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.

Strengthening the oral health system in Nigeria: A health systems building block approach.

Aim: The present study aimed to describe the building blocks of the oral health system, including the role that the community plays in strengthening the oral health system in Nigeria. Methodology: This research was a scoping review of the existing literature retrieved from search engines and databases. Thus, we utilised grey literature, peer-reviewed literature, policy documents and websites. The oral health system was analysed using the World Health Organisation's Health systems framework, and we adapted this framework by introducing a seventh block, community participation. We also inserted the links between the oral health service delivery and oral health workforce blocks of the framework to improve the oral health outcomes. Results: More dental clinics are required to improve the availability and accessibility of oral health services. Dental workforce expansion is imperative. This can be approached by training of junior cadre dental professionals and incorporating community health practitioners to deliver basic oral care. There is an unregulated access to medication to treat dental conditions; hence, oral disease treatments need to be included in the country's treatment guidelines to improve standard of care. The government needs to improve on overall health spending and invariably increase oral health care allocation urgently. Furthermore, the country's stewardship of oral health care is hinged on well disseminated and implemented national policies on oral health. The oral health system can achieve its overall goals with community participation, engagement and ownership. Conclusion: Strengthening the oral health system in Nigeria requires urgent attention on each building block and cross-cutting interventions across the system's building blocks. The role of the community will need to be recognised because it is vital in sustaining any organisational change.

Study motivations, specialty preferences, and empathy of dental students in a Nigerian university.

Introduction: dental training aims to produce committed dentists who are professional and empathetic in providing patient-centered oral healthcare and improved quality of life. This study aimed to assess the motives of dental students to study dentistry, their specialty preferences, and their empathy scores by motives and specialty preference. Methods: this cross-sectional study utilized a self-administered questionnaire designed to assess the empathy measured by the Jefferson Scale of Empathy-Health Professions Student version, motives to study dentistry, dental specialty preferences among students of a dental school in Nigeria. Differences in mean empathy across gender, motives to study dentistry, and specialty preferences were analysed with t-test and ANOVA. P-values of <0.05 were considered significant. Results: a total of 211 students participated fully in the study with a mean age of 21.19 years ± 2.43 and 140 (66.4%) females. Personal interest (27.0%) and failure of admission to other undergraduate programmes (20.9%) were the top two motives for studying dentistry. Oral and maxillofacial surgery (OMFS) was the most preferred specialty (44.1%) and community dentistry and periodontology were the least preferred (2.8%) respectively. The total mean empathy score was 104.06 ± 19.1. The highest empathy score for motivation was for high income from dentistry (112.33 ± 13.34). The participants who preferred paediatric dentistry had the highest empathy score (108.73 ± 13.68). Conclusion: knowledge of the empathy levels, the motivation for studying dentistry, and preferences for particular specialties may encourage trainers to ensure the development of a positive attitude among dental students that is professional and empathetic.

Strengthening the oral health system in Nigeria: A health systems building block approach

Aim: The present study aimed to describe the building blocks of the oral health system, including the role that the community plays in strengthening the oral health system in Nigeria. Methodology: This research was a scoping review of the existing literature retrieved from search engines and databases. Thus, we utilised grey literature, peer-reviewed literature, policy documents and websites. The oral health system was analysed using the World Health Organisation's Health systems framework, and we adapted this framework by introducing a seventh block, community participation. We also inserted the links between the oral health service delivery and oral health workforce blocks of the framework to improve the oral health outcomes. Results: More dental clinics are required to improve the availability and accessibility of oral health services. Dental workforce expansion is imperative. This can be approached by training of junior cadre dental professionals and incorporating community health practitioners to deliver basic oral care. There is an unregulated access to medication to treat dental conditions; hence, oral disease treatments need to be included in the country's treatment guidelines to improve standard of care. The government needs to improve on overall health spending and invariably increase oral health care allocation urgently. Furthermore, the country's stewardship of oral health care is hinged on well disseminated and implemented national policies on oral health. The oral health system can achieve its overall goals with community participation, engagement and ownership. Conclusion: Strengthening the oral health system in Nigeria requires urgent attention on each building block and cross-cutting interventions across the system's building blocks. The role of the community will need to be recognised because it is vital in sustaining any organisational change.

Prevalence of oral mucosal lesions and oral health related quality of life among adolescents in a rural Nigerian population

Background: Oral mucosal lesions affect people of all age groups, and vary in presentation; from asymptomatic to severely debilitating. Studies reporting the prevalence and effects of these lesions in adolescents are generally few compared to those describing the demography of dental caries and other oral diseases. Objective: To determine the prevalence of oral mucosal lesions, factors that contribute to the prevalence, and the association with the oral-health related quality of life (OHRQoL) of adolescents in the population. Methods: A cross-sectional survey was done on 240 secondary school students aged 10-19 from three secondary schools selected using multi-stage cluster random sampling. A pre-designed questionnaire was used to collect demographic information, presence of systemic illness, and oral habits. Oral-health related quality of life was assessed using the oral-health impact profile (OHIP-14), and intraoral examination was performed within the school premises by a single trained investigator. Results: A total of 33 participants (13.7%) had oral mucosal lesions. Overall, commissural lip pits (5.0%) were the most prevalent, while geographic tongue and irritation fibroma (0.4% each) were the least prevalent lesions. The mean OHIP-14 score of the participants in this study was 7.17+8.64. Participants with systemic diseases and cheek biting habits had statistically significant worse scores than those without either. Conclusion: The most prevalent oral mucosal lesions in the adolescent age group are those of developmental origin. Quality of life was negatively impacted by the presence of systemic diseases as well as cheek biting habit.

Self-reported halitosis and oral health related quality of life in adolescent students from a suburban community in Nigeria.

BACKGROUND: Halitosis is an important cause of impaired quality of life in adolescents. Little is known about the prevalence of self-reported halitosis in adolescents in Nigeria and the extent to which self-reported halitosis impairs their oral health related quality of life. OBJECTIVES: To determine the prevalence and impact of self-reported halitosis on the oral health related quality of life of adolescent students in a suburban community in Nigeria. METHODS: An analytical cross-sectional study. Pre-tested self-administered pro-forma was used to obtain the adolescents' demographic data and their self-perception of halitosis. The Oral Health Impact Profile (OHIP-14) was used to assess the adolescents' OHRQoL. The Mann-Whitney U test was used to compare the median OHIP-14 scores between adolescents who reported halitosis and those who did not. The level of significance was set at p < 0.05. Ethics approval for this study was obtained from the Health Research and Ethics Committee of the Lagos University Teaching Hospital. RESULTS: A total of 361 adolescents aged 10 - 19 years (mean age 14.1 ± 1.79 years) took part in the study. Of these, 32.7% (n=118) had self-reported halitosis. The median OHIP-14 score among adolescents with self-reported halitosis was 3 (0-9) while those who did not report halitosis had a median OHIP-14 score of 0 (0 - 5). This difference was statistically significant (p < 0.0001). CONCLUSION: Self-reported halitosis significantly impaired the oral health related quality of life of the adolescents.

Dentine hypersensitivity and associated factors: a Nigerian cross-sectional study.

INTRODUCTION: Prevalence of dentine hypersensitivity (DH) may be on the increase as a result of changing lifestyles. This study aimed to assess the prevalence of DH and relative importance of associated factors in 18-35 year old Nigerians and compare to findings from a similar European study. METHODS: Following ethical approval, 1349 subjects from the six geopolitical zones in Nigeria participated in this cross sectional study. DH was clinically evaluated by cold air tooth stimulation, patient pain rating (yes/no) and investigator rated pain using the Schiff ordinal scale (0-3). Erosive tooth wear using the BEWE index was assessed. A questionnaire regarding the nature of the DH, erosive dietary intakes, tooth brushing habits and other factors was completed by patients. Bivariate analysis was conducted. RESULTS: 32.8% of patients reported pain on tooth stimulation and 32.9% scored ≥1 on Schiff scale for at least one tooth. Questionnaire reported sensitivity was 41.2%. There were statistically significant associations between Schiff score and clinically elicited DH (p < 0.001); and BEWE erosive tooth wear score and clinically elicited DH (p < 0.001). There were significant associations between DH and some oral hygiene practices such as brushing frequency, brush movement and brushing after breakfast. Fresh fruit and fruit/vegetable juice intake also showed significant association. CONCLUSION: The most important risk factors of DH for this population in Nigeria appear to be the frequency and characteristics of tooth brushing. This should be considered in its prevention and management.

Empathy among dental students in a Nigerian institution.

OBJECTIVES: To determine the reliability and validity of the Jefferson Scale of Empathy-Health Profession Students (JSE-HPS) version as a tool to measure the empathy levels in undergraduate dental students in Nigeria. METHODS: A cross-sectional study conducted from 15 December 2015 to 12 January 2016 among 234 undergraduate dental students of the University of Lagos, Nigeria. Participants were proportionately selected from the first to sixth year by systematic sampling technique. Data were collected with a self-administered JSE-HPS questionnaire with internal consistency determined by Cronbach's α-coefficient reliability test. Data were analysed with SPSS software. Exploratory factor analysis was used to test for the fundamental construct validity of the scale among the students. P values <0.05 were considered significant. RESULTS: The response rate of the respondents was 90.60% with 212 completed questionnaires with a mean age (SD) of 21.18 years (2.43) and internal reliability (Cronbach's α-coefficient) was 0.84. Factor analysis revealed "Compassionate Care," "Standing in Patients' Shoes" and "Perspective Taking" as first, second and third factors, respectively. The total mean empathy score (SD) was 104.01 (19.64). The mean empathy for females (SD) of 105.34 (17.31) was not significantly higher than the males (P = 0.08). There was a significant difference in empathy levels between the second- and the fourth-year students (P = 0.01). CONCLUSION: The mean JSE-HPS score was comparable to those reported for dental, medical and other health professions students and physicians. Thus, this study demonstrates the construct validity and reliability of the JSE-HPS for measuring empathy among Nigerian dental students.

Correlates of illness behaviour related to orofacial infections of odontogenic origin among adults in a semi urban community in Nigeria.

BACKGROUND: Infections of facial spaces in the maxillofacial region occur in most cases as a complication of odontogenic infections. It often results in substantial morbidity, with serious and potentially life threatening outcomes if allowed to progress without prompt medical attention. OBJECTIVE: To identify factors that determine illness behaviour related to maxillofacial space infections. METHOD: This was a descriptive cross-sectional study of adult residents of pakoto community, Ifo local government area, Ogun state. The study was conducted using an interviewer administered questionnaire which included key information about respondents' awareness of predisposing factors of maxillofacial space infections; common actions taken with regards to treatment, and the factors that influenced their utilization of the available oral health care service. RESULTS: A total of 187 individuals were sampled, mean age was 30.5(SD 11.7) years with majority being females (59.4%) The proportion of the total respondents who reported a history suggestive of orofacial space infection was 20.3% (n=38). Visiting a patent medicine dealer (26.3%) along with visiting a dentist (31.6%) were the illness behaviours most frequently engaged in by respondents who have had an orofacial swelling following a toothache, with majority (73.7%) indicating the action they took was based on what was most convenient. CONCLUSION: This study has revealed that engagement in unorthodox practises by individuals in a semi-urban community studied is prevalent, and influenced by factors such as age, gender, level of education and occupation. FUNDING: None.

A national survey of tooth wear on facial and oral surfaces and risk factors in young Nigerian adults.

OBJECTIVE: The objective of this study is to assess the prevalence of tooth wear and to identify risk factors in a sample of young Nigerian adults. MATERIALS AND METHODS: Participants were individuals aged 18-35 years, attending dental clinics located in eight centers representing the six geopolitical zones of the country. Calibrated examiners measured tooth wear using basic erosive wear examination (BEWE) index. Individuals were characterized by the highest BEWE score recorded for any facial/oral tooth surface. Previously validated questionnaire was used to gather information on demographics and risk factors. RESULTS: A total of 1349 participants were examined. The prevalence of tooth wear was 60.2%. Bivariate analysis showed significant differences in the prevalence of tooth wear with age, educational level, and occupation (P ≤ 0.05). There were significant differences in tooth wear among the participants from the different states. Tooth wear was found to increase with smoking. Tooth wear was associated with brushing frequency, use of chewing stick, and other local cleaning agents. Multiple regression analysis showed that age, brushing frequency, brushing after breakfast added statistically significantly to the prediction of tooth wear (P < 0.05). CONCLUSION: Tooth wear was common in the population. The frequency of tooth brushing, use of chewing sticks and other local tooth cleaning agents may be contributory.

Knowledge, diagnosis and management of dentine hypersensitivity: a national survey of dentists in Nigeria.

AIM: To assess the knowledge of Nigerian dentists regarding dentine hypersensitivity (DH) and their methods of diagnosis and management. METHODS: A cross-sectional questionnaire-based study of dentists practicing in all six geopolitical zones of Nigeria was conducted. The questionnaire focussed on participant's demography, exposure to patients with DH, knowledge-based questions, diagnosis and management of DH. Data analysis using EPI Info statistical software determined frequencies and proportions. Associations between discrete variables were assessed using the chi-square test (P ≤ 0.05). RESULTS: A total of 1,057 dentists responded; the majority (83.8%) had practiced for up to 15 years, and 92.0% reported that, on average, between one and 10 of their patients each week complained of DH. The majority (92.8%) of dentists described DH as stimulated brief pain from the tooth; 24.2% expressed that DH can be treated by altering the number of dentinal tubules. A diagnosis of DH is made by tapping (20.6%) or scratching (73.4%) the tooth. Although radical treatments, such as extraction (24.7%) and root canal therapy (34.5%), were mentioned by some, the majority identified aetiological and predisposing factors (98.8%) and provided diet (95.1%) and oral hygiene (95%) counselling as part of the management of DH. Evaluation of 36 knowledge-based questions revealed that only 1.8% of the respondents provided at least 25 correct answers. Knowledge was significantly associated with respondent age and number of years in practice (P ≤ 0.05) but was not associated with the number of patients with DH seen per week (P = 0.46). CONCLUSION: Dentists practicing in Nigeria exhibited knowledge gaps concerning DH and its diagnosis and management.

Impact of an educational intervention on smoking counseling practice among Nigerian dentists and dental students.

INTRODUCTION: Oral health professionals are important in smoking cessation and prevention as their role is very crucial given the impact of smoking on oral health. Therefore, dental professionals need adequate education in tobacco use prevention and cessation skills to increase their confidence and be able to help patients to quit smoking. This study was aimed at determining the impact of an educational intervention on the attitudes, willingness, and perceived barriers of a group of Nigerian dental students and dentists to smoking cessation counseling in the dental clinic. METHODS: A self-administered questionnaire-based study was conducted in September 2007 at the Lagos University Teaching Hospital Idi Araba, Lagos. This was followed by a series of lectures and seminars using the brief intervention strategies for patients willing to quit using the Ask, Advise, Assess, Assist, and Arrange of cessation. A repeat study was conducted in January 2009 using the same questionnaire. Post intervention attitudes were significantly improved over pre intervention values for each parameter used in the assessment. RESULTS: A significantly higher proportion of the respondents were interested in providing cessation services after the intervention (P = 0.00002). Most (83.1%) of the respondents were willing to undergo training with a slight increase in the post intervention group from 80.9% to 86%. All the reported barriers were significantly reduced after the intervention (P = 0.000). CONCLUSION: This study has shown that educational interventions such as didactic instructions and practical training in tobacco use cessation can help to increase the willingness, confidence, and ability to provide information, during encounters with patients.

Smoking cessation counseling in dentistry: attitudes of Nigerian dentists and dental students.

The study was aimed at assessing the awareness, attitude, practices, willingness, and perceived barriers of dental students and dentists in Lagos University Teaching Hospital, Lagos, Nigeria, in relation to smoking cessation in the dental care setting. An anonymous self-administered questionnaire that contained questions relating to attitudes, views, and perceived barriers to smoking cessation activities in the dental clinic was hand-delivered to all dentists and clinical dental students in 2007. One hundred and thirty-six respondents took part in the study (response rate=81.9 percent). Although 95 percent of the respondents believed that smoking affects the dental management of the patient, only 65 percent always ask their patients about their smoking habits, and only 30 percent have heard about smoking cessation programs. A significantly higher proportion of students always ask patients about their smoking habits compared with dentists (p=0.0017). Also, a significantly higher proportion of dentists (97 percent) advised their patients against tobacco use compared with 77 percent of students (p=0.0000). Only 2 percent and 3 percent agreed that it is their professional responsibility to educate or encourage patients to quit smoking, respectively. Also, 98 percent strongly disagreed that it is within the scope of dental practice to ask about tobacco use, and 86 percent disagreed that tobacco counseling can be effective in helping patients quit tobacco use. Perceived barriers reported were lack of time (88 percent), lack of necessary materials (81 percent), and lack of knowledge of smoking cessation (74 percent). However, 81 percent of the respondents said they are willing to undergo training in tobacco use cessation. Since most of the dentists and dental students had poor attitudes and negative perceptions of smoking cessation activities, possibly due to lack of training and resources to carry it out in the clinics, there is need to include smoking cessation training in the dental curriculum in Nigeria.

Infection control knowledge and practices related to HIV among Nigerian dentists.

BACKGROUND: Many diseases including HIV/AIDS can be transmitted in the dental setting when effective infection control procedures are ignored. The aim of this study, therefore, was to evaluate the infection control knowledge and practices of Nigerian dentists in the era of HIV/AIDS. METHODOLOGY: Information on knowledge of transmission of HIV, occupational vulnerability, infection control practices, and opinion on adequacy of infection control facilities were gathered from dentists through a self-administered questionnaire. Knowledge was assessed on a total score of 20 questions. RESULTS: Only 3.6% of the dentists had poor knowledge. Younger males and dentists working in teaching hospitals had significantly better knowledge than their counterparts. While 40.8% believed HIV could be transmitted through saliva, only 43.2% knew it could be transmitted through the conjunctiva. Most (93.2%) wore gloves routinely and the most common barrier to glove use was non-availability. Most (79.2%) used autoclaves for sterilization; however, chemical disinfectants and boiling were also used. The majority (72.4%) believed the facilities for infection control in their centres were inadequate. Close to half of the respondents (47.6%; n = 118) rated the occupational risk of becoming infected with HIV as high. CONCLUSION: The results of this study have shown that while the level of knowledge of the dentists was generally acceptable, there were still some misconceptions on the transmission and occupational vulnerability of HIV. It also indicates only partial compliance with recommended infection control procedures among Nigerian dentists as a result of inadequate supplies.

Coping with oral pain: lay management strategies adopted by patients prior to presentation.

OBJECTIVES: To identify lay measures taken by patients in response to oral pain before seeking professional care and to determine factors leading to demand for professional oral health care. METHODS: A cross-sectional survey of patients aged 16 years and above who presented with oral pain at the oral diagnosis clinics of the Lagos University Teaching Hospital and the Lagos State University Teaching Hospital was carried out. Data was collected by means of questionnaires which sought information on onset and duration of pain, character, aggravating and relieving factors and actions taken by the patients before presentation at the dental clinic. RESULTS: A total of 215 patients participated. More than half of them described their pain as severe to very severe with 106 (49.3%) and 21 (9.8%) reporting sleep disruptions and severe agony respectively. Delay in presentation range from over a month in 56 (26%) patients to years in 85 (39.5%). Responses to pain symptoms included, communication with different persons for advice in 192 (89.3%) and application of at least one lay measure in 183 (85.1%) patients. Duration and persistence of pain was associated significantly with the use of more than one measure. There was no association between gender or age and the use of lay measures. Use of measures with possible adverse effects like petrol and acid was reported in 5 (2.7%) of the respondents. CONCLUSION: Lay strategies in response to oral pain are common in this Nigerian population and appear to be used as an alternative to professional oral health care.

Oral cancer education in dental schools: knowledge and experience of Nigerian undergraduate students.

The objective of this study was to determine the knowledge and experiences of clinical dental students of the College of Medicine, University of Lagos, Nigeria related to the management and prevention of oral malignancy and premalignancy. A self-administered questionnaire was distributed to all clinical dental students. Most of the students (87.7 percent; n=57) had witnessed at least a patient with oral malignancy, while 61.5 percent (n=40) had witnessed or examined a patient with oral premalignancy. While 61.5 percent of the students had observed biopsies of malignant and premalignant lesions, only 13.8 percent (n=9) had ever performed one under supervision. All the respondents believed that oral malignancy is always or sometimes associated with pain, and most of the students were more familiar with the late signs of oral malignancy than the early signs. Almost two-thirds (64.6 percent) of the respondents believed that oral screening programs were effective for early diagnosis and management of oral malignancies. This study revealed a need for a more structured teaching program with increased emphasis on the early signs and symptoms of oral malignancies and involvement of the students in the examination and biopsies of malignant and premalignant lesions.