Introduction

Though caries prevalence in Tanzania is low, generally carious teeth are not treated with restorations but eventually extracted. Seeking dental treatment in the rural areas is often time consuming and expensive due to the lack of infrastructure in the country.

In order to overcome these obstacles as well as to provide dental students with real life experience with patients, the Department of Community Dentistry, School of Dentistry Muhimbili began an outreach programme involving primary schools in the nearby areas of Dar es Salaam and Morogoro.

The Muhimbili School of Dentistry, main entrance

Children waiting in line for examination

A classroom is used as a temporary clinical facility

The sterilization process used during the examination

This presentation is based on information collected and photographs taken in Dar es Salaam, Tanzania, by Pontus Schölander and Edgardo Alfaro, final year dental students from the Faculty of Odontology, Malmo University, Sweden, April 2007.

Background

The outreach programmes started back in 1983, only three years after the Dental Faculty was founded and are financially supported by the Faculty, which in turn is financially supported by the Ministry of Higher Education, Science and Technology.

The final year students visit Morogoro, a region which has a population that consists of people from all the tribes of the country and is representative for Tanzania as a whole, when it comes to oral health status, while the 4th year (penultimate year) dental students visit the primary schools in Dar es Salaam. The schools are chosen randomly within these regions, and may be visited more than once.

This presentation is based on the outreach programme involving the primary schools in the Dar es Salaam area.

Edgardo and Cecilia looking for caries

Dr Febronia Kahabuka supervising student

Problems with non-powder gloves

Pontus and Cecilia examining a student

Project outline

The concept behind the outreach program is primarily to perform screening of the children’s oral health, with emphasis on oral health education, oral hygiene and caries status.

The schoolchildren line up outside the classroom where they are informed about how the examination procedure will be done. Following this brief information, the children will enter one by one and be examined by the dental students, whom with the help of sunlight, a dental mirror and a dental probe will register eruption stages, caries, and gingivitis, as well as an estimation of the oral hygiene by registration of visible plaque.

After the examination the children receive a sample of toothpaste and oral health education and oral hygiene instructions.

The information gathered by the students is then compiled and feedback is given to the authorities (The District Educational Offices) and the schools. Feedback and advice/recommendation are also given individually to the child and its parents, in the form of a letter.

Achievements

• During one visit to a primary school, 302 children aged 6-13 were examined.
• 206 children showed at least one caries affected tooth, 24 had spontaneous bleeding.
• A total of 55 were caries free. (see Table 1)
• All the children were given oral health education and tooth pastes.
• Letters of advice/recommendation were sent to parents of children needing further treatment.

Grade	Total	Age	Boys	Girls	Health	Caries	Plaque	Bleeding
1	40	6-9	19	21	13	27	5	0
2	50	6-10	25	25	5	43	9	0
3	72	7-13	25	47	8	56	33	3
4	77	8-14	36	41	17	49	50	12
5	63	8-13	38	25	12	31	40	9
Total	302		143	159	55	206	137	24

Table 1. Results from a visit to a Primary School, as examined by the 4th year students (April 2007).

Health = healthy individual without caries, plaque or bleeding.

Caries = individuals with at least 1 caries affected tooth.

Plaque = individuals with any amount of visible plaque.

Bleeding = individuals with spontaneous gingival bleedings during examination.

 

Students during examination

Dr Hawa Mbawalla giving instructions

Conclusion

Outreach programme providing screening, feedback and oral health education to school children in the Dar es Salaam area is effective. Many of these children otherwise will not receive any oral health related advice or guidance.

Acknowledgements

We would like to thank Dr Febronia Kahabuka (Head of Department of Preventive and Community Dentisry), Dr Hawa Mbawalla, Dr Joyce Masalu as well as the staff and students at the Muhimbili School of Dentistry for their contribution to this presentation, and their warm hospitality.

* This project was performed by Pontus Schölander and Edgardo Alfaro as a Student Research Project at the Faculty of Odontology, Malmö University, Sweden under the guidance of Dr J. Stjernswärd and Dr L. Widerström.

 

More pictures

Edgardo during outreach programme

Schoolchildren lining up for a photo

Upanga Primary School, Dar es Salaam

Dar es Salaam in a rainy day

A class room from the Dental School

Minor surgery theatre

During a biopsy

A good road on the countryside

Tanzania from air

The WHO Zanzibar office