Barriers to restorative care as perceived by dental practitioners in Tanzania.

OBJECTIVE: To identify barriers to restorative care, as perceived by dental practitioners. METHODS: Of the total of 147 dental practitioners employed in regional and district government hospitals and municipal health centres, 138 completed a pre-tested questionnaire: a response rate of 94%. Factor analysis was performed to extract barrier factors. Chi-square test was used to test the influences of independent variables on discrete dependent variables, and ANOVA was used to test the influences of independent variables on continuous dependent variables. RESULTS: Knowledge of patients and beliefs of patients were perceived as the most important barriers. Others were financial, motivation of practitioners, dentistry looked down upon by administration and patients' fear of noise from drill. Practitioners who worked in high and medium economic zones perceived patients' fear of noise from drill as a barrier to restorative care more than their counterparts in low economic zones. Practitioners who worked in low economic zones perceived dentistry looked down upon by administration as a barrier to restorative care more than colleagues in high and medium economic zones. CONCLUSIONS: Knowledge and beliefs of patients about restorative care were the two main factors that hindered restorative care, as perceived by dental practitioners in Tanzania. Organized information provision to the population and regular continuing education meetings for practitioners on restorative and preventive care, plus adoption of Atraumatic Restorative Treatment in daily clinical work are considered appropriate in addressing these barriers.

Barriers to restorative care as perceived by dental patients attending government hospitals in Tanzania.

OBJECTIVES: Perceptions of dental patients in Tanzania regarding barriers to restorative care were examined. METHODS: A total of 1138 dental patients aged 15 years and above, attending 12 selected government dental clinics in January 2005, completed a pre-tested questionnaire. anova and logistic regression were used to identify the effects of independent variables upon the barrier factors. RESULTS: Ten barriers to restorative care in Tanzania were identified. The five main barriers included: No advice received from dentist (mean = 3.82); Lack of knowledge on restorative care (mean = 3.58); Lack of habits for going for dental check-ups (mean = 3.31); Bother that one may get in seeking restorative care (mean = 3.28) and Past experience with dental treatment (mean = 3.25). Less respondents in the middle economic zone perceived issues related to beliefs and misinformation, lack of knowledge on restorative care and past experience with dental treatment to be barriers than respondents in low and high economic zones (P < 0.01). However, more of them perceived issues related to high fee for restoration, bother that one may get in seeking restorative care and few clinics rendering restorative care (P < 0.0001) to be barriers than respondents in the high economic zone did. Women, more than men, perceived few clinics rendering restorative care and no advice received from dentist as barriers to restorative care (P < 0.01). Respondents who had received a restoration and/or had relatives who had received a restoration perceived bother that one may get in seeking restorative care and no advice received from dentist more as barriers to restorative care than did those who lacked that experience and whose relatives had not received a restoration (P < 0.05). CONCLUSIONS: No advice received from dentist and lack of knowledge on restorative care, were the two major barriers to restorative care, as perceived by dental patients in Tanzania. Implementation of the Atraumatic Restorative Treatment approach may overcome many of the barriers identified.

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.

Need for orthodontic treatment among Tanzanian children.

OBJECTIVE: To determine the need for orthodontic treatment among Tanzanian Bantu children. DESIGN: Prospective study using dental casts. SETTING: Sixteen randomly selected schools from the Ilala district, Dar-es-Salaam, Tanzania. SUBJECT: Six hundred and forty three Tanzanian children from an urban district. METHOD: Dental casts of 643 Tanzanian subjects in age groups 3-5, 6-8, 9-11 and 15-16 years, were assessed using the Index of Orthodontic Treatment Need (IOTN). MAIN OUTCOME MEASURES: Need for orthodontic treatment. RESULTS: Aesthetic treatment need (AC grades 8-10) and dental health component (DHC grades 4-5) occurred in 5-15% and 16-36% of the studied children, respectively. The need measured by DHC increased significantly between the two oldest age groups. An absolute need measured by combining AC grades 8-10 and DHC grades 4-5 was found in 3-12% of the subjects and it increased significantly with age (p<0.03). The most prevalent severe occlusal feature placing the children in the great need category was cross bite. While about 3-19% of the children had distal occlusion (Angle's Class II), mesial molar occlusion (Angle's Class III) was rare, occurring in 1-3% of the children. CONCLUSIONS: This study provides baseline data on the need for orthodontic treatment among Tanzanian children that may be useful for the public oral health service to determine priority for orthodontic treatment as part of comprehensive child oral health care in Tanzania.

Demand for orthodontic treatment among 9-18 year-olds seeking dental care in Dar-es-Salaam, Tanzania.

OBJECTIVE: To investigate the demand for orthodontic treatment among 9-18 olds seeking dental care in Dar-es-Salaam, Tanzania. DESIGN: Case-control, interview and clinical study. SETTINGS: Children seeking dental care. MAIN OUTCOME MEASURES: Demand for orthodontic treatment. RESULTS: Most of the children (85%) in the case group attended the dental clinic because of crowding. Aesthetic impairment (AC grades 8-10) and severe malocclusions (DHC grades 4-5) were higher in cases than in controls being 47 and 5%; and 67 and 18%, respectively (p<0.0001). Absolute need (combined AC grade 8-10 and DHC 4-5) was found in 29% of the cases and 5% of the controls (p<0.0001). A relative probability for a child with absolute need to seek orthodontic treatment was 7.9 higher (95%) CI for OR = (5,13), compared to a child without an absolute need for orthodontic treatment. The most prevalent severe occlusal feature placing cases in the highest need category was crowding (74%). For the cases, it was mainly a mother (45%) who first recognized the problem in the family, and tooth extraction (62%) was the most common expected mode of treatment. Most parents (96%) were prepared to pay for their children's orthodontic treatment. CONCLUSION: Most children in the case group had come to the clinic due to crowding. Ectopic canines were the driving factor for children and parents to seek orthodontic care. Further studies are recommended to map the demand for orthodontic treatment in the Tanzanian rural settings.

Comparison between the opinions of Tanzanian parents and their children on dental attractiveness.

The objective was to investigate the opinion of Tanzanian parents on dental attractiveness and to compare their opinion with that of their children. A prestructured questionnaire with 18 intraoral frontal photographs was given to 286 parents and their children aged 9-18 years. The photographs represented various types of occlusion traits, with the first 10 intraoral photographs representing grade 1-10 of the aesthetic component (AC) of the index of orthodontic treatment need, and the remaining eight photographs were added to represent malocclusions that are often seen in Tanzania. Basic statistical techniques were used to analyze the data. Photographs showing severe deviations were perceived by both children and parents as the most unattractive. The opinion was significantly correlated with children's age (P = .02) and sex (P < .0005), with older girls tending to dislike photographs showing severe deviations the most. The mean of the opinion for the photographs showing some spacing with overbite < or = 2 mm or open bite and overbite > 2 mm fell in the middle of the scale, with a tendency toward unattractiveness. Photographs matching 8-10 on the AC scale were perceived as the most unattractive, indicating what could be a lay person's priority when considering an orthodontic treatment policy in Tanzania.

Survival of Fuji IX ART fillings in permanent teeth of primary school children in Tanzania.

OBJECTIVE: To evaluate the clinical performance of atraumatic restorative treatment (ART) fillings using Fuji IX as a filling material in field conditions. DESIGN: Longitudinal study of the ART fillings in permanent teeth of primary school children aged eight to fifteen years. SETTING: Primary schools in Morogoro municipality, Tanzania. SUBJECTS AND METHODS: Standard 3 and 4 children in five primary schools randomly selected from a list of 36 primary schools of Morogoro municipality were examined for dental caries and periodontal conditions. All 296 carious lesions that were indicated for restoration were treated using ART approach according to the instructions given in the manual for ART approach for the control of dental caries. Essential measurements for treated teeth and cavity were taken. The cavities were filled with Fuji IX glass ionomer cement as per manufacturer's instructions. After one year, 238 restorations were evaluated using the criteria for evaluating ART restorations. MAIN OUTCOME MEASURE: Clinical appearance of the surface of the restorations. RESULTS: Ninety four per cent of the restorations evaluated were rated as good and intact, while 1.7% were rated as having slight defects that needed no repair, giving a one year survival rate of 96.1%. Mean working time was 14.5 minutes. CONCLUSIONS AND RECOMMENDATIONS: The one-year survival rate of 96.1% is high enough to recommend wide use of ART in Tanzania. Town and municipal councils should be encouraged to adopt ART in their school oral health programmes.

Dental caries and periodontal conditions among primary school children in Morogoro municipality, Tanzania.

OBJECTIVE: To describe the occurrence of dental caries and periodontal conditions among standards three and four primary school children in Morogoro municipality and compare the obtained oral health indicators with the goals stipulated in the National Plan for Oral Health by the year 2002. DESIGN: Cross sectional study of the oral health status among eight to 15-year old primary school children. SETTING: Primary schools in Morogoro municipality, Tanzania. SUBJECTS AND METHODS: A total of 1,297 standards three and four children in five primary schools randomly selected from a list of 36 primary schools of Morogoro municipality were examined for oral health status. Dental caries and periodontal status were recorded using the criteria described in the WHO manual for Oral health Surveys, Basic Methods (1997). Oral cleanliness was assessed using plaque index. MAIN OUTCOME MEASURES: Dental caries prevalence, experience and its distribution by tooth type and jaw and prevalence and severity of periodontal conditions and oral cleanliness. RESULTS: Seventy six percent of the children were caries free, and the mean DM-T was 0.41. No fillings were encountered. Seventy six per cent of carious lesions were in pits and fissures of lower molars. Only 21% of the caries lesions were in the pits and fissures of upper molars. Seventy five per cent of the children had all sextants with no gingivitis or calculus. Mean sextants with gingivitis, calculus and visible plaque were 0.25, 0.69 and 2.44 respectively. CONCLUSIONS: Standard four and standard four children in Morogoro municipality primary schools had very low levels of dental caries, good oral hygiene and a very low prevalence of gingivitis. No restorative treatment had been provided to these pupils. It is recommended that Morogoro municipality should start a dental caries treatment programme in primary schools in order to attain the national goal of 10% of the "F" component of DMF-T by the year 2002.

Factors influencing career choice among high school students in Tanzania.

The aim of this study was to identify factors that influenced career choice among high school students in Tanzania. The information obtained would be used to formulate effective recruitment strategies and counseling students on their career expectations in dentistry. All 352 high school students who were studying in five randomly selected high schools completed a pre-tested questionnaire containing twenty-four items addressing five factors. Image of a profession (good experiences from the work of professionals, professionals who are attractive to respondents, and professionals who command high respect in the community) was perceived as an important factor in career choice by the majority of respondents (over 88 percent). Work/profession characteristics (knowledge about work to be done, treating patients, giving medicines to patients, helping relatives, etc.) was ranked as the second most important factor, and course characteristics (availability of postgraduate studies, size of annual intake, pass rate, geographic location, etc.) was ranked third. Direct gains and advice from important persons were perceived as least important in career choice.

Tanzanian high school students' attitude towards five university professional courses.

OBJECTIVE: To determine the attitude of high school students majoring in Physics, Chemistry and Biology (PCB) towards Medicine, Pharmacy, Dentistry, Veterinary Medicine and Nursing as professions at university. DESIGN: A cross sectional study of a representative sample of high school students using a pretested attitudinal questionnaire. Attitude components tested were degree of liking, degree of admiration and intentions to visit a professional at work. SETTING: High schools in Tanzania mainland majoring in PCB. SUBJECTS AND METHODS: All 352 high school students from a representative sample of five schools: two boy-schools; two girl-schools; and one mixed gender-school participated by filling in a questionnaire. The questionnaire consisted of demographic variables on age, sex, class, education and employment status of father and mother as background variables, and questions on the degree of liking, admiration and preference to visit a particular professional at work. All the attitudinal questions were scored on a 5-point scale. Scores for the three-attitudinal components were summed to group subjects into positive, neutral and negative attitude. MAIN OUTCOME MEASURE: Attitude of students to five professions they could study at a higher level. RESULTS: Eighty seven percent of the high school students had a positive attitude towards medicine, 66% towards pharmacy, 40% dentistry, 12% veterinary and 9% nursing. Dentistry and veterinary had the highest percentage of students (46.5% and 37.3%) who had a neutral attitude towards the professions, and the highest percentage of students (11.7% and 9.9%) who reported to have had no sufficient information to enable them indicate whether they admired dentistry and veterinary medicine or not. Significantly more girls than boys liked, admired and preferred to study nursing (chi2 varied from 11.39 to 12.99; p-value < 0.005). CONCLUSION: Medicine was the most liked profession while nursing was the least liked. Pharmacy, dentistry and veterinary medicine fell in between. There was insufficient knowledge about dentistry and veterinary medicine among the high school students.

Integrating oral health into primary health care--experiences in Bangladesh, Indonesia, Nepal and Tanzania.

When primary health care (PHC) was developed and implemented in developing countries, oral health was not included. The present consequences are marked disparities in the distribution of oral health care, since conventional dentistry can only serve relatively few people and at high costs. Oral health care is virtually non-existent in rural areas of most developing countries where more than 80 per cent of the population live. More recently, community based oral health programmes have been initiated in some countries to fill the gap. These programmes give more emphasis on oral health promotion and on the prevention of oral diseases than on treatment of its consequences, since history has shown that the latter is ineffective in preventing oral diseases. Unfortunately, most of these oral health programmes have been implemented next to the existing PHC system and hence they face enormous management, logistic and financial problems, which seriously threaten their sustainability. This paper presents a proposal to counteract the problems that many countries face in developing an adequate primary oral health care (POHC) service.

Tooth bud extraction and rubbing of herbs by traditional healers in Tanzania: prevalence, and sociological and environmental factors influencing the practices.

The practice by traditional healers in Tanzania of extracting tooth buds or of rubbing herbs on to the gingivae of young children to cure fevers and diarrhoea has been known for many years. The aim of this study was to determine the prevalence of these practices in different regions of Tanzania and to identify sociological and environmental factors influencing belief in their efficacy. A total of 1052 children were examined for missing primary teeth, or scars or wounds on the gingivae, resulting from tooth bud extraction. In addition, 268 parents of children who had received treatment from a traditional healer were interviewed to identify factors that led them to go to a traditional healer. The prevalence of tooth bud extraction in villages in which tooth bud extraction was first reported in the early 1980s was 0.5%, and in villages in which the practice was only recently reported it was 60%; the prevalence of rubbing herbs was 32% and 0.4%, respectively. Persistent fevers and diarrhoea were the major symptoms which led parents to go to a traditional healer. However, 60% of the parents had taken their child to a hospital before going to a healer; 72% of these had attended at least three times but only 5.5% reported that the treatment given in the hospital cured the condition. It is recommended that intensive health education on the causes, treatment and prevention of fevers and diarrhoea should be instituted, in conjunction with effective management of these conditions in hospital facilities.

Oral health knowledge and attitude among public health nurse students at Muhimbili Public Health Nurse Shool [sic]; Tanzania : an assessment before oral education sessions are conducted

The aim of this paper was to assess the oral health knowledge and attitude of public health nurse students at Muhimbili Public Health Nurse School. The questionnaire was used to assess both knowledge and attitude. A total of 43 students participated in this study. The results show that the group had high knowledge on etiology and prevention of tooth decay (81.4 per cent); but very low knowledge on the etiology and prevention of gingivitis (21 and 44 per cent respectively). A high proportion of the participants showed positive attitude towards oral health. Since tooth decay is the leading cause of tooth loss in Tanzania; it can be concluded that the oral health knowledge and attitude of the public health nurses students 1989/90 was adequate for them as future oral health educators in Tanzania

Missing primary teeth due to tooth bud extraction in a remote village in Tanzania.

The practice by traditional healers of extracting tooth buds as a cure for diarrhoea and fevers in children has existed in Tanzania for many years, but its extent is not known. This paper reports on the prevalence of missing primary teeth due to this practice among children living in Manghweta, a remote village in Tanzania. All children (n = 262) aged 5 years and below were examined for missing primary teeth. Only cases in which mothers confirmed that tooth bud extraction had been performed were recorded. Tooth buds had been extracted from 37.4% of the children. The majority of extractions (60.5%) were from the lower jaw, and almost all (99.4%) were canines. Tooth bud extraction was always bilateral. It is concluded that the practice of extracting tooth buds as a cure for diarrhoea and fevers in children still exists in Tanzania.