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South African Dental Journal

versão On-line ISSN 0375-1562
versão impressa ISSN 0011-8516

S. Afr. dent. j. vol.71 no.4 Johannesburg Mai. 2016




Chimes of the Times



WG Evans

Managing editor,




We progress a little further in each tick of the clock. Ronnie Cornelisz Philosopher and Jehovah's Witness.

Never send to know for whom the bell tolls it tolls for thee. John Donne, 1624.

Two diametrically opposed thoughts, both so relevant to our brief sojourn here. And perhaps it is fortuitous that our stay is relatively short, when I last checked the World Population Meter, the total number of folk had reached seven and a half billion .. at that time, and to be precise 7,427,593,441! Forecasts indicate a world population of 10 billion by 2083!

There had been 261,000 births that day alone, when I checked the meter, and 110,000 deaths, giving a growth of 151,000 in that one day. Over the year to date, the population had grown by 36 million people.

Do we dare to translate those terrifyingly high numbers into our dental responsibilities just how many teeth are being formed right now, how many teeth are carious right now, how many malocclusions are developing right now!! But we know the profession is facing an escalating problem in the endeavour to maintain oral health for our populations. No need to paint a picture of a dental tsunami!

We do however have a serious additional responsibility which may also be escalating with the expansion of population. We are, as has often been stated, frequently the first professional health care personnel who have the opportunity to recognise the early signs of drug addiction in our patients. It is true that in the world stakes on estimated frequency of drug abuse, South Africa does not in fact feature prominently. We are not in the top ten when numbers of users of amphetamine -type stimulants, like Ecstasy, are considered, whilst Australia and New Zealand hold second and third places respectively (2.7% and 2.3% of population), with El Salvador leading the list (3.28%). It is Spain which records the highest numbers of cocaine users, at 2.7% But, Scotland comes in as dual first, also with 2.7%. Of course our favourite drug in South Africa is cannabis.. and how frequently is a stand of dagga found growing surreptitiously in the garden! We are listed as having a 3.65% cannabis users in the population.. a figure hotly disputed by .. guess cannabis users who suggest a much higher figure! In terms of world usage, South Africa is rated in the 100th place. Other common drugs in use in South Africa include cocaine, where we are ranked 32nd in the world with only a 1.02% local usage, amphetamines, at 27th, also with 1.02% of population using the drug.



These figures may be low by comparison with elsewhere Iceland is rated as having a population of whom no less than 18.3% are identified as cannabis users. It is without doubt the most commonly used drug, with Australia registering a 10.6% usage at rank number 10 worldwide. We shall not engage in the heated argument as to whether cannabis should be unbanned suffice to record a comment "There is no scientific reason for the criminal prohibition of cannabis if alcohol and tobacco are legal and regulated and STILL cause thousands of deaths every year. Remember that no one has ever died of a cannabis overdose EVER." Each to his or her own.

Whether harmful or not, whether widespread or not, drugs do affect our patients and it is pertinent that the early warning signs are in the forefront of our minds as we observe patients in our care. Look out for:

Bloodshot eyes - Aggressive behaviour - Inability to sit still - Anorexia - Weight loss

And there are the dental and oral problems with which we must contend and which are explicitly detailed in a paper in this issue from the University of Western Cape. That deals with "Meth mouth" and demonstrates just how devastating an effect the drug may have on oral health.

Progress may be being made every day, a little at a time but drugs may just be the braking force delaying that advance.. and tugging on the bell rope to warn us. it tolls for us.