Samkelisiwe Khumalo first noticed cavities in her daughter Unathi’s teeth when she was four. Two years later, Unathi has sixteen cavities-six in her bottom teeth and ten in her upper. She has never seen a dentist.

“I think she got these cavities because I started teaching her to brush her teeth at a late age, when she was four. I didn’t know that we must assist our children whenever they brush their teeth,” Khumalo tells Health-e News. 

“I had once shown her how to brush her teeth, and I assumed that was enough. I’ve also seen her doing exactly what I taught her. So, I didn’t worry,” she says.

The two closest clinics, Isipingo Municipal Clinic and Unjani Clinic Isipingo (a private clinic), only offer oral health services during health promotion campaigns run by the Department of Health or NGOs during Oral Health Month in September.

Khumalo says she received oral health education at Isipingo Clinic once, when Unathi was two years old, on an Oral Health Awareness Day. 

Lack of oral health training and education

Dr Bulela Vava, a dentist and founder of the Public Oral Health Forum, says oral health education at health facilities is lacking, and many clinics don’t complete the oral health examination section of children’s “Road to Health Card”. 

He attributes this to insufficient oral health training of nurses at primary care facilities. 

“Oral health literacy should start during pregnancy when the mother goes to clinics for check-ups,” Vava says. “Mothers should be taught how to take care of their children’s teeth and be informed that it is important to assist their children to brush their teeth up to at least eleven years.”

Vava recommends that caregivers start cleaning children’s teeth from the age of two. From four to six, kids should be taught to brush their teeth in circular motions by themselves, with an adult supervising. 

According to the World Health Organisation, tooth decay is the most common health condition globally. In South Africa, it’s estimated that 41% of children under nine have untreated tooth decay. 

It affects everyone, so it can’t be serious

Luthando Dlamini believes her five-year-old daughter’s cavities started after she stopped giving her formula milk and replaced it with a flavoured rooibos tea marketed for children. 

“I would overhear some ladies at the clinic, but I didn’t take it seriously until it happened to my child. I just assumed the cause is because she likes to eat popcorn, and food made out of maize such as samp, mielies, and chips.”

Her clinic, Halley Scott Community Health Centre in KwaNyuswa, offers oral health services, but Dlamini says she’s never received any oral health education there. 

She once picked up a pamphlet with details on how to take care of infants’ and toddlers’ teeth. But by then, her child’s teeth had already decayed.

Her daughter has still not had a dental check-up. “I didn’t take it seriously at first, as many children have the same problem,” says Dlamini. 

The cavities have now impacted what her daughter can eat. “She can’t eat certain foods like rice, spaghetti or noodles because these kinds get stuck in her molars. Sometimes she’d cry because of the pain,” says Dlamini. “If I cook rice for our household, I must cook phuthu or pap for her because it doesn’t give her problems.” 

Dr Denica Smit, from the East London Oral Health Centre, points to the broader access problem. “Sometimes the parents of these children are being overwhelmed by the struggle of survival with fewer resources, which means that something like tooth brushing will take a back seat, especially for children from townships and rural areas,” she says.

Vava adds that lower socioeconomic status, unemployment and poverty also drive children’s tooth decay, because parents give their children whatever they can afford, not thinking much about the impact on a child’s development. 

Inadequate care 

Andiswa Zwane’s six-year-old son has decay in his lower and upper teeth, causing him immeasurable pain. Whenever he eats, he cries. He also has boils on his gums, which keep appearing, even after treatment.   

Zwane took her son to the local clinic, where she says he was given pain relievers and antibiotics. The advice for the boils: rinse his mouth with lukewarm salt water at least thrice a day. 

He has never seen a dentist, and his only exposure to dental health is from an oral health campaign at his school, where he was given a toothbrush and toothpaste. 

Unemployed Zwane says if she had money, she’d take him to see a dentist. In the meantime, she’s doing her best to prevent further decay. 

“He brushes his teeth three times a day, I make sure of that. And I have recently avoided giving him sugary things such as cola, juice, sweets and biscuits because I think that might have caused these cavities,” Zwane says.

It’s not just teeth

Smit warns that poor oral health is a serious problem and can be life-threatening.

“People tend to view teeth in isolation; they forget that they are attached to the skull, attached to a body. Therefore, a single, untreated rotten tooth can lead to life-threatening sepsis and airway obstruction,” she says. 

Smit explains that premature tooth loss can affect a child’s health and development, as it can lead to speech pronunciation issues. Without healthy teeth, children are unable to chew effectively, which can lead to nutritional deficiencies.

The appearance of rotten teeth can also severely affect a child’s confidence. “Despite her beautiful smile with the little dimples, she’s shy and does not laugh a lot,” says Dlamini about her daughter. 

“The cavities are having a big impact on Unathi, who is bubbly and loves to laugh when she’s at home. But in public, she is shy and covers her mouth with her hands when she laughs,” says Khumalo. 
Zwane is grateful that her son still likes to laugh and doesn’t seem isolated from others because of his teeth. “It’s like he forgets that he has such teeth,” laughs Zwane. – Health-e News