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.

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.

Honoring Dental Patients' Privacy Rule Right of Access in the Context of Electronic Health Records.

A person's right to access his or her protected health information is a core feature of the U.S. Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. If the information is stored electronically, covered entities must be able to provide patients with some type of machine-readable, electronic copy of their data. The aim of this study was to understand how academic dental institutions execute the Privacy Rule's right of access in the context of electronic health records (EHRs). A validated electronic survey was distributed to the clinical deans of 62 U.S. dental schools during a two-month period in 2014. The response rate to the survey was 53.2% (N=33). However, three surveys were partially completed, and of the 30 completed surveys, the 24 respondents who reported using axiUm as the EHR at their dental school clinic were the ones on which the results were based (38.7% of total schools at the time). Of the responses analyzed, 86% agreed that clinical modules should be considered part of a patient's dental record, and all agreed that student teaching-related modules should not. Great variability existed among these clinical deans as to whether administrative and financial modules should be considered part of a patient record. When patients request their records, close to 50% of responding schools provide the information exclusively on paper. This study found variation among dental schools in their implementation of the Privacy Rule right of access, and although all the respondents had adopted EHRs, a large number return records in paper format.

A 50-year audit of published peer-reviewed literature on pit and fissure sealants, 1962-2011.

OBJECTIVE: Pit and fissure sealants have been used for many decades to prevent the initiation of caries on susceptible tooth surfaces. The purpose of this study was to analyze the peer-reviewed published scientific literature on pit and fissure sealants over the last 50 years. MATERIALS AND METHODS: On the PubMed database, all publications on pit and fissure sealants from 1962-2011 were extracted using the search phrase [(pit OR fissure) AND (sealant OR sealants OR adhesive)]. Details of all retrievals were individually entered into SPSS for analysis. RESULTS: A total of 2829 publications were found. The mean number of authors was 2.73 ± 1.90 (range = 1-23). Although single-authorship was the modal group with 32.1%, it had a sustained decrease from 75.0% for 1962-1971 to 17.6% for 2002-2011. On the contrary, publications with three or more authors increased from 8.3% to 47.3% during the same period. Human studies accounted for 88.6% and clinical trial was 11.9%, followed by reviews at 10.2% and randomized controlled trials at 6.9%. English was the language of reporting for 82.0% of the studies. CONCLUSION: It is anticipated that future research on pit and fissure sealants will focus on newer and more effective materials.

Dental sealant knowledge, opinion, values and practice of Spanish dentists.

BACKGROUND: Multiple guidelines and systematic reviews recommend sealant use to reduce caries risk. Yet, multiple reports also indicate that sealants are significantly underutilized. This study examined the knowledge, opinions, values, and practice (KOVP) of dentists concerning sealant use in the southwest region of Andalusia, Spain. This is a prelude to the generation of a regional plan for improving children's oral health in Andalusia. METHODS: The survey's target population was dentists working in western Andalusia, equally distributed in the provinces of Seville, Cadiz, and Huelva (N=2,047). A convenience sample of meeting participants and meeting participant email lists (N=400) were solicited from the annual course on Community and Pediatric Dentistry. This course is required for all public health sector dentists, and is open to all private sector dentists. Information on the dentist's KOVP of sealants was collected using four-part questionnaire with 31, 5-point Likert-scaled questions. RESULTS: The survey population demographics included 190 men (48%) and 206 women (52%) with an average clinical experience of 10.6 (±8.4) years and 9.3 (±7.5) years, respectively. A significant sex difference was observed in the distribution of place of work (urban/suburb) (p=0.001), but no sex differences between working sector (public/private). The mean±SD values for each of the four KOVP sections for pit and fissure sealants were: knowledge=3.57±0.47; opinion=2.48±0.47; value=2.74±0.52; and practice=3.48±0.50. No sex differences were found in KOVP (all p>0.4). Independent of sex: knowledge statistically differed by years of experience and place of work; opinion statistically differed by years of experience and sector; and practice statistically differed by years of experience and sector. Less experienced dentists tended to have slightly higher scores (~0.25 on a Likert 1-5 scale). Statistically significant correlations were found between knowledge and practice (r=0.44, p=0.00) and between opinion and value (r=0.35, p=0.00). CONCLUSIONS: The results suggest that, similar to other countries, Andalusian dentists know that sealants are effective, have neutral to positive attitudes toward sealants; though, based on epidemiological studies, underuse sealants. Therefore, methods other than classical behavior change (eg: financial or legal mechanisms) will be required to change practice patterns aimed at improving children's oral health.

Oral health and the elderly in Nigeria: a case for oral health promotion.

OBJECTIVES: To determine the prevalence of problems associated with chewing and the relationship with body mass index, the self-reported rating of oral health and normative oral hygiene assessment among the elderly. MATERIALS AND METHODS: This was a descriptive community based study carried out in three locations in Ife-Ijesa zone (south western Nigeria). Elderly persons of 55 years and above were recruited through the religious organisations. All elderly who volunteered were assisted in completing a questionnaire on their socio-demographic status, chewing ability, any quadrant associated with problems and self-rating of oral health. An oral examination under a natural daylight using sterile wooden spatulae and an upright chair was carried out. The Oral Hygiene Index of Greene and Vermillion [Journal of the American Dental Association (1964) 61, p. 172] was used to determine the oral hygiene status. RESULTS: The lower right quadrant had the highest frequency of complaint on difficulty with chewing (15.6%), and 44.1% of the subjects had problems with chewing. Twenty-nine per cent rated their oral health as poor or very poor. There was a statistically significant association between the rating of oral health and the presence of calculus (p = 0.022). This was also true for oral hygiene and having any problem with chewing (p = 0.001). The self-rating of oral health was not in agreement with that of the normative finding. CONCLUSION: Health promotion focusing on the oral health of the elderly is a significant requirement for the study population. Proper evaluation of the effectiveness of traditional dentifrices must be carried out and interventions designed to address the possibility of improper usage.

Is malaria a predisposing factor for third molar pericoronitis in the tropics?

BACKGROUND: Malaria is an important disease in the tropics, and its role as a predisposing factor or co morbidity has been investigated in many diseases including HIV infection and tuberculosis. There are very few studies, which have investigated its role in oral and dental diseases. Our study aimed to demonstrate the possible role of malaria in predisposing to pericoronitis, an infection affecting impacted third molars predominantly. PATIENTS AND METHODS: Thirty-eight patients presenting with pericoronitis were tested for malaria parasites and results compared with that obtained from controls that were equally susceptible to pericoronitis but did not have the infection. RESULTS: 19.7% of the study group compared to 6.6% of control group had malaria parasite in their blood. This difference was statistically significant, P=0.018 (Fisher's exact). The odds ratio was 4.3 (95% CI=1.2-17.0). CONCLUSIONS: Malaria appears to be a predisposing factor to pericoronitis in this study. There is a need for further studies on the possible role of malaria in oral and dental diseases.

Oral health status in a population of Nigerian diabetics.

Oral manifestations of diabetes mellitus have been documented, but the effect of glycemic control on the oral tissues has been scantily reported. The oral health status of 65 metabolically controlled adult diabetic patients attending the Diabetes Clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, was prospectively assessed over six months and compared with that of 54 non-diabetic acting as controls. The mean duration of diabetes was 100.5+/-85.1 months. The difference in periodontal status of the patients and control, assessed using the Community Periodontal Index of Treatment Needs (CPITN), was not statistically significant (p=0.07). The degree of hyposalivation between the two groups was, however, statiscally significant (p<0.05). No significant difference was observed in the altered taste, burning mouth sensation, angular cheilitis, glossitis, and stomatitis status of the two groups. We conclude, with adequate metabolic control, the oral health status of a diabetic may not be significantly different from that of a non-diabetic except for xerostomia. A good understanding of the interactions between systemic diseases and oral health is imperative for physicians and dental practitioners. The need for early detection and closer linkages between the dental and medical professions in managing diabetic patients is emphasized.

Gender distribution of dentists in Nigeria, 1981 to 2000.

In Nigeria, modern dental practice is relatively recent. The dawn can be traced to 1915 when the first government dentist was employed in Lagos, then the country's capital. There are presently four dental schools in the country; each graduates an average of thirty dentists annually. The present study determined the trends in the gender distribution of dental practitioners over the twenty-year period from 1981 to 2000 and used available data to project into the future. Data was collected from governmental and nongovernmental publications. The results indicate that there are now 2,598 licensed dentists serving the country's population of 123 million. A vast majority of these dentists work in urban centers, and only about 20 percent work in the rural areas where over 70 percent of Nigerians reside. There has been a male preponderance in the number of practicing dentists: only fifty-eight (15.3 percent) of 379 dental practitioners were female in 1981, though this figure has risen steadily to 35.1 percent of 2,598 dentists at the end of 2000. However, over the twenty-year period, the percentage of females was consistently higher among dental than medical practitioners. In 1981, for example, the percentage female was 15.0 among both dental and medical practitioners, but by the end of 2000 this had increased to 35.1 percent among dental practitioners and only 19.0 percent among medical practitioners. The imbalance in gender distribution of dental practitioners is steadily normalizing, and projections, using current trends, indicate that gender balance will be attained in the year 2015.

From didactic teaching to participatory learning. An innovative approach.

A course in Public Oral Health is currently offered by the Division of Public Oral Health (POH) to students in their final (6th year) of study for the degree of Bachelor of Dental Science. A fundamental aspect of this project was to shift the teaching methods from didactic to a participatory, student-centred approach, based on current local and international trends in medical, dental and general education. In 1999 the course covering core Public Health topics was presented over a period of 20 weeks to 49 students who were divided into three groups. Staff members were trained in participatory, student-centred teaching methods. An evaluation of students and staff was conducted at the end of the course. Results show that students were satisfied with the teaching methods employed and commended the Division on the organisation of the course. Students were unhappy with the amount of reading required in preparation for weekly seminars. They felt that the course was inappropriately positioned in their final year of study, due to pressure of achieving quotas for the clinical courses. Nevertheless, the main objectives of the Public Oral Health course were achieved through the adoption of a participatory, student-centred teaching approach.

HIV/AIDS situation in Africa.

The HIV/AIDS pandemic marks a severe development crisis in Africa, which remains by far the worst affected region in the world. Forty-two million people now live with HIV/AIDS of which 29.4 million (70.0%) are from sub-Saharan Africa. Approximately 5 million new infections occurred in 2002 and 3.5 million (70.0%) of these were also from sub-Saharan Africa. The estimated number of children orphaned by AIDS living in the region is 11 million. In 2002, the epidemic claimed about 2.4 million lives in Africa, more than 70% of the 3.1 million deaths worldwide. Average life expectancy in sub-Saharan Africa is now 47 years, when it would have been 62 years without AIDS. HIV/AIDS stigma is still a major problem despite the extensive spread of the epidemic. A complex interaction of material, social, cultural and behavioural factors shape the nature, process and outcome of the epidemic in Africa. However, too many partners and unprotected sex appear to be at the core of the problem, Even if exceptionally effective prevention, treatment and care programmes take hold immediately, the scale of the crisis means that the human and socio-economic toll will remain significant for many generations. Although 70% of people living with HIV/AIDS are in Africa, only 6,569 (4.7%) of the 140,736 scientific publications on HIV/AIDS, from 1981 to 2000, are directly related to Africa. Effective responses to the epidemic require a multisectoral approach, including governments, the business sector and civil society.

HIV/AIDS pandemic and surgical practice in a Nigerian teaching hospital.

The objective of the study was to determine the effects of the HIV/AIDS pandemic on surgical practice in a Nigerian teaching hospital. It involved a questionnaire survey of all the doctors practising in the surgical specialties at Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria, in order to obtain their attitudes and practices toward HIV-positive surgical patients. Sixty-five doctors were interviewed, their ages ranged from 26 years to 62 years with a mean age of 35.1 years. The majority (35.4%) were in general surgery or obstetrics and gynaecology (24.6%). Almost half (47.7%) had operated on known HIV-positive patients and the majority were in support of preoperative HIV screening. Almost all (95.4%) were worried about occupational HIV infection--a significant number of consultants would refuse to be screened if their patient were allowed to know the results (P = 0.014). The cross infection control commonly employed included adequate instrument sterilization, presurgical hand washing and the use of gloves and facemasks. The wearing of eye goggles, double gloving, indirect instrument passing and wearing of water impervious gowns were used less frequently. As HIV/AIDS infected individuals are presenting for surgical procedures in the hospital, there is a need to improve the use of universal infection control measures and to educate all categories of healthcare personnel in order to allay the fears and to prevent discrimination that could militate against effective management of HIV/AIDS patients.