Mpho Matlakale Molete, University of the Witwatersrand, School of Oral Health Sciences & Consortium for Advanced Research Training in Africa (CARTA) Graduate.

Oral health is a vital part of overall health and well-being, but it is often ignored or neglected. Neglecting oral health can have serious consequences for physical and mental health, including tooth decay and gum disease.

In  South Africa schoolchildren are particularly susceptible to tooth decay because of factors such as limited access to dental care, a lack of oral hygiene knowledge, and high sugar consumption. It is therefore essential to address these challenges and improve oral health among this population group.  

A survey done in Ehlanzeni district in Mpumalanga found that almost half of the participating children had active tooth decay in 2012. Another study in the Western Cape found levels of tooth decay among this population of over 70%. Nationally estimates of tooth decay among children are around 60%. These figures are significantly higher than in countries with better-resourced healthcare systems.

School  oral health programmes have the potential to make a significant impact in combating this crisis. These programmes can provide oral hygiene and nutritional education to children, as well as supervised tooth-brushing activities. Additionally, preventative clinical care, such as fluoride treatments and sealants, can be made available in schools.

This report presents research findings on the implementation of school oral health programmes in Gauteng, including the challenges that hinder their effectiveness. It also provides recommendations for improving these programmes.

The study took place in Tshwane, South Africa and consisted of three parts. The first part explored the views of oral hygienists and oral health managers on the scope of school oral health services. The second part examined how the programme was implemented in practice. The third part assessed the impact of the programme on expected outcomes and identified factors that affected the programme’s quality.

Key findings

The schools’ oral health policy was not consistently put into action by the managers and oral hygienists, leading to poor delivery of the programme.

There was a lack of technical support, capacity building, and collaboration among different sectors.

The programme’s implementation fidelity, which refers to how closely it followed the key components needed for success, was only 39.6%.

While the oral hygienists visited a high number of schools, exceeding the policy’s recommendation (109%), there were still a high number of unmet treatment needs (71.2%).

The study clearly showed that to improve the implementation and outcomes of oral health initiatives in schools, there needs to be better collaboration between stakeholders in planning and using available resources. It is important to have a comprehensive approach that combines increased access to care with effective public health interventions to prevent and intervene early in oral health conditions. By implementing policies intentionally and monitoring progress regularly, the overall burden of oral disease can be reduced over time.

Recommendations

To address the increasing oral health crisis in South Africa, a comprehensive approach emphasising prevention and early intervention is necessary. Here are three key strategies that should be implemented:

1. Improved access to dental care: It is crucial to ensure that all children in South Africa have better access to dental care. This can be achieved by increasing the number of dental therapists and oral hygienists. Additionally, mobile dental clinics could be used to reach school-aged children in underserved areas. Public education campaigns should also be launched, using community health workers to educate parents and guardians on the importance of regular dental check-ups and preventive measures such as dietary changes and proper brushing techniques.

2. Oral hygiene education in schools: School-based oral hygiene education is vital for preventing oral health issues. Oral hygienists, school nurses, and Ward-Based Outreach Teams should provide basic instructions on how to prevent cavities and gum disease through diet, proper brushing habits, and flossing techniques. To further reduce the prevalence of cavities in schoolchildren, schools could provide fluoridated rinses or other fluoride treatments.

3. Targeted outreach programs for marginalized populations: Special initiatives should be developed to reach marginalized populations who face greater barriers to dental care. These programs could include free screenings at local clinics and follow-up treatment as needed. Additional support from social workers or other healthcare professionals may also be provided to address any additional barriers that marginalized populations may face in accessing dental care.

All in all, a multifaceted approach is required to address the oral health crisis in South Africa. By improving access to dental care, prioritising oral hygiene education for the wider school community, and implementing targeted outreach programmes for marginalised populations, we can work towards preventing and addressing oral health issues more effectively.