Dean, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Professor Morenike Ukpong, in this interview by SADE OGUNTOLA, speaks on dental problems in children, reasons they are prevalent and how best they can be tackled, among others. Excerpts:
ACCESS to dental care is a challenge in Nigeria, particularly for children and those in underserved communities. What is the implication of this on health generally?
Gaining access to oral health care is a multifaceted challenge, attributed to several factors. One of the prominent reasons for this challenge is the scarcity of oral healthcare centres. Despite being an integral component of primary healthcare, the integration of oral healthcare into the practices of primary healthcare centres in Nigeria remains limited, with less than 10 percent of these centres offering such services. The inadequate number of healthcare professionals equipped with the necessary competencies to provide comprehensive oral healthcare across all age groups is also a concern. Adding to this dilemma is the substantial financial burden associated with accessing oral healthcare, often requiring significant out-of-pocket expenses. Furthermore, there is a notable deficiency in oral health literacy, compounding the overall issue. The cumulative effect of these challenges are huge for Nigeria’s population and manifests in various ways. A substantial portion of Nigeria’s population does not have timely access to preventive care. Consequently, the prevalence of dental conditions, such as dental caries and periodontal disease, is disproportionately elevated, causing discomfort, pain and impairments in basic functions like eating and speaking.
Left untreated, oral infections can trigger systemic inflammation, adversely affecting vital bodily systems, including the cardiovascular system. It can further contribute to an increased susceptibility to conditions like heart disease, diabetes and adverse pregnancy outcomes. The interplay between these two challenges, oral health and general health, collectively diminishes the quality of life for affected individuals, including children’s ability to concentrate and perform effectively in educational settings, their self-esteem and their confidence as individuals.
Some people are suggesting instituting interventions like dentistry without borders, especially for children. Will this help tackle the problem?
‘Dentistry without borders for children’ refers to a concept or approach in oral healthcare that aims to provide dental services and care to children in underserved or marginalised communities, regardless of geographic, economic or social boundaries. ‘Medicine Without Borders’ or ‘Doctors Without Borders,’ which involves providing medical assistance and care to people in need, especially in regions facing humanitarian crises or lacking adequate healthcare infrastructure, inspired the concept.
In the context of dentistry, ‘Dentistry without Borders for Children’ specifically focuses on addressing the oral health needs of children who may not have regular access to dental care due to various challenges, such as poverty, remote location, lack of dental facilities and limited resources. Its goal is to ensure that all children, regardless of their background or circumstances, have access to essential oral health services and preventive care.
Dentistry without borders for children would involve dental professionals and volunteers to provide expertise and services on a voluntary or humanitarian basis. Working closely with local communities and organisations to raise awareness about the importance of oral hygiene and dental care, dentistry without borders can augment the current gap in access to oral healthcare, especially in remote areas, as well as the gaps created by poor governmental response to the oral needs of children.
What dangers do amalgams portend, considering the call by some experts against their use in treating children and pregnant women?
Amalgam is a dental restorative material commonly used to fill cavities caused by tooth decay. It is a mixture of metals, primarily silver, tin, copper and mercury. The mercury content in dental amalgam raises concerns among some experts due to potential health risks. The main danger associated with this dental amalgam is the release of small amounts of mercury vapour over time. Mercury is a toxic substance that can have adverse effects on the nervous system, especially in high quantities or with prolonged exposure. Although the amount of mercury released from dental amalgam fillings is considered relatively low, some experts argue that vulnerable populations, such as children and pregnant women, may be more susceptible to its effects. For children whose bodies and brains are still developing, there are concerns that even low levels of mercury exposure from amalgam fillings could have a negative impact on their neurological development. Pregnant women are also considered a vulnerable group because mercury can cross the placenta and potentially affect the developing foetus.
In response to these concerns, some experts advocate replacement with alternative restorative materials like composite resin, glass ionomer cement, ceramic restorations and cast metal restorations. In addition to using alternative restorative materials, preventive measures such as sealants and regular dental check-ups can help reduce the need for dental restorations in the first place. However, it is important to note that the decision to use alternative materials depends on the individual patient’s needs, the dentist’s judgment and the availability of materials and resources.
What are the common dental health problems in children and their causes generally?
Dental caries, also known as tooth decay, is indeed one of the most common dental health problems in children. It can occur when bacteria in the mouth act on the sugar consumed to produce acids that break down the tooth’s outer layer (enamel) and create cavities or holes. This condition is often caused by poor oral hygiene and a lack of fluoride exposure.
However, other dental issues that children may experience include gingivitis, which is a form of gum disease characterised by inflammation and swelling of the gums. This is commonly caused by poor oral hygiene, leading to the buildup of plaque and calculus along the gum line.
Others are improper positioning of the teeth, which is called malocclusion. Malocclusion can lead to issues with chewing and speaking and can sometimes impact the child’s appearance and self-esteem. Also, it can be due to prolonged thumb-sucking or pacifier use.
In addition, tooth erosion can occur when the tooth’s enamel is worn away by acids from certain foods and drinks or due to frequent vomiting. Besides, accidents and injuries can result in chipped, cracked, or knocked-out teeth. Fluoride is essential for strengthening tooth enamel and preventing cavities. Regular dental check-ups and cleanings are essential for maintaining good oral health.
What are common beliefs, attitudes and practices that contribute to increasing dental problems in Nigerians?
Inadequate tooth brushing, flossing and a lack of regular dental check-ups contribute to poor oral hygiene. Poor oral hygiene allows bacteria and plaque to accumulate, increasing the risk of dental caries, gum disease and other oral health problems. Frequent consumption of sugary foods also contributes to tooth decay. That is why putting children to bed with a bottle of milk or sweetened liquids can lead to decay of the milk teeth, as the sugary liquids bathe the teeth in sugar for prolonged periods.
Fear of dental treatment is a common issue among Nigerians, leading some to avoid visiting the dentist even when they have dental problems. This fear sometimes results from past negative experiences, cultural beliefs, or a lack of understanding about dental procedures. Delay in seeking dental treatment may also be due to cost concerns and a lack of awareness of the seriousness of their dental issues, worsening dental problems and leading to more extensive interventions. Likewise, the smoking and chewing of tobacco can cause stains on teeth, gum disease and oral cancer.
Conditions or medications that cause dry mouth by reducing saliva flow can also increase the risk of tooth decay and gum inflammation. Genetics can play a role in dental health; children with a family history of dental problems may be at a higher risk of developing dental caries and gingivitis. Likewise, children exposed to second-hand smoke are at increased risk of developing gingivitis and other oral health issues.
Is there possible link between dental caries and brain development in children?
In the short term, untreated tooth decay can lead to pain, infection and disrupted sleep, among other issues. In the long term, it is associated with poor oral health much later, an increased risk of caries in permanent teeth and adverse effects on physical and psychological development. There may be a link between untreated caries in children and adverse cognitive and neuro developmental outcomes in young children, though the exact pathways are not fully understood.
Impaired chewing function due to caries in children can affect the hippocampus, a key region responsible for memory and learning. Furthermore, untreated caries in children can cause chronic inflammation, leading to the release of pro-inflammatory cytokines that may damage the brain. Sleep disturbances resulting from caries-related pain and discomfort can also impact brain development and cognitive functioning.
Additionally, frequent use of antibiotics and analgesics to address caries-related infections can potentially affect the brain through the gut-brain axis and untreated caries in children can cause nutritional deficiencies and elevated nutritional risk, further hindering brain development. So, addressing dental caries comprehensively within early childhood can help mitigate potential long-term consequences and promote optimal brain development in young children.
Can severe dental problems be contributory to malnutrition and poor IQ in Nigerian children generally?
Untreated, severe dental problems in Nigerian children can potentially contribute to malnutrition and affect overall health, including cognitive development. While direct causation is complex and multifactorial, dental problems can indirectly impact nutrition and cognitive function through various mechanisms, such as pain and discomfort while eating. This can lead to reduced food intake and avoidance of certain foods, which may result in malnutrition, especially if essential nutrients are not adequately consumed. This can lead to deficiencies in essential vitamins and minerals necessary for overall health and cognitive development.
Also, chronic gum inflammation and untreated dental infections can affect the body’s ability to absorb nutrients properly from the gastrointestinal tract and lead to poor oral health-related quality of life, affecting a child’s overall wellbeing and psychological health. This may indirectly impact their cognitive development.
Likewise, dental problems that cause pain or discomfort, can distract children at school, affecting their concentration and ability to learn, which may have implications on academic performance and cognitive development. While dental problems alone may not directly cause poor IQ, they can contribute to a cascade of negative effects on a child’s health and development, potentially exacerbating existing health disparities and impacting cognitive abilities over time.
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