Just what does it take to become an endodontist?

There are dentists, and then there are endodontists. Dr Tom Joseph Mboya Dienya falls in the latter category.

While all endodontists are dentists, less than three percent of dentists are endodontists. An endodontist is a dentist who specialises in studying diseases of the dental pulp and how to treat them.

Dr Dienya has been, for about 10 years, the only endodontist in the country and the larger Eastern and Central Africa. There are less than 15 endodontists across the continent and around 5,200 in the world.

“We currently have only three endodontists in Kenya, but for a long time, I have been the only one in the country and the entire Eastern and Central Africa,” says Dr Dienya, adding that last year, two graduated from the University of Philippines, one now works at the University of Nairobi, while the other is based at Moi University.

The senior lecturer at UoN, where he teaches endodontics and dental implants, explains that a dentist is a person who has studied the teeth in general, dealing with their extraction, cleaning, removing, replacing, and aligning.

However, an endodontist specialises in diseases inside the tooth, known as the dental pulp, and is concerned with preserving, rather than removing the teeth. For one to become an endodontist, he or she has to complete an advanced training in endodontics that takes three years after graduating from a dental school.

“We preserve or conserve the tooth, we do not remove it unless it is so broken down that it cannot be preserved, but those are rare cases as most of the time we are able to preserve them,” he explains.

Some of the diseases he deals with include dental caries or decay of the tooth, tooth wear or tooth surface loss caused by consumption of a lot of acidic fruits, and trauma suffered by the teeth due an accident.

Very expensive specialty

The 49-year-old explains that toothache is a common problem, and for a very long time, people used to have their teeth removed, with quite a number of people ending up losing almost all their teeth, whenever they had tooth aches because of lack of technology to help in saving the teeth.

This reduced the ability to eat and chew, pronounce, as well as dent their self-confidence, therefore eating into their self-esteem.

“Traditionally, when you feel pain you would go to a dentist to remove the tooth but now we have technology to preserve the tooth by doing a nice root canal so that it remains.”

Currently, there are only two universities offering training related to endodontics, but not as full-fledged departments. The two are UoN and Moi University, though the latter is only just starting.

But even at UoN, they are still operating under a common department, the department of Conservative Dentistry in the School of Dental Sciences.

Doctor Dienya, who is the former chairperson of the department of Conservative and Prosthetic Dentistry, says that endodontics is a very expensive specialty since the course costs about Sh4 million a year.

Further, the Commonwealth Scholarship that he is a beneficiary of is very competitive and takes only two recipients from Africa every year. The doctor hopes that the government can make available funding to the two universities, and even better, to have a fully-fledged endodontic department to boost local capacity in the field.

“It is our vision to have a department of endodontic because endodontic problems are very common. It is something that we cannot ignore. We hope to have it so that we can start training students locally to be endodontic just like us.”

He explains that they have a 70-28 vision at the university. This means that they expect people to reach the age of 70 with at least 28 teeth to be able to function well.

“This is our aim because without teeth, an individual is limited in their eating habits which generally affects one’s health,” he points out.

But how did he end up in this field?

Growing up in Awasi, Kisumu County, Dr Dienya aspired to be a pharmacist. He was sold to the career during his numerous visits to chemists at home.

“When we fell sick, we used to be sent to buy drugs, and I admired how they dispensed the medicine, I thought it was something special, so I wanted to become one,” he recalls.

He would join Kapsabet Township Primary School in the current Nandi County, getting grade A in all the three papers and becoming the top pupil in the then Nandi District in the Certificate of Primary Education.

His exemplary performance would earn him a secondary school scholarship from Jomo Kenyatta Foundation. He received two admission letters from Maseno and Lenana Schools.

“Because Maseno School was near my rural home, my father thought it wise that I join the school, not Lenana,” he explains.

An exemplary student, he would again score grade A in all the subjects except Kiswahili, in which he scored B+ in the Kenya Certificate of Education. He would proceed to Cardinal Otunga High School for the Kenya Advanced Certificate of Education before gaining admission to UoN for a Bachelor of Science in Pharmacy in 1991.

When he joined the university however, a friend of his father, Dr George Owino, a renowned dentist, influenced him to drop Pharmacy and take up a course in Dental Surgery. He would graduate in 1995 with a Bachelor’s degree in Dental Surgery before proceeding for a one-year internship at the Kenya National Hospital after which he was posted to Kisumu’s New Nyanza Provincial Hospital as deputy provincial dentist. He worked there until 2003.

Study endodontics

Dr Dienya then joined the Diocese of Maseno South, Anglican Church to work in their hospital in Kisumu as a senior dentist in charge of the facility until 2005.

UoN would then advertise openings for tutorial fellows, which he applied for, joining the university in 2007. He later received a Commonwealth Scholarship to study at the State University of Malaya in Malaysia.

“I chose to study endodontics because at the time there was nobody in the field in the whole country, I also wanted to gain extra knowledge on how to manage the complicated root canal cases,” he explains.

His motivation to specialise in the field stemmed from his experience working as a dentist where he would see many patients presenting with painful teeth and broken teeth. The dentists would struggle to deal with the cases because of limited knowledge on how to handle those cases, often preferring to use dentures, which presented talking and eating problems.

“This motivated me to specialise in the field and embark on a Masters in Dental Science (Endodontics) spending three years between 2007 and 2009 studying the course,” he says.

While doing the masters, Dr Dienya also enrolled for a nine-month certificate course in Implantology at Apsun Implant Training Centre, completing the course in 2008.

“I developed interest in tooth replacement using dental implants while in Malaysia, ending up taking a part time course in the same. This involves replacing missing teeth using dental implants.”

In 2010, Dr Dienya, who is the proprietor of Nairobi Endodontics and Dental Implants Centre in Hurlingham, returned to Kenya as the first endodontist in the region, he also got promoted from tutorial fellow to lecturer.

“I am currently a senior lecturer, hopefully, by next year or 2023, I will be an associate professor - I have published two books on endodontics.”

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