Despite progress in dentistry, tooth loss in old age is still a reality, even more so in long-term-care residents. However, recent trends indicate that natural teeth are lost later in life. Functional decline and age-related pathologies have to be considered in oral health care for this vulnerable population. Retaining and restoring teeth and oral function in elders is important. Tooth loss significantly impairs masticatory performance, which cannot be fully restored by prosthodontic means. Hence an unconscious change in food intake occurs, often involving malnutrition and withdrawal from common meals. Poor oral appearance and bad breath may further impede social activities. Although a chewing activity may be beneficial for cognitive function, natural teeth can present a considerable risk for fragile elders, in whom aspiration of biofilm can lead to pneumonia and death. The presence of natural teeth is also correlated with higher life expectancy, but socio-economic confounding factors have to be considered. When evaluating oral health in the elderly population, standards and priorities for reporting oral health outcome measures have to be defined. Anatomical indicators such as the number of natural teeth or the presence of prostheses might be one option for reporting. However, functional indicators such as masticatory performance and patient-centred outcome measures may be more relevant. In conclusion, there is an overwhelming body of evidence that maintaining a healthy natural dentition in old age is beneficial from a structural, functional and psycho-social point of view.

BackgroundOral pain has been the major cause of the attendances in the dental clinics in Tanzania. Some patients postpone seeing the dentist for as long as two to five days. This study determines the prevalence of oral pain and barriers to use of emergency oral care in Tanzania.MethodsQuestionnaire data were collected from 1,759 adult respondents aged 18 years and above. The study area covered six urban and eight rural study clusters, which had been selected using the WHO Pathfinder methodology. Chi-square tests and logistic regression analyses were performed to identify associations.ResultsForty two percent of the respondents had utilized the oral health care facilities sometimes in their lifetime. About 59% of the respondents revealed that they had suffered from oral pain and/or discomfort within the twelve months that preceded the study, but only 26.5% of these had sought treatment from oral health care facilities. The reasons for not seeking emergency care were: lack of money to pay for treatment (27.9%); self medication (17.6%); respondents thinking that pain would disappear with time (15.7%); and lack of money to pay for transport to the dental clinic (15.0%). Older adults were more likely to report that they had experienced oral pain during the last 12 months than the younger adults (OR = 1.57, CI 1.07–1.57, P < 0.001). Respondents from rural areas were more likely report dental clinics far from home (OR = 5.31, CI = 2.09–13.54, P < 0.001); self medication at home (OR = 3.65, CI = 2.25–5.94, P < 0.001); and being treated by traditional healer (OR = 5.31, CI = 2.25–12.49, P < 0.001) as reasons for not seeking emergency care from the oral health care facilities than their counterparts from urban areas.ConclusionOral pain and discomfort were prevalent among adult Tanzanians. Only a quarter of those who experienced oral pain or discomfort sought emergency oral care from oral health care facilities. Self medication was used as an alternative to using oral care facilities mainly by rural residents. Establishing oral care facilities in rural areas is recommended.

The aim of this study was to investigate the prevalence of teeth with untreated dental trauma among children aged 4-15 years in Dar es Salaam, Tanzania. A sample of 4524 children from three districts of different socio-economic status in the Dar es Salaam area was examined for signs of dental trauma in 1998/99. In 21% of all children examined, at least one type of untreated dental trauma was observed. A high percentage of untreated dental trauma was observed at the ages of 4 and 15 years. The most frequently observed type of dental trauma was enamel fracture (67%) followed by enamel-dentin fracture (26%). A significant gender influence on the occurrence of untreated dental trauma was observed, with more boys (23%) having untreated dental trauma than girls (19%). A higher percentage of untreated dental traumas was observed among children in the district with highest SES (26%) compared to the prevalence in the other two districts (14-17%). The findings of this study show that dental traumas are prevalent among Tanzanian children. Therefore, provision of information to the lay community about the importance of early management of dental trauma, ways of preventing trauma and appropriate handling of avulsed teeth is essential in order to minimize the rate of dental injuries and the related complications.

The aim of this study was to investigate the nature of initial treatment provided by dental practitioners to children aged 1-17 years with various types of traumatic dental injuries at public dental clinics in Tanzania. Questionnaires on initial treatment were mailed to 188 practitioners and returned by 138 (73%). The reported treatments were analyzed in relation to the dental practitioners' qualifications and area of practice. Extraction of injured teeth was frequently reported for 64% of the injuries and prescription of antibiotics was reported by 67%, 48% and 46% of the practitioners for soft tissue injuries, concussion, and alveolar fracture respectively. Practitioners working at the Faculty of Dentistry were less involved in treating dental trauma than those at urban and rural clinics (P = 0.001), while no significant association was found with the level of education of the practitioners. Equal proportions of practitioners, about one-third each, reported correct, unnecessary and wrong treatment options. The quality of the treatments provided could not be explained by background variables. It can be concluded that dental practitioners in Tanzania provide a lot of over-treatment for traumatic dental injuries. Therefore, it is suggested that efforts should be made to improve and standardize treatment methods in Tanzania.

Eighty-eight per cent and 83% of the children knew the cause of tooth decay and bleeding gums respectively and 17-68% were aware of preventive measures. At the institutions visited, 92% of the children said they brush their teeth but 74% brushed when living on the streets, this difference was significant (chi2=4.40, P=0.05). About half did not use toothpaste during street life, whilst 8% do not use toothpaste at institutions, the difference was significant (chi2=5.081, P=0.025). Almost 22% use sweets and biscuits at institutions, about 44% used the snacks when living on the streets, the differences were significant (chi2=3.798, P=0.04, and chi2=3.893, P=0.04). Only 6% use sodas and sweetened juices at institutions, while 32-36% used the drinks during street life, the differences were significant (chi2=4.38 P=0.05 and chi(2)-12.87, P=0.01). The findings of this study show that most former street children are aware of the causes of dental caries and bleeding gums but have poor knowledge on prevention of the two diseases. Furthermore, children living on the streets are more likely to eat cariogenic foods and have poor oral hygiene practices.