Low awareness, inadequate access threatens Nigeria’s oral health policy

Although not always life-threatening, oral diseases represent a major public health problem due to their high prevalence and significant impact on general health. Though reliable data are scarce, oral diseases seem to be on the rise in the African Region, including Nigeria with gum complications seen as becoming more common, especially in older people.

Latest findings reveal that periodontal diseases affect the tooth supporting structures with the prevalence put at over 50 percent of the nation’s population. Seen as a low priority in Africa, where poverty tends to ensure that limited resources available to health are skewed towards life threatening conditions such as HIV/AIDS, dentistry and oral health issues is not receiving priority attention due to the dearth in the consequences of poor oral health.

The Federal Government’s recently introduced standard guidelines for medical check-up that prioritise dental examination of patients alongside other relevant medical data promised newer techniques to promote and protect oral health hygiene among Nigerians.

With the mandatory guideline in place, every individual undergoing medical check-up would go through as a necessity, dental examination to provide accurate dental records and data which would be stored for identification purposes in the event of any emergency.

The National Oral Health Policy, which is in tandem with international standard, focuses on priority areas as oral health promotion, training/human resources development, service delivery, research, monitoring and evaluation, information and communication technology, including oral health information system.

Given numerous efforts geared towards repositioning dental health in the country, stakeholders have called for increased awareness on the part of individuals, families and communities in a bid to lower the incidence of oral disease in the country.

Olujimi Osisanya, former president, Nigerian Dental Association (NDA), described oral health as an integral part of total healthcare and factors that affect oral health also affects total health and vice versa. Osisanya identified some generic factors that affect oral well-being of individuals to include genetics, environment, cultural beliefs, habits and religious practices.

The former President NDA disclosed that some of the aforementioned problems translate into non-communicable diseases which accounts for 60 percent of global deaths, according to the World Health Organisation (WHO). Interestingly, the United Nations classification in October 2011 of oral health as non-communicable diseases (NCDs) for the first time called for attention on the dangers of NCDs.

“The classification in Article 19, that renal, oral and eye diseases pose a major health burden for many countries and that these diseases share common risk factors and can benefit from common resources for non-communicable diseases is an attestation to the reality of oral health problems by UN,” Osisanya explained.

Some common oral health diseases include dental caries, malocclusion, cleft lip and palate among others, as trauma from road traffic accidents, oral presentation of HIV/AIDS and systemic diseases like anaemia and diabetes are also posing challenges to healthcare in Nigeria

Osisanya however called for sustainability in the advocacy of tooth brushing twice a day, vigorous integration of oral healthcare into the PHC, effective utilisation of other stakeholders like community health extension workers, compulsory NHIS for affordable and available oral health services, direct access to oral healthcare primary providers, acceptance of scale and polish as a veritable preventive tool in the oral health care system of NHIS not as a cosmetic preference but one that can enhance early detection of oral diseases.

Bode Adesoji, medical director, GlaxoSmithKline Consumer Nigeria plc, said that oral health awareness is poor in the country because people do not understand the interconnection between oral health and general well-being.

“I have also realised that a lot of people associate the dentist with pain and this fear has prevented a lot of people going for dental check-ups. Nigerians also believe that dental treatments/procedures are too expensive hence they would rather cope with the pain,” Adesoji stated.

As regards the relationship between poor oral health and heart related diseases, Adesoji said, “It is a long established fact that oral health is a direct reflection of the overall health of an individual and various literatures are in support of this notion.”

Concerning tooth sensitivity which has been a major concern for many individuals across the world, Adesoji said patients with such concerns should try to use toothpastes that are specifically developed for individuals with sensitive teeth and clinically proven to relief the pain of teeth sensitivity with continuous use.

On the ratio of qualified dentists to patients in Nigeria which many believe is very wide, Adesoji suggested more training institutions and better remuneration to avoid brain drain and influx of quacks in the profession.

“I believe the wide ratio is as a result of inadequate training institutions for dentists in the country as well as the unattractive remuneration compared to other opportunities in other parts of the world. This has led to significant brain drain to this great profession.

“Dental equipment is also prohibitively expensive, thus discouraging even experienced dentists from setting up individual practice. These issues adequately addressed will definitely improve the situation,” Adesoji explained.

Adeyemi Olusile, a professor in the faculty of dentistry, Obafemi Awolowo University, Ile-Ife, advised that Nigeria’s dentistry and oral health should be given proper priority as part of general health and not be considered a speciality of medicine.

“There should be proper funding and attention to oral health and oral health care delivery. Presently, none of the three arms of the government has any budget for dentistry at any level. This makes planning and delivery of oral health care difficult if not impossible.

“There should be a functional dental clinic in every local government. Since more than half of the population in Nigeria live in the rural areas where there are no facilities for dental health care delivery, mobile dental units should be made available to visit remote towns and villages.

“And of course all state hospitals must have functional dental units that are adequately equipped. The different tiers of government should also sponsor researches into dentistry and encourage training of dental personnel.

There is no gainsaying that the new National Health Policy which was developed by the Federal Ministry of Health in collaboration with other stakeholders and approved by the Federal Executive Council in October 2011 is a welcome departure from the abysmal past.

The first line of oral health care is with the individual through prevention, especially twice-brushing daily with fluoride toothpaste and regular check-ups. Globally, there are over one million qualified dentists who, using modern dental treatments can restore almost all functions and aesthetics of a healthy dentition.

However, they are not equally distributed around the world leaving many of the poorest and most needy regions with fewer than one dentist per 300,000 population.

ALEXANDER CHIEJINA