COMMUNICATION

 

Oral Health in South Africa: Exploring the role of dental public health specialists

 

 

KJ Ramphoma

B.Ch.D (UWC). M.Ch.D (Comm Dent) (UWC). School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa

Correspondence

 

 

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ABSTRACT

This report explores the role of dental public health specialists in the South African health system in curbing the increasing burden of oral diseases, most of which are preventable. Globally, these specialists play vital roles in addressing the oral health needs and wellbeing of the whole population through influencing policies and informing decisions. The general neglect of oral health in South Africa coupled with the individually-focused management of oral diseases has led to an exorbitant expenditure of public health funds in the attempt to provide care.
Their expertise equips these specialists competent to design, supervise and evaluate appropriate oral health interventions and preventive programmes to benefit the population as a whole. While there are 33 of these professionals registered with the Health Professions Council of South Africa, their skills seem to be largely under-utilised in the public health system arena with only one being so employed. The increasing prevalence of oral diseases and the lack of success in management of the problem thus far necessitates a critical review of alternative strategies of addressing oral health matters. This paper explores the role of these specialists in addressing the oral health of the South African public at large.

Keywords: oral health, South Africa, dental public health specialists.

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INTRODUCTION

The significance of a healthy mouth in general health and well-being cannot be overemphasised. Not only does it allow the individual to eat, speak and chew without difficulty and embarrassment but it is also important for socializing.¹ Diseases of the mouth, on the other hand, may be indicative of systemic conditions including the serious afflictions of HIV, oral cancer and other diseases. An affected mouth may lead to unbearable pain, discomfort, poor nutritional intake and poor growth, often ending in time lost from both school and work. Most oral diseases are preventable and while they are not always life-threatening, they are a major public health problem in South Africa, posing an inordinate economic threat due to the growing demand for public health care.² In spite of the impact oral health has on general health and quality of life, it is still one of the most neglected aspects of health in most developing countries, including South Africa.

 

STATE OF ORAL HEALTH IN SOUTH AFRICA

Oral health disparities continue to widen, more so in the disadvantaged and vulnerable groups where the vast majority experience the highest burden of oral diseases.^3-5 Moreover, there is a general lack of oral health facilities and workforce, exacerbated by an unequal distribution of dental services in the country. To escalate matters further, the high burden of infectious diseases such as HIV and TB faced by the country impacts upon budgetary priorities reducing the availability of funding for oral health matters.⁶ While 84-90% of the South African population is dependent on the public oral health services, only just one quarter of all South African dentists were employed by the public sector in 2009.⁷

The results of the last National Oral Health Survey (1999-2002) revealed that approximately 45-60% of children living in South Africa require treatment for dental decay.⁸ In the Western Cape Province alone, 80% of children needed dental care. It was further indicated that 32% of children require orthodontic treatment because of premature dental extractions. The considerable majority of adolescents and adults presented with gingivitis and periodontal diseases.⁸ With the high prevalence of HIV/AIDS, many of the infected patients also suffer oral HIV-associated lesions.

 

MEETING THE ORAL HEALTH NEEDS OF THE POPULATION

To effectively address these issues, there is a need for an alternative oral health care system, which is population-based with a focus on prevention of oral disease and oral health promotion, as opposed to the existing curative-driven and individually focused system. This requires the expertise of dental public health specialists also known as community dentistry specialists. These cadres of specialists in dentistry are particularly trained to work for the public to assess the dental needs of the population through conducting oral health surveys and surveillances of the country, together with community-based disease prevention and health promotion programmes and other similar activities. Moreover, they are also trained to plan appropriate evidence-based interventions, to formulate oral health policies, strategies and the implementation thereof and to manage the oral health services of the country. These specialists are unique in that they are not primarily clinical specialists but rather focus on the oral health status of the whole population as opposed to that of individuals. According to the current records of the Health Professions Council of South Africa,⁹ there are 36 of these specialists registered. However, only the Limpopo Province has previously (no longer) employed such a specialist for these population health purposes, while the majority of the Community Dentists are in academia, primarily due to lack of employment opportunities in the public sector.

The manner in which oral health issues have been addressed in the South Africa has not been effective to date. Curative treatment of oral diseases is economically draining for the country, with estimates that the total costs for providing curative dental care would outstrip the whole healthcare budget in low-income countries.¹⁰ Curative treatment is technically challenging and requires the use of expensive equipment and highly skilled professionals.¹¹ Some developed countries have taken strides in investing in preventive oral health programmes, largely with the expertise of dental public health specialists. They have not only reported significant savings in dental health expenditure but also reductions in the prevalence of oral diseases.

In contrast to South Africa, where the role of these specialists is mainly limited to academic institutions, several other countries have demonstrated an effective use of community dentists in other areas of health. In some countries, these specialists work collaboratively with communities, governments and other health agencies to develop resources, to plan and implement oral diseases prevention programmes and the promotion of good oral health. They also work with food and drug administration where they can influence policies in regulations regarding constraint of certain harmful trades in order to protect and promote good public oral health. Under the aegis of Medical Research Councils and National Health Institutes, population based studies are conducted to answer critical dental public health questions and the specialists are also involved in translating their findings into recommendations. As lecturers in schools of public health, medical schools and nursing schools, they incorporate dental education in different curriculums. They work as oral health advocates, advising, amongst other responsibilities, how to balance budgetary resource allocations to meet the identified needs. It may be seen that their essential role is the assessment of dental care needs and the monitoring of disease trends, of the utilization of dental services and of the required manpower of the dental workforce, enabling an evaluation of the delivery of dental services.

 

CONCLUSION

The last National Oral Health Survey in South Africa was conducted over a decade ago.⁸ There are currently no oral health surveillance data being collected on a continuous basis besides that of services provided. There are very few existing school-based oral health programmes in the country and regrettably, there is no monitoring and evaluation of these efforts resulting in very little knowledge regarding the effectiveness of these programmes. These factors raise critical questions with regards to the reliability of what is now known about the state of oral health in the country and hence what resource allocation is appropriate. Evidence shows that dental public health specialists are the driving force and the key experts in efforts to improve the oral health of the population. The current strategies in place such as the National Health Insurance (NHI) and the School Health Policy provide a good platform on which these professionals may most effectively be used. The South African Government and the Department of Health need to make informed decisions leading to utilizing these professionals in Provincial Health Departments to facilitate delivery of the much needed oral health services. This would not only ensure that the training invested in these specialists and their future colleagues does not go in vain but, more importantly, is definitively for the good of the public in ensuring the delivery of optimal oral health care.

Acknowledgements: The author wishes to acknowledge Professor Ehimario U. Igumbor (U.S. Centers for Disease Control and Prevention (CDC), Pretoria South Africa) for his support on this important issue and his continuous interest in oral health matters.

Conflict of Interest: None declared.

 

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Correspondence:
KJ Ramphoma
King Dinuzulu Hospital, Oral and Dental Training Centre
Durban, South Africa.
King George V Ave, Durban, 4041.
E-mail: ramphomak@ukzn.ac.za