changed colour to dark brown.
A 40-year-old man has sunken cheeks due to missing teeth.
“I haven’t abused any drugs in my youth. What you see is a result of drinking water from the river,” he says.
He says parents who don't want their children to develop brown teeth have to take their newborns to their relatives outside Makindu, where they stay until they've grown up to a certain age, before returning them home.
In the next household, Alex Ali sits at a family makeshift shop, awaiting customers.
His dental formulae have browned, and you can only see few patches of white, the original colour, after keen inspection.
He says his aunt has lost all her teeth after using water from nearby sources for drinking and cooking.
Along the road, we stop a woman with her two young sisters. After realising we are there to find out about the browning of teeth in the area, they shy away and smile sheepishly.
The three have mild discolouration.
I haven’t abused any drugs in my youth. What you see is a result of drinking water from the river
WATER SHORTAGE
Many other residents in Makindu not only suffer from teeth discolouration but also share the common problem of clean water shortage.
A river that residents depended on has since dried up.
Residents have to buy water to fill their tanks from lorries, which source the commodity from the neighbouring town of Kibwezi.
But many tanks remain empty as families ran out of cash to buy the commodity.
Many of the water boreholes dug by area MP Patrick Musimba have since stopped functioning after vandals stole solar panels used to pump water.
“Politicians come back during the electioneering period to source for votes with the promise of bringing us fresh water,” Ali says.
Residents who can afford buy a 20 litre jerrican of fresh water at Sh50. The water comes from Emali, almost 47km from Makindu.
Residents who can't afford to buy the fresh water use the borehole water.
A study published by Geosciences, an open-access journal, found that fluoride, among other physiochemical parameters analysed, “exceeded the permissible drinking water limits set by both the World Health Organisation and the Kenya Bureau of Standards (Kebs) in up to 55 per cent of the samples”.
The study was titled, ‘Naturally Occurring Potentially Harmful Elements in Groundwater in Makueni County, Southeastern Kenya: Effects on Drinking Water Quality and Agriculture’. It was authored by scholars Patrick Kirita, Mark Cave, Kim Dowling, Peter Gikuma-Njuru and Hassina Mouri.
It reported on the physiochemical characteristics of 20 drinking water sources (boreholes, shallow wells, streams and tap water) collected during the dry season (November 2018). It also reviewed the geochemical processes controlling their composition, and their suitability for drinking water and irrigation.
The water samples were collected in the central and southern parts of the county in the area around Makindu and Kibwezi.
“Consumption of high amounts of fluoride (more than 1.5 mg/L) can be detrimental as it can result in several degrees of dental and skeletal fluorosis, depending on the dosage and duration of consumption,” the study published in February 2020 noted.
“Signs of dental fluorosis were observed in some members of the local population during sampling, indicating the area has a fluorosis issue.”
While fluoride is important in teeth development, excess exposure to fluoride can lead to dental and skeletal fluorosis.
AESTHETIC PROBLEM
As many residents cannot afford expensive water from Kibwezi and Emali, they have had to contend with borehole water, which is highly salty and contains high levels of fluoride.
At Makindu Primary School, they rely on piped water from the only spring in Makindu.
But the spring water, which is less salty and has lower levels of fluoride, is not reliable.
Headteacher David Ngalyuka says initially, the school used to buy 3,000 litres of clean water at Sh4,500 to supplement the tap water.
“Now with Covid-19, we need more clean water, and we purchased 6,000 litres for Sh6,500 in August as taps have no water,” he said in an interview with the Star at the school.
At a grade 4 class, the teeth of 33 pupils who are natives of Makindu have started to show signs of discolouration. Only four have spotless teeth.
Medics say staining of teeth causes an aesthetic problem, as many people, especially the youth, want a perfect smile, and the youth attach negative attributes to people with severe fluorosis, such as being less attractive, less clean and less healthy.
Mueni said one of her daughters, aged 33, recently travelled to Nairobi to have her teeth whitened for about Sh8,000.
Achieng says most residents, who troop for free biweekly dental check-ups at nearby Sikh Temple hospitals, have dental caries (tooth decay).
Studies have shown dental caries increases with the increasing severity of dental fluorosis in low, moderate and high-fluoride areas.
Achieng says up to 70 per cent of patients who turn up at the dental clinic from Makindu environs exhibit signs of dental fluorosis.
“When they come, we offer curative, which involves the extraction of teeth, and preventive and promotive treatment. With more resources, we could go to villages and schools for awareness on the issue,” the oral health officer says.
The main treatment for discoloured teeth is bleaching and masking, both of which are expensive procedures and not currently available in Makindu hospitals.
COSTLY TREATMENT
Dr Sarit Shah, a cosmetic and implant dentist based in Nairobi, says masking, which involves placing a thin layer of white filling material over the natural tooth, can be expensive.
Direct masking will cost between Sh5,000 and Sh10,000, while indirect masking, which is longer lasting, costs between Sh25,000 and Sh80,000.
“Parents might be from a generation where self-confidence doesn’t really make a difference to their day-to-day life,” he said in a phone interview.
“But then they are educating their children who are going out to a world out there and get employed in the formal sector, so it's very important to be confident.”
He said dental surgeries are driven by the need for self-confidence and self-esteem.
“Nowadays people are conscious of themselves. It's similar to how some people have poor self-esteem when they are overweight, then when they slim down through various means, their self-esteem and confidence increases.”
With almost no attention paid to the condition in the area for years, many residents of Makindu town and its surrounding areas continue to live with discoloured teeth they can't fix.
And with no interventions, the scourge has been normalised, with discoloured teeth almost giving residents a new identity apart from the national identity card.
The residents not only want clean, healthy water near their homes but also national and county governments and well-wishers to help in purchasing machines that help in defluoridation of water in the area.
Edited by T Jalio
