The dentist-scientist career pathway in Africa: opportunities and obstacles

Bridging the gap between omics research and dental practice

AIM

The burgeoning field of omics research has witnessed exponential growth in both medicine and dentistry. However, despite more than a decade of advancements, clinical dentistry, particularly in Low- and Middle-Income Countries (LMICs), has seen limited progress in integrating omics-based approaches into routine practice. This review aims to provide a comprehensive overview of the integration of omics approaches in dentistry, focusing on the challenges and opportunities for translating research findings into clinical practice.

METHODS

we conducted a literature review using key databases to provide a brief overview of the history of genomics in dentistry. Additionally, we summarised recent breakthroughs in omics relevant to oral health practitioners, emphasising the inadequate translation of omics research into clinical practice.

RESULTS

Despite significant growth in omics research in both medicine and dentistry, its translation into routine clinical practice in dentistry remains limited. We summarise recent breakthroughs in omics and highlight the gap between research advancements and clinical implementation.

DISCUSSION AND CONCLUSION

The integration of omics approaches holds promise for enhancing diagnostics, personalised treatment strategies, and preventive measures in dental practice, ushering in a new era of precision oral healthcare. However, several challenges, including infrastructure limitations, cost-effectiveness, and education gaps, hinder the widespread adoption of omics-based approaches in clinical dentistry. A strong commitment to transforming dentistry is required to embrace this transition. This shift has the potential to revolutionise oral healthcare by advancing precision diagnostics and treatment strategies tailored to individual patient needs.

Liquid Biopsy in Head and Neck Cancer: Its Present State and Future Role in Africa

The rising mortality and morbidity rate of head and neck cancer (HNC) in Africa has been attributed to factors such as the poor state of health infrastructures, genetics, and late presentation resulting in the delayed diagnosis of these tumors. If well harnessed, emerging molecular and omics diagnostic technologies such as liquid biopsy can potentially play a major role in optimizing the management of HNC in Africa. However, to successfully apply liquid biopsy technology in the management of HNC in Africa, factors such as genetic, socioeconomic, environmental, and cultural acceptability of the technology must be given due consideration. This review outlines the role of circulating molecules such as tumor cells, tumor DNA, tumor RNA, proteins, and exosomes, in liquid biopsy technology for the management of HNC with a focus on studies conducted in Africa. The present state and the potential opportunities for the future use of liquid biopsy technology in the effective management of HNC in resource-limited settings such as Africa is further discussed.

Assessing Malawi’s recent development of a National Oral Health Policy – learning for the future

Background

Policymakers in many low- and middle-income countries do not prioritize oral health and are inadequately informed about the burden of oral and maxillofacial problems, their connection with systemic health and the possible threat to human life. In Africa, the absence of oral health policies is a key problem contributing to increased oral disease burden, health workforce shortage, and inadequate oral health service provision. Context-relevant policies and research to determine needs and monitor progress are key components in eradicating oral health inequalities. This paper focuses on the work of Malawi to follow the direction of travel outlined at the 2021 World Health Assembly by developing its first National Oral Health Strategy and Implementation Plan.

Methods

A case study approach examined the processes followed by Malawi to develop its National Oral Health Policy, launched in April 2022. The aim was to understand how oral health policy is being developed within the context of an African country. Specifically, the objectives were to identify how oral health policy was being developed in Malawi and the contributors to the development of that policy. Qualitative data were collected from semi-structured interviews (n=8) of purposively selected key informants from the Malawi National Oral Health Policy Taskforce team involved in the policy creation. Data were analyzed in the thematic areas within the Health Policy Triangle of actors, context, processes, and content.

Results

The policy development process was guided by Malawi’s Ministry of Health and involved a diverse group of actors, both local and international. The funding of the policy development process by the Scottish Government and Borrow Foundation provided critical support. Five groups of stakeholders have conducted the relevant background investigations and written the Oral Health Policy: international development partners, academics, policy experts, dental practitioners, and civil society organizations. The partnership skill-sharing and well-managed dynamics of the group, together with the reliable funding base, all contributed to a successful outcome.

Conclusions

A multisectoral approach was used. Malawi is uniquely placed in its oral health policy development, having a solid stakeholder base (local and international) and resources to support the policy development and, partly, its implementation.

The genetic determinants of oral diseases in Africa: The gaps should be filled

Oral diseases are a major health concern and are among the most prevalent diseases globally. This problem is becoming more prominent in the rapidly growing populations of Africa. It is well documented that Africa exhibits the most diverse genetic make-up in the world. However, little work has been conducted to understand the genetic basis of oral diseases in Africans. Oral health is often neglected and receives low prioritisation from funders and governments. The genetic determinants of highly prevalent oral diseases such as dental caries and periodontal disease, and regionally prevalent conditions such as oral cancer and NOMA, are largely under-researched areas despite numerous articles alluding to a high burden of these diseases in African populations. Therefore, this review aims to shed light on the significant gaps in research on the genetic and genomic aspects of oral diseases in African populations and highlights the urgent need for evidence-based dentistry, in tandem with the development of the dentist/scientist workforce.

Integrating Oral Health into Primary Health Care: A Systematic Review of Oral Health Training in Sub-Saharan Africa

Background

Globally, oral health training has shown positive influence on knowledge, competency and practices for both oral and non-oral health-care workers towards integration of oral health into primary health care (PHC). Sub-Saharan Africa has very divergent social-cultural-political-economic settings. Since healthcare is contextual, it is necessary to review oral health training programs in this region to establish if their formulation, implementation and evaluation are context-reliant.

Objective

To assess if oral health trainings aimed at integrating oral health into PHC in sub-Saharan Africa were context-reliant.

Methodology

The reviewers searched five electronic databases and WHO sites. Selection of publications was done using the PRISMA framework. Oral health training programs for oral and non-oral health-care workers in sub-Saharan Africa published in English language between year 2001 and 2020 were included in the study.

Findings

Only 4 (0.8%) of the original 512 publications for oral health-care workers and 9 (1.5%) of the 613 for non-oral health-care workers publications met the inclusion criteria. Countries established and/or increased number of dental schools, 1 university adopted competency-based curriculum and 2 introduced community rotations. Dental auxiliaries varied by cadre, training duration and scope of practice. Non-oral health-care workers training programs used diverse approaches like pre-service, workshops and printed materials. Target groups for the trainings varied from nurses, traditional healers, health promotion officers to community health volunteers. Evaluations were done mainly using pre-post or quasi-experimental studies. Outcomes of interest varied from level of knowledge, services provision, early childhood caries, oral health seeking behavior and oral hygiene practices.

Conclusion

Oral health training for integration of oral health into PHC in sub-Saharan Africa varied by targeted cadre, training methods and evaluation method and scope. It was thus context-reliant. More programs are necessary to accommodate other training approaches, evaluation methods and other health-care cadres in the region.