Oral Health Policy and Research Capacity: Perspectives From Dental Schools in Africa.

INTRODUCTION AND AIMS: The prioritisation of oral health in all health policies in the WHO African region is gaining momentum. Dental schools in this region are key stakeholders in informing the development and subsequent downstream implementation and monitoring of these policies. The objectives of our study are to determine how dental schools contribute to oral health policies (OHPs) in this region, to identify the barriers to and facilitators for engaging with other local stakeholders, and to understand their capacity to respond to population and public health needs. METHODS: We developed a needs assessment survey, including quantitative and qualitative questions. The survey was developed electronically in Qualtrics and distributed by email in February 2023 to the deans or other designees at dental schools in the WHO African region. Data were analysed in SAS version 9.4 and ATLAS.ti. RESULTS: The capacity for dental schools to respond to population and public health needs varied. Most schools have postgraduate programs to train the next generation of researchers. However, these programs have limitations that may hinder the students from achieving the necessary skills and training. A majority (75%) of respondents were aware of the existence of national OHPs and encountered a myriad of challenges when engaging with them, including a lack of coordination with other stakeholders, resources, and oral health professionals, and the low priority given to oral health. Their strengths as technical experts and researchers was a common facilitator for engaging with OHPs. CONCLUSION: Dental schools in the region face common challenges and facilitators in engaging in the OHP process. There were several school-specific research and training capacities that enabled them to respond to population and public health needs. Overall, shared challenges and facilitators can inform stakeholder dialogues at a national and subnational level and help develop tailored solutions for enhancing the oral health policy pipeline.

Dental injuries in 12-year old Nigerian students.

OBJECTIVES: To determine the prevalence and causes of Traumatic Dental Injuries (TDIs) in 12-year-old Nigerian students. The study also sought to ascertain the relationship(s) among gender, location (urban and rural areas) and overjet in the presentation of TDIs. METHODS: The sample size included 719 school children aged 12years from 36 public schools. They were proportionately selected through a multistage sampling technique. TDIs to the teeth were evaluated clinically by one examiner (intra-examiner reliability test was 0.771 by Cronbach's Alpha test). The TDIs were classified according to the WHO classification. Overjet was considered a risk when its values were >6mm. The children answered a structured questionnaire on sociodemographics and oral health behaviours. Analysis was performed using spss V16.0 (SPSS Inc, Chicago, IL, USA). Pearson's Chi-squared test was used to test for association between variables and Odds ratio (OR). P values <0.05 were considered statistically significant. RESULTS: There were 411 (57.2%) boys. More than half (54.2%) were from the urban areas. Prevalence of TDI was 15.2% (prevalence in the urban and rural locations were 15.1% and 15.2% respectively). The maxillary central incisors (66.7%) were the most affected teeth followed by the laterals (17.4%). Enamel fracture (73.5%) was the most common type of TDI noticed followed by enamel and dentine fracture (15.9%). Falls (64.2%) were the most frequent cause of trauma. Collisions account for 9.2%. Eighteen (2.5%) students had overjet >6mm. TDIs were more prevalent among males (P=0.025, OR=1.520, 95% CI =1.049, 2.202) and those with overjet >6mm (P=0.029, OR=0.344, 95% CI=0.141, 1.088). The occurrence of TDIs was not related to location (P>0.05). CONCLUSIONS: The prevalence of traumatized teeth among 12-year-olds in Nigeria was comparable to other studies. Being male and having an overjet >6mm were associated with a higher probability of having a traumatized tooth.

The impact of Highly Active Antiretroviral Therapy (HAART) on the clinical features of HIV - related oral lesions in Nigeria.

BACKGROUND: This study aimed to determine the therapeutic effects of highly active anti-retroviral therapy (HAART) on the clinical presentations of HIV related oral lesions (HIV-ROLs) in an adult Nigerian population. METHODS: A 5 month prospective study on HAART naïve HIV positive adults recruited into the HAART program of an AIDS referral centre. HIV-ROLs were diagnosed clinically by the EEC Clearinghouse on oral problems related to HIV infection. Baseline clinical features of HIV-ROLs was documented by clinical photographs using SONY(R) 5.2 M Cybershot digital camera. Post HAART monthly review was conducted using clinical photographs. RESULTS: A total of 142 patients were seen. Age range was 19 - 75 years. Mean age was 35.6 +/- 10.5 (SD). Eighty (56.3%) were females. Prevalence of HIV-ROLs was 43.7%. Oral candidiasis (22.4%) was the most prevalent HIV-ROL. 114 (83.2%) patients had clinical AIDS at presentation (CDC 1993). 89.4% were placed on Tenofovir/Emtricitabine +;Nevirapine, 9.9% on Tenofovir/Emtricitabine + Efavirenz. There was strong decline in the clinical features of oral candidiasis from a month of commencing HAART. Oral hairy leukoplakia was slow in responding to HAART. Parotid gland enlargement, melanotic hyperpigmentation and Kaposi's sarcoma were more persistent and had slower response to HAART. There was no clinical change noticed in linear gingival erythema. CONCLUSION: HAART has different clinical effects on HIV related oral lesions depending on the size, duration of treatment and etiology of the lesions. HIV-ROLs of fungal origin have the fastest response to HAART. These lesions alongside immunologic parameters can be used as indicators of success or failure of antiretroviral therapy.

Post-consent assessment of dental subjects' understanding of informed consent in oral health research in Nigeria.

BACKGROUND: Research participants may not adequately understand the research in which they agree to enroll. This could be due to a myriad of factors. Such a missing link in the informed consent process contravenes the requirement for an "informed" consent prior to the commencement of research. This study assessed the post consent understanding of Nigerian study participants of the oral health research they were invited to join. METHODS: A descriptive cross sectional study with research participants who had just consented to one of three ongoing research studies on oral health. Study sites included two centers, one in the northern and one in the southern part of Nigeria. Data were collected using a combination of quantitative and qualitative methods. RESULTS: A total of 113 research participants were interviewed. The southern part of the country had 58 respondents with the north having 55. The age range was 21 - 80 years. Mean age was 46.1 (SD16.3). The sample was predominantly male (69.9%) and married (64.6%). There was poor understanding of some key elements of the informed consent process such as involvement in research, benefits, contacts, confidentiality and voluntariness. Some identified factors potentially compromising understanding were poverty, illiteracy, therapeutic misconception and confusion about the dual roles of the Dentist and the researcher. CONCLUSION: The participants recruited into the oral health research in Nigeria did not adequately understand the studies they were invited to join nor do they understand their rights as research participants. Measures should be taken to include research bioethics into the curricula of Dental schools and to train oral health researchers in the country on research ethics.