New Recording 8

The discussion on oral health in Nigeria emphasizes the impact of dental products, access to care, education, culture, and economics on oral hygiene practices. Challenges include limited access to dental care, reliance on over-the-counter products, and cultural influences on oral hygiene habits. Dental services are provided at different levels, but access is limited, with most Nigerians paying out of pocket for care. The use of traditional remedies alongside modern dental products reflects cultural beliefs. Dental education and workforce face shortages, impacting quality of care. Restorative materials used are cost-effective and durable, prioritizing functionality over aesthetics. Cultural beliefs influence dental care-seeking behaviors, with traditional practices coexisting with modern dentistry. Hello everyone and welcome. Today I'm going to be discussing oral health in Nigeria, more specifically how dental products, access to care, education, culture, and economics all come together and shape how people take care of their teeth in Nigeria. So, Nigeria is a country where many people do not have regular access to dental care. There is no nationwide water fluoridation program and cultural traditions still strongly influence daily oral hygiene habits, right? So because of this, toothpaste, chewing sticks, and a lot of various over-the-counter products play a much bigger role in oral health than they may in the United States, as this is way more accessible to many people than regular dental home office care. So let's delve in a little bit about the country's overview and their oral health status. So, in Nigeria oral health challenges are quite common. Dental caries and periodontal disease are just as widespread, if not more, and many people only really go to a dentist when they're in pain rather than for preventative care. It's way less expected to go for regular checkups and more so like an emergency type thing. So access to care is very limited. Fewer than 20% of Nigerians have regular access to dental services and most dental clinics and professionals are located in urban areas like Lagos and Abajo. Rural areas are highly underserved. Like I mentioned earlier, because there is no national water fluoridation, fluoride toothpaste becomes the primary defense against cavities for most of the population. And another thing is that oral health education is quite limited. Economic barriers prevent routine visits and cultural beliefs often favor traditional remedies over modern dentistry. Now let's talk about some of the dental services available. So dental care in Nigeria is provided at three levels. There's primary care centers that may offer basic cleanings, oral health education, and simple extractions. Secondary facilities can provide fillings, some pulpal treatments, and basic restorative care. And then tetriary teaching hospitals provide more advanced services such as prostodontics, periodontal therapy, and surgical procedures. However, many clinics lack the equipment and materials as well as staff. So even when services should be available, they may not be. Common restorative procedures in private clinics include fillings, crowns, and root canals. Fillings costing about $5,000 to $20,000 Naira, so roughly $6 to $25 USD. Crowns ranging from about $20,000 to $100,000 Naira, so about $25 to $125 USD. And root canals costing about $30,000 to $100,000 Naira, so about $37 to $125 USD. These prices may seem low compared to the U.S., but relative to income in Nigeria, they are quite expensive. So preventative services like dental sealants are not widely documented or commonly used due to limited resources and emphasis on emergency care over prevention. Like I said, many people don't go for preventative care. OHI is not as common. So most of the time when you are visiting the dentist, it's because something has already progressed to a point where they are experiencing a lot of pain. So now it becomes more of restorative care rather than preventative care. Now you may be wondering, how does insurance and access to care play a role here? So the National Health Insurance Scheme of Nigeria provides very limited dental coverage, usually only for extractions and basic care, meaning that most Nigerians pay for dental care completely out of pocket. Because of this, many people delay dental care until pain becomes severe. Extractions are often chosen over restorative treatment, and some people rely mostly or entirely on traditional healers or home remedies instead of dentists. Now, as I mentioned earlier, most people use over-the-counter or at-home remedies instead of traditional dental hygienists or dentists. So let's talk about some of these. Because access to dentists is limited, daily oral hygiene products are extremely important. One of the ones that's very popular right now is actually Miswak. So Miswak is a traditional oral hygiene product. Many Nigerians use it. It's a chewing stick from the Salvador persica tree. It's been used for centuries and can help remove plaque mechanically and support gingival health. It's inexpensive, accessible, and culturally accepted, especially in rural areas. However, it does not provide fluoride and cannot reliably replace brushing with fluoridated toothpaste for cavity prevention. It's most understood as a traditional adjunct to modern care. Some of the toothpastes that they use are, one, Unilever Nigeria Close-Up Toothpaste. It's one of the most accessible brands. It also contains sodium fluoride and is sold in tubes in small sachets. And the sachets allow people with low income to just buy small amounts at a time based on however much they feel they need at that time, something that we rarely see in the U.S. Another toothpaste is Dabur Herbal Clove Toothpaste. So this combines fluoride with herbal ingredients like clove and neem. This appeals to Nigerians who prefer natural and traditional remedies while still getting cavity protection. Another one is Aspera Nigeria LTD, which is Oracura Plus Red Gel. It's a local gel toothpaste marketed as modern, refreshing, and affordable. And on the more expensive side, we have GlaxoSmithKline Parodontics. This is available but is more expensive and targeted toward gum health, usually found in pharmacies. So fluoridated toothpastes generally meet recommended levels of 1,000 to 1,500 ppm fluoride, which is critical since there is no fluoridated water supply. Now let's talk about dental education and the dental workforce in Nigeria. So Nigeria does have multiple accredited dental schools where students complete a five-year Bachelor of Dental Surgery degree, which is then followed by clinical and licensing. However, there is a shortage of professionals. About one dentist for every 46,000 people. So only around 400 dental hygienists nationwide. Dental hygiene is a recognized profession, but hygienists are far fewer than in the United States. Many preventative services are performed by dentists or other dental personnel. Students training in dentistry sometimes report limited access to modern equipment and clinical materials, which can affect the quality of hands-on training in restorative and orthodontic procedures. Now, speaking of restorative options, compared to the U.S., preventative sealants are not commonly part of routine care in Nigeria. Again, this is due to limited resources and less emphasis on prevention and lack of insurance reimbursement. In fact, most of the restorative materials that may be very common to us in the U.S., such as composite resins, bonding agents, and glass ionomer cements are imported, which increase costs. Because of this, clinics may choose materials that are more durable and affordable rather than aesthetic. Some of these are dental amalgams or silver fillings. Because it's durable, it's long-lasting, it requires less technique, and it works well in areas where moisture control is difficult. It's also much cheaper than tooth-colored restorations. Glass ionomer cement is still used because it releases fluoride and it bonds chemically to the tooth. It also tolerates less moisture, but it's more commonly used for cervical lesions, pediatric restorations, and temporary and semi-permanent fillings. It's more so used as a base in the U.S., but in Nigeria, it can be used as a primary restorative material. They also use zinc oxide eugenol, so ZOE. It's very inexpensive, and it's a sedative effect on the pulp. It's commonly used as a temporary restoration or base, or when patients cannot immediately afford definitive treatment. There's also acrylic denture materials, so polymethyl methacrylate. It's used for full and partial dentures. It's affordable and easy to fabricate, and most commonly used as a prosthetic material in public and teaching hospitals. We do also use composite resin, but much more limited due to the cost of equipment, because it's more expensive. It requires bonding agents, curing lights, and good moisture control, and it's more technique-sensitive. It's more so used in urban clinics rather than in rural or public settings, so more so in private clinics. The reason they focus more on the previous products I listed is because they last a long time, even if follow-up care is uncertain. So hypothetically, you can only go to the dentist maybe once every year or once every two years, but you need something that's going to last you a good amount of time without following up and having to get it checked on and possibly redone. These things will last. They're more durable. They're more inexpensive. And they prioritize strength, practicality, and fluoride benefit as well as affordability over things like invisibility and aesthetics that we prioritize more in the U.S. Now, as I also mentioned earlier, cultural beliefs play a big role in how dental care is perceived in Nigeria. So some communities see teeth in the mouth as having a spiritual meaning, not just a biological function. This affects when and how people seek care. Culturally sensitive education is very important to help people engage with modern dentistry, because when you don't respect people's previous or existing views on dentistry, it makes it a lot harder for people to open up and take heed of what you're saying, even if you do feel like it could help them significantly. Traditional practitioners offering non-scientific treatments are sometimes preferred because of this, because they are familiar, trusted, and less expensive than private dental clinics. This explains why traditional practices like miswak and herbal paste continue to be very prevalent alongside modern toothpaste brands, because they go along with people's existing beliefs and they bring comfort, as they are familiar. All in all, Nigeria's oral health system highlights how culture, access, and economics shape dental practices. With limited dental access and no water fluoridation, as well as high out-of-pocket costs, toothpaste and traditional tools like miswak are essential to oral health, and modern dentistry and traditional practices exist side by side. Understanding all of these things are key to providing culturally respectful and informed care in Nigeria. Thank you so much for listening.