South Africa: Oral Health - Dire Shortage Of Dental Practitioners In Public Sector
Oral health is critical to people's overall health, but a dire shortage of oral health practitioners in the public health sector means that many people are not getting the oral healthcare services they need.
Some dental practitioners such as Dr Bulela Vava says these chronic shortages, especially in provinces like the Eastern Cape, force dentists in the public health system to operate as "dental butcheries as opposed to oral healthcare centres".
Vava is the founder and national chairperson of the Public Oral Health Forum.
Oral healthcare is integrated into the primary health care package provided in the public health sector.
As the rural and poor province that it is, the focus of the Eastern Cape should be on prevention, but it does not have more than 50 oral hygienists, says Vava. The Eastern Cape health sector is under immense pressure when it comes to oral and dental healthcare. Owing to the lack of qualified staff, the provinces' dentists have no time for restoration services or sophisticated processes other than pulling teeth, according to Vava.
But this situation is not limited to the Eastern Cape.
Vava tells Spotlight that oral health patients across the country do not have access to the requisite services.
"With more than 6 000 registered dentists in the country, [fewer] than 2 000 of these practice in the public service, though the public healthcare system has the majority of the population. Even the 2 000 is not evenly distributed across the provinces. As usual, urban areas have the better share of dentists," says Vava.
"The poor population in rural and peri-urban areas depend on a strained and under-resourced public health service for most of their oral healthcare needs. It becomes worse in the rural areas, as patients do not have access to the oral health services that they should have. The government is pushing for the National Health Insurance programme that will focus on providing primary healthcare to the citizens, but the current service delivery model focuses on curative as opposed to preventative and educational efforts."
According to Vava, the challenges to access oral healthcare highlights the need for the successful implementation of primary oral healthcare, but with the shortage of oral hygienists and dental therapists, this becomes a challenge.
The shortage of qualified personnel can easily be felt both in rural and urban areas, as patients are struggling to access the most basic services such as preventative support. Without the required oral and dental health education, many people find themselves dealing with unpleasant consequences like tooth decay and gum diseases.
The numbers
According to the Health Professions Council of South Africa's (HPCSA) 2018/19 annual report, there are 6 374 dentists in South Africa serving a population of 59.6 million people. This translates into 9 350 people per dentist. The report states that the country has 4 325 dental assistants and 1 257 dental therapists. According to the report the country has only 740 oral hygienists.
A dental assistant is registered with the Professional Board for Dental Therapy and Oral Hygiene of the HPCSA and often works in dental practices, clinics, or hospitals where they help prepare patients and "assist in dentistry with regard to infection control, practice management and the education of patients, the public and the community regarding basic oral health".
The Regulations relating to the scope of practice of the profession of oral hygiene gazetted in 2017, refers to an oral hygienist as a practitioner who can develop and implement oral health promotion programmes; assess and clinically examine patients' oral health, take x-rays and make diagnoses on oral hygiene and advise and educate patients about oral self-care.
The Regulations defining the scope of the profession of dentistry gazetted in 2009, defines a dentist as a practitioner who, among others, can physically examine, make diagnoses of oral diseases and injuries, perform dental procedures, and prescribing medicine to manage the oral health of a patient.
Health Department spokesperson Popo Maja tells Spotlight that there is indeed a shortage of dental practitioners for the entire public health sector, and the challenge is worse in rural areas.
"The shortage [resulted from] 80% of oral and dental health practitioners who prefer the private sector, making it difficult for the majority of citizens who are not on medical aid to access services," he says.
"While there is a dire shortage of dental practitioners in the public sector, all oral and dental health services and specialties are offered at different primary healthcare facilities throughout the country. But the waiting list for none emergency services may be long depending on the provinces. It's best for patients to check with their nearest clinic or hospital if oral health services are offered by the facility, or if you need to be referred to a facility that does. In some provinces there are mobile services to accommodate some communities," he says.
Maja could not confirm exactly how many registered dentists, dental assistants, dental therapists, and oral hygienists are available in the country. He referred Spotlight to the HPCSA.
Saving teeth
Vava is convinced that patients do not have access to even 50% of the oral health services they are supposed to have access to because government opts for cheaper services.
"At a clinic in a regional hospital where a patient is expected to receive restorative services, it is just extraction every day. Unused dental supplies are expiring on healthcare facilities' shelves because dentists are busy with extraction," he said.
According to Vava, it is often cheaper to just extract teeth compared to restorative and preventative procedures. "Hence there are elderly people who have never visited a dentist in their lifetime. They are terrified of the dentist and don't see the need for dental care unless they feel excruciating pain that forces them to consult a dentist. Our oral health system needs more dental hygienists to travel to under-serviced [sections of the] population to perform preventative education," says Vava.
'Incessant pain'
When Spotlight visited the dental clinic in Motherwell, it was Sinazo April's (42) second visit to the clinic. Four years ago her tooth was extracted, and she developed an infection that made her wary of dental visits. She says pain forced her to return.
"Incessant pain drove me to the clinic though I did not want anything to do with this clinic owing to my previous experience," she tells Spotlight. April says she was not informed about whether or not the tooth can be saved, it was just extracted.
Gcobisa Magwala (31) also visited the clinic with her eight-year-old son Aphiwe, who was suffering a toothache. Magwala said the child's tooth was extracted, and she wanted to have her own teeth cleaned at the same time but was told to make an appointment, which meant a two to three-month waiting time. Magwala told Spotlight she doubts she will return to have that done. "But my boy was excited about consulting the dentist as it was his first time. Everything went well. We didn't experience anything untoward. The dentist was friendly."
A nurse who spoke to Spotlight on condition of anonymity, says that there is a dire need for dentists in areas such as Motherwell in the Nelson Mandela Bay metro. She says these shortages have been a problem for several years.
"Although the number of practising dentists at this clinic increased from two to three in recent years, it still doesn't meet the demand. Motherwell is one of the fastest-growing townships in Nelson Mandela Bay and services neighbouring townships such as Wells Estate and Ikamvelihle, [all using] the same dental clinic," she says.
Bring dental care to schools
"Oral health education is the integral component at all primary health care facilities," says Professor Yusuf Osman of the faculty of dentistry at the University of the Western Cape. "Employing an oral hygienist in all primary health care facilities will ensure that oral health becomes part of the general health system and that all patients visiting primary health care facilities will be screened for oral health conditions and are informed about how to practice good oral hygiene."
Osman says the best approach to improve oral health is to bring dental care to schools to ensure that the burden of the disease does not continue into the future. "It is also important to seal the grooves of the first permanent molar soon after it erupts into the mouth. This prevents decay from setting in at the base of the groove in the tooth, but more importantly, it is the awareness of the tooth and its health in the mind of the child and the parent," he says.
Dental Care Remains Neglected In State, Nation
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In this image released on Thursday, March 18, 2021, dentists are confronting the fallout from a year of disrupted dental care and treatment. Press release and media available to download at www.Apmultimedianewsroom.Com/newsaktuell. HANDOUT IMAGE - please refer to special instructions. (Shutterstock/FDI World Dental Federation/news aktuell via AP Images)
COLUMBUS, Ohio — The following article was originally published in the Ohio Capital Journal and published on News5Cleveland.Com under a content-sharing agreement.
One of the leading health care needs in the state of Ohio is one that’s most neglected, especially when it comes to low-income communities.
As dental director at the Cincinnati Health Department and as part of the CincySmiles dental clinic program, Dr. Larry Hill’s major task was making sure low-income and high risk populations had access to oral health services, something he says isn’t enough of a priority in the state.
“It’s been a decades long battle to try to do something about this,” Hill said. “Oral health is…connected to everything else (in health), but it’s been forgotten in most state and national health policy.”
Hill said it’s hard to understand how dental care has been overlooked by state legislation, federal measures and insurance companies alike, when the small area of the mouth makes so much of a difference in overall health.
According to the Harvard Medical School, those with gum disease are more likely to have other medical issues, such as high blood pressure, rheumatoid arthritis and osteoporosis.
Infections in the oral cavity can make diabetes worse, impact the cardiovascular system, and can even create adverse pregnancy outcomes, something Ohio already struggles with when it comes to people of color.
Health disparities that impact low-income communities and people of color extend to dental care as well, Hill said.
“The system hasn’t responded to the needs of these populations,” Hill said. “The system is there for people who have insurance and who can afford to take time off work.”
An Ohio Department of Health screening of more than 3,000 third-grader’s oral health from 2017-18 showed nearly half of the children screened had a history of tooth decay.
According to the study, while 84% of the third-graders reported having a dental visit within the past year, 20% had at least one untreated cavity. Parents of children in the study cited several difficulties in getting dental care for their children.
“The cost of dental care was the factor most often cited by parents as a barrier to care, followed by the lack of dental insurance,” the study stated.
The study also found that lower-income families, those covered by Medicaid, and uninsured children “experience more tooth decay and have a more urgent need to see the dentist because of pain or infection.”
“However, these children are also those who are less likely to see the dentist on a regular basis,” according to the study.
Part of the problem, statewide and nationally, with getting access to dental care is a shortage in dental health professionals, and a shortage in those professionals who accept Medicaid. For that reason, David Maywhoor, executive director of the Ohio Public Health Association says the industry needs to be more open to a different way of caring for community dental care: dental therapists.
Dental therapists are trained in oral health care, usually in specific procedures like root canals or cavity filling, but work under the supervision of dentists. Typically, dental therapists work in facilities or communities that understaffed or without the resources to have full-time dental care.
“When it works best, young people from communities of need go into an education program, come back out and begin working in communities of need,” Maywhoor said. “When a child is sitting in a (dental) chair…they’re seeing a person that looks like them.”
Maywhoor said it’s been a struggle having the nation embrace dental therapists because of “misinformation” claiming therapists have less training and less supervision than dentists, despite taking some of the same classes and dental students and being supervised by licensed dentists.
“I don’t know if it’s a question of control, or fear of the unknown,” Maywhoor said.
In 2017, Ohio state Sens. Peggy Lehner, and Cecil Thomas introduced a bill to establish the licensing of dental therapists in Ohio, but the Health, Human Services and Medicaid Committee only held two hearings on the bill, and it was never put up for a vote.
But with legislation passed in Minnesota and Connecticut, and several other states reviewing legislation on dental therapy, Hill said it’s time for Ohio to move forward, especially with a pandemic spotlight on public health.
“Every day that we don’t do this, people aren’t getting the care that they should be able to get,” Hill said.
Copyright 2021 Scripps Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Happy Smiles: Good Oral Health Important To Overall Well-being | Mahoney
Mark A. Mahoney, Guest columnist Published 3:07 p.M. ET April 27, 2021
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A dental hygienist cleans 11-year-old Deitra "DeeDee" Jackson’s teeth at Neighborhood Medical Center as her mom Kisha Simms, 38, looks on in this file photo. (Photo: Alicia Devine/Tallahassee Democrat)
Oral health is essential to general health and well-being. Oral disease can cause pain and infections that may lead to problems with eating, speaking, and learning. It can also affect social interaction and employment potential.
The three oral conditions that most affect overall health and quality of life are cavities, severe gum disease and severe tooth loss.
Oral health refers to the health of the teeth, gums, and the entire oral-facial system that allows us to smile, speak, and chew. Some of the most common diseases that impact our oral health include cavities (tooth decay), gum (periodontal) disease, and oral cancer.
Oral conditions are frequently considered separate from other chronic conditions, but these are actually inter-related. Poor oral health is associated with other chronic diseases such as diabetes and heart disease. Oral disease also is associated with risk behaviors such as using tobacco and consuming sugary foods and beverages.
Cavities
Cavities are caused by a breakdown of the tooth enamel by acids produced by bacteria located in plaque that collects on teeth, especially along the gumline and in the crevices on the chewing surfaces of the teeth.
Eating and drinking foods high in carbohydrates cause this bacteria to produce the acids that can cause the outer coating of the tooth (enamel) or root surface to break down (demineralize).
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Deitra "DeeDee" Jackson, 11, has her teeth cleaned at the Neighborhood Medical Center located near Rickards High School. (Photo: Alicia Devine/Tallahassee Democrat)
Although cavities are largely preventable, they are one of the most common chronic diseases throughout the lifespan. About one-fourth of young children, half of adolescents and more than 90% of adults experienced tooth decay.
Untreated tooth decay affected 10% of young children to 26% of adults aged 20–64.2 Untreated tooth decay can lead to abscess (a severe infection) under the gums which can spread to other parts of the body and have serious, and in rare cases fatal, results.
Gum (periodontal disease)
About 4 in 10 adults aged 30 years or older had gum (periodontal) diseases in 2009–2014. Gum disease is mainly the result of infections and inflammation of the gums and bone that surround and support the teeth.
Certain chronic conditions increase one’s risk for periodontal disease including diabetes, a weakened immune system, poor oral hygiene, and heredity. Tobacco use is also an important risk factor for gum disease.
If early forms of periodontal diseases are not treated, the bone that supports the teeth can be lost, and the gums can become infected. Teeth with little bone support can become loose and may eventually have to be extracted.
Details on periodontal disease can be found at cdc.Gov.
Oral cancer
In 2016, there were nearly 45,000 new cases of cancer of the oral cavity and pharynx diagnosed in the United States and more than 10,000 deaths.
Preventing high risk behaviors, that include cigarette, cigar or pipe smoking, use of smokeless tobacco, and excessive use of alcohol are critical in preventing oral cancers. Early detection is key to increasing the survival rate for these cancers.
Disparities in access to oral health
Cavities (also called tooth decay) are one of the most common chronic conditions affecting millions of Americans. Non-Hispanic Blacks, Hispanics, and American Indians and Alaska Natives generally have the poorest oral health compared to other US racial and ethnic groups.
This is often a result of the social determinants of health – conditions in the places where people are born, live, learn, work, and play. More details on disparities in oral health are available at cdc.Gov.
Additional educational resources
Two additional factors that play important roles in promoting oral health are nutrition and diabetes. Links to two beneficial resources to better understand their role(s) follow:
Nutrition and your dental health (American Dental Association)
mouthhealthy.Org.
Diabetes and your teeth (National Diabetes Education Program) – 2 page information sheet is at cdc.Gov/diabetes.
To better understand the health and economic benefits of preventing chronic diseases (oral disease in this case) read the two page Power of Prevention fact sheet.
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