In a country with 5 licensed dentists serving a population of over 3 million, Liberia currently receives
negligible attention to oral health. Consequently many suffer for years with dental pain, and
complications can even reach a fatal stage, contributing to the nation's low life expectancy. Liberia is
one of the 10 poorest nations on earth. It is emerging from a 14 year civil war that destroyed the
Most of Liberia's population lives at or below the poverty line. It is currently impossible therefore for
each one to cover the true value of their treatment. Even with no dentists' salaries, most dental
materials and supplies are only available from and priced by the American and European market,
resulting in very high shipping costs, and the lack of electricity in Liberia means high prices for utilities
and operation costs.
Liberia is still in need of relief concerning dental treatment. Yet the quality and diversity of relief
treatment needs to be increased to include surgical care for potentially fatal problems. These otherwise
fall in between the spectrums of current local dental and health care.
It is said that our will to breathe is one of the strongest that we have, making suffocation one of the
worst ways to die. That is exactly what happens to an unknown number of Liberians, most likely
dozens, each year that cannot make it to a dental clinic in time to treat a severe infection.
Ludwig's Angina is a condition in which an infection spreads from tooth to tissue and causes the
tissue of the floor of the mouth to swell, pushing the tongue up and out. If not treated early enough,
the patient's airway is blocked and the patient suffocates.
Osteomyelitis: From a single tooth to a serious problem
When Dr. Chapman first met nine year old Foday (lower left in above picture), the young boy
appeared to have an extremely large piece of tartar (calculus, tooth-stone) on his lower teeth. Dr.
Chapman would soon discover that it was actually the right side of his jaw bone, which had lost its
vitality and was trying to be expelled by his body. Foday's mother told us he had suffered for three
years with the problem. It was all caused (and is often caused) by only one decayed and severely
infected baby tooth, causing a condition known as osteomyelitis, a condition practically unheard of in
developed nations. This would be the first of many cases that Dr. Chapman would see over the next
several years of working in West Africa. Because the infection from the tooth goes untreated for so
long, it causes the cells of the bone to swell, cutting off its blood supply. A large piece of dead bone
now exists as an even larger source of infection than the original problem. This causes severe
swelling, pain, draining outside the face, disrupted jaw function, and, if left untreated, irreversible
distortion of the face.
In a smaller, more contained case the body might be able to rid itself of or isolate the dead bone, but
surgical intervention is necessary for cases like Foday's. In a 45 minute surgery, the bone was
removed and healing began.
It is extremely common in Liberia for a person to have one or more painful teeth for months or even
years before they are treated. The body's immune system can often bring a tooth infection to a
manageable state, where it then grows slowly and sometimes painlessly under the tooth for years. It
eventually becomes too large for the body to manage, and several severe problems can occur. In a
developed country, issues such as these would be addressed very early in their progression.
However, in countries such as Liberia, due to the lack of health care professionals, facilities,
education and funding, these simple problems can evolve into a dangerous, even fatal stage.
In a developed world, a dentist may see a case of osteomyelitis or Ludwig's Angina once in his
career. While in Liberia, Dr. Chapman sees at least a case of one of these two conditions about every
two weeks, sometimes every week. This does not include other problems requiring surgical
intervention such as jaw fractures, cysts, and infectious swellings too complex and painful to treat
under a local anesthetic.