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Sibanda L, Ghotane SG, Bernabe E, Challacombe SJ, Pitts NB, Gallagher JE. Caries clusters at lesion-severity thresholds: A Sierra Leone case study. Community Dent Oral Epidemiol 2024; 52:76-83. [PMID: 37622680 DOI: 10.1111/cdoe.12903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 06/30/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES Despite being almost entirely preventable, globally, dental caries is extremely prevalent. Moreover, dental caries will continue to present an even larger challenge for lower income countries, particularly those in the African context, as they transition to a more Western diet. Hence, epidemiological data providing insight into disease patterns and trends is critical to inform public health action. The purpose of this study was to examine dental caries clusters by caries detection threshold among 15-year-old adolescents in Sierra Leone, using data from the latest national survey, and to explore associated sociodemographic factors. METHODS This paper presents a secondary analysis of oral health data on 490 15-year-olds from the Sierra Leone national oral health survey of schoolchildren. Hierarchical cluster analysis of dental caries experience was conducted across all surfaces at four decay detection thresholds using the International Caries Detection and Assessment System (ICDAS) (clinical: ICDAS 2-6, cavitated: ICDAS 3-6, obvious: ICDAS 4-6 and extensive obvious: ICDAS 5-6 decay) across the four regions of Sierra Leone. Ordered logistic regression was used to estimate the association of sociodemographic factors with generated clusters relating to clinical and obvious decay experience. These are of both clinical and epidemiological relevance. RESULTS A 3-cluster decay pattern representing a 'low' to 'high' decay experience distribution was observed under each decay detection threshold across surfaces. For clinical decay (including visual enamel caries), 28.8% had low, 55.1% medium and 15.9% high caries status. In the adjusted model, the only significant risk factor across obvious and clinical decay thresholds was region, with adolescents outside the Western region more likely to experience decay. CONCLUSION This study suggests that adolescents in Sierra Leone fall into three distinct caries clusters: low, medium to high decay experience distribution, regardless of decay threshold. It reinforces the importance of recognizing dental caries detection thresholds and the use of contemporary epidemiological methodology. This suggests that adolescents outside the Western region are likely to have higher caries experience. The data also provides insight to the nature of adolescents in each cluster and should help to inform policy and planning of the integration of oral health into primary care and school systems.
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Affiliation(s)
- L Sibanda
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, London, UK
- NHS England London Region, Wellington House, London, UK
| | - S G Ghotane
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - E Bernabe
- Centre of Dental Public Health and Primary Care, Institute of Dentistry, Queen Mary University of London, London, UK
| | - S J Challacombe
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Tower Wing, Guys Hospital, London, UK
| | - N B Pitts
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Oral, Clinical and Translational Sciences, King's College London, Tower Wing, Guys Hospital, London, UK
| | - J E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Denmark Hill Campus, London, UK
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Gallagher JE, Mattos Savage GC, Crummey SC, Sabbah W, Varenne B, Makino Y. Oral Health Workforce in Africa: A Scarce Resource. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2328. [PMID: 36767693 PMCID: PMC9915704 DOI: 10.3390/ijerph20032328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
The World Health Organization (WHO) African Region (AFR) has 47 countries. The aim of this research was to review the oral health workforce (OHWF) comprising dentists, dental assistants and therapists, and dental prosthetic technicians in the AFR. OHWF data from a survey of all 47 member states were triangulated with the National Health Workforce Accounts and population data. Descriptive analysis of workforce trends and densities per 10,000 population from 2000 to 2019 was performed, and perceived workforce challenges/possible solutions were suggested. Linear regression modelling used the Human Development Index (HDI), years of schooling, dental schools, and levels of urbanization as predictors of dentist density. Despite a growth of 63.6% since 2010, the current workforce density of dentists (per 10,000 population) in the AFR remains very low at 0.44, with marked intra-regional inequity (Seychelles, 4.297; South Sudan 0.003). The stock of dentists just exceeds that of dental assistants/therapists (1:0.91). Workforce density of dentists and the OHWF overall was strongly associated with the HDI and mean years of schooling. The dominant perceived challenge was identified as 'mal-distribution of the workforce (urban/rural)' and 'oral health' being 'considered low priority'. Action to 'strengthen oral health policy' and provide 'incentives to work in underserved areas' were considered important solutions in the region. Whilst utilising workforce skill mix contributes to overall capacity, there is a stark deficit of human resources for oral health in the AFR. There is an urgent need to strengthen policy, health, and education systems to expand the OHWF using innovative workforce models to meet the needs of this region and achieve Universal Health Coverage (UHC).
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Affiliation(s)
- Jennifer E. Gallagher
- Dental Public Health, King’s College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Denmark Hill Campus, London SE5 9RS, UK
| | - Grazielle C. Mattos Savage
- Dental Public Health, King’s College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Denmark Hill Campus, London SE5 9RS, UK
| | - Sarah C. Crummey
- Dental Public Health, King’s College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Denmark Hill Campus, London SE5 9RS, UK
| | - Wael Sabbah
- Dental Public Health, King’s College London, Faculty of Dentistry, Oral & Craniofacial Sciences, Denmark Hill Campus, London SE5 9RS, UK
| | - Benoit Varenne
- Dental Office, WHO Oral Health Programme NCD Department, Division of UHC/Communicable and NCDs, World Health Organization, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Yuka Makino
- Dental Office, Noncommunicable Diseases Team, WHO Regional Office for Africa, Cité Djoué, Brazzaville P.O. Box 06, Congo
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Ghotane SG, Challacombe SJ, Don-Davis P, Kamara D, Gallagher JE. Unmet need in Sierra Leone: a national oral health survey of schoolchildren. BDJ Open 2022; 8:16. [PMID: 35701398 PMCID: PMC9194785 DOI: 10.1038/s41405-022-00107-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/29/2022] [Accepted: 05/10/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Sierra Leone (SL), in West Africa, with a population of over 7.5 million people has suffered the effects of a civil war previously, and more recently Ebola & Covid-19. Dental care is very limited, mostly in the capital Freetown and the private sector. No dental education is available in the country. The objective of this research was to investigate the oral health needs of schoolchildren at key ages, to inform future action. MATERIALS AND METHODS This first national oral health survey of schoolchildren at 6-, 12- and 15-years was conducted in urban and rural settings across all four regions using a multi-stage cluster sampling in line with the WHO guidelines, adapted according to contemporary survey methods to include 'International Caries Detection and Assessment System (ICDAS)'. Whilst parents were invited to complete a questionnaire for 6-year-old children, 12- and 15-year-olds self-completed a questionnaire. Data were weighted according to age and regional population and analysed using STATA v.15 and SPSS v.22. RESULTS A total of 1174 children participated across 22 schools from all four regions. Dental caries was prevalent (over 80% of all age-groups having clinical decay; ICDAS score ≥ 2) and largely untreated. No children had fillings and only 4% had missing teeth. Amongst 6, 12 and 15-year-olds, average decay levels at ICDAS > 3 threshold was 3.47 (primary teeth), 2.94 and 4.30 respectively. Almost, 10% (n = 119) of all children reported experiencing pain in their teeth with 7% (n = 86) children having PUFA lesions present. At least one in five children required one or more dental extractions. 'Age' was a significant predictor of dental caries experience and the odds of having dental caries experience was higher in rural areas at D3-6MFT (p < 0.05). CONCLUSION The findings demonstrate a vast unmet oral health need in the children of SL. Using ICDAS as an epidemiological tool in a low-income country provides valuable insight to the pattern of oral disease to inform health service planning. Urgent action is required to address this silent epidemic.
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Affiliation(s)
- S G Ghotane
- Department of Women & Children's Health, Faculty of Life Sciences & Medicine, King's College London, Becket House, 1 Lambeth Palace Road, London, SE1 7EU, UK.
| | - S J Challacombe
- Faculty of Dentistry, Oral & Craniofacial Sciences, Centre for Host Microbiome Interactions, King's College London, Floor 22, Guys Tower, Guys Hospital, London, SE1 9RT, UK
| | - P Don-Davis
- College of Medicine and Allied Health Sciences, Connaught Hospital, Freetown, Sierra Leone
| | - D Kamara
- Oral Health Department, Connaught Hospital, Freetown, Sierra Leone
| | - J E Gallagher
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Centre for Host Microbiome Interactions, Denmark Hill Campus, Bessemer Road, London, SE5 9RS, UK
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Martignon S, Cortes A, Gamboa LF, Jácome-Liévano S, Arango-De-la-Cruz MC, Cifuentes-Aguirre OL, Fortich-Mesa N, Ramos-Martínez K, Sanjuán-Acero J, Alfaro L, Mejía L, Usuga-Vacca M. Effectiveness of the ICCMS caries management system for children: a 3-year multicentre randomised controlled trial. Acta Odontol Scand 2022; 80:501-512. [PMID: 35166190 DOI: 10.1080/00016357.2022.2038263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This 3-year multicentre randomised controlled trial compared, in 6-7-year-old Colombian children, the effectiveness of the ICCMS (International Caries Classification and Management System) with a conventional caries-management system (CCMS) in terms of individual caries-risk, caries lesions, and secondarily, oral-health-related knowledge/attitudes/practices, and number of appointments. MATERIAL AND METHODS With ethical approval, 240 6-7-year olds from six Colombian clinics were recruited. Trained examiners conducted the following baseline/follow-up assessments: Caries risk (Cariogram-ICCMS); caries severity/activity staging (ICDAS-merged combined radiographic/visual); sealants/fillings/missing teeth, and oral-health-related knowledge, attitudes and practices. Children received their randomly allocated (ICCMS/CCMS) care from dental practitioners. Outcomes: caries-risk control (children); caries-progression control (tooth surfaces); oral-health-related knowledge/attitudes/practices improvement (parents/children), and appointments' number (children). Descriptive and non-parametric/parametric bivariate analyses were performed. RESULTS Three-year-follow-up: n = 187 (77.9%; ICCMS: n = 92; CCMS: n = 95) disclosed a baseline-to-3-year overall high-caries-risk children decrease (ICCMS: 60.9-0%, p < .001; CCMS: 54.7-5.3%, p < .001) (p > .05). ICCMS versus CCMS showed: fewer tooth-surface caries progression (6.2% vs 7.1%, p = .010) and fewer active-caries lesions (49.8% vs. 59.1%, p < .05); higher proportion of children with ≥2/day fluoride-toothpaste tooth-brushing practice (p < .05); similar mean number of appointments (10.9 ± 5.9 vs. 10.0 ± 3.8, p = .15). CONCLUSION Both caries-management systems showed similar effectiveness in caries-risk control, with ICCMS more effectively controlling tooth-surface caries progression and improving toothbrushing practices.
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Affiliation(s)
- Stefania Martignon
- UNICA – Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
| | - Andrea Cortes
- UNICA – Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
| | - Luis Fernando Gamboa
- UNICA – Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
| | - Sofia Jácome-Liévano
- UNICA – Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
| | | | | | - Natalia Fortich-Mesa
- School of Dentistry, Corporación Universitaroa Rafael Núñez, Cartagena, Colombia
| | | | - Johanna Sanjuán-Acero
- Paedriatric Dentistry Department, Fundación Universitaria de Colegios de Colombia (UNICOC), Bogotá, Colombia
| | - Lizelia Alfaro
- UNICA – Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
| | - Lofthy Mejía
- UNICA – Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
| | - Margarita Usuga-Vacca
- UNICA – Caries Research Unit, Research Department, Universidad El Bosque, Bogotá, Colombia
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