- The school oral health policy in South Africa was not consistently implemented, leading to poor delivery of oral health programs in schools.
- There was a lack of technical support, capacity building, and collaboration among different sectors involved in oral health initiatives.
- While a high number of schools were visited by oral hygienists, there were still a high number of unmet treatment needs (71.2%).
- The implementation fidelity of the program was only 39.6%, indicating that it did not closely follow the key components required for success.
- To improve oral health outcomes, there needs to be better collaboration between stakeholders, increased access to dental care, and comprehensive approaches that include prevention and early intervention strategies.
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. South African schoolchildren are particularly susceptible to tooth decay due to 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 South African schoolchildren.
According to surveys, almost half of South African schoolchildren had active tooth decay in 2012. Other studies have also found high levels of tooth decay among this population, with one survey reporting that over 70% of schoolchildren had decay in their primary teeth. These figures are significantly higher than in countries with better-resourced healthcare systems.
To combat this issue, school oral health programs have the potential to make a significant impact. These programs 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 programs in Gauteng, including the challenges that hinder their effectiveness. It also provides recommendations for improving these programs.
The study took place in Tshwane, South Africa. It used a mixed-methods approach 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 program was implemented in practice. The third part assessed the impact of the program on expected outcomes and identified factors that affected the program's quality.
- The schools' oral health policy was not consistently put into action by the managers and oral hygienists, leading to poor delivery of the program.
- There was a lack of technical support, capacity building, and collaboration among different sectors.
- The program'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 utilizing 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.
To address the increasing oral health crisis in South Africa, a comprehensive approach emphasizing prevention and early intervention is necessary. Here are three key strategies that should be implemented:
- 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.
- 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.
- 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, prioritizing oral hygiene education for the wider school community, and implementing targeted outreach programs for marginalized populations, we can work towards preventing and addressing oral health issues more effectively.
Author and affiliation
Mpho P Molete: University of the Witwatersrand, School of Oral Health Sciences & Consortium for Advanced Research Training in Africa (CARTA) Graduate.
School-based oral health programs in the Tshwane district of Gauteng: Scope, implementation, and outcomes. PhD thesis, University of the Witwatersrand, Johannesburg, South Africa.
Fraihat N, Madae’en S, Bencze Z, Herczeg A, Varga O. Clinical effectiveness and cost-effectiveness of oral-health promotion in dental caries prevention among children: systematic review and meta-analysis. International journal of environmental research and public health. 2019 Aug;16(15):2668.
Jackson SL, Vann Jr WF, Kotch JB, Pahel BT, Lee JY. Impact of poor oral health on children's school attendance and performance. American journal of public health. 2011 Oct;101(10):1900-6.
Jordan RA, Krois J, Schiffner U, Micheelis W, Schwendicke F. Trends in caries experience in the permanent dentition in Germany 1997–2014, and projection to 2030: Morbidity shifts in an aging society. Scientific reports. 2019 Apr 2;9(1):5534.
Macnab AJ, Gagnon FA, Stewart D. Health promoting schools: consensus, strategies, and potential. Health Education. 2014 Apr 7;114(3):170-85.
Molete M, Stewart A, Igumbor J. Implementation fidelity of school oral health programs at a district in south africa. PLoS One. 2020 Nov 17;15(11):e0241988.
Molete MM, Igumbor J, Stewart A, Yengopal V. Dental status of children receiving school oral health services in Tshwane. South African Dental Journal. 2019 May;74(4):171-7.
Molete, M., Stewart, A., Moolla, A. and Igumbor, J.O., 2021. Perceptions of provincial and district level managers’ on the policy implementation of school oral health in South Africa. BMC Health Services Research, 21, pp.1-10.
Peres MA, Macpherson LM, Weyant RJ, Daly B, Venturelli R, Mathur MR, Listl S, Celeste RK, Guarnizo-Herreño CC, Kearns C, Benzian H. Oral diseases: a global public health challenge. The Lancet. 2019 Jul 20;394(10194):249-60.
Reddy M, Singh S. Dental caries status in six-year-old children at health promoting schools in KwaZulu-Natal, South Africa. South African Dental Journal. 2015 Oct 1;70(9):396-401.
Sachs JD. From millennium development goals to sustainable development goals. The Lancet. 2012 Jun 9;379(9832):2206-11.
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