Unmet need in Sierra Leone: a national oral health survey of schoolchildren

Challenges in oral health practice in Somalia: a call for regulatory strengthening and inclusion into primary healthcare services

BACKGROUND

Oral diseases remain a significant public health problem worldwide despite being largely preventable. Oral disorders such as dental caries, periodontal diseases, and oral cancers are highly prevalent chronic conditions that negatively impact quality of life. The oral health practice in Somalia has been evolving over the years, we therefore explored the challenges of oral health practice in a security-constrained poorly regulated environment to guide policy development.

METHODS

We conducted a descriptive cross-sectional study among 15 oral health practitioners in Somalia. Using in-depth interviews, we gathered data on challenges working in private dental clinics and governmental institutions. Additionally, we gathered data on gender, age, marital status, profession, country of graduation, current location of practice, and years of clinical experience. Because the participants worked in different cities, we conducted interviews over the phone and recorded them. The data were analyzed via thematic analysis.

RESULTS

In this study, 9 of the participants were men and the median age was 29 years. Most of the participants (10) were dentists and remaining were dental specialists. The findings on challenges fall under four broad thematic areas: (1) Patient-related challenges; low patient literacy, preference for dental quacks, delay in seeking oral care, and dental phobia. (2) Institutional-related challenges: limited access to basic oral health services, oral health not an integral part of primary health care, and unregulated private dental clinics resulting in unqualified quacks practising as private caregivers. (3) Societal-related challenges, the absence of community-oriented preventive oral health services and low prioritization of oral health. (4) Personal-related challenges: female dentists in this study faced challenges related to the preference of male dentists and the shortage of oral health specialists in the country.

CONCLUSION

This study reveals the need for the establishment and strengthening of regulation of oral services and its inclusion into the basic primary service package provided to the populace. It also calls for community enlightenment and more investment in dental health care in Somalia.

CLINICAL TRIAL NUMBER

Not applicable.

Universal coverage for oral health care in 27 low-income countries: a scoping review

BACKGROUND

Low-income countries bear a growing and disproportionate burden of oral diseases. With the World Health Organization targeting universal oral health coverage by 2030, assessing the state of oral health coverage in these resource-limited nations becomes crucial. This research seeks to examine the political and resource commitments to oral health, along with the utilization rate of oral health services, across 27 low-income countries.

METHODS

We investigated five aspects of oral health coverage in low-income countries, including the integration of oral health in national health policies, covered oral health services, utilization rates, expenditures, and the number of oral health professionals. A comprehensive search was conducted across seven bibliographic databases, three grey literature databases, and national governments' and international organizations' websites up to May 2023, with no linguistic restrictions. Countries were categorized into "full integration", "partial integration", or "no integration" based on the presence of dedicated oral health policies and the frequency of oral health mentions. Covered oral health services, utilization rates, expenditure trends, and the density of oral health professionals were analyzed using evidence from reviews and data from World Health Organization databases.

RESULTS

A total of 4242 peer-reviewed and 3345 grey literature texts were screened, yielding 12 and 84 files respectively to be included in the final review. Nine countries belong to "full integration" and thirteen countries belong to "partial integration", while five countries belong to "no integration". Twelve countries collectively covered 26 types of oral health care services, with tooth extraction being the most prevalent service. Preventive and public health-based oral health interventions were scarce. Utilization rates remained low, with the primary motivation for seeking care being dental pain relief. Expenditures on oral health were minimal, predominantly relying on domestic private sources. On average, the 27 low-income countries had 0.51 dentists per 10,000 population, contrasting with 2.83 and 7.62 in middle-income and high-income countries.

CONCLUSIONS

Oral health care received little political and resource commitment toward achieving universal health coverage in low-income countries. Urgent action is needed to mobilize financial and human resources, and integrate preventive and public health-based interventions.

Caries clusters at lesion-severity thresholds: A Sierra Leone case study

OBJECTIVES

Despite being almost entirely preventable, globally, dental caries is extremely prevalent. Moreover, dental caries will continue to present an even larger challenge for lower income countries, particularly those in the African context, as they transition to a more Western diet. Hence, epidemiological data providing insight into disease patterns and trends is critical to inform public health action. The purpose of this study was to examine dental caries clusters by caries detection threshold among 15-year-old adolescents in Sierra Leone, using data from the latest national survey, and to explore associated sociodemographic factors.

METHODS

This paper presents a secondary analysis of oral health data on 490 15-year-olds from the Sierra Leone national oral health survey of schoolchildren. Hierarchical cluster analysis of dental caries experience was conducted across all surfaces at four decay detection thresholds using the International Caries Detection and Assessment System (ICDAS) (clinical: ICDAS 2-6, cavitated: ICDAS 3-6, obvious: ICDAS 4-6 and extensive obvious: ICDAS 5-6 decay) across the four regions of Sierra Leone. Ordered logistic regression was used to estimate the association of sociodemographic factors with generated clusters relating to clinical and obvious decay experience. These are of both clinical and epidemiological relevance.

RESULTS

A 3-cluster decay pattern representing a 'low' to 'high' decay experience distribution was observed under each decay detection threshold across surfaces. For clinical decay (including visual enamel caries), 28.8% had low, 55.1% medium and 15.9% high caries status. In the adjusted model, the only significant risk factor across obvious and clinical decay thresholds was region, with adolescents outside the Western region more likely to experience decay.

CONCLUSION

This study suggests that adolescents in Sierra Leone fall into three distinct caries clusters: low, medium to high decay experience distribution, regardless of decay threshold. It reinforces the importance of recognizing dental caries detection thresholds and the use of contemporary epidemiological methodology. This suggests that adolescents outside the Western region are likely to have higher caries experience. The data also provides insight to the nature of adolescents in each cluster and should help to inform policy and planning of the integration of oral health into primary care and school systems.

Oral health of adolescents in West Africa: prioritizing its social determinants

Oral health is a major public health issue in West Africa, yet it has gotten little attention. Individual and group disparities in health status are influenced by social determinants of health (SDH), which also affect oral health. Adolescence is a significant transition into adulthood, a time when the SDH can contribute to lifelong health status. This article explored the SDH associated with oral health behaviour, perception, and oral health development amongst adolescents in West Africa. This article engaged articles published in peer-reviewed journals relating to adolescents' oral health and West Africa. The authors undertook this desk review to determine the social determinants of adolescents' oral health in West Africa. The literacy levels and oral health awareness of adolescents, family and social circle influences, socioeconomic status, nutritional levels, and cultural and environmental factors have been identified as important social determinants. Adequate policy implementation with the integration of oral health in schools' curriculum, health systems reorientation with the adoption of oral health delivery in primary health care and expansion in oral health research with the assessment of cultural influences on oral health development have been recommended as interventions to reduce oral health inequalities in West Africa.

Oral Health in 12- and 15-Year-Old Children in Serbia: A National Pathfinder Study

The aim of the paper is to present the oral health profile of 12- and 15-year-old schoolchildren in Serbia. Basic Methods for Oral Health Surveys of the WHO were implemented to record: Decayed, Missing, and Filled Teeth/Surfaces Index (DMFT/DMFS), gingival bleeding, enamel fluorosis and other structural anomalies, dental erosion, dental trauma, and oral mucosal lesions. In addition, Silness and Löe plaque index and orthodontic status were assessed. A total of 36% of 12-year-olds and 22% of 15-year-olds in Serbia were caries-free. The mean DMFT was 2.32 ± 2.69 for 12-year-olds and 4.09 ± 3.81 for 15-year-olds. DMFT was made up largely by the decayed component. Gingival bleeding was present in 26% of examined 12-year-old and 18% of 15-year-old children. Dental plaque was observed in 63% of both 12- and 15-year-olds. Fluorosis, structural anomalies, dental erosion, dental trauma, and oral mucosal lesion were rarely detected. Low prevalence of malocclusions was found. Oral disease is still a common public health problem among schoolchildren in Serbia. A significant increase in the prevalence of caries disease between 12- and 15-year-old groups implies that preventive care for adolescents requires special attention. Corrective actions and reforms to the current school-based oral health prevention program are needed to further improve oral health in Serbian children.