BackgroundThe aim of the study was to compare the prevalence and types of HIV-related oral lesions between children and adult Tanzanian patients on HAART with those not on HAART and to relate the occurrence of the lesions with anti-HIV drug regimen, clinical stage of HIV disease and CD4+ cell count.MethodsParticipants were 532 HIV infected patients, 51 children and 481 adults, 165 males and 367 females. Children were aged 2–17 years and adults 18 and 67 years. Participants were recruited consecutively at the Muhimbili National Hospital (MNH) HIV clinic from October 2004 to September 2005. Investigations included; interviews, physical examinations, HIV testing and enumeration of CD4+ T cells.ResultsA total of 237 HIV-associated oral lesions were observed in 210 (39.5%) patients. Oral candidiasis was the commonest (23.5%), followed by mucosal hyperpigmentation (4.7%). There was a significant difference in the occurrence of oral candidiasis (χ2 = 4.31; df = 1; p = 0.03) and parotid enlargement (χ2 = 36.5; df = 1; p = 0.04) between children and adults. Adult patients who were on HAART had a significantly lower risk of; oral lesions (OR = 0.32; 95% CI = 0.22 – 0.47; p = 0.005), oral candidiasis (OR = 0.28; 95% CI = 0.18 – 0.44; p = 0.003) and oral hairy leukoplakia (OR = 0.18; 95% CI = 0.04 – 0.85; p = 0.03). There was no significant reduction in occurrence of oral lesions in children on HAART (OR = 0.35; 95% CI = 0.11–1.14; p = 0.15). There was also a significant association between the presence of oral lesions and CD4+ cell count < 200 cell/mm3 (χ2 = 52.4; df = 2; p = 0.006) and with WHO clinical stage (χ2 = 121; df = 3; p = 0.008). Oral lesions were also associated with tobacco smoking (χ2 = 8.17; df = 2; p = 0.04).ConclusionAdult patients receiving HAART had a significantly lower prevalence of oral lesions, particularly oral candidiasis and oral hairy leukoplakia. There was no significant change in occurrence of oral lesions in children receiving HAART. The occurrence of oral lesions, in both HAART and non-HAART patients, correlated with WHO clinical staging and CD4+ less than 200 cells/mm3.

BackgroundOral pain has been the major cause of the attendances in the dental clinics in Tanzania. Some patients postpone seeing the dentist for as long as two to five days. This study determines the prevalence of oral pain and barriers to use of emergency oral care in Tanzania.MethodsQuestionnaire data were collected from 1,759 adult respondents aged 18 years and above. The study area covered six urban and eight rural study clusters, which had been selected using the WHO Pathfinder methodology. Chi-square tests and logistic regression analyses were performed to identify associations.ResultsForty two percent of the respondents had utilized the oral health care facilities sometimes in their lifetime. About 59% of the respondents revealed that they had suffered from oral pain and/or discomfort within the twelve months that preceded the study, but only 26.5% of these had sought treatment from oral health care facilities. The reasons for not seeking emergency care were: lack of money to pay for treatment (27.9%); self medication (17.6%); respondents thinking that pain would disappear with time (15.7%); and lack of money to pay for transport to the dental clinic (15.0%). Older adults were more likely to report that they had experienced oral pain during the last 12 months than the younger adults (OR = 1.57, CI 1.07–1.57, P < 0.001). Respondents from rural areas were more likely report dental clinics far from home (OR = 5.31, CI = 2.09–13.54, P < 0.001); self medication at home (OR = 3.65, CI = 2.25–5.94, P < 0.001); and being treated by traditional healer (OR = 5.31, CI = 2.25–12.49, P < 0.001) as reasons for not seeking emergency care from the oral health care facilities than their counterparts from urban areas.ConclusionOral pain and discomfort were prevalent among adult Tanzanians. Only a quarter of those who experienced oral pain or discomfort sought emergency oral care from oral health care facilities. Self medication was used as an alternative to using oral care facilities mainly by rural residents. Establishing oral care facilities in rural areas is recommended.

The practice by traditional healers in Tanzania of extracting tooth buds or of rubbing herbs on to the gingivae of young children to cure fevers and diarrhoea has been known for many years. The aim of this study was to determine the prevalence of these practices in different regions of Tanzania and to identify sociological and environmental factors influencing belief in their efficacy. A total of 1052 children were examined for missing primary teeth, or scars or wounds on the gingivae, resulting from tooth bud extraction. In addition, 268 parents of children who had received treatment from a traditional healer were interviewed to identify factors that led them to go to a traditional healer. The prevalence of tooth bud extraction in villages in which tooth bud extraction was first reported in the early 1980s was 0.5%, and in villages in which the practice was only recently reported it was 60%; the prevalence of rubbing herbs was 32% and @4%, respectively. Persistent fevers and diarrhoea were the major symptoms which led parents to go to a traditional healer. However, 60% of the parents had taken their child to a hospital before going to a healer; 72% of these had attended at least three times but only 5.5% reported that the treatment given in the hospital cured the condition. It is recommended that intensive health education on the causes, treatment and prevention of fevers and diarrhoea should be instituted, in conjunction with effective management of these conditions in hospital facilities.

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No advice received from dentist and lack of knowledge on restorative care, were the two major barriers to restorative care, as perceived by dental patients in Tanzania. Implementation of the Atraumatic Restorative Treatment approach may overcome many of the barriers identified.

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.

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Most respondents used toothpaste regularly and one-third regarded it as expensive. Toothpaste manufactured in Tanzania had free fluoride concentrations below the optimum levels for dental caries prevention. For a well-functioning Basic Package of Oral Care, the authority responsible for oral health has to take measures aimed at lowering the price of toothpaste, and toothpaste manufacturers have to ensure that their products have the optimal fluoride concentration for dental caries prevention.