Preventing tooth decay in resource-limited settings


For the first time since it was first published in 1977, dental medicines have been added to the World Health Organization Essential Drug List. How could it take 44 years to include these items on a list addressing people’s priority needs given that untreated tooth decay is the most common global health condition?

The mouth is a gateway to the body. Illnesses that occur in the mouth have far-reaching implications for our health, especially for people with poor access to dental care.  Both of us are global health equity advocates and through our work, we have first-hand contacts with underserved communities that have no access to the most basic dental healthcare.

Dental health inequity is disproportionately skewed towards the Global South. According to WHO oral health fact sheet, 44% of the global population (3.5 billion people) are affected by oral diseases; and above 530 million children suffer from tooth decay of primary teeth (milk teeth). However, most oral health conditions are largely preventable and can be treated in their early stages. Prevention and treatment of oral health conditions in resource-poor settings is challenging due to poor availability of dental health practitioners. The statistics are grim. There is only 1 dentist per 152,721 in low-income countries; 1 per 13,810 citizens in middle-income countries; and 1 dentist per 1,708 citizens in high-income countries.

The recently added dental preparation medicines of Fluoride Toothpaste, Glass Ionomer Cement, and Silver Diamine Fluoride help prevent and treat the commonest oral problem, tooth decay. These items do not come cheap and are not readily available in health facilities located in underserved communities. Thus, it would take a while for the new additions to become available in many health facilities and accessible to everyone.

Without intentional ways of ensuring access, adding these dental needs to the WHO list will be meaningless. These are four interventions that should be prioritized to ensure equitable access for all.

First, community education is imperative in ensuring dental health equity. This can be achieved through community outreaches to counter harmful practices which worsen oral health and provide care. The story of Debola, a 7-year-old girl in Ekiti state, southwest Nigeria is pertinent. She grew up with yellow irregular pits in her teeth. At 11 months old, she was hospitalised for malnutrition. This caused the outer layers of her teeth not to form properly, causing a yellow visible discolouration, holes and pains regularly. Debola’s parents could not afford the cost of dental care services she needed, and the nearest dental facility was two hours away. So, they would constantly give her local herbs. An encounter with Adekemi’s team on routine community outreach was the game changer. Debola was treated with a conventional glass ionomer cement in the affected teeth. She no longer had any tooth loss, pain and sensitivity.

Second, improve access to clean piped water with the right fluoride content in underserved communities. Fluoride in water makes teeth stronger, prevents cavities and tooth decay. Sadly, billions have poor exposure to fluoride in water. Only 24% of Africans have access to safe drinking water. Instead, groundwater is the major water source for most Africans and it contains too much fluoride, which can affect the outer covering of teeth and create pits in the teeth. Therefore, many people are caught between a rock and a hard place because they either don’t have fluoride in water or they have too much. Both situations pose serious consequences for their oral health. A low-cost tablet for fluoridation of rural water resources is available through research funded by the U.S. Centers for Disease Control. The tablet through a feeder system can fluoridate water and serve 50 to 10,000 people. This fluoridation tablet and feeder system are available through US-based KC Industries.

Third, improving household incomes can enable them to buy fluoride toothpastes when otherwise, paying for items like food usually takes precedent. Improving economic empowerment could be achieved through efforts like supporting community women to form cooperatives and establish small-scale businesses. It could also be done through universal income paid by governments to families living beyond the poverty line. Further, the foods low-income families buy are usually rich in sugars and carbohydrates. Consuming these foods and not brushing their teeth with fluoride toothpastes can lead to vicious cycles of malnutrition and tooth decay. Thus, being able to afford healthier food and better toothpaste would make a big difference.

Fourth, low- and middle-income countries need more dentists. Nigeria has only 8 fully accredited dental schools that graduate about 300 dentists yearly; half of them migrate. We need more dental schools and incentives to keep dentists in areas with high need. It is also imperative to train community health workers on providing basic dental education and serving as dental assistants. Further, mentoring high school students as done under the “Determined to be a Doctor Someday (DDS)” project founded by Christina T. Rosenthal, a dental surgeon, is a way to inspire future dentists.

As we wait for the additions to come to fruition, governments, civil society organizations and the private sector must ensure that girls like Debola do not go through such a traumatic experience which is preventable.


About the authors: Dr. Ifeanyi M. Nsofor is the Senior Vice President for Africa at Human Health Education and Research Foundation. He is a public health physician, a Senior New Voices Fellow at the Aspen Institute, a Senior Atlantic Fellow for Health Equity at George Washington University and an Innovation Fellow at PandemicTech. You can follow him on Twitter @ekemma.

Dr. Adekemi Adeniyan is a rural dentist breaking down barriers to oral health for underserved communities to ensure equitable health access for all in Nigeria. She is Senior New Voices Fellow at the Aspen Institute. You can follow her on Twitter @PstDrKemi

Competing interests: None

Handling Editor: Neha Faruqui

Thumbnail pic: Pixabay website

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