Aim. To determine oral hygiene practices, knowledge, and experience of dental caries and gingival problems among urban and rural primary schoolchildren in Lilongwe District, Malawi. Methodology. This was an analytical and quantitative descriptive cross-sectional study. Four urban and four rural primary schools were conveniently sampled. Pupils aged 11–14 years (n = 409) were recruited using self-administered structured questionnaire. Data were analyzed using SPSS program v20.0. Results. Out of 409 pupils, most of them had knowledge that dental caries is caused by consumption of sugary foodstuffs (91.4%), toothache is a symptom of dental caries (77.6%), gingivitis is caused by ineffective tooth brushing (92.7%), and gingival bleeding is a sign of gingivitis (85.3%). Most pupils experienced toothache (30.8%); many of them had parents with secondary education and above (35.0%) compared to those with primary education (23.5%). 24.4% experienced gingival bleeding with higher percentages from urban (30.1%) than rural (18.5%) schools. Plastic toothbrush users (95%) overshadowed chewing stick users (24.9%). The use of chewing stick was significantly higher in rural (49%) than in urban (1.9%) schools. Likewise, tooth brushing before bed was significantly higher in rural (33%) than in urban (17.2%) pupils. The use of toothpaste during tooth brushing was significantly higher among urban (91.9%) than among rural (64%) pupils. The prevalence of tongue cleaning was 70.2%, and the differences were significantly higher among pupils who had parents with secondary and higher education in urban schools and among pupils aged 11–12 years in comparison with their counterparts. Conclusions. Most pupils reported cleaning their teeth regularly, mostly using plastic toothbrush rather than chewing stick, using toothpaste, and having adequate knowledge about dental caries and gingival disease, and a quarter of them had suffered from these diseases with evidence of rural-urban disparities. Integration of oral health in school health promotion program and further research on its impact on oral health status are recommended.

Objectives: To identify underlying clusters of general and oral health behaviours and acertain possible factors influencing the existence of the behaviours. Materials and Methods: A cross sectional study was conducted among 4,847 school adolescents aged 11 to 17 years. Data were collected using a structured questionnaire in Kiswahili inquiring about general and oral health related behaviours, socio-demographics and adolescents' school relationship. Principal component analysis was employed to identify clusters of health behaviour. Frequency distribution for proportions, cross tabulations with chi-square and a two stage binary logistic regression were done. Results: Principal component analysis identified four clusters from twelve health behaviours; hygiene practices, dietary behaviours, cigarette smoking & alcohol consumption and sedentary related behaviours. Girls, OR 0.8 (95% CI 0.7, 0.9); secondary school attendees, OR 0.5 (95% CI 0.4, 0.7) and adolescents with good school relationship OR 0.7 (95% CI 0.6, 0.8) were less likely to smoke or use alcohol. Urban residents were less likely OR 0.8, (95% CI 0.7, 0.9) to report acceptable dietary behaviours. Adolescents whose fathers had secondary education or higher, were in secondary schools and had good school relationship were most likely to have acceptable hygiene behaviours, OR 1.4 (95% CI 1.2, 1.6), 1.6 (95% CI 1.1, 2.2) and 1.4 (95% CI 1.3, 1.7), respectively. Conclusion: Oral and general health behaviours of Tanzanian adolescents factored into four clusters with hygiene behaviours being most practiced and physical exercise the least. The clustered behaviours were influenced by socio-demographics and school environment.

Aim. To determine the level of knowledge of periodontal diseases, practices regarding oral hygiene, and self-perceived periodontal problems among pregnant and postnatal women attending reproductive and child health clinics in rural districts of Zambia.Methodology.This was a quantitative, questionnaire-based, descriptive, and cross-sectional study that recruited 410 women aged 15 to 43 years. Data were analyzed using SPSS v19.0 computer program.Results. Participants knowledgeable of periodontal diseases were 62%; gingivitis signs included gum swelling (87.4%) and bleeding (93.3%). Of all participants, 95.6% practiced tooth brushing: twice/day (38.5%), using plastic toothbrush (95.6%), chewing stick (12.2%), toothpick (10.7%), dental floss (2.0%), and tongue cleaning (55.4%). Self-reported periodontal problems were bleeding gums (23.2%), gums that were reddish (10.5%), swollen (11.0%), painful (15.9%), and mobile teeth (3.4%). In logistic regression analysis, painful gums, reddish gums, and toothpick use were 21.9, 4.7, and 4.3 respectively, significantly more likely to cause gum bleeding on tooth brushing.Conclusions. Most studied women had general knowledge of periodontal diseases but only few knew the cause. All participants performed tooth cleaning; however, majority did not know appropriate practices, and only few had periodontal problems. Integration of oral health to general health promotion and periodontal therapy to pregnant women at high risk is recommended.

Aim. To assess self-reported halitosis, oral hygiene practices, oral health conditions, general health problems, sociodemographic factors, and behavioural and psychological characteristics among workers in Ilala and Temeke municipals. Materials and Methods. This was a cross-sectional descriptive study. Four hundred workers were recruited using a self-administered structured questionnaire. Results. Self-reported tooth brushing practice was 100%, tongue cleaning 58.5%, dental flossing 4.3%, gum bleeding on tooth brushing 79.3%, presence of hard deposits on teeth 32%, mobile teeth 15.3%, and self-reported halitosis (SRH) 48.5%. Tea users were 95%, coffee users 75.8%, smokers 21%, and alcohol consumers 47%. The SRH was significantly associated with bleeding gums, hard deposits, and mobile and malaligned teeth. Tongue cleaning and regular change of toothbrush were associated with low prevalence of SRH (P < 0.001). Higher occurrence of SRH was significantly related to low education and smoking. Conclusion. Self-reported halitosis was prevalent among workers and was significantly associated with bleeding gums, hard dental deposits, mobile teeth, and smoking. All participants brushed their teeth and cleaned the tongue regularly but use of dental floss was extremely low. Oral health education and health promotion are recommended.

Background: Periodontal diseases have been reported to be associated with cardiovascular diseases. Aim: The aim of this study was to determine the periodontal status and treatment needs among adult cardiac patients in Dar-es-Salaam, Tanzania. Methodology: A hospital based descriptive cross-sectional study was conducted. A self-administered questionnaire was used to obtain socio-demographic information, followed by clinical examination for dental plaque, gingival bleeding, calculus, periodontal pockets (PPT) and gingival recession. To enable determination of periodontal treatment needs, data for periodontal conditions was transformed into Community Periodontal Index and Treatment Needs (CPITN) codes. Chi-square test was used to determine the associations of periodontal conditions with demographic variables studied. Level of significance was set at p<0.05. Results: The prevalence of periodontal conditions was high for gingival bleeding (100%), dental plaque (99.4%)and calculus (99.7%), but very low for periodontal pockets ≥ 3.5 mm (9.4%). Statistically significant higher mean percent site with plaque, calculus and gingival bleeding was seen in posterior teeth ( t -tests = -16.07, 12.22, and -4.8; p< 0.001 respectively). Gingival recession and loss of attachment was statistically significantly higher in upper teeth ( t -test= -3.45, p< 0.001), anterior teeth (t-test= 6.3 and 5.5; p< 0.001 respectively). Periodontal treatment needs was 100.0%, 99.7%, and 0.9% for oral hygiene instructions (OHI), scaling and root planing (SRP), and periodontal surgery respectively. Conclusion: The prevalence of plaque, calculus and gingival bleeding was high among cardiac patients examined, but low for periodontal pocketing, gingival recession and loss attachment. The periodontal treatment needs were mainly oral hygiene instructions, scaling and root planning. Surgical periodontal therapy was limited to the few. Keywords: Periodontal status, cardiovascular diseases, cardiac patients, treatment needs, Muhimbili National Hospital

Many low- and middle-income countries do not yet have policies to implement effective oral health programs. A reason is lack of human and financial resources. Gaps between resource needs and available health funding are widening. By building capacity, countries aim to improve oral health through actions by oral health care personnel and oral health care organizations and their communities. Capacity building involves achieving measurable and sustainable results in training, research, and provision of care. Actions include advancement of knowledge, attitudes and skills, expansion of support, and development of cohesiveness and partnerships. The aim of this critical review is to review existing knowledge and identify gaps and variations between and within different income levels in relation to the capacity building and financing oral health in the African and Middle East region (AMER). A second aim is to formulate research priorities and outline a research agenda for capacity building and financing to improve oral health and reduce oral health inequalities in the AMER. The article focuses on capacity building for oral health and oral health financing in the AMER of the IADR. In many communities in the AMER, there are clear and widening gaps between the dental needs and the existing capacity to meet these needs in terms of financial and human resources. Concerted efforts are required to improve access to oral health care through appropriate financing mechanisms, innovative health insurance schemes, and donor support and move toward universal oral health care coverage to reduce social inequality in the region. It is necessary to build capacity and incentivize the workforce to render evidence-based services as well as accessing funds to conduct research on equity and social determinants of oral health while promoting community engagement and a multidisciplinary approach.

This paper is based on a conference presentation made during the inauguration of the Faculty of Dentistry, Kuwait University, as a World Health Organization Collaborating Centre for Primary Oral Health Care (POHC) on November 27-28, 2012. The aim of this paper is to review how the POHC approach has been integrated into the dental curriculum, sharing the Tanzanian experience as a case presentation from a developing country. The burden of oral diseases worldwide is high, and the current oral health workforce is inadequate to meet the challenges. Curative oral health care is very costly and not accessible to the poor and minorities. To tackle the problem, the POHC approach rooted in primary health care that emphasizes equity, community involvement, prevention, appropriate technology and a multi-sectorial approach was developed and has been operating for more than 3 decades now. Execution of a comprehensive POHC requires a trained oral health workforce mix with essential competencies. For this case study, a literature search was done using the search engines subscribed to by the library of Muhimbili University of Health and Allied Sciences, including PubMed, Cochrane, ScienceDirect and Scopus, Wiley-Blackwell Interscience, Sage and the Health InterNetwork Access to Research Initiative (HINARI) that gives access to Scirus and Google Scholar. Challenges are discussed with an emphasis more on addressing the common risk factors and determinants of oral health. Integration of the POHC approach in the dental curriculum for training a competent workforce is crucial in attaining better oral health. Resources are still a major challenge, and the impact of the POHC approach in the curriculum is yet to be evaluated.

From 2008 to 2011, the School of Dentistry at Muhimbili University of Health and Allied Sciences in Tanzania revised and then initiated implementation of a curriculum to improve the educational process for, and competence of, its graduates. As an increasing body of research demonstrates the detrimental effects of oral diseases on health and the interrelationships between oral and systemic diseases (including HIV and diabetes), the importance of dentistry education grows. We describe the population oral health problems in Tanzania, the need to enhance the dental workforce, and the process of curricular reform to meet these needs. This reform included transition to a competency-based curriculum featuring teaching methods that will enhance the effectiveness of the education and performance of graduates in traditional and new roles. We conclude with lessons for Tanzania and for health professions educational institutions elsewhere, as well as for public health-care planners concerned about linking health professions education to improving population health in resource-poor countries.

UNLABELLED:The present research was carried out at the School of Dentistry, Muhimbili University of Health and Allied Sciences, Tanzania.OBJECTIVE:To assess smoking and drinking habits as well as attitudes towards smoking cessation counselling among dental students in Tanzania.BASIC RESEARCH DESIGN:A 28-item pretested and self-administered questionnaire was delivered to all dental students enrolled at the end of the 2006 academic year. The questionnaire covered socio-demographics, smoking and drinking habits, knowledge concerning health effects and attitudes towards smoking cessation counselling.PARTICIPANTS:Dental students enrolled at the end of the 2005/2006 academic year in the School of Dentistry, University of Dar-es-Salaam, Tanzania.MAIN OUTCOME MEASURES:Self-reported smoking, alcohol use and attitudes to smoking cessation counselling.RESULTS:The response rate was 73.2% (109/149) and 76.1% of respondents were male. Smoking was reported by 12.8%, all being male. Alcohol use during the last 30 days was reported by 23.8% and binge drinking during the last two weeks by 11.8%. Both smoking and alcohol use were more common among clinical than basic science students. The majority (67.0%) reported that they had not received education on smoking cessation counselling although 86.2% considered that dentists and physicians should provide such counselling.CONCLUSION:Reported smoking and alcohol consumption are on a low level compared to dental students internationally. Willingness and need for cessation counselling training was expressed by the majority of Tanzanian dental students. This should be taken into consideration in dental curriculum development.

BACKGROUND:Females are generally more motivated with regard to oral hygiene practices and thus brush their teeth more frequently than males.OBJECTIVE:To determine the prevalence of gingival recession, oral hygiene status, oral hygiene practices and associated factors in women attending a maternity ward in Tanzania.DESIGN:Cross-sectional descriptive study.SETTING:Maternity ward of Muhimbili National Hospital, Tanzania.SUBJECTS:Four hundred and forty six women were interviewed on oral hygiene practices and maternal factors, and a full-mouth examination was done to determine the presence of plaque, calculus, gingival bleeding and gingival recession at six sites per tooth.RESULTS:The prevalence of gingival recession (GR) > or =1 mm was 33.6%, calculus 99.3%, plaque 100%, and gingival bleeding 100%. Oral hygiene practices included toothbrushing (98.9%), brushing frequency > or =2 times/day (61.2%), horizontal brushing method (98%), and using a plastic toothbrush (97.8%). Factors that were significantly associated with gingival recession were age (OR = 2.0, 95% CI = 1.3-3.2), presence of calculus (OR(a) = 3.8, 95% CI=2.5-7.1), and gingival bleeding on probing (OR = 4.2, 95% CI = 2.5-7.1). Tooth cleaning practices and maternal factors, especially the number of pregnancies or deliveries were not significantly associated with gingival recession.CONCLUSION:In this study population, oral hygiene was poor and gingival recession was associated with age, calculus and gingival inflammation rather than with tooth cleaning practices.

Abstract The aim of this study was to determine some risk factors for signs and symptoms of temporomandibular disorders (TMD) in a rural adult population of Southeast Tanzania. Two hundred and eighteen adults aged 40+ years participated in the study. Joint clicking was significantly higher (p<0.024) in the adults aged 60+ years than in the younger age group. Limited jaw opening was higher in females than males (χ2 = 46.4 on 2df; p<0.001), and there was a significant association between the type of toothbrush and limitation in jaw opening (χ2 = 156.6 on 4df; p<0.001). The results suggest that the use of miswaki (chewing sticks) and advanced age are risk factors for the high prevalence of signs and symptoms of TMD in this rural population. Further studies are recommended to control for other confounding factors such as socio-economic status.

OBJECTIVETo determine the prevalence of tooth and lip mutilation (TLM) and the prevalence of tooth loss and the associated oral mucosal lesions among adults in south east Tanzania.DESIGNA cross sectional, clinical study and questionnaire administration.SETTINGRural population in southeast Tanzania.SUBJECTSRandomly selected 217 adults aged 40 years and older.RESULTSAbout 16% of all participants performed tooth mutilation. There were more females (20.6%) than males (11.3%) who performed tooth mutilation but the difference was not statistically significant. There was only about 17% of participants in the age group 40-54 years who performed tooth mutilation while there was 50% and 32% in the age groups 55-64 years and 65-95 years and the difference was statistically significant (P < 0.001). Tooth loss due to mutilation was significantly (P < 0.001) less than tooth loss due to other reasons in the anterior teeth and there was no tooth loss due to mutilation in the posterior teeth. Lip mutilation in form of piercing the upper lip and inserting a wooden stick called "ndonya" was found only in women. No oral mucosal lesions were found in this study group.CONCLUSIONTooth mutilation does not lead to significant tooth loss and lip mutilation and the use of "ndonya" does not cause oral mucosal lesions in this society. Extraction of anterior teeth due to other reasons was significantly higher than extraction following mutilation while in the posterior teeth there was no tooth loss due to tooth mutilation.

Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.

In 1921, New Zealand began training school dental nurses, subsequently deploying them throughout the country in school-based clinics providing basic dental care for children. The concept of training dental nurses, later to be designated dental therapists, was adopted by other countries as a means of improving access to care, particularly for children. This paper profiles six countries that utilise dental therapists, with a description of the training that therapists receive in these countries, and the context in which they practice. Based on available demographic information, it also updates the number of dental therapists practising globally, as well as the countries in which they practice. In several countries, dental therapy is now being integrated with dental hygiene in training and practice to create a new type of professional complementary to a dentist. Increasingly, dental therapists are permitted to treat adults as well as children. The paper also describes the status of a current initiative to introduce dental therapy to the United States. It concludes by suggesting that dental therapists can become valued members of the dental team throughout the world, helping to improve access to care and reducing existing disparities in oral health.

Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.

Aim To determine the type of tooth cleaning devices, presence of calculus, occurrence of gingival recessions and tooth sensitivity. Study Participants and Methods This was a cross-sectional descriptive study conducted among adults in Mtwara-Rural district. Randomly selected 201 participants aged 40 years or more, 113 males and 88 females were interviewed on commonly used tooth cleaning devices and tooth sensitivity using a structured questionnaire. Clinical examination was done to assess gingival recessions (> 3.5 mm) and calculus using the Community Periodontal Index Probe and a mouth mirror. Results Tooth cleaning devices included plastic toothbrush (51.7%), chewing stick (25.9%), both chewing stick and plastic toothbrush (17.4%), and other unspecified devices (5.0%). Prevalence of calculus was 99.5%, gingival recession > 3.5mm was 86.1% and TS was 50.2%. There was no significant difference between males and females for the occurrence of gingival recessions, tooth sensitivity and the type of tooth cleaning devices used. The mean number of sextants having teeth with gingival recessions and tooth sensitivity did not differ among different types of tooth cleaning devices used (P > 0.05). The study participants that had no gingival recessions had slightly higher mean number of sextants with calculus (5.79 ± 0.57) than those with gingival recessions (5.50 ± 1.17), (P = 0.04, 95% confidence interval: 0.01, 0.57), but the finding was considered to be of no clinical significance. Conclusion Participants of this study mainly used plastic toothbrush and chewing stick as tooth cleaning devices and the prevalence of calculus and gingival recession were very high with substantial reported tooth sensitivity. The relationship between tooth cleaning devices or calculus accumulation and gingival recessions could not be elucidated. Keywords: Plastic toothbrush; chewing stick; dental calculus; gingival recessions; tooth sensitivity. Tanzania Dental Journal Vol. 13(2) November 2006: 43-49

Objective: To study the periodontal health status of Mtwara adult population aged 40+ years. Design: A cross-sectional descriptive study Settings: Mtwara Rural district Main outcome measures: Presence of gingival bleeding on gentle probing, dental calculus, probing periodontal pocket depth (PPD): 4-5 mm or 6+ mm, according to Community Periodontal Index (CPI). Results: A total of 201 adults (males 115 (55.8%) and females 86 (44.2%)), aged 40+ years were recruited. Based on hierarchical CPI scoring (Score 0-4), no participant had healthy periodontal tissues or gingival bleeding as highest CPI score. The prevalence for calculus was 13.9% and there were more males than females that had calculus (p=0.019). The prevalence of PPD 4-5 mm and 6+ mm were 41.8% and 44.3%, respectively. The mean number of sextants with PPD 4-5 mm was higher in males than in females (p=0.009), but for PPD 6+ mm, there was no difference. Conclusion: The findings of this study population have shown an extremely high prevalence of gingival bleeding, high prevalence of calculus and periodontal disease but of low severity. The Mtwara Rural adult population aged 40+ years should be considered at increased risk for destructive periodontal disease, and hence need to plan for a preventive intervention. Keywords: Gingival bleeding, Calculus, Periodontal pockets, Community Periodontal Index, Mtwara Rural. Tanzania Medical Journal Vol. 19 (1) 2004: pp.

Aim: To study Oral health behavior and prevalence of dental caries, among 12-year-old pupils in Dar-es-Salaam, Tanzania. Materials and methods: This was a cross-sectional study that involved 310 pupils of 12-year-old (males - 43.5% and females - 56.5%). Oral health related behavior and knowledge on causes and prevention of dental caries were investigated using a structured questionnaire. Caries experience was assessed using WHO methods. Results: Tooth brushing at least once/day was reported by 92.1% of the children and 71.9 % used toothpaste. Children reported to consume sugary snacks/drinks more often at home (64.5%) than in school (35.5%). Most of the pupils (76.1%) had never visited a dentist. Most children (71.9%) indicated sugary snacks as the main cause of dental caries, and for prevention, they recommended avoiding sweets/sugary foods (53.5%), and tooth brushing (40.3%). The mean Decay-Missing-Filled-Teeth (DMFT) was 0.76 ± 1.17 (SD), was significantly higher among girls (0.84) than boys (0.64), (P = 0.02). A total of 58.4% of the participants were caries free. Higher caries experience was related to lower brushing frequency, irregular use of toothpaste and high frequency of sugary snack consumption (P < 0.05). Conclusions: The prevalence of dental caries among 12-year-olds was lower than the WHO global goal, knowledge on the causes and prevention of dental caries were reasonably good, and consumption of sugary food stuffs was done more at home than in schools. Most of the children had never visited a dentist. Keywords: Dental caries, DMFT, tooth brushing, Sugary-food-stuffs, 12-year-old children. Tanzania Dental Journal Vol. 14 (1) 2007: pp. 1-7

The study examined the relationship between oral health status (periodontal disease and carious pulpal exposure (CPE)) and preterm low-birth-weight (PTLBW) infant deliveries among Tanzanian-African mothers at Muhimbili National Hospital (MNH), Tanzania.