A Case Study Optimizing Human Resources in Rwanda's First Dental School: Three Innovative Management Tools.

Harvard School of Dental Medicine, University of Maryland School of Dentistry, and the University of Rwanda (UR) are collaborating to create Rwanda's first School of Dentistry as part of the Human Resources for Health (HRH) Rwanda initiative that aims to strengthen the health care system of Rwanda. The HRH oral health team developed three management tools to measure progress in systems-strengthening efforts: 1) the road map is an operations plan for the entire dental school and facilitates delivery of the curriculum and management of human and material resources; 2) each HRH U.S. faculty member develops a work plan with targeted deliverables for his or her rotation, which is facilitated with biweekly flash reports that measure progress and keep the faculty member focused on his or her specific deliverables; and 3) the redesigned HRH twinning model, changed from twinning of an HRH faculty member with a single Rwandan faculty member to twinning with multiple Rwandan faculty members based on shared academic interests and goals, has improved efficiency, heightened engagement of the UR dental faculty, and increased the impact of HRH U.S. faculty members. These new tools enable the team to measure its progress toward the collaborative's goals and understand the successes and challenges in moving toward the planned targets. The tools have been valuable instruments in fostering discussion around priorities and deployment of resources as well as in developing strong relationships, enabling two-way exchange of knowledge, and promoting sustainability.

Periodontal diseases and adverse pregnancy outcomes: Is there a role for vitamin D?

Studies have shown a relationship between maternal periodontal diseases (PDs) and premature delivery. PDs are commonly encountered oral diseases which cause progressive damage to the periodontal ligament and alveolar bones, leading to loss of teeth and oral disabilities. PDs also adversely affect general health by worsening of cardiovascular and metabolic diseases. Moreover, maternal PDs are thought to be related to increasing the frequency of preterm-birth with low birth weight (PBLBW) in new-borns. Prematurity and immaturity are the leading causes of prenatal and infant mortality and is a major public health problem around the world. Inflamed periodontal tissues generate significantly high levels of proinflammatory cytokines that may have systemic effects on the host mother and the fetus. In addition, the bacteria that cause PDs produce endotoxins which can harm the fetus. Furthermore, studies have shown that microorganisms causing PDs can get access to the bloodstream, invading uterine tissues, to induce PBLBW. Another likely mechanism that connects PDs with adverse pregnancy outcome is maternal vitamin D status. A role of inadequate vitamin D status in the genesis of PDs has been reported. Administration of vitamin D supplementation during pregnancy could reduce the risk of maternal infections and adverse pregnancy outcomes. As maternal PDs are significant risk factors for adverse pregnancy outcome, preventive antenatal care for pregnant women in collaboration with the obstetric and dental professions are required.

Building oral health research infrastructure: the first national oral health survey of Rwanda.

BACKGROUND: Oral health affects quality of life and is linked to overall health. Enhanced oral health research is needed in low- and middle-income countries to develop strategies that reduce the burden of oral disease, improve oral health and inform oral health workforce and infrastructure development decisions. OBJECTIVE: To implement the first National Oral Health Survey of Rwanda to assess the oral disease burden and inform oral health promotion strategies. METHODS: In this cross-sectional study, sample size and site selection were based on the World Health Organization (WHO) Oral Health Surveys Pathfinder stratified cluster methodologies. Randomly selected 15 sites included 2 in the capital city, 2 other urban centers and 11 rural locations representing all provinces and rural/urban population distribution. A minimum of 125 individuals from each of 5 age groups were included at each site. A Computer Assisted Personal Instrument (CAPI) was developed to administer the study instrument. RESULTS: Nearly two-thirds (64.9%) of the 2097 participants had caries experience and 54.3% had untreated caries. Among adults 20 years of age and older, 32.4% had substantial oral debris and 60.0% had calculus. A majority (70.6%) had never visited an oral health provider. Quality-of-life challenges due to oral diseases/conditions including pain, difficulty chewing, self-consciousness, and difficulty participating in usual activities was reported at 63.9%, 42.2% 36.2%, 35.4% respectively. CONCLUSION: The first National Oral Health Survey of Rwanda was a collaboration of the Ministry of Health of Rwanda, the University of Rwanda Schools of Dentistry and Public Health, the Rwanda Dental Surgeons and Dental (Therapists) Associations, and Tufts University and Harvard University Schools of Dental Medicine. The international effort contributed to building oral health research capacity and resulted in a national oral health database of oral disease burden. This information is essential for developing oral disease prevention and management strategies as well as oral health workforce and infrastructure.

Dietary phosphorus burden increases cariogenesis independent of vitamin D uptake.

An association between excessive sugar consumption and dental decay, particularly in children, has been well-established. In this study we have analyzed whether consumption of phosphorus, an important ingredient of sugary drinks, has any association with the evolvement of dental decay. Food consumption, gingival redness and dental decay were evaluated in a total of 8,317 children with the mean age of 9.99+0.68 years with a strong gender bias (p<0.0005); boys being more affected than girls. Our results showed a significant association (p=0.044) between dental decay and calorie-adjusted sugar intake. Presence of gingival inflammation also correlated (p=0.008) with the formation of dental decay. In addition, decayed teeth were positively associated with increased salivary levels of adiponectin (p=0.0002) and matrix degrading MMP-9 (p=0.015), while negatively associated with salivary levels of the vascular endothelial growth factor (VEGF; p=0.008). More importantly, we found a statistically significant correlation (p=0.0008) between calorie-adjusted dietary phosphorus intake and occurrence of dental decay. Our analyzed results also showed a significantly high percentage of dental decay in children who consumed a diet, low in sugar but high in phosphorus (6.58%, n=661), compared to those who consumed a low sugar and low phosphorus containing diet (5.02%, n=413). Finally, we did not find any significant association between vitamin D uptake and the genesis of dental decay. From these results, we concluded that both high sugar and high phosphate consumption can influence evolvement of dental decay, and that, a healthier diet could be achieved by reducing consumption of dental cariogenic dietary factors, sugar and phosphate.