When a Toothache Becomes a Medical Emergency: Why too many Nigerians wait until It’s too late

By Mariam Olayode

It often starts with something that feels manageable.

A dull ache in the jaw. A tooth that sends a sharp signal whenever something cold touches it. A swelling that appears overnight and seems, at first, like it might go away on its own.

Paracetamol first.Then ibuprofen.

Then amoxicillin bought from a nearby pharmacy because someone said antibiotics kill infections.

When that doesn’t work, perhaps a home remedy. Alcohol held against the gum. Something traditional. Something recommended by a neighbour.

All of it accompanied by the same quiet promise:

“I’ll go to the dentist next week.” Working chair-side in a busy dental clinic in Lagos, I have watched this sequence unfold more times than I can count.

And I have watched what happens when next week arrives too late.

One thing I’ve noticed after years in this profession is that very few people come to the clinic because of a small cavity. Most arrive because they can no longer sleep, eat, or ignore the pain. By then, what started as a routine dental problem has often had weeks—or even months—to quietly worsen.

In some cases, an untreated tooth infection doesn’t remain in the mouth. It spreads into the surrounding tissues, making it difficult to swallow, breathe, and, without urgent treatment, even survive.

The people who reach this stage are rarely careless.

More often, they simply waited.And for many Nigerians, there are understandable reasons why they do. A Country With Too Few Dentists

Nigeria had just 3,112 registered dentists as of 2022 serving a population of over 220 million people.

That works out to roughly one dentist for every 28,000 Nigerians—far below the World Health Organization’s recommended ratio.

The shortage is even more striking when you look across the country.

While the South West has the highest concentration of dentists, the North West has only about one dentist for every 254,000 people.

For millions of Nigerians, especially those living outside major cities, the problem isn’t simply that dental care is expensive.

Sometimes, there simply isn’t a dentist nearby.

The situation has become even more difficult as trained healthcare professionals continue to leave Nigeria in search of better opportunities abroad, leaving fewer professionals to care for an ever-growing population.

When Professional Care Feels Out of Reach

When access becomes difficult, people don’t stop getting toothaches.

They simply stop getting professional treatment.

By the time many patients finally sit in the dental chair, they’ve often tried everything else first.Painkillers.Antibiotics.Home remedies.

Advice from friends and neighbours.Sometimes all of them.

The pattern is painfully familiar.Antibiotics may temporarily suppress an infection, but they cannot remove a decayed tooth or treat its underlying cause.

The pain reduces for a while.

The infection continues spreading.The patient feels just well enough to postpone treatment again.Until one day, the pain returns—often worse than before.

Research shows that 90% of dental decay in sub-Saharan Africa remains untreated, contributing to preventable tooth loss and unnecessary suffering.

Nigeria sits squarely within that reality.Why So Many Nigerians Delay Dental Care

It would be easy to assume people delay treatment because they don’t care.

That would also be wrong.

The reasons are usually far more complicated.

Cost is often the first barrier.Most Nigerian health insurance plans provide little or no routine dental coverage, meaning patients pay for consultations, fillings, extractions and other treatments entirely out of pocket.

When families are already struggling with food, school fees and transport, a toothache often gets pushed down the priority list—until it becomes impossible to ignore.

There are also cultural beliefs.

Some studies suggest that many Nigerians attribute dental disease to spiritual causes or believe pain will eventually disappear on its own.

And then there is fear.

Fear of pain.Fear of extractions.

Fear of hearing bad news.Fear of discovering treatment will cost more than they can afford.

These fears are real.But unfortunately, delaying treatment often makes every one of those fears worse.

The Conversation Nigeria Needs to Have

We talk about malaria.We talk about hypertension.We talk about maternal health.

We talk about diabetes.And rightly so.

But oral health rarely becomes part of Nigeria’s national healthcare conversation until something has already gone terribly wrong.

More than a decade after Nigeria introduced its National Oral Health Policy, many communities still have limited access to affordable dental services.

Preventive dental care remains outside the reach of many families, while routine oral health education receives far less attention than it deserves.

Yet every day, dental clinics continue seeing infections that could have been prevented.

Teeth that could have been saved.

Pain that never needed to become an emergency.

Every severe dental infection reminds me of the same truth.

The emergency rarely began that day.

It began weeks—or months—earlier with a toothache someone hoped would simply go away.That is why a toothache should never be dismissed as “just a tooth problem.”

Sometimes, it is the earliest warning that something much more serious has already begun.

Mariam Olayode is a Dental Surgery Assistant based in Lagos, Nigeria. Her writing on oral health and patient psychology has been published by BellaNaija and KevinMD. She writes about oral health at www.oraltalkwithmariam.com.ng.

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