DENTAL OR ORAL HEALTH PATIENTS PERSPECTIVE

DENTAL OR ORAL HEALTH PATIENTS PERSPECTIVE Presented by DR. O.O. AKINWUMI

INTRODUCTION

DENTAL HEALTH CHALLENGES PATIENT SEEK ATTENTION Dental Health Challenges or diseases for which patients seek attention are quite numerous including various oral ulcerations, different types of infections bacteria and viral such as Dental carries or tooth decay, pulpitis, gum infections, ANUG – Acute Necrotising Ulcerative Gingivitis which could lead to NOMA or Cancrum Oris, if not treated on time, Ludwigis Angina. Various oral cancers, hallitosis or bad mouth odour. Congenital malformations. NOTE: It is usually unbearable pains, massive swellings and debilitating conditions that commonly bring patients to the hospitals to seek treatment.

KNOWLEDGE OR IGNORANCE ABOUT DENTAL HEALTH What Dental Health is all about; dental health education, Accessibility – where to seek for dental Health Care Services, who provides dental health – the Dental Professionals, Dental infrastructural facilities available and locations, quacks in dentistry, dental legal or litigation issues, culture and local traditions, cost of receiving dental care services, dental health policies (WHO, Federal and States).

DENTAL HEALTH EDUCATION For quite a while now, we have embarked on an aggressive and massive Dental Health education to the public at large. Our dental health professionals (Dentists, Nurses, Technicians etc.), Particularly the dental Nurses, regularly visit different schools – Nursery and Primary, as well as Secondary Schools to educate the young ones at that level and ages, market places, out – patients units and Ate – natal clinics of our hospitals. NOTE: Establishments of various Dental Schools in Nigeria over the years such as the first Dental School at the University of Lagos in 1973 followed by the University of Ibadan Dental School in 1975 and later other Universities like Obafemi Awolowo and Benin to train and re-train and graduate Dental Professionals have equally enhanced knowledge about Dental Health Care tremendously. Contributions of other schools like different Dental Schools of Technology and Therapy at Enugu, Abeokuta and Akure etc to produce Paradental professionals must be acknowledged here.

ACCESSIBILITY AND DENTAL FACILITIES Dental Health Care Services are now more accessible to the people at least in Oyo State and I must commend the efforts of UCH (University of Ibadan College of Medicine and the Government of Oyo State regarding this, though a lot still needs to be done. Dental facilities (Centres) are found in many towns in Oyo State which are Ibadan and its environ which has about Six Functioning Government owned (Federal and State) Dental Centres located at the University of Ibadan Dental School, Aremo, Dugbe, Moniya and Ring Road (New Adeoyo State Hospital) not mentioning the numerous private Dental Clinics spread all over the state. Other major towns like Eruwa, Oyo, Ogbomoso, Shaki and Iseyin also have Government owned Dental Centres.

DENTAL PROFESSIONALS There are many qualified, well trained Dental Surgeons (Dentists) both General practitioners, and Specialist in different branches of Dental Health practice, Dental Technologists, Dental Surgery Technicians, Dental Nurses and Dental Therapists. So who to provide quality Dental Health Care Delivery to our people is no longer a problem and the public now know the proper professionals to approach whenever, they have dental Health challenges. These are positive developments.

QUACKS IN DENTAL PRACTICE I cannot leave knowledge about Dental Health without talking about the existence of Dental quacks who abound and are flourishing in every part of the state, doing great damages to the health of our people and at times killing them. Hopefully, with more Dental Health Education, general education, appropriate legislations and enforcements, more decisive actions on the part of various heath professionals and their associations, other concerned bodies and the public, this menace will be reduced to the bearest minimum safe level. NOTE: That it could be difficult to tackle quackery because of certain factors that usually play out, like poverty, ignorance, illiteracy, lack of proper legislations against it and appropriate prescribed sanctions (but I bet the citizens are getting enlightened and they could take court actions against anybody who messes around with their health). Sentiments and cover – up, ethnicity and tribalism, socialization between the quacks and the public whereby quacks relate well with the law enforcement agents, Obas and Chiefs, Big Men and Big Women in the society, cult groups and those in governments at federal, state and Local, Religious Leaders so that any time they are in trouble resulting from their quack practice, they quickly run to them for possible assistance. I believe it will soon be no business as usual.

COST OF RECEIVING DENTAL HEALTH CARE People who seek Dental Health Care Services now know that Dental Services or treatments are relatively very expensive. This is due partly to the expensive dental equipments, materials and other items which of course have to be purchased in foreign currencies like American Dollars, Euro and British Pound Sterling. All have to be imported into Nigeria from those Countries because Nigeria does not produce or manufacture most if not any of them. It is a pity with all our abundant Human and Material resources. NOTE: Some form of subsidy and financial assistance are occasionally provided especially by kind hearted individuals, health professionals, associations and Governments. NHIS – National Health Insurance Scheme will be of benefits to the people including the masses.

LITIGATIONS: MEDICO – DENTAL LEGAL ISSUES More and more Nigerians are now aware they can sue to court any practitioner for malpractices (True or false). Cases or incidents of straight set – ups are gradually coming up probably because some of them feel they can make dirty money from Health professionals. So colleagues be careful about what you do with your patients and proper documentations is very important. Most Nigerians now know their RIGHTS.

GENERAL ATTITUDE OF PATIENTS CONCERNING DENTAL HEALTH CARE Patients general attitudes about dental health care vary from person to person, location to location, culture to culture, environment to environment and are deeply rooted in a number of factors such as culture and traditions environment, orientation, past or previous experiences (Good or bad if bad they run away), finance, age of the patient, financial capabilities of the patient, challenges, accessibility, facilities available, literacy level, ignorance, fears, beliefs, personality make – up, stories, attitude to life generally, how competent, friendly, gentle and confident the dental health care provider is at the point of contact.

The physical appearance, how well or neatly dressed or poorly dressed the practitioner is also goes along way to affect the patient’s attitude. Also the conditions of the equipment and instruments to be used (sterilization) we have seen a patient requesting that the instruments to be used on her must be sterilized in her presence, duration of the treatment and type, functional equipment available or lack of it, prognosis or outcome of the procedure, success or failure of such treatment especially if very expensive reassurance and expectations, all these affect the attitude of the patients. Generally, patient’s attitudes towards dental health care are very poor in Nigeria especially if it involves some form of payments for the treatments. Most of them cannot be bothered and it is only very bad, compelling health conditions that make them seek treatment including unbearable pains. Nobody wants painful conditions, nobody wants to die. Pressures from neighbours, religious bodies, relations and friends also push them to seek attention. I ask you how many of you out there have gone for dental check – ups, scaling and polishing this year? You see now, even the highly educated people just could not be bothered.

A FEW EXAMPLES OF ATTITUDES OF PATIENTS Let us look at a few examples that may directly or indirectly relate to attitude. PATIENT ABANDONMENT POSITIVE ATTITUDES TRUST STRANGE BEHAVIOUR SUPERSTITIONS

STORIES AND FEAR Some patients are afraid as they come to the Dental Centres either due to bad stories they have been told or previous terrible experiences. Imagine stories like Mama Kabiru went for Tooth extraction the other day and ran mad (Insanity) so do not go. Please educate me, is there a mutually exclusive relationship between tooth extraction and insanity? I do not know. It can be a Research topic in the nearest future. Other stories like once you begin to remove your teeth you probably will end up removing all one day so go to spiritual homes or kokoro centres for a more acceptable solution. Fears: If you put on an orthodontic appliances (metallic) to correct malocclusions and achieve an acceptable aesthetics as is done for children, the god of thunder or Iron will strike the child and all those who see the iron (metal) in his or her mouth dead. Of course the parents of such a child are somehow discouraged and prefer such child to live with the bad condition. NOTE: When that baby becomes a big boy or big girl in future will quarrel with such parents and blame them for his/her condition. By which time it may be too late to intervene.

PATIENT’S PRACTICES, USE OF ACIDIC SUBSTANCES, THE “KOKORO SAGA” USE OF LOCAL SOAPS, HERBS, CONCOCTIONS, CONSUMPTION OF MULTIPLE ANALGESICS AT THE SAME TIME SACRIFICES TO APPEASE THE SMALL GODS, VISITS TO HERBALISTS, SPIRITUAL HOMES, INSTRUCTIONS AND COUNTER INSTRUCTIONS, FORCEFUL SELF TOOTH EXTRACTIONS, CULTURAL AND TRADITIONAL PRACTICES, ARTIFICIAL DIASTEMA PHENOMENON (FOR BEAUTY AND AESTHETICS), USE OF SUPER GLUES ON DENTURES ETC.

EXAMPLES OF PRACTICES • Topical applications of such things like Acidic substances like battery water, local soaps, hot drinks, ground aspirin tablets, concortions and others to the painful tooth, gums or Dental Lesions. Imagine, the Dangers in this practice. • Consumption of several analgesics. (ALAKANPO) packed together at the same time, like Butazolidin tablets, Indomethacin, Paracetamol, Aspirin and Feldene tablets all in order to get relieved of severe Dental Pains. You can imagine the systemic effects particularly on the Kidneys and Liver.

THE “KOKORO SAGA OR PRACTICE This is an interesting and unimaginable practice for a number of reasons. Let me ask a general question is it really possible to call verbally through some incantations/or words various bacteria and viruses responsible for infections in the oral cavity or any part of the human body out in large numbers up to about one hundred and sixty and brought out on a cotton wool or a container and be counted one by one just like that.

UNHYGIENIC FORCEFUL TOOTH EXTRACTIONS A lot of our youths are very daring and do try to remove a painful tooth by themselves at home using dirty unsterilized instruments like chisels, screw drivers and pliers and then pack the extraction socket with toilet papers or clothing materials. Some of them do come down with operative and post – operative complications like severe haemorrhage, pains, severe infections, Tetanus, Ludwig’s Angina hopeless conditions and at times eventual Death especially if they do not report at the proper Dental Centre on time.

AESTHETICS ISSUES ARTIFICIAL DIASTEMA At times, particularly young big girls do request for artificial diastema in the upper jaw regarding it as an additional beauty things e.g. Two Ladies, one of them felt her friend is being sprayed with too much money by men whenever they are on the dancing floor because of her diastema. Since both of them have all that a lady can have, she felt the only thing missing in her was this diastema so she requested for an artificial diastema between the two upper central incisors. The request was turned down because drilling the teeth may compromise the tooth pulps which may lead to bigger problems later even though she was ready to pay any amount of money charged. She left feeling disappointed

POVERTY ISSUES Some patients are so poor that they cannot afford to pay for their Dental Treatments. An example was a 40years old Danfo Driver who sustained severe injuries to his facial region, facial soft tissues lacerations requiring extensive suturing, and maxillary Dentoalveolar Bone fractures resulting from a Road Traffic Accident around Moniyaand was brought to our centre soaked with his own blood. He had no money and it was badly blood soaked two hundred naira (N200.00) he had. His wife and relations were called but refused to come. It was only his mother that came the following day without any money. What will the attending Dentist do? Luckily for him it was a Pastor Dentist seeing him who mobilized and paid for his treatment assisted by other health workers around.

RECOMMENDATIONS

ESTABLISHMENT OF DENTAL FACILITIES OR CENTRES

ADVICE/AN APPEAL I appeal to our people to take adequate care of their health as they go on with their daily activities. Any infectious in the oral cavity can spread throughout the whole body and can kill, so do not take your Dental Health for granted. Do something before it is too late. “DON’T LET ME CRY” In the 1970s and 1980s, this used to be a popular Disco dance track, and I vividly remember what used to happen. I won’t go into that because of time. However, I want to pass an appeal message by this song. To my colleagues-Health Professionals please don’t let your patients cry whenever they need your attention. Be friendly, understanding, merciful and take good care of them. To the authorities please take care of people under your care (administration). To the various Governments (Federal, State and Local) please don’t let Nigerians continue to cry because majority of the citizens are already crying. Stop the crying, eradicate poverty, hunger, diseases and ignorance in our nation. Create massive employments for the teeming youths, develop the country, let there constant supply of water and electricity. Let there be security of life and properties. Equip and fund health care sector adequately. PLEASE, PLEASE, DON’T LET US CRY.

IT IS WELL THAN YOU VERY MUCH FOR TAKING YOUR TIME TO LISTEN TO WHAT I HAVE TO SAY. THANKS FOR YOUR PATIENCE AND AUDIENCE I STOP HERE GOD BLESS

DENTAL OR ORAL HEALTH PATIENTS PERSPECTIVE