Dental care in Africa: Challenges and solutions

Issues:

1. Inadequate personnel

In 2019, the following numbers of dental personnel were reported for the WHO Africa region: [1]

• 36,222 dentists.
• 32,783 dental assistants/therapists, and
• 11,986 dental prosthetics/technicians.

The average density per 10,000 population in the region was:

• 0.44 for dentists (i.e., just over 10% of the global ratio of 3.28 per 10,000 population).
• 0.39 for dental assistants/therapists, and
• 0.10 for dental prosthetics/technicians. [1]

The lowest and highest density of dentist per 10,000 population were in South Sudan (0.003) and Seychelles (4.287) respectively. [1]

The WHO estimates that oral diseases affect an estimated  480 million people in the WHO African region in 2019. [2]

60% of children suffering from dental diseases remain untreated at any given time.

With a dentist to population ratio standing at approximately 1:36,000, majority of the Africans have little or no access to proper oral health care. In most industrialized countries this ratio stands at 1:2000, presenting a very different picture. 

Registered number of doctors, nurses and dentists in Nigeria as at 2017. (Credit Premium Times, 2019) 

2. Uneven Resource Distribution and Cost of Care

Dental clinics and trained dental personnel whether in the public or private sectors are few and not evenly spread throughout many African countries. 

In places where these resources are available, dental care is very expensive and not affordable by the majority of people.

Moreover, the dental clinics and private providers focus more on curative rather than preventive services. 

3. Inappropriate Oral Care Training

African countries also face challenges with regards to inappropriate oral care training and education provided to dental students and frontline nurses that are responsible for educating local people about preventive oral healthcare.

Recommendations

Given the serious inadequacy in the number of dentists and oral hygienists in most African countries, health leaders have a duty to look urgently at cost effective options to improve the oral health of the population.

To this end, massive population-based health education campaign suggests itself as promotive and preventive healthcare are better than costly cures. Here are examples of what could be done.

1. Public education to promote personal responsibility

The core objective of such campaign will be to educate the population in how to take personal responsibility for their oral health so as to prevent costly cures.

For example, awareness should be created among local people to brush their teeth every day in the morning and evening with fluoride toothpaste or alternatively chew sticks where tooth pastes are not available or too costly to buy.

Studies show that brushing everyday prevents plaque formation and reduces the incidence of tooth decay by about 50%.

Education should also be provided to create awareness about: 

• Risk factors associated with sugar consumption
• Brushing teeth every day in the morning and  night
• Having regular dental checkup from childhood

These three activities help people maintain optimum oral health. 

2. Public education on the impact of nutrition on dental health

Nutrition also plays a big role in dental health. Oral hygiene and nutrition are linked.

Studies have found that poor diet is associated with increased chances of oral disease.

Therefore it is extremely important to make people aware about what constitutes a healthy food for proper oral health.

For example, sugar is an empty calorie food because even though it provides calories, it does not provide any nutrition. Sugar heavy diet and unhealthy food will fill the stomach and eliminate hunger, but will not provide nutrition your body needs to stay healthy and to grow and develop.

3. Public education and action for behaviour change

Creating awareness and educating people is important but not sufficient to instill consistent brushing habit.

This requires a behavioural change wherein people make it part of their life to brush day and night every day. 

It should become part of the social norm.

This is something that government cannot do all alone.

With effective government partnership with non-governmental organisations (NGOs), teachers, midwives, and community health workers, working at the grass root level, gradual changes in the habit of the general population can be created.

This calls for a strong partnership to develop strategies that is inclusive to everyone including children in rural areas, pregnant women and the elderly.

Suggested approaches

Governments in African countries can impact and improve population-centred dental care through focused education program that are geared towards developing habit in children to maintain good oral health and provide training to community health workers. 

Here are four ways in which governments can improve oral health care of the African public:

• Support awareness programs about maintaining oral health and hygiene.
• Provide mobile dental care for children in schools.
• Discourage sugary drinks and candy consumption in school children.
• Produce more dentists and oral hygienists to work in rural communities.

Support awareness programs about maintaining oral health and hygiene

Community health workers can be trained to provide education to communities where people reside.

For example every village that has about a hundred to 150 households should be supported and encouraged to elect one female and one male to act as a community health worker.

The community health workers should be trained regularly so that they can bring awareness in their village about maintaining proper oral health and identify simple oral problems for intervention before they become serious issues. 

Provide mobile dental care for children in schools

Effective partnership of government and school authorities can pave the way for promoting dental health in school through mobile services and develop good oral hygiene habits in children from a very young age. 

Promoting activities such as washing hands with soap and using washed fingers to scrub teeth daily with fluoride toothpaste in situations where toothbrushes are not affordable should be considered scalable public health interventions to improve healthy oral hygiene in school children. 

Government should also focus on ensuring that children have access to basic primary education.

More than 263 million children throughout the world and more so in Africa drop out of school before completing their minimum education.

Since schools can work as a central place to promote good oral health and fight malnutrition among children, it is important that all children attend school. 

Discourage sugary drinks and candy consumption in school children

Sugary drinks not only provide empty calories, they also badly affect oral health.

Multinational beverage companies with deep pockets invest heavily in marketing to promote their sugary drink in most rural communities of Africa.

For example, Coca-Cola Company will spend USD $12 billion in Africa alone in 2020, according to Marion Nestle.

Government can impose a special tax on companies that produce soft drink and other candies as well as proscribe the sale of sugary drinks to schools and near school vicinities.

A one percent tax imposed on the marketing budget of Coca-Cola, the government will generate availability of 170 million US $ equivalent in local currency as at 2020.

This can fund public health activities at grass root level to promote awareness about health and hygiene in general among people.

Even free distribution of toothbrush and fluoride toothpaste can be initiated from such funds in order to get local people including school children started in cleaning their teeth daily.

Produce more dentist and dental hygienists

African governments can create appropriate environment that makes it easy and encourages people to consider becoming dentists and dental hygienists.

This will help bridge the current supply gap in these oral care professionals.

More dental colleges, polytechnics and universities can be setup and qualified candidates should be given some form of incentive from government and policymakers to train in the field and eventually incentivized to work in underserved communities across Africa.  

Conclusion

These are but few suggestions that can help to improve oral health in populations across Africa in the short and long term. More needs to be done through public-private partnering to implement policies, programs and strategies to step up good oral care in African countries as part of overall population health improvements generally.

References

1. Gallagher, J.E.; Mattos Savage, G.C.; Crummey, S.C.; Sabbah, W.; Varenne, B.; Makino, Y. Oral Health Workforce in Africa: A Scarce Resource. Int. J. Environ. Res. Public Health 2023, 20, 2328. https:// doi.org/10.3390/ijerph20032328.

2. World Health Organisation. Oral health

3. Owoseye A. It’s official: Nigeria gravely lacks doctors to address citizens’ health needs. Premium Times. [Internet, Feb. 4, 2019]. Cited October 20, 2019. 

Related:

• The right ways to maintain your dental health 

Created: October 20, 2019

Last updated: July 20, 2024.

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