Oral Hygiene Practices, Knowledge, and Self-Reported Dental and Gingival Problems with Rural-Urban Disparities among Primary School children in Lilongwe, Malawi.

AIM: To determine oral hygiene practices, knowledge, and experience of dental caries and gingival problems among urban and rural primary schoolchildren in Lilongwe District, Malawi. Methodology. This was an analytical and quantitative descriptive cross-sectional study. Four urban and four rural primary schools were conveniently sampled. Pupils aged 11-14 years (n = 409) were recruited using self-administered structured questionnaire. Data were analyzed using SPSS program v20.0. RESULTS: Out of 409 pupils, most of them had knowledge that dental caries is caused by consumption of sugary foodstuffs (91.4%), toothache is a symptom of dental caries (77.6%), gingivitis is caused by ineffective tooth brushing (92.7%), and gingival bleeding is a sign of gingivitis (85.3%). Most pupils experienced toothache (30.8%); many of them had parents with secondary education and above (35.0%) compared to those with primary education (23.5%). 24.4% experienced gingival bleeding with higher percentages from urban (30.1%) than rural (18.5%) schools. Plastic toothbrush users (95%) overshadowed chewing stick users (24.9%). The use of chewing stick was significantly higher in rural (49%) than in urban (1.9%) schools. Likewise, tooth brushing before bed was significantly higher in rural (33%) than in urban (17.2%) pupils. The use of toothpaste during tooth brushing was significantly higher among urban (91.9%) than among rural (64%) pupils. The prevalence of tongue cleaning was 70.2%, and the differences were significantly higher among pupils who had parents with secondary and higher education in urban schools and among pupils aged 11-12 years in comparison with their counterparts. CONCLUSIONS: Most pupils reported cleaning their teeth regularly, mostly using plastic toothbrush rather than chewing stick, using toothpaste, and having adequate knowledge about dental caries and gingival disease, and a quarter of them had suffered from these diseases with evidence of rural-urban disparities. Integration of oral health in school health promotion program and further research on its impact on oral health status are recommended.

Knowledge of Periodontal Diseases, Oral Hygiene Practices, and Self-Reported Periodontal Problems among Pregnant Women and Postnatal Mothers Attending Reproductive and Child Health Clinics in Rural Zambia.

AIM: To determine the level of knowledge of periodontal diseases, practices regarding oral hygiene, and self-perceived periodontal problems among pregnant and postnatal women attending reproductive and child health clinics in rural districts of Zambia. METHODOLOGY: This was a quantitative, questionnaire-based, descriptive, and cross-sectional study that recruited 410 women aged 15 to 43 years. Data were analyzed using SPSS v19.0 computer program. RESULTS: Participants knowledgeable of periodontal diseases were 62%; gingivitis signs included gum swelling (87.4%) and bleeding (93.3%). Of all participants, 95.6% practiced tooth brushing: twice/day (38.5%), using plastic toothbrush (95.6%), chewing stick (12.2%), toothpick (10.7%), dental floss (2.0%), and tongue cleaning (55.4%). Self-reported periodontal problems were bleeding gums (23.2%), gums that were reddish (10.5%), swollen (11.0%), painful (15.9%), and mobile teeth (3.4%). In logistic regression analysis, painful gums, reddish gums, and toothpick use were 21.9, 4.7, and 4.3 respectively, significantly more likely to cause gum bleeding on tooth brushing. CONCLUSIONS: Most studied women had general knowledge of periodontal diseases but only few knew the cause. All participants performed tooth cleaning; however, majority did not know appropriate practices, and only few had periodontal problems. Integration of oral health to general health promotion and periodontal therapy to pregnant women at high risk is recommended.

Self-Reported Halitosis in relation to Oral Hygiene Practices, Oral Health Status, General Health Problems, and Multifactorial Characteristics among Workers in Ilala and Temeke Municipals, Tanzania.

Aim. To assess self-reported halitosis, oral hygiene practices, oral health conditions, general health problems, sociodemographic factors, and behavioural and psychological characteristics among workers in Ilala and Temeke municipals. Materials and Methods. This was a cross-sectional descriptive study. Four hundred workers were recruited using a self-administered structured questionnaire. Results. Self-reported tooth brushing practice was 100%, tongue cleaning 58.5%, dental flossing 4.3%, gum bleeding on tooth brushing 79.3%, presence of hard deposits on teeth 32%, mobile teeth 15.3%, and self-reported halitosis (SRH) 48.5%. Tea users were 95%, coffee users 75.8%, smokers 21%, and alcohol consumers 47%. The SRH was significantly associated with bleeding gums, hard deposits, and mobile and malaligned teeth. Tongue cleaning and regular change of toothbrush were associated with low prevalence of SRH (P < 0.001). Higher occurrence of SRH was significantly related to low education and smoking. Conclusion. Self-reported halitosis was prevalent among workers and was significantly associated with bleeding gums, hard dental deposits, mobile teeth, and smoking. All participants brushed their teeth and cleaned the tongue regularly but use of dental floss was extremely low. Oral health education and health promotion are recommended.

Capacity Building and Financing Oral Health in the African and Middle East Region.

Many low- and middle-income countries do not yet have policies to implement effective oral health programs. A reason is lack of human and financial resources. Gaps between resource needs and available health funding are widening. By building capacity, countries aim to improve oral health through actions by oral health care personnel and oral health care organizations and their communities. Capacity building involves achieving measurable and sustainable results in training, research, and provision of care. Actions include advancement of knowledge, attitudes and skills, expansion of support, and development of cohesiveness and partnerships. The aim of this critical review is to review existing knowledge and identify gaps and variations between and within different income levels in relation to the capacity building and financing oral health in the African and Middle East region (AMER). A second aim is to formulate research priorities and outline a research agenda for capacity building and financing to improve oral health and reduce oral health inequalities in the AMER. The article focuses on capacity building for oral health and oral health financing in the AMER of the IADR. In many communities in the AMER, there are clear and widening gaps between the dental needs and the existing capacity to meet these needs in terms of financial and human resources. Concerted efforts are required to improve access to oral health care through appropriate financing mechanisms, innovative health insurance schemes, and donor support and move toward universal oral health care coverage to reduce social inequality in the region. It is necessary to build capacity and incentivize the workforce to render evidence-based services as well as accessing funds to conduct research on equity and social determinants of oral health while promoting community engagement and a multidisciplinary approach.

Smoking and drinking habits and attitudes to smoking cessation counselling among Tanzanian dental students.

UNLABELLED: The present research was carried out at the School of Dentistry, Muhimbili University of Health and Allied Sciences, Tanzania. OBJECTIVE: To assess smoking and drinking habits as well as attitudes towards smoking cessation counselling among dental students in Tanzania. BASIC RESEARCH DESIGN: A 28-item pretested and self-administered questionnaire was delivered to all dental students enrolled at the end of the 2006 academic year. The questionnaire covered socio-demographics, smoking and drinking habits, knowledge concerning health effects and attitudes towards smoking cessation counselling. PARTICIPANTS: Dental students enrolled at the end of the 2005/2006 academic year in the School of Dentistry, University of Dar-es-Salaam, Tanzania. MAIN OUTCOME MEASURES: Self-reported smoking, alcohol use and attitudes to smoking cessation counselling. RESULTS: The response rate was 73.2% (109/149) and 76.1% of respondents were male. Smoking was reported by 12.8%, all being male. Alcohol use during the last 30 days was reported by 23.8% and binge drinking during the last two weeks by 11.8%. Both smoking and alcohol use were more common among clinical than basic science students. The majority (67.0%) reported that they had not received education on smoking cessation counselling although 86.2% considered that dentists and physicians should provide such counselling. CONCLUSION: Reported smoking and alcohol consumption are on a low level compared to dental students internationally. Willingness and need for cessation counselling training was expressed by the majority of Tanzanian dental students. This should be taken into consideration in dental curriculum development.

Gingival recession, oral hygiene and associated factors among Tanzanian women.

BACKGROUND: Females are generally more motivated with regard to oral hygiene practices and thus brush their teeth more frequently than males. OBJECTIVE: To determine the prevalence of gingival recession, oral hygiene status, oral hygiene practices and associated factors in women attending a maternity ward in Tanzania. DESIGN: Cross-sectional descriptive study. SETTING: Maternity ward of Muhimbili National Hospital, Tanzania. SUBJECTS: Four hundred and forty six women were interviewed on oral hygiene practices and maternal factors, and a full-mouth examination was done to determine the presence of plaque, calculus, gingival bleeding and gingival recession at six sites per tooth. RESULTS: The prevalence of gingival recession (GR) > or =1 mm was 33.6%, calculus 99.3%, plaque 100%, and gingival bleeding 100%. Oral hygiene practices included toothbrushing (98.9%), brushing frequency > or =2 times/day (61.2%), horizontal brushing method (98%), and using a plastic toothbrush (97.8%). Factors that were significantly associated with gingival recession were age (OR = 2.0, 95% CI = 1.3-3.2), presence of calculus (OR(a) = 3.8, 95% CI=2.5-7.1), and gingival bleeding on probing (OR = 4.2, 95% CI = 2.5-7.1). Tooth cleaning practices and maternal factors, especially the number of pregnancies or deliveries were not significantly associated with gingival recession. CONCLUSION: In this study population, oral hygiene was poor and gingival recession was associated with age, calculus and gingival inflammation rather than with tooth cleaning practices.

Profile of the oral healthcare team in countries with emerging economies.

Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.

Tooth and lip mutilation practices and associated tooth loss and oral mucosal lesions in the Makonde People of southeast Tanzania.

OBJECTIVE: To determine the prevalence of tooth and lip mutilation (TLM) and the prevalence of tooth loss and the associated oral mucosal lesions among adults in south east Tanzania. DESIGN: A cross sectional, clinical study and questionnaire administration. SETTING: Rural population in southeast Tanzania. SUBJECTS: Randomly selected 217 adults aged 40 years and older. RESULTS: About 16% of all participants performed tooth mutilation. There were more females (20.6%) than males (11.3%) who performed tooth mutilation but the difference was not statistically significant. There was only about 17% of participants in the age group 40-54 years who performed tooth mutilation while there was 50% and 32% in the age groups 55-64 years and 65-95 years and the difference was statistically significant (P < 0.001). Tooth loss due to mutilation was significantly (P < 0.001) less than tooth loss due to other reasons in the anterior teeth and there was no tooth loss due to mutilation in the posterior teeth. Lip mutilation in form of piercing the upper lip and inserting a wooden stick called "ndonya" was found only in women. No oral mucosal lesions were found in this study group. CONCLUSION: Tooth mutilation does not lead to significant tooth loss and lip mutilation and the use of "ndonya" does not cause oral mucosal lesions in this society. Extraction of anterior teeth due to other reasons was significantly higher than extraction following mutilation while in the posterior teeth there was no tooth loss due to tooth mutilation.

Oral hygiene practices, periodontal conditions, dentition status and self-reported bad mouth breath among young mothers, Tanzania.

OBJECTIVES: To determine the oral hygiene practices, periodontal conditions, dentition status and self-reported bad mouth breath (S-BMB) among young mothers. STUDY PARTICIPANTS AND METHODS: This was a cross-sectional descriptive study conducted at Muhimbili National Hospital, Dar es Salaam, Tanzania. A total of 302 postpartum mothers, aged 14-44 years, were interviewed on oral hygiene practices and S-BMB using structured questionnaire. Oral hygiene, dentition and periodontal status were assessed using the Community Periodontal Index probe and gingival recessions (GR) using Williams Periodontal probe. RESULTS: Tooth brushing practice was 99%; tongue brushing (95%), plastic toothbrush users (96%), chewing stick (1%), wooden toothpicks (76%), dental floss (<1%); and toothpaste (93%). The prevalence of plaque and gingival bleeding on probing was 100%, gum bleeding during tooth brushing (33%), calculus (99%), probing periodontal pocket depth (PPD) 4-5 mm (27%), PPD 6+ mm (3%), GR 1+ mm (27%) and tooth decay (55%). The prevalence of S-BMB was 14%; the S-BMB had higher mean number of sites with plaque compared to the no S-BMB group (P=0.04). Factors associated with S-BMB were gum bleeding on tooth brushing (OR=2.4) and PPD 6+ mm (OR=5.4). CONCLUSION: Self-reported bad mouth breath is a cause of concern among young mothers, and associated significant factors were gum bleeding on tooth brushing and deep periodontal pockets of 6+ mm. Further research involving clinical diagnosis of bad mouth breath and intervention through oral health promotion and periodontal therapy are recommended. CLINICAL RELEVANCE: This study provides baseline information on oral health status and the complaint on bad mouth breath which necessitates in the future need for objective assessment, diagnosis and management of bad mouth breath for enhanced social and professional interaction without embarrassment.

Tooth loss among habitual chewing-stick and plastic toothbrush users in the adult population of Mtwara, rural Tanzania.

OBJECTIVES: The aim of this study was to determine the extent and type of tooth loss in relation to habitual chewing-stick (CS) and plastic toothbrush (PT) users in adults. METHODS: A cross-sectional descriptive study was conducted in Mtwara's rural population aged >or=40 years. A total of 206 randomly selected study participants - males (55.8%) and females (44.2%) - were interviewed on oral hygiene practices using a structured questionnaire, and a clinical examination performed for assessment of tooth loss. RESULTS: Of the total, 93.2% were partially edentulous, 2.4% completely edentulous and those with no tooth loss 4.4%. The total number of missing teeth were 1728 (mean, 8.38 +/- 7.9), and the causes were caries (74.9%), mutilation (4.8%) and others including periodontal and trauma (20.3%). There was no significant difference in the mean number of tooth loss between the upper and lower jaw, and between males and females. However, the mean number of missing teeth in the lower jaw was higher in females than in males (P = 0.04), and on lower left than lower right jaw (P = 0.008). Lower molars, especially first molars, were the teeth lost most often. Tooth-cleaning devices included PT (51.5%), CS (25.7%), both type (BT; 17.0%) and unspecified (5.8%). The differences in the mean number of missing teeth were higher in CS than habitual PT users (P = 0.024) and in BT (P = 0.029). Tooth loss was also higher among those who brushed once when compared with those who brushed two times or more per day (P = 0.046). CONCLUSION: Tooth loss was significantly higher in CS than PT habitual users and affected mostly the lower molars and especially the first molar. However, for economical reasons, effective use of CS should be promoted for enhanced tooth retention.

The usefulness of using Ramfjord teeth in predicting periodontal status of a Tanzanian adult population.

OBJECTIVES: The only partial mouth index that has been validated against full-mouth examinations in the East African population is the CPITN (Community Periodontal Index of Treatment Needs). Since the Ramfjord index can potentially shorten the examination time by almost half, we evaluated Ramfjord teeth in predicting full-mouth periodontal status of an adult population in Tanzania. MATERIAL AND METHODS: Pocket depth was measured for 192 consecutive patients aged from 15 to 77 years (36 years old on average); 86 (45%) females referred to the Department of Restorative Dentistry, Muhimbili National Hospital, Tanzania between January 1997 and December 1999, and the mean pocket depth for full-mouth and Ramfjord teeth was calculated. RESULTS: The correlation between the mean pocket depth calculated from the full-mouth and Ramfjord teeth was 0.96. The beta coefficient for the mean pocket depth measured by Ramfjord teeth to predict the full-mouth mean was 0.94, and was not affected by adjustment for age, missing teeth or sex. CONCLUSION: This overall high agreement between Ramjford teeth and full-mouth periodontal pocket situation confirms the epidemiological validity of Ramfjord's dental sample in our setting.

Knowledge on gingivitis and oral hygiene practices among secondary school adolescents in rural and urban Morogoro, Tanzania.

OBJECTIVES: To assess and compare knowledge on gingivitis and oral hygiene practices among rural and urban secondary school students. DESIGN: A cross-section descriptive study involving secondary school students aged between 13 and 17 years in Morogoro rural and urban districts. METHODS: Questionnaire was used to collect information about knowledge on causes, signs, symptoms, complications, treatment modalities and prevention of gingivitis, as well as on oral hygiene practices. RESULTS: A total of 196 students participated in this study, of which 58.7% were females, and 52% were from urban schools. The responses were graded into three criteria namely 'lack of knowledge', 'partial knowledge' and 'total or full knowledge'. There was a partial knowledge about gingivitis and full knowledge of the basic oral hygiene measures among secondary school teenagers. The difference between rural and urban residence on the level of understanding was statistically significant in relation to tooth brushing practices (P = 0.0088), necessity of using toothpaste (P = 0.0204), reasons for using toothpaste (P = 0.0057), signs and symptoms of gingivitis (P = 0.0261) and treatment of gingivitis (P = 0.0106). However, there were no statistically significant differences in distribution of study participants, understanding of tooth brushing practices, reasons for tooth brushing, causes, prevention and complications of gingivitis. CONCLUSION: Secondary school teenagers have partial knowledge about gingivitis and a good knowledge of the basic oral hygiene measures necessary to maintain proper oral health. A small difference on knowledge in specific areas was noted among rural and urban respondents.

Periodontal status and treatment needs in a rural area of Ukonga, Tanzania.

The study reported here assessed the periodontal status in Ukonga using the CPITN index in the oral health survey data collected in 1988, and subsequently estimated the treatment needs in relation to Tanzanian circumstances. The resultant calculations showed that the estimated need was far greater than the dental services could supply. The authors therefore question whether or not all persons with a positive CPITN score do need treatment and speculate that there may be a more realistic approach using other models.

Risk factors for periodontal diseases in Ilala, Tanzania.

The purpose of this study was to evaluate associations between periodontal diseases and the common risk factors in Ilala, Tanzania. To determine behavioural and socioeconomic background, a total of 1764 subjects (827 males and 937 females) aged 3-84 years were randomly selected and interviewed. The subjects were examined clinically for the presence of plaque, calculus, gingival inflammation, periodontal probing depths and gingival recessions. Logistic regression analyses showed that the risk factors for gingivitis were male sex, presence of plaque or calculus and use of local "mswaki", the risk factors for periodontal pockets were age of 35 years or more, presence of plaque, and rural residence. The risk factors for gingival recession were identified as age of 35 years or more, male sex, lower educational status, presence of plaque and gingival inflammation. The most significant risk factors to have periodontal diseases in this study population were age, sex, education, rural residence, plaque and calculus.

Occlusal and space characteristics among 12-year-old school children in Bukoba and Moshi, Tanzania.

The aim of the study was to investigate the frequency of occlusal and space characteristics in Bukoba and Moshi, two towns in North-Western and Eastern parts of Tanzania. The entire sample consisted of 47% boys and 53% girls. Angle's and Foster's classifications were used in the study. Sagittal, vertical and transversal occlusion variables were included in the classification. Most of the children had Angle's class I in both townships. No child had distal occlusion in Bukoba but 8% of the school children had Angle's class III which was present in only 5% of the Moshi children. The most prevalent occlusal anomalies in both populations were large overjet and deep bite (greater than or equal to 3.5 mm), the prevalence of which was significantly higher in Moshi. Open bite also occurred more often in Moshi girls than Bukoba girls. No child had scissors bite in Moshi. Open bite and scissors bite in Bukoba girls and cross-bite in Moshi girls were rare. Diastema mediale prevailed mostly in the maxilla in the whole sample. About one fifth of the whole sample had crowding. The results suggest that different occlusal and space characteristics are present in Bukoba and Moshi children.