Reporter Volume 25, No.26 April 28, 1994

By MARY BETH SPINA
News Bureau Staff
Money doesn't grow on trees, but toothbrushes do! At least they do in
parts of East Africa and the Middle East, says UB dentist and
researcher William Carl.
	Properly chewed into "brushes" and used correctly, the ends of
sticks plucked from the desert's ever-green miswak tree have been
effective natural toothbrushes for more than 1,000 years. The sticks
contain chemicals that are helpful in fighting oral bacteria
associated with dental decay and gum disease.
	"Oral health is generally good among the Rendille and Samburu
nomads who call the Kaisut desert of northern Kenya home," says Carl,
a senior cancer dental surgeon at Roswell Park Cancer Institute and
clinical associate professor of fixed prosthodontics at the UB School
of Dental Medicine.
	Carl was the dental member of a UB medical team that provided
treatment to these desert-dwellers during two visits to Kenya.
Practicing "tree-side dentistry" and armed with very basic dental
instruments, Carl collected information on the oral health and diet of
the wandering population, extracting diseased teeth when necessary.
	"An appointed village elder routinely extracts the mandibular
central incisors, or two lower front teeth, of members of these tribes
in order for them to take nourishment should lockjaw (tetanus) develop
later in life," he notes.
	The ritual is performed, without benefit of anesthesia, when
tribe members reach their early teens. After the extractions, males
receive a cow or camel; women are rewarded with a goat.
	Miswak sticks not only serve as natural toothbrushes when used
correctly, but they contain oral health promoters such as chlorides,
fluoride, silica, Vitamin C and flavenoids.
	Carl says it's important to note that oral health is not equal
throughout the Third World.
	"Members of the Mende tribe in Sierra Leone, for example,
generally don't have the same high level of oral health and require
more extractions due to a decay-causing diet and lack of natural
sources to clean teeth and gums," he points out.
	Among the more than 100 Kenyan nomads Carl examined, he
randomly selected and persuaded 37 to allow him to take plaque samples
from around key teeth. Placing the samples in sterile containers, Carl
brought them to the UB dental school for analysis by Joseph Zambon, an
oral biologist and periodontist.
	Zambon's comparison of bacterial samples from the Kenyans and
37 Western New York adults in a control group showed virtually no
difference in the kinds of disease-causing oral bacteria.
	Porphyromonas gingivalis and Prevotella intermedia were the
predominant periodontal disease-causing organisms present in both
groups. Among the control group, 62 percent was found to have p.
gingivalis, as opposed to 64 percent of the nomads; 81 percent of both
groups exhibited p. intermedia. 
	However, there was a greater incidence of Fusobacterium
nucleatum Q55 percentQamong the nomads vs. 22 percent in the control
group.
	While this is believed to be the first sampling of oral
bacteria from these nomadic tribes of Kenya, Zambon said other risk
factors that contribute to periodontal disease, a major cause of adult
tooth loss, could not be assessed.
	"The transient lifestyle of the nomads and lack of a setting
in which to do refined scientific studies impairs our ability to do
controlled research," says Zambon. 
	Carl emphasizes that Western dentists should not try to impose
impractical solutions in Third World nations, but instead should
encourage the use of natural resources for good oral health. Attempts
to force Western products for preventive dental health on poor or
transient populations are doomed to fail.
	"Many clinics are short of supplies or are located in rural
areas, miles from many of the people who would utilize their
services," he says.
	Carl has received three international service awards from the
American Dental Association. He is a longtime volunteer in dental
projects that have taken him to Sierra Leone, Haiti and Honduras, in
addition to Kenya.