Assessing association of dental caries with child oral impact on daily performance; a cross-sectional study of adolescents in Copperbelt province, Zambia.

BACKGROUND: Dental caries and child oral impact on daily performance (C-OIDP) have been linked in several studies. However, the studies used caries indices, which limit the ability to examine how C-OIDP prevalence varies across various stages of the dental caries process. Furthermore, cross-cultural differences between Zambia and other African countries where the C-OIDP instrument has been widely used necessitate testing its pychometric properties. This study's primary aim was to evaluate the association between dental caries and C-OIDP. Secondarily, the study reports the psychometric properties of the C-OIDP index among Zambian adolescents. METHODS: A cross-sectional study was conducted between February and June 2021 among grade 8-9 adolescents in Copperbelt province, Zambia. A multistage cluster sampling method was used to select participants. Using a pretested self-administered questionnaire, socio-demographics, oral health behaviors, self-reported oral health, and C-OIDP were evaluated. The test-retest and internal consistency reliability of the C-OIDP were evaluated. The Caries Assessment and Treatment Spectrum (CAST) was used to evaluate dental caries. Adjusted odd ratios and 95% confidence intervals were used to evaluate the association between dental caries and C-OIDP after adjusting for confounders identified by a directed acyclic graph. RESULTS: Among 1,794 participants, 54.0% were females, while 56.0% were aged 11-14 years. About a quarter (24.6%) had one or more teeth at the pre-morbidity stage, 15.2% at the morbidity, 6.4% at the severe morbidity and 2.7 at the mortality stage. The internal consistency reliability of the C-OIDP Cohen's Kappa was 0.940, while the Kappa coefficients of the C-OIDP items ranged from 0.960 to 1.00. Participants with severe caries had a high prevalence of C-OIDP, with rates for morbidity, severe morbidity, and mortality stages being 49.3%, 65.3%, and 49.3%, respectively. Oral impacts were 2.6 times (AOR 2.6, 95% CI 2.1-3.4) more likely to be reported by participants with dental caries than those without caries. CONCLUSIONS: Dental caries was associated with high reporting of C-OIDP, and C-OIDP prevalence was high among participants in the severe stages of the caries process. The English version of the C-OIDP demonstrated adequate psychometric characteristics for assessing OHRQoL among Zambian adolescents.

Sub-clinical rheumatic heart disease (RHD) detected by hand-held echocardiogram in children participating in a school-based RHD prevention program in Tanzania.

BACKGROUND: Rheumatic Heart Disease (RHD) continues to cause suffering and premature deaths in many sub-Saharan Africa (SSA) countries, where the disease is still endemic. RHD is largely preventable and determining its community burden is an important critical step in any RHD prevention program. METHODS: We conducted a cross-sectional study of 5-16 years old pupils from 11 primary schools participating in an RHD prevention program in 4 districts in Tanzania, between 2018 and 2019. At the school, all children were invited to participate after receiving consent from their parents/guardians. Participating children filled a questionnaire and were auscultated for cardiac murmurs. Echocardiographic screening was done by two experienced cardiologists, using a hand-held machine (V-Scan, GE®). All positive screening tests were stored for further examination by the same two cardiologists to reach to a consensus of definite, borderline or no RHD, using a modified World Heart Federation (WHF) criterion. RESULTS: Of the 6895 children invited, 4738 (68.7%) were screened and 4436 (64.3%) had complete data. The mean (SD) age was 10.04 (2.43) years, and 2422 (54.6%) were girls. Fifty three (1.2%) children were found to have a murmur. The proportion of children with trace or mild valvular regurgitation, sub-valvular/chordal thickening and valvular thickening/deformity were 8.3%, 1.3%, and 1.0%, respectively. Sub-clinical RHD was found in 95 children (59 definite and 36 borderline), giving a prevalence of 2.1%, [95% CI 1.7% - 2.6%]. Sub-clinical RHD was independently associated with female sex (aOR 1.83, 95% CI 1.18-2.85, p = 0.007), older age groups (aOR 1.73, 95% CI 1.10-2.72, p = 0.018 for age group 11-14 years; and aOR 3.02 95% CI 1.01-9.05, p = 0.048 for age group 15-16 years), as well as presence of a cardiac murmur, aOR 5.63 95% CI 2.31-13.69, p < 0.0001. None of the studied socio- or economic factors was associated with the presence of sub-clinical RHD in this study. CONCLUSION: The prevalence of sub-clinical RHD among primary school children in Tanzania is 2.1%, similar to previous reports in SSA. Efforts to prevent and control RHD in our communities are highly warranted.

Dental caries according to CAST among Zambian adolescents; pattern, socio-demographic and behavioral correlates.

BACKGROUND: Dental Caries affect more than half of children and adolescents globally and more so in Africa. Most caries studies in Africa are based on DMFT index which does not assess early carious lesions making early prevention and minimal invasive treatment impossible. This study therefore aimed at determining pattern, socio-demographic and behavioral correlates of dental caries according to Caries Assessment and Treatment Spectrum (CAST). METHODS: Cross-sectional study involving secondary school adolescents in Copperbelt province, Zambia. Socio-demographics and oral health related behaviors were assessed using a structured questionnaire while dental caries was assessed using CAST. Data were summarized as frequency distributions while cross-tabulation with Chi-squire test and adjusted multinomial logistic regression assessed strength and direction of relationship between socio-demographics, oral health behaviors and dental caries. Level of statistical significance was set at 5%. RESULTS: A total of 1,794 participants were enrolled 54% being females. Total frequency of adolescents with healthy teeth (CAST0-2) was 51.1%, pre-morbidity stages (CAST 3-4) was 24.7%, severe morbidity CAST (6-7) was 6.4% and mortality was 2.7%. The odds of being found with teeth at pre-morbidity stage decreased among male OR (95%CI) = 0.55 (0.44, 0.70) and younger participants OR (95%CI) = 0.77 (0.61, 0.98). Participants in high socio-economic status had lower odds of morbidity OR (95%CI) = 0.69 (0.52, 0.92) while those taking sugary foods five times or more per day had higher odds of morbidity OR (95%CI = 1.52 (1.01, 2.34). The odds of being found at mortality clinical stage of caries was lower among males OR (95% CI) = 0.53 (0.29, 0.96) and those who did not attend to a dentist in the previous year OR (95%CI) = 0.42 (0.23, 0.75), while higher odds OR (95%CI = 2.01 (1.02, 3.97) were among the high socio-economic status. CONCLUSIONS: The proportion of participants with teeth at pre-morbidity and morbidity were high. Socio-demographics and behavioral predictors of dental caries were sex, socio-economic status, frequency of sugary food intake per day and dental visit in the previous year.

Schoolteachers for Action Against HIV/AIDS-related Oral Disease of Children in Africa.

PURPOSE: The intention of the study was to evaluate whether Sub-Saharan schoolteachers may play a key role in oral health promotion of primary schoolchildren, particularly in terms of prevention of HIV/AIDS-related oral health problems. MATERIALS AND METHODS: The study examined the level of knowledge about oral disease and the prevention of HIV/AIDS oral lesions amongst schoolteachers of Tanzania and Burkina Faso, identified their sources of information, and evaluated their ability for HIV/AIDS intervention. A multi-centre cross-sectional study was implemented in the two Sub-Saharan African countries. Participants comprised primary school teachers selected by stratified cluster sampling: 261 teachers from Tanzania and 313 teachers from Burkina Faso. All participants completed a structured questionnaire prepared for self-administration. The questions were designed from a standardised questionnaire developed by the World Health Organization. RESULTS: Most teachers knew about the principal causes of the major oral diseases and the means of disease prevention. Nearly all teachers (95.6%) were aware of HIV/AIDS and they knew (92.3%) a virus was the direct cause of AIDS. Teachers were well informed of the general symptoms of HIV/AIDS, although oral symptoms were mentioned less often. In all, 17.6% of schoolteachers reported that children suffering from HIV/AIDS were found in their classes and 10.3% of teachers were conscious of students receiving anti-retroviral therapy (ART). Knowledge about the disease seemed to reflect mass media as a source, while teacher colleagues and health personnel played a somewhat lesser role in communication. In total, 83.2% emphasised that they should teach children about HIV/AIDS and the mouth. Schoolteachers from Tanzania (70.5%) were more often engaged in classroom-based oral health education than were the Burkinabe teachers (53.9%). CONCLUSION: The study confirms that schoolteachers may be a relevant source in the fight against HIV/AIDS among children. However, they would benefit from interaction with health personnel.

Behavioural and Sociodemographic Determinants of Oral Health-related Quality of Life Among Adolescents in Zanzibar, Tanzania.

PURPOSE: To identify and assess the predictors of oral impacts on daily performance among adolescents in Zanzibar, Tanzania. MATERIALS AND METHODS: This was a cross-sectional study among primary school pupils. A single stage cluster sampling design was used. Data were collected using a structured questionnaire which inquired about sociodemographics, oral impacts on daily performance and oral health related behaviours. The Statistical Package for Social Sciences version 20.0 was used for data analysis using chi-squared statistics and standardized logistic regression. The level of significance was set at p ˂ 0.05. RESULTS: A total of 682 pupils aged 12 to 17 years participated in the study. 45.6% of the participants had at least one oral impact, the most common being difficulties in eating (27.9%). Statistically significantly more participants who reported eating between-meal sugared snacks (52.8%) or those who had visited a dentist (55.6%) reported oral impacts on daily performance, compared to their complimentary groups, which did not. The participants who reported having visited a dental clinic were 1.7 times more likely to report having an impact on daily performance than those who had not been to a dentist. CONCLUSION: The prevalence of oral impacts on daily performance was high among the adolescents in the current study. The oral impacts were associated more with behaviour than social differences. Having had a dental visit influenced the oral impacts on daily performances.

Current status of nylon teeth myth in Tanzania: a cross sectional study.

BACKGROUND: Nylon teeth myth is a belief of associating infant illnesses with bulges on infants' alveolus that mark the positions of underlying developing teeth and that it is necessary to treat the condition mainly by traditional healers to prevent infant death. The traditional treatment often leads to serious complications that may lead to infant death. Although the government instituted educational campaigns against the myth in 1980s to 1990s, to date, repeated unpublished reports from different parts of the country indicate continued existence of the myth. Therefore, this study aimed to assess the current status of the nylon teeth myth in Tanzania. METHODS: The study population was obtained using the WHO Oral Health pathfinder methodology. A structured questionnaire inquired about socio-demographics as well as experiences with "nylon teeth" myth and its related practices. Odds ratios relating to knowledge and experience of the nylon teeth myth were estimated. RESULTS: A total of 1359 respondents aged 17 to 80 years participated in the study. 614 (45%) have heard of nylon teeth myth, of whom 46.1% believed that nylon teeth is a reality, and 42.7% reported existence of the myth at the time of study. Being residents in regions where nylon teeth myth was known before 1990 (OR = 8.39 (6.50-10.83), p < 0.001) and/or hospital worker (OR = 2.97 (1.99-4.42), p < 0.001) were associated with having have heard of nylon teeth myth. Proportionately more residents in regions where nylon teeth myth was not known before 1990 (p < 0.001), the educated (p < 0.001) and hospital workers (p < 0.001) believed modern medicine, whereas, proportionately more residents in regions where nylon teeth was known before 1990 (p < 0.001), less educated (p < 0.001) and non-hospital workers (p < 0.001) believed traditional medicine to be the best treatment for symptoms related to nylon teeth myth respectively. CONCLUSION: The "nylon teeth" myth still exists in Tanzania; a substantial proportion strongly believe in the myth and consider traditional medicine the best treatment of the myth related conditions.

Oral health for an ageing population: the importance of a natural dentition in older adults.

Despite progress in dentistry, tooth loss in old age is still a reality, even more so in long-term-care residents. However, recent trends indicate that natural teeth are lost later in life. Functional decline and age-related pathologies have to be considered in oral health care for this vulnerable population. Retaining and restoring teeth and oral function in elders is important. Tooth loss significantly impairs masticatory performance, which cannot be fully restored by prosthodontic means. Hence an unconscious change in food intake occurs, often involving malnutrition and withdrawal from common meals. Poor oral appearance and bad breath may further impede social activities. Although a chewing activity may be beneficial for cognitive function, natural teeth can present a considerable risk for fragile elders, in whom aspiration of biofilm can lead to pneumonia and death. The presence of natural teeth is also correlated with higher life expectancy, but socio-economic confounding factors have to be considered. When evaluating oral health in the elderly population, standards and priorities for reporting oral health outcome measures have to be defined. Anatomical indicators such as the number of natural teeth or the presence of prostheses might be one option for reporting. However, functional indicators such as masticatory performance and patient-centred outcome measures may be more relevant. In conclusion, there is an overwhelming body of evidence that maintaining a healthy natural dentition in old age is beneficial from a structural, functional and psycho-social point of view.

Application of Behavior Management Techniques for Paediatric Dental Patients by Tanzanian Dental Practitioners.

BACKGROUND: Management of children's behavior is an integral component of pediatric dental practice. OBJECTIVE: To investigate the oral health care providers' awareness, use and factors for choice of behavior management techniques when attending paediatric dental patients. METHODS: A cross-sectional study among dental practitioners in Dar es Salaam, Tanzania. Data collection was done through interview using a structured questionnaire. The recorded information included: awareness and application of behavior management techniques (BMT) when attending a child dental patient, factors influencing choice of a particular technique, socio-demographics, level of professional training, working experience and facility profile. Using SPSS program version 18, frequency distributions and cross tabulations analyses were performed. RESULTS: 74 dental practitioners participated in the study, of whom 49 (66.2%) were males and 44 (59.5%) were graduates. Most participants were aware of the behavior management techniques, ranging from 100% for Tell-Show-Do to 86% for distraction. A small proportion (9.5%) reported to have adequate skills, all of them were graduates. The use of universally accepted BMTs was reported by 65% of experienced practitioners, 61% of graduates, 59% of those reporting to have received formal training and all of those reporting to have fair/inadequate skills to apply BMTs (p= 0.01). CONCLUSION: Most participants were aware of BMTs, although few acknowledged having adequate skills to apply the techniques. They use BMTs during treatment of paediatric dental patients and their choice of the technique is mainly influenced by children's factors.

Socio-demographic and behavioural correlates of oral health related quality of life among Tanzanian adults: A national pathfinder survey.

In response to the growing recognition of quality of life measurement in health care, indicators that address the social and psychological consequences of oral disorders have been developed to complement conventional clinical assessment. The objective of this study was to determine socio-demographic and behavioural correlates of oral health related quality of life (OHRQoL) among Tanzanian adults. The national pathfinder survey methodology described in the WHO Oral Health Surveys - Basic Methods was used to obtain a total of 1,759 Tanzanian adults aged 18 years and above. In line with the pathfinder methodology clusters were purposively selected to represent cities, towns and rural areas. In each cluster individuals were stratified by age and sex. The outcome variable was the OHRQoL in terms of oral impacts on daily performances (OIDP). Frequency distribution, bivariate analyses, and generalized linear models using log binomial regression models were performed by SPSS version 15. About half (49.1%) of the respondents reported at least one oral impact during a period of three months before the survey. Difficulty in chewing was the most prevalent impact affecting 3 9.9% of participants. A higher proportion of those who reported poor conditions of teeth had difficulties in chewing and sleeping was often interrupted. Multivariate analysis indicated that those who perceived their teeth conditions to be good (PR=0.38; CI: 0.32-0.44), were of younger age (PR=0.84; CI: 0.77-0.90), and had visited a dentist during the past five years or more (PR=0.84; CI: 0.77-0.90) and were less likely to have an oral impact. On the other hand those who restricted their sugar consumption (PR=1.12; CI: 1.03-0.1.22) were more likely to have an impact on at least one daily performance. It is concluded that the prevalence of OIDP was high while perceived teeth conditions and age varied with OHRQoL in terms of OIDP in the expected direction. Those who visited the dental clinic in the recent past had more impacts than those who did not. The findings of this study confirm the usefulness of subjective indicators in explaining peoples' suffering. In this regard it is recommended that in the next national pathfinder survey traditional clinical oral health indicators should be complemented with subjective indicators in order to obtain triangulated data for planning oral health services in Tanzania.

Oral health related behaviors among adult Tanzanians: a national pathfinder survey.

BACKGROUND: The oral health education programs which have been organised and delivered in Tanzania were not based on a thorough understanding of behaviours which influence oral health. Therefore, evaluation of these programs became difficult. This study aimed at investigating the oral health related behaviours and their determinants among Tanzanian adults. METHODS: A national pathfinder cross sectional survey was conducted in 2006 involving 1759 respondents from the six geographic zones of mainland Tanzania. Frequency distributions, Chi square and multiple logistic regression analyses were performed using SPSS version 13.0. RESULTS: The rates of abstinence from alcohol for the past 30 days and life time smoking were 61.6% and 16.7% respectively, with males being more likely to smoke (OR 9.2, CI 6.3 -12.9, p < 0.001) and drink alcohol (OR 1.5, CI 1.2 -1.8, p < 0.001). Multiple regression analysis revealed that; having dental pain (OR 0.7, CI 0.5-0.8; p < 0.001) and being minimally educated (OR 0.48, CI 0.4-0.6; p < 0.001) reduced the likelihood of having a high sugar score. Whereas being male (OR 1.5, CI 1.2- 1.8; p < 0.001), urban (OR 1.9, CI 1.5 -2.3; p < 0.001), and young (OR 1.5, CI 1.2 -1.8; p < 0.001) increased the likelihood of having a high sugar score. Urban residents were less likely to take alcohol (OR 0.7, CI 0.6-0.9; p < 0.01), or smoke cigarette (OR = 0.7, CI = 0.6-0.9); less likely to be those who do not use fruits (OR 0.3, CI 0.2-0.4; p < 0.001); dental clinic (OR 0.5, CI 0.4-0.7; p < 0.001); factory made tooth brushes (OR 0.1, CI 0.08-0.17; p < 0.001) and toothpaste (OR 0.1, CI 0.1-0.2; p < 0.001) than their rural counterparts. More rural (13.2%) than urban (4.6%) residents used charcoal. CONCLUSION: The findings of this study demonstrated social demographic disparities in relation to oral health related behaviors, while dental pain was associated with low consumption of sugar and high likelihood to take alcohol.

Satisfaction with urgent oral care among adult Tanzanians.

The aim of this study was to determine patient satisfaction with urgent oral care and to evaluate the association between patient satisfaction and different aspects of such care. A 5-point Likert scale questionnaire on patient satisfaction (score 1 = very dissatisfied; score 5 = very satisfied) was administered to 741 adults. Chi-squared test and logistic regression analysis were used to identify associations between dependent and independent variables. The mean patient satisfaction score was 3.79 (SEM = 0.02). Cleanliness of the clinic; hospitality of the dentist; and effectiveness of local anaesthesia; had the highest mean satisfaction scores of 4.0 to 4.15. Cost of treatment and explanation of treatment had the lowest mean scores (2.79 and 3.17 respectively). Sixty-eight percent of respondents were satisfied with urgent oral care. Rural residents were more satisfied with cost of treatment than urban residents (P < 0.0001). Urban residents were more satisfied with explanation of treatment than rural residents (P < 0.0001). Women were more satisfied with many aspects of oral care than men (P < 0.05). It is concluded that adult Tanzanians have moderate levels of satisfaction with urgent oral care. Cost of treatment and explanation of treatment are the two aspects of urgent oral care that are least satisfactory for patients.

Risk factors for injuries to maxillary permanent incisors and upper lip among schoolchildren in Dar es Salaam, Tanzania.

BACKGROUND: Dental trauma is common among children, and the maxillary permanent central incisors are the most often affected teeth. AIM: This study aimed to investigate the risk factors for injury to maxillary permanent incisors and the upper lip among Tanzanian schoolchildren aged 8-14 years. DESIGN: A cross-sectional study involving 1119 children. The risk variables investigated included age, gender, lip competence, and overjet. The corresponding proportions of injuries and the relative risk (with 95% confidence interval) were calculated and tested by Fisher's exact test. Logistic regression was applied to ascertain the strength and direction of the association of the risk variables to injuries, and backward selection was used to test significant risk factors. RESULTS: About 24% of the children had trauma to maxillary incisors, 45% had incompetent lip whereas 31% had increased overjet. Age, gender, overjet, and lip competence showed significant association with injuries to upper lip and maxillary incisors. Boys had sustained more injuries than girls, with a higher relative risk for luxation injuries. Enamel fracture was associated with overjet combined with lip competence, whereas enamel dentine fracture without pulp involvement was related to gender. Luxation injuries were associated with gender, tooth avulsion with overjet, and lip competence. Injury to the upper lip was associated with age. CONCLUSION: Male gender, increased overjet, and lip incompetence were the main risk factors of getting trauma to maxillary incisors, whereas age was the risk factor for injury to the upper lip.

Prevalence of oral pain and barriers to use of emergency oral care facilities among adult Tanzanians.

BACKGROUND: Oral pain has been the major cause of the attendances in the dental clinics in Tanzania. Some patients postpone seeing the dentist for as long as two to five days. This study determines the prevalence of oral pain and barriers to use of emergency oral care in Tanzania. METHODS: Questionnaire data were collected from 1,759 adult respondents aged 18 years and above. The study area covered six urban and eight rural study clusters, which had been selected using the WHO Pathfinder methodology. Chi-square tests and logistic regression analyses were performed to identify associations. RESULTS: Forty two percent of the respondents had utilized the oral health care facilities sometimes in their lifetime. About 59% of the respondents revealed that they had suffered from oral pain and/or discomfort within the twelve months that preceded the study, but only 26.5% of these had sought treatment from oral health care facilities. The reasons for not seeking emergency care were: lack of money to pay for treatment (27.9%); self medication (17.6%); respondents thinking that pain would disappear with time (15.7%); and lack of money to pay for transport to the dental clinic (15.0%). Older adults were more likely to report that they had experienced oral pain during the last 12 months than the younger adults (OR = 1.57, CI 1.07-1.57, P < 0.001). Respondents from rural areas were more likely report dental clinics far from home (OR = 5.31, CI = 2.09-13.54, P < 0.001); self medication at home (OR = 3.65, CI = 2.25-5.94, P < 0.001); and being treated by traditional healer (OR = 5.31, CI = 2.25-12.49, P < 0.001) as reasons for not seeking emergency care from the oral health care facilities than their counterparts from urban areas. CONCLUSION: Oral pain and discomfort were prevalent among adult Tanzanians. Only a quarter of those who experienced oral pain or discomfort sought emergency oral care from oral health care facilities. Self medication was used as an alternative to using oral care facilities mainly by rural residents. Establishing oral care facilities in rural areas is recommended.

Awareness of HIV/AIDS and its oral manifestations among people living with HIV in Dar es Salaam, Tanzania.

The aim of this study was to investigate the awareness of the oral manifestations of HIV/AIDS and general issues about HIV and AIDS among people living with HIV (PLHIV) in Dar es Salaam, Tanzania. A structured questionnaire was used to collect information from 187 participants chosen by convenience sampling from NGOs supporting PLHIV. A total of 13.4% of the participants were completely unaware of the oral manifestations of HIV/AIDS whereas all participants were fully aware of general symptoms of AIDS. There were no significant associations between awareness of oral manifestations and general awareness of HIV/AIDS, or level of education. Participants were relatively well aware of the different types of oral manifestations (e.g. oral ulcers 87%, oral candidiasis 84%) while their knowledge of the management of specific oral manifestations and the problems associated with oral manifestations was more limited. It is recommended that health authorities in Tanzania establish population-oriented health education for improving knowledge about oral disease in HIV/AIDS and that oral health professionals provide sound information to PLHIV in community-outreach oral healthcare programmes.