Oral health and noma
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Dental and oral health refers to the well-being of the oral cavity, including the dentition and its supporting structures and tissues. The oral health profile is not homogeneous across Africa, and differs today from previous decades. Dental caries and periodontal disease in African countries appear to be neither as common nor of the same order of severity as in the developed world. Oral diseases must, however, be individually assessed in the local context in terms of prevalence and severity. A number of serious oral conditions exist in the African Region, and these need to be urgently addressed due either to their high prevalence, or to the severe damage or death they can cause. Cancrum oris (Noma), and the acute necrotizing ulcerative gingivitis with which it is associated, is still common among children in Africa.
The most recently available annual incidence figure for Noma is 20 cases per 100 000 population. The disease occurs in 39 of the 46 countries of the African Region. Historically, Noma is a disease occurring along the “Noma belt” of Mauritania, Senegal, Mali, Niger, Chad, Sudan, and Ethiopia. But cases from outside the “Noma belt” have been reported with an increased incidence, related to the HIV/AIDS pandemic. About 90% of children with Noma die without receiving any care. In conditions of poverty, where many children are malnourished or undernourished, the prevalence of conditions such as Noma is likely to increase.
The prevalence of oral and pharyngeal cancers is also on the increase in Africa.4 Greater alcohol use is associated with increasing levels of oral cancer. Rapid urbanization, and increasing use of tobacco, are factors also considered to greatly increase the incidence of oral pre-cancer and cancer. The oral manifestations of HIV/AIDS are very widespread, and most commonly include fungal infections such as those caused by Candida, necrotizing gingivitis or oral hairy leukoplakia. National surveys and smaller studies in Africa have shown the prevalence of dental caries to be quite low, but with substantial regional variations. Most of these cases (90%) remain untreated.
Maxillo-facial trauma has increased in many countries as a result of interpersonal violence, motor vehicle accidents and war. Chronic destructive periodontal disease is known to occur in a small proportion of most populations, regardless of location or socioeconomic status. Harmful practices such as the removal of tooth germs of deciduous canines, extraction of upper and lower anterior teeth, and the trimming or sharpening of upper anterior teeth, still prevail. Fluorosis is common in areas such as the Rift Valley in east Africa, and malnutrition is known to increase the likelihood of fluorosis in children. Edentulism, congenital malformations and benign tumours occur, but little prevalence data is available. The African Region faces an acute lack of recent, reliable and comparable data on oral health issues.
The prevalence of oral disease closely mirrors levels of social deprivation. Increasing urbanization has been shown to lead to observable increases in the prevalence of oral disease. Where public or private oral health services do function, they are treatment oriented, providing mainly for the relief of pain and sepsis. A successful approach to oral health in Africa needs to focus on the social and environmental determinants of oral disease in local context, and ensure equitable and universal access to affordable health services.