Oral health related behaviors among adult Tanzanians: a national pathfinder survey

Oral Health Status of Healthcare Workers in Ilembula/Tanzania during the COVID-19 Condition

The challenge of reduced dental treatment and education infrastructure in the Tanzanian highlands affects the oral health situation of both the general population and local healthcare workers. The aim of this study was to investigate the oral health status of healthcare workers at Ilembula Lutheran Hospital (ILH), Tanzania, during the COVID-19 pandemic. In total, 134 healthcare workers (62 women, 72 men; mean age 36.48 ± 9.56 years, range 19-59 years; median age 35.00 years) participated in this cross-sectional study, conducted from 12 February to 27 February. A dental examiner trained in oral health screening performed the oral health data collection. Data collection was performed by probability sampling using the Ilembula Data Collection Form-Oral Health (IDCF-Oral Health) questionnaire distributed in paper form. Ethical approval was obtained from the National Institute for Medical Research/Tanzania. The decayed, missing, and filled teeth (DMF/T) index proposed by the World Health Organization (WHO) was used with the associated caries measurement method and the simplified oral hygiene index (OHI-S). Details regarding edentulism, nutritional habits, and socio-economic factors were collected. Statistical analysis was performed using linear regression (α = 0.05). The average DMF-T index was 3.33 ± 0.82, with age, gender, meal frequency, and soft drink consumption significantly influencing the index. No evidence of dental plaque was detected in 43.3% of the participants. Of the participants, 32.8% required prosthetic treatment (Kennedy Class III), while 16.4% needed it for acute malocclusions. Oral hygiene products were used in 97% of cases. A total of 35.8% of the participants had an OHI-S score of up to 1.0, with (p < 0.001) age and (p < 0.001) sex having a significant influence on the index. The current oral health situation of healthcare workers at ILH shows a moderate need for restorative and prosthetic treatment in rural Tanzania. Despite the COVID-19 pandemic, there was no change in the need for dental treatment, which may be explained by the generally restricted access to dental healthcare in the investigated region. The development of an interdisciplinary oral health prophylaxis system could help to reduce the need for future treatments.

Oral health in an urban slum, Nigeria: residents' perceptions, practices and care-seeking experiences

BACKGROUND/INTRODUCTION

One of the key recommendations for the new WHO global strategy for oral health is inclusion of disadvantaged populations and their engagement in policy dialogues such that their needs and views are addressed in policy decisions.

OBJECTIVES

This study explored oral health perceptions, practices and care-seeking experiences of slum residents in Ibadan, Nigeria.

METHOD

Focus group discussions (FGD) were conducted with family health-decision makers in an urban slum site. Oral health perceptions, practices, and care-seeking experiences were discussed. FGDs were recorded, transcribed, and translated. ATLAS.ti qualitative research software was deployed for analysis using thematic analysis.

RESULTS

Six FGD sessions, divided by gender and age, were conducted between September-October 2019, (N = total 58 participants, aged 25 to 59 years). Common dental ailments mentioned were dental pain, tooth sensitivity, bleeding gums, tooth decay, mouth odor, gum disease, and tooth fracture. Perceived causes of dental conditions included poor dental hygiene and habits, sugary diets, ignorance, and supernatural forces. Mouth cleaning was mostly done once daily using toothbrush and paste. Other cleaning tools were ground glass, wood ash, charcoal, "epa Ijebu" (a dentrifice), and "orin ata" (a type of chewing stick). Remedies for relieving dental pain included over-the-counter medicines, warm salted water, gin, tobacco (snuff/powdered), cow urine/dung, battery fluid, and various mixtures/ concoctions. Visits to the dentists were mentioned by a few but this was usually as last resort. Main barriers to accessing care from dental care facilities were unaffordability of service charges and fear of extreme treatment measures (extraction). Suggested measures to improve timely access to dental health care included reducing/subsidizing costs of treatments and medications, offering non-extraction treatment options, and oral health education programmes.

CONCLUSION

The slum residents experience various forms of dental ailments mostly pain-related. The residents perceived formal dental clinics as unaffordable, thereby engaging in self-care remedies and harmful oral health practices before seeking professional help. Policymakers and decision-makers may leverage this empirical evidence for the people's education on early dental care and address challenges to affordable, available, and acceptable oral healthcare services among slum residents to improve access to care facilities.

Effects of Charcoal Toothpaste on the Surface Roughness, Color Stability, and Marginal Staining of Resin Composites

OBJECTIVE

This study was designed to evaluate the effects of charcoal toothpaste on the surface roughness, color stability, and marginal staining of resin composite restorations.

METHODS

A total of 100 bovine incisors was collected. The crowns were sectioned and randomly divided into 10 groups (n=10) according to two study factors: toothpaste groups and nanoparticle resin composite groups. Five toothpastes-Bianco Pro Clinical (Bianco Oral Care, Uberlândia, MG, Brazil) - Control group; Bianco Carbon (Bianco Oral Care); NAT, Natural Suavetex Carvão Ativado (Suavetex, Uberlândia, MG, Brazil); Nano Action Black Be Emotion (Polishop, Jundiaí, SP, Brazil); and BIW, Black is White (Curaprox, Curaden AG, Kriens, Switzerland)-and two resin composites-Z350XT, Filtek Z350XT (3M Oral Care) and Vittra, Vittra APS (FGM, Joinville, SC, Brazil)-were used. Circular cavities with a diameter of 4 mm and a depth of 1 mm were prepared on the buccal face of the tooth crowns and restored with resin composites. The specimens were subjected to three months of simulated toothbrushing. The surface roughness (right angle [Ra], in micrometers [μm]) of the resin composites was measured before and after toothbrushing in five areas per specimen. The resin composite color and luminosity changes (ΔE and ΔL, respectively) were measured using reflectance spectroscopy (Vita EasyShade). Macro photographs were taken before and after toothbrushing to qualitatively analyze the marginal staining (MSt) of the resin composite restorations. Scanning electron microscopy (SEM) was performed before and after the simulated toothbrushing. Ra data were analyzed using two-way analysis of variance with repeated measures and the Tukey HSD test; MSt was analyzed using Kruskal-Wallis and Dunn tests (α=0.05), and the resin composite color change was analyzed using the clinically unacceptable level of ΔE > 3.3.

RESULTS

Simulated brushing increased Ra irrespective of the resin composite or toothpaste used. No significant differences were found in Ra between the control group and all groups on which the charcoal toothpastes were tested. A clinically unacceptable level of resin composite color change (ΔE>3.3) was found after the use of most charcoal toothpastes. Use of Bianco Carbon resulted in marginal staining similar to that of the control group and was lower than that of the other charcoal toothpastes. Vittra brushed with black toothpaste showed the highest marginal staining.

CONCLUSION

Use of charcoal toothpaste resulted in Ra values of resin composites similar to those found with conventional toothpastes. Charcoal toothpaste generally resulted in clinical resin composite color changes (ΔE). All charcoal toothpastes, except Bianco Carbon, caused marginal staining of the resin composite restorations.

Oral health status of nursing staff in Ilembula, Wanging'ombe District, Njombe region, Tanzania: a cross-sectional study

BACKGROUND

Owing to the reduced dental treatment infrastructure in the Tanzanian highlands, maintaining good oral health is a challenge for not only the general population but also individual professional groups. In this study, the caries prevalence and, subsequently, the prosthetic treatment needs of the nurses of the Ilembula Lutheran Hospital (ILH) and Ilembula Institute of Health and Allied Sciences (IIHAS), Tanzania, were investigated.

MATERIALS AND METHODS

One hundred and sixty-eight ILH and IIHAS nurses and nursing students (87 women, 81 men; age 23.1 ± 6.1 years, range 18-58 years) participated in this cross-sectional study conducted in February 2020. The participants were examined at the dental office of ILH. The Decayed, Missing, and Filled Teeth (DMF/T) Index, Simplified Oral Hygiene Index, and details regarding edentulism, nutrition habits, and socioeconomic factors were collected. Linear regression and binary logistic regression were used for statistical analysis.

RESULTS

The mean DMF/T-Index was 6.30 ± 4.52. In 7.14% of the investigated nurses, no dental plaque was detected. An enhanced prosthodontic treatment (Kennedy Class III) demand was identified in 31.50% of the participants, and 4.80% of the participants required treatment for acute malocclusion. Oral hygiene products were used by 99.4% of the patients.

CONCLUSIONS

The current oral health situation of the study participants showed a moderate restorative and prosthetic treatment demand in the rural area of Tanzania. The development of an interdisciplinary oral health prophylaxis system could be a means to remedy this situation.

Socio-economic inequality in reported dental self-care behavior among Iranian households: a national pooled study

BACKGROUND

Setting out effective prevention strategies in dental diseases needs recognition related factors of the prevention behaviors and targeting the most disadvantaged groups in the term of dental hygiene. This study aimed to investigate socio-economic inequality in the dental self-care status (DSS) of Iranian households and decompose the measured inequality into its contributors.

METHOD

In this cross-sectional study pooled data was extracted from Households Income and Expenditure Surveys (HIESs) conducted in Iran from 2012 to 2017. The index of socioeconomic status (SES) for each household was constructed using principal components analysis (PCA). We used Wagstaff normalized concentration index as a measure of socioeconomic inequality in dental self-care. Decomposition analysis was applied to determine the main factors contributed to the measured inequality.

RESULTS

The prevalence of dental self-care in the whole population was 40.56%. The total concentration index was 0.271 (CI: 0.266, 0.275). The results of decomposition analysis for the measured inequality showed that SES, was the highest positive contributors (90.19 %) followed by sex of household's head (12.15 %), place of residence (11.79 %), and education level of household's head (11.71 %). Furthermore, the province of residence had the highest negative contribution (-11.37) to the inequality.

CONCLUSION

The findings of this study showed that a huge portion of the observed inequality was explained by SES that might give us a policy recommendation: There is room for improving dental health and reducing inequality in dental self-care by paying more attention to SES-disadvantaged households.

Oral health conditions and correlates: a National Oral Health Survey of Rwanda

Background: Dental diseases are chronic, lifelong and preventable yet affect over half the world's population. Personal oral hygiene practices and socio-economic factors contribute to oral health outcomes affecting oral health quality of life. Integrating basic oral care within community level health systems increases accessibility and availability of oral health resources.Objective: National Oral Health Survey of Rwanda (NOHSR) data were investigated for associations of socio-demographic characteristics, personal oral hygiene practices, oral health outcomes, and oral health quality of life indicators.Methods: Data were analyzed and descriptive statistics calculated. Multivariable logistic regression models were developed to assess associations between untreated caries, calculus, and pain with various independent variables (demographics and personal oral hygiene practices). Additional logistic regression models examined associations between quality of life indicators and the aforementioned independent variables as well as untreated caries and pain.Results: Those who did not use a toothbrush (62.7%), or toothpaste (70.0%), and cleaned their teeth less than once per day (55.3%) had a higher prevalence of untreated caries. Approximately one-third of those in rural areas cleaned their teeth once per day or more compared to two-thirds of those in urban areas (35.4% vs. 71.2%). Those cleaning their teeth less than once daily were estimated to have 56.0% higher odds of caries than those who cleaned their teeth once a day or more (OR = 1.56, [95% CI 1.25-1.95]). Those with secondary education or higher and those with skilled jobs demonstrated more frequent teeth cleaning and higher toothbrush and toothpaste use. Quality-of-life indicators varied significantly with untreated caries and pain.Conclusion: Socio-economic, individual, and workforce characteristics are important considerations when assessing oral health outcomes. This study investigated social demographic disparities in relation to oral health related behaviors and outcomes. This information can help guide oral health care programming in Rwanda.

Tobacco Use and Orofacial Pain: A Meta-analysis

Introduction

The relationship between smoking and general body ache has been shown to be bidirectional. The specific association between tobacco consumption and orofacial pain remains unclear, however.

Aim and Methods

The aim of this systematic review was to explore the association between pain related to diseases of the oral cavity and use of tobacco. A systematic search of PubMed, Embase, Web of Science, and Cochrane databases was carried out in September 2019. Tobacco exposure was included irrespective of the method of consumption (smokeless and smoked tobacco), and frequency of the habit. The outcome was defined as clinically diagnosed or self-reported pain in the orofacial region, with no limitation in the duration of the condition or the site of the pain.

Results

Altogether, eight studies were selected, with three of them demonstrating good methodology and none of them being of poor quality. Meta-analysis of six studies showed that orofacial pain was significantly worse in tobacco (smoked and smokeless) users (odds ratio [OR] = 3.55, 95% confidence interval [CI]: 1.92, 6.58) in comparison to nonusers. Subgroup analysis showed that the odds of orofacial pain was three times (OR = 3.13, 95% CI: 1.16, 8.46) higher among smokers, but was not associated with smokeless tobacco.

Conclusions

The odds of experiencing orofacial pain among patients with oral diseases increase for patients who are also smokers. The findings could help dentists and other health specialists more effectively manage patients with orofacial pain who are tobacco consumers.

Implications

This study shows that the odds of orofacial pain among patients with oral diseases increase for patients who are smokers. The results are a significant contribution to the literature because, while the relationship between smoking and general body ache has been shown to be bidirectional, the specific association between tobacco use and orofacial pain warranted further study. The findings could help dentists and other specialists more effectively manage patients with orofacial pain who are also tobacco consumers.

Knowledge and Practices on Periodontal Health among Adults, Misungwi, Tanzania

The level of knowledge and practices on periodontal health of 388 adults in Misungwi District, Tanzania, was assessed. Analysis included frequency distributions and the chi-square test at a p value of 0.05. Many more participants were males (n=197; 50.8%) and of younger age group (n=215; 55.4%) and having seven years of education (n=257; 66.2%). Higher number of participants reported owning a mobile phone (n=289; 74.5%) and a radio (n=298; 76.8%), while few (n=45; 11.6%) had their houses connected to electricity. Study participants who were males (n=101; 51.3%), had more than seven years of schooling (n=67; 72.3%), who owned a mobile phone (n=143; 49%), owned a radio (n=144; 48.3%), and resided in houses having electricity (n=37; 82.2%) were statistically significantly more knowledgeable on periodontal health when compared to their counterparts. A statistical significant difference was seen in oral health practices conducive to periodontal health among those who were males (n=133; 67.0%), having more than seven years of education (n=78; 83.0%), owning a mobile phone (n=189; 65.4%), owning a radio (n=195; 65.4%), and residing in house having electricity (n=35; 77.8%). This study observed that participants who were males, owned a mobile phone, owned a radio, resided in houses having electricity, and having more than seven years of education were more knowledgeable and had more conducive oral health practices on periodontal health.

Factores asociados a la utilización de servicios de salud odontológicos

Resumen El presente trabajo se propone analizar los factores asociados a la utilización de servicios de salud odontológicos (USSO) en individuos adultos de la Ciudad de Corrientes; Argentina. Se realizó un estudio transversal. A través de una encuesta domiciliaria se recolectó información de las variables de estudio. Se determinó el tamaño de la muestra estableciéndose un nivel de confianza del 95% (381 individuos). Se aplicó un diseño muestral aleatorio simple, que se complementó con un muestreo no probabilístico por cuotas. Se analizaron los datos con los programas SPSS 21.0. y Epidat 3.1. El nivel socioeconómico, la cobertura social odontológica, la percepción sobre la salud bucal, los conocimientos de salud bucal y los hábitos de higiene bucal se asociaron significativamente a la USSO en los últimos 12 meses. Los mismos factores, a excepción de la cobertura social odontológica y de los conocimientos de salud bucal, se asocian a la USSO por motivos de control/chequeo dental de rutina. Se deben implementar medidas tendientes a aumentar la USSO con fines de prevención en individuos de ambos sexos, de todos los niveles socioeconómicos, especialmente en aquellos menos favorecidos.

Charcoal and charcoal-based dentifrices: A literature review

BACKGROUND

Sales of charcoal dentifrices and powders have rapidly emerged into the Internet marketplace. The authors conducted a literature review to examine the efficacy and safety of charcoal and charcoal-based dentifrices.

METHODS

The authors searched the MEDLINE and Scopus databases for clinical studies on the use of charcoal and charcoal-based dentifrices and laboratory investigations on the bioactivity or toxicity of charcoal and charcoal-based dentifrices, published through February 2017. The authors used a defined search strategy to identify randomized, controlled clinical trials with a follow-up duration of 3 months or longer. In addition, the authors selected the first 50 consecutive charcoal dentifrices from Google.com and Amazon.com for ascertainment of product assortment and advertising promotions.

RESULTS

The authors' literature search identified 118 potentially eligible articles. Thirteen studies reported brushing the teeth with raw charcoal or soot; however, none of these studies met the inclusion criteria. Two studies offered nonspecific caries reductions, 3 studies reported deleterious outcomes (increased caries, enamel abrasion, nonquantified negative impact), and 1 study indicated only that brushing with raw charcoal had no adverse effects on oral hygiene. Seven other studies reported only on the use of charcoal for oral hygiene. Internet advertisements included unsubstantiated therapeutic claims-such as antibacterial, antifungal, antiviral, and oral detoxification, as well as potentially misleading product assertions. One-third of the charcoal dentifrices contained bentonite clay, and 1 contained betel leaves.

CONCLUSIONS

The results of this literature review showed insufficient clinical and laboratory data to substantiate the safety and efficacy claims of charcoal and charcoal-based dentifrices. Larger-scale and well-designed studies are needed to establish conclusive evidence.

PRACTICAL IMPLICATIONS

Dental clinicians should advise their patients to be cautious when using charcoal and charcoal-based dentifrices with unproven claims of efficacy and safety.

New curriculum in dentistry for Tanzania: competency-based education for patient and population health (2008-2011)

From 2008 to 2011, the School of Dentistry at Muhimbili University of Health and Allied Sciences in Tanzania revised and then initiated implementation of a curriculum to improve the educational process for, and competence of, its graduates. As an increasing body of research demonstrates the detrimental effects of oral diseases on health and the interrelationships between oral and systemic diseases (including HIV and diabetes), the importance of dentistry education grows. We describe the population oral health problems in Tanzania, the need to enhance the dental workforce, and the process of curricular reform to meet these needs. This reform included transition to a competency-based curriculum featuring teaching methods that will enhance the effectiveness of the education and performance of graduates in traditional and new roles. We conclude with lessons for Tanzania and for health professions educational institutions elsewhere, as well as for public health-care planners concerned about linking health professions education to improving population health in resource-poor countries.

Edentulism risk indicators among Mexican elders 60-year-old and older

The objective of this study was to determine the prevalence of edentulism in Mexican elders aged 60 years and older, and the associated risk indicators. A cross-sectional study was undertaken in 139 elders living in either of two long-term care (LTC) facilities, or attending an adult day center (ADC) in Pachuca, Mexico. A subject was edentulous when natural teeth were completely absent, determined through a clinical examination. Risk indicators were collected using questionnaires. Analyses were performed using binary logistic regression in STATA 9.0. Mean age was 79.0±9.8 years. Many subjects were women (69.1%). The prevalence of edentulism was 36.7%. In multivariate analysis, after adjusting for age and sex, the variables that were inversely associated (p<0.05) with edentulism were living with a spouse (odds ratio=OR=0.31), and lacking health insurance (OR=0.70). Variables associated with higher risk of being edentate were lower educational attainment (OR=1.61), having received radiation therapy (OR=4.49), being a smoker (OR=4.82), and having diabetes (OR=2.94) or other chronic illnesses (OR=1.82) (with hypertension approaching significance, p=0.067). In this sample of Mexican elders, diverse variables were associated with edentulism, in particular smoking and past radiotherapy. Oral health programs within and outside LTC/ADC should take into account risk factors specific to the older population.