ANB-BIA SUPPLEMENT
ISSUE/EDITION Nr 323 - 01/05/1997
CONTENTS | ANB-BIA HOMEPAGE
Senegal
People have toothache
by Yacinthe Diene, Dakar, Senegal, 30 January 1997
THEME = HEALTH
INTRODUCTION
On the 11-13 December 1996, the National Association of Dental
Surgeons of Senegal held its Second Annual Congress, in the
Meridian-President Hotel in Dakar. The meeting, at which were
present dental surgeons from 15 African countries as well as
their counterparts in France and Switzerland, focused on how the
new techniques which are used all over the world, could be
adapted to the oral-dental problems encountered in Africa and
particularly in Senegal
The Congress proved, if that was necessary, that oral-dental
health in African is a public health problem. People's oral-
dental problems can be reduced to two factors: tooth decay
and para-odontopathy (gum disease, loose and falling teeth).
The Congress tried to focus on those problems in order to adapt
the new costly and sophisticated procedures used everywhere in
the world, to African countries with very little resources.
In his communication on the evolution of public health in African
countries, Professor Ndioro Ndiaye, head of the Department
of Odontostomatology in the faculty of medicine in Dakar, shared
some reflections with those attending the Congress: "The
integration of odontology into the public health system in our
countries, continues to be a problem, in spite of our leaders'
efforts. Why? Is it a question of lack of competence on the part
of professional dentists at every level? What must be done to
find fitting short or long term solutions?
Interesting Discussions
The reflections of Professor Ndiaye gave rise to a very
interesting debate!
Poor buccal-dental health. Twenty years ago, the World
Health Organization (WHO) attained its objectives in matters of
buccal dental hygiene, in 90 of the 150 member countries of the
organisation. There has been a significant decline in some
diseases like tooth decay, in Europe and developed countries. By
contrast, in Africa, gum disease and the predominance of tooth
decay continues to be a serious problem, especially in the two
to twelve age group. This observation led the specialists to
devote a large part of their discussions to finding solutions to
this problem. Preventive measures. Preventive measures can
be taken to avoid some dental diseases. However, to attack the
problem, it is imperative to use modern means of communication
to teach dental hygiene. There is a lack of an uniform policy to
make people aware of what preventive means are available. In
Senegal, for example, studies on dental care have highlighted the
active elements contained in some plants or roots, which protect
the gums or the surface of teeth. The results of these studies
showing economic and efficacious means of dental hygiene, are not
always publicised, unlike new procedures in dental care which are
very expensive. Relationship between quality and price.
In Africa, losing your teeth can means losing ones "good
looks". This may result in the patient involving himself in
costly
"aesthetic" dental surgery which probably he can't
afford. If the dental profession is going to do something about
simplifying techniques or reducing costs, then there's the whole
problem of equipment or materials to be used: a) for making and
fitting false teeth; b) for implanting fixed dentures into the
bone of the jaw by means of an artificial root made of titanium;
c) for primary dental treatment. Concerning the latter point, it
should be noted that the two great buccal-dental problems
identified (dental decay and paradontopathy) have their origins
in an infection: it is a problem of microbes which can become
aggressive and pathogenic. Bacteriological research. A
good part of the discussion was devoted to the means of
combatting infection, following the outstanding contribution by
Dr.Paulette Agboton Mignon, of the faculty of Medicine of Dakar.
She spoke about "The
bacteriological study of the seat of buccal-dental
infection". The results of this study reveal a strong
connection between buccal-dental health and the presence of
infection of the endocardium. This means that bacterial flora and
especially streptococci are seated in dental infections which in
turn cause infection of the endocardium!
Brown colouring of the teeth or fluorosis. This
phenomenon which affects some sectors of the population of
Senegal, is connected with the fact that water in some areas
contain a lot of fluorine. This strengthens the bones and the
teeth, provided it is used in measured proportions. Without a
certain amount of fluorine, bones and teeth become fragile, and
then you've got major problems!
Senegal's dental situation
All subjects on the programme were treated extensively. Then
Congress participants turned their attention to Senegal's dental
situation. As in all other countries with limited dental health
means, Senegal is faced with an imbalance between lack of
resources and the increasing need for adequate health provision
- a permanent challenge in Africa!
Professor Ndiaye does not shirk the problem: "We don't
have enough dentists or the necessary auxiliary services such as
senior qualified dental technicians. Community workers able to
organise necessary dental health education programmes among the
people, are also woefully lacking"!
Senegal's situation is an indicator of what's happening in
other African countries (with some notable exceptions in the
Maghreb and South Africa). Senegal has only 200 dentists for
eight million inhabitants, or one for 40,000 people. However, the
capital Dakar, with 2 million inhabitants, has 100 practitioners.
The other three quarters of the population, or six million people
spread over nine regions, has to make do with 43 dentists. And
even then, about 20 of them are unemployed!
The political will is clear. Two years ago, by using the Fund
for Economic Development, the government set up 65 consulting
rooms for dentists. However, this initiative which needs to be
continued and intensified comes up against three obstacles:
- All dentists want to practice in Dakar, even though
the need for dentists is much greater in the interior. Even those
who are established in the interior want to move to Dakar,
because the people in the countryside do not have much money.
- Caution and optimism. Even though Senegal has a ratio of one
dentist for every 40,000 people, the academic authorities are
very cautious: they know that dentists are needed but they
don't want to skimp on the training of students, because that
would be against the best interests of the people. This cautious
attitude contrasts with the relative
optimism of the government, for now the situation is less
dire than in 1975, when there were only ten dentists and a
handful of dental technicians in Senegal. Since then, two
institutes for the local training of those two
professions have been established.
- The demand for dental care is constantly on the
increase. Demographic growth (3% per year) means there is
a large section of young people under 30 years of age, who suffer
from dental ailments of all sorts. Some have to visit a dentist
twice a month. Dental care has become more and more accessible
thanks to dental insurance at an affordable price, available
through public institutions. But side by side with that, there
are private surgeries who thrive on competition. There are the
"large surgeries" serving a clientele of some standing,
who are attracted by the quality of the equipment used. Then
there are the "small surgeries" which charge small fees
in order to attract clients!
This Second Congress was an opportunity for delegates to
assess their human, material, technological and financial needs
against available resources. However, it is one thing to study
the problems arising from dental diseases and quite another to
do something about them. The main concern is to make these
disorders less costly, less painful and less incapacitating for
the people. But lack of resources remains a serious problem!
END
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