Use of plants in oral health care by the population of Mahajanga, Madagascar

BACKGROUND

The use of medicinal plants to address oral health problems is not well documented in Madagascar, yet the country is full of endemic flora. The aim of this study was to collect information on the use of plants in the region of Mahajanga, Madagascar, for the treatments of oral diseases mainly tooth decay.

METHODS

The ethnobotanical survey with respect to the use of plants for curing dental problems was carried out in 2012. A cluster sampling at three levels was applied when choosing the study sites. The target population was made up of heads of household. The following data were collected from a semi-structured questionnaire: name of plants, part used, mode of preparation, and administration. The Informant Consensus Factor and Fidelity Level indexes were calculated for each condition treated and used plants. The Results revealed that 93 per cent of the targeted population has used plants to calm dental pain, whereas 44.2% have reported using plants due to financial problems. About 65 species of plants are commonly used for oral health care and 63 of them treated caries. Cajanus cajan (L.) Millsp. was the most plant used. It was mostly used in crushed form of 5 to 9 leaves which were prepared and placed directly on the affected oral part or in the tooth cavity. In general, the treatment lasted about 5 days or minus. The ICF were 0.83 for caries and 0.81 for periodontal diseases.

CONCLUSION

This ethnobotanical survey will serve as database for further phytochemical and pharmacological study of plants in order to identify their active components and advise the population on the most effective administration.

Rare diseases with oral components: care course and quality of life

AIM

To describe links between the care course of individuals suffering from rare diseases and socio-behavioural risk factors and to ascertain the impact of dental conditions on the quality of life.

DESIGN

A cross-sectional comparative study involving self-reported questionnaire was performed. Care course was evaluated using predisposing, enabling and needs factors. The impacts of dental conditions on quality of life were measured with the OHIP 14 questionnaire. Proportions were compared by Chi-square test. Logistic regression for multivariate analysis assessed statistical association between variables.

RESULTS

Responses were received from 355 subjects (mean age 36.9 years, 67.6% females). Thirty-three rare diseases were recorded. Respondents were classified as group A, individuals suffering from rare diseases with a dental component (n=207, 58.3%), and group B, without dental component. Group A reported earlier diagnosis, more positive attitude toward dentists, functional limitation and higher prosthetic treatment needs. Only 17.4% of subjects having fewer than 20 teeth wear prosthetics. A higher percentage of individuals claiming pain, physical disability, psychological discomfort and social disability, was found among group B (p<0.001). Logistic regression analysis retained two impact factors: psychological disability (Exp(B)=8.66; 95% CI 1.86-40.34) and social wellbeing (Exp(B)=0.06; 95% CI 0.02-0.215).

CONCLUSION

Rare diseases with a dental component benefited from earlier identification of symptoms. Dentists could contribute to patients' quality of life by helping in early diagnosis, reducing functional limitation and improving social wellbeing.

Barriers to the treatment of childhood caries perceived by dentists working in different countries

OBJECTIVE

To explore whether dentists' beliefs and attitudes to providing preventive and restorative dental care for young children can form a barrier to the provision of care.

BASIC RESEARCH DESIGN

The Barriers to Childhood Caries Treatment (BaCCT) Questionnaire, a standardised international measure was developed and applied.

PARTICIPANTS

Through a research consortium, each site was asked to recruit 100 dentists. The sample participating was not intended to be nationally representative. Dentists were mainly randomly selected and contacted by mail with one or more mailings depending on site.

RESULTS

2,333 dentists in 14 countries and 17 sites participated. Factor analysis identified four factors as potential barriers. Two factors were found to be barriers in many sites. First, in most countries, dentists agreed that young children's coping skills limit their ability to accept dental care. Secondly, dentists with negative personal feelings, for example, that providing care can be stressful and troublesome and that they feel time constrained. Differences in dentists' beliefs can be partly explained by their work profile, with those treating children often, and those working under systems where they feel they can provide quality care being least likely to identify barriers to providing care for children.

CONCLUSIONS

The BaCCT Questionnaire was determined to be a valid psychometric measure. Separately, it was found that health systems do impact on dentists' ability to deliver preventive and restorative care for children but that these effects vary across countries and further work is needed to determine how best these should be examined.

Familial and cultural perceptions and beliefs of oral hygiene and dietary practices among ethnically and socio-economicall diverse groups

OBJECTIVE; The aim of this international study was to develop a valid and reliable psychometric measure to examine the extent to which parents' attitudes about engaging in twice-daily tooth brushing and controlling sugar snacking predict these respective behaviours in their children. A supplementary objective was to assess whether ethnic group, culture, level of deprivation or children's caries experience impact upon the relationships between oral health related behaviours, attitudes to these respective behaviours and to dental caries.

CLINICAL SETTING

Nurseries, health centres and dental clinics in 17 countries.

PARTICIPANTS

2822 children aged 3 to 4 years and their parents.

MAIN OUTCOME MEASURES

Dental examination of children and questionnaire to parents.

RESULTS

Factor analysis identified 8 coherent attitudes towards toothbrushing, sugar snacking and childhood caries. Attitudes were significantly different in families from deprived and non-deprived backgrounds and in families of children with and without caries. Parents perception of their ability to control their children's toothbrushing and sugar snacking habits were the most significant predictor of whether or not favourable habits were reported. Some differences were found by site and ethnic group.

CONCLUSIONS

This study supports the hypothesis that parental attitudes significantly impact on the establishment of habits favourable to oral health. An appreciation of the impact of cultural and ethnic diversity is important in understanding how parental attitudes to oral health vary. Further research should examine in a prospective intervention whether enhancing parenting skills is an effective route to preventing childhood caries.

Carbamide-containing polyol chewing gum and prevention of dental caries in schoolchildren in Madagascar

The objective of this investigation was to evaluate the effect on dental caries experience of using carbamide polyol chewing gum as a supplement to standard oral hygiene procedures for schoolchildren in a developing country (Madagascar). In 1994, grades 1 and 4 children of demonstration schools were allocated to experimental and control groups; all children participated in a school-based oral health education programme, including daily toothbrushing supervised by the classroom teacher. At grade 1, the test group (n = 125) also used chewing gum (V6: 55.5 per cent sorbitol, 4.3 per cent xylitol, 2 per cent carbamide) three times a day. At grade 4, one test group (n = 177) had chewing gum three times a day and an additional test group (n = 74) had chewing gum five times a day. The control groups included 117 children at grade 1 and 209 at grade 4. Dental caries was registered in 1994 and 1997 according to the Recording System for the Danish Child Dental Services. In grade 1 children, the preventive effect of the total DMFS was not statistically significant except for occlusal caries (-0.65 DMFS, P < 0.01). In the grade 4 test groups, non-significant reductions of dental caries experience were found when compared with controls. The present community trial indicates that the use of polyol chewing gum may be considered a supplement to the control of occlusal dental caries in young primary schoolchildren, particularly in developing countries with limited resources for dental care.

Oral health status of children and adults in Madagascar

The present national study was undertaken in order to describe the oral health situation of the population in Madagascar. The WHO pathfinder sampling procedures were applied to obtain representative samples of the following age groups: 6 years (n = 1866); 9 years (n = 1905); 12 years (n = 1992); 15 years (n = 1130); 18 years (n = 792), and 35-44 years (n = 1809). Data were collected in 1993 according to the methods recommended by WHO, including dental caries, dental treatment need, and CPITN. In 6-year-olds, 85 per cent had caries in primary teeth and a mean of 3.1 DMFT was observed among the 12 year-olds; the 35-44-year-olds had an average of 13.1 DMFT. Differences in dental caries prevalence were found according to sex, urbanisation, region, and ethnic group. Ninety-one percent of individuals at age 18 and 72 per cent at age 35-44 had maximum CPITN score 2 (gingival bleeding and calculus). In an African perspective, the oral health status of the Malagasy population is extraordinary poor, and the implementation of community-based oral health promotion and prevention is urgently needed.