Nigerians deserve better oral health; Here’s what we must do to get it

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By Toluwani Oluwatola (Guest Writer)

Globally, March 20 is set by the International Federation of Dentists to celebrate oral health and raise awareness about oral health. Since its inception in 2013, every year has been marked by a theme to call individuals and governments to take action for oral health. This year’s theme is ‘Be Proud of your Oral Health”, a challenge for everyone globally to value and take care of their oral health because of its role in influencing overall health. In Nigeria, this day usually goes without notice, except for a few side events by people in the oral health industry.

The awareness and state of oral health among Nigerians is poor. However, this “poor” state is not uniform. In a survey of socio-demographic variables that influence oral health utilization habits and oral hygiene behaviour among adult Nigerians, it was found that socio-demographic variables: age, sex, educational status, and occupation, influence oral health utilization habits and oral hygiene behaviour among adult Nigerians. This state of inequality means that being proud of the mouth will mean different things for different categories of Nigerians. While some privileged Nigerians will require high-end aesthetic procedures to align and whiten the teeth, for those not as privileged, awareness about oral health and oral health education is what they need.

Individuals need protective dental care by maintaining good oral hygiene (fluoridated toothpaste to brush twice daily), good diets, avoiding tobacco, and prophylactic scaling (tooth cleaning) and polishing every six months. For this year’s celebration, population-based interventions aimed at improving the oral health of Nigerians are essential, including;

Image credit: Nigeria Health Watch

(i) Improve Dental Care Awareness:
Poor awareness is one of the greatest challenges of oral health care in Nigeria. Many Nigerians regard the absence of pain as the gold standard of care. For many in the lower socioeconomic class, this is worse as they don’t know who to consult when they have a dental problem. To overcome this challenge, government and other oral health industry stakeholders must provide oral health education through mediums that are accessible to different populations. Dental care is expensive. Therefore, it is better to prevent oral diseases than wait for expensive treatments. Though the internet has proven to be an important tool to generate awareness, and there are efforts by individuals in this regard, oral health education must go beyond the use of the internet to other ways of community engagement. One of such efforts that could be replicated across the country for greater impact is the 100,000 smiles project — a community dental health initiative dedicated to improving access to affordable dental healthcare and promotion of modern oral hygiene methods in rural and under-served communities of Northern Nigeria.

This should be complemented with the integration of basic teachings about oral health into school curricula at the primary and junior secondary education levels (Basic 1–9) to build a culture of oral health awareness among kids. It has been shown that teachers are as effective as dentists in the delivery of oral health education.

Image credit: Nigeria Health Watch

(ii) Use innovative ways to bridge the gap in dental health workforce:
The dental industry in Nigeria is grossly understaffed, with a total of less than 10,000 clinical dental staff in the entire country. This comprises 4060 dentists, 1220 therapists, 1540 dental nurses, 500 dental hygienists serving a population of 200 million Nigerians — a ratio of 1:27,000. This gap is further compounded by the preference of most clinicians to work in urban areas where there are better opportunities, facilities, and salaries. This leaves many Nigerians in rural areas at the mercy of quacks and drug vendors. Task-shifting is an effective approach in bridging human resources for health challenges. Therefore, community health extension workers and community health officers should be retrained to provide basic package of oral health services and refer patients appropriately. Tele dentistry and mobile dental clinics are other approaches that can overcome the dental workforce in Nigeria. Organizations like Dental Care Foundation are doing this already. However, these efforts need to be amplified to give more reach.

Image credit: Nigeria Health Watch

(iii) Expand Dental Health Infrastructure to rural areas:
Professor Isaac Adewole, a former health minister, said that less than 20% of Nigerians have access to oral health in Nigeria. Though this statement remains unproven, it can’t be far from the truth. In 2017, Nigeria had just 446 dental clinics, the majority of which were located in urban areas. To make oral health accessible to all Nigerians, it is important to expand dental infrastructure to provide basic package of oral health services to Nigerians in rural areas. This is best achieved in the form of public-private partnerships to introduce dental units at comprehensive health centres and general hospitals across the country. These units are created using appropriate local technology to reduce the cost of setting them up. A public-private partnership could ensure affordability, efficiency, and sustainability in these dental units.

Image credit: Nigeria Health Watch

(iv) Expand access to health insurance with coverage of dental procedures:
Dental care though a necessity, is expensive. Paying out-of-pocket for dental services is inequitable. This is yet another justification to amplify efforts at providing health insurance cover with dental care benefits to Nigerians. As long as the high out-of-pocket spending continues, many Nigerians cannot be proud of their oral health because they cannot afford treatment.

This year’s celebration of world oral health day is an important reminder to all stakeholders that equity should be the focus of the provision of oral services because everyone deserves to be proud of their oral health. This perfectly aligns with the United Nations SDG goal of “Leaving no one behind.” Every Nigerian deserves to be proud of their oral health.
 
Toluwani Oluwatola is a dentist based in Lagos Nigeria. His major interests are health financing and health systems. He looks forward to seeing a sub-Saharan Africa with an adequately financed health system and reduced out-of-pocket expenditure. He can be reached at: toluwanioluwatola@gmail.com or @tolu_oluwatola on Twitter.

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