Challenges dog oral health, but that’s about to change

dental health

Oral health is a key indicator of overall health, wellbeing and quality of life. 

Photo credit: File | Nation Media Group

Oral health is a key indicator of overall health, wellbeing and quality of life.

The World Health Organisation defines it as a state of being free from chronic mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and other diseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial wellbeing.

In Kenya, more than seven in 10 adults and more than four in 10 children under the age of five have dental caries; 90 per cent of Kenyans have periodontal disease, and 40 per cent of children have fluorosis.

There is also a high incidence of oral-facial trauma from road traffic accident injuries and especially motor cycle accidents, congenital malformations, oral manifestations of HIV/AIDS and dental malocclusions and cancer.

NO ORAL HEALTH POLICY

Kenya lacks a national oral health policy and oral health infrastructure in lower levels of healthcare (community to level 3).

There is inadequate infrastructure from level 4 and dental clinics do not offer standardised services (several offer dental extraction as the only curative service).

Other challenges include inadequate financing, lack of essential medicines and commodities and inadequate health information systems. Moreover, there are only about 1,000 dentists in both the private and public sector, translating to a ratio of one dentist for 50,000 Kenyans. About 80 per cent of these dentists are in urban centres because dental treatment is capital intensive and rural areas lack the infrastructure. There are only 67 dental specialists (in 14 specialities) and most work in teaching institutions and internship centres.

Lack of adequate specialists affects dental training, and a large population in need of specialised care is left unattended. Kenya trains about 60 dentists every year, but there is poor retention of trained dentists.

The Kenya Medical Training College has trained 3,000 community oral health officers since 1984, but they have not been absorbed by the government, even though they would play an important role in promotion, education/awareness, prevention and early diagnosis.

UNIVERSAL ORAL HEALTHCARE

To achieve universal oral healthcare, oral health should be integrated into primary healthcare and in existing health services (maternal and child health, school health programmes, comprehensive care centers and non-communicable disease programmes) so that the benefits of promotive, preventive and early diagnosis are realised, and to leverage on the funding and infrastructure of these programmes.

Post-intern dentists should be employed to enhance oral healthcare.

County governments should be encouraged to employ community oral health officers and deploy them to the community and level 2 and 3 facilities.

Oral health infrastructure and equipment should be made available from dispensary level. Funding for oral health must be increased at all levels.

The NHIF oral health benefit package should be defined per cohort on age, oral health needs, special needs and level of service.

Projects for insurance for indigent and vulnerable populations should include oral health.

Training institutions should be encouraged and supported to increase the number of dentists trained yearly, and mechanisms of retaining dentists in service must be explored.

The Ministry of Health is establishing four centres of excellence for eye and oral health in four counties, and the oral health benefit package is in the National Health Insurance Fund hence in universal health coverage.

The Ministry is also developing an oral health strategy aimed at integrating oral health into the existing health programmes especially non-communicable diseases, and a draft National Oral Health Policy is ready awaiting launch before the end of the year.

 

Dr Muriithi is the chief dentist, Ministry of Health