Oral health care decays as shortage of dentists worsens

A shortage of dentists and unequal distribution across provinces and between public and private sectors are a health threat to most South Africans, public health experts have warned.

They also say the situation is getting worse, with the national shortfall of 430 dentists in 2018 expected to reach 1,252 by 2024 and up to 2,267 by the end of the decade.

Writing in the journal PLOS One, researchers at Stellenbosch University said 80% of dentists work in the private sector, which caters for about 16% of the population.

2,267: The predicted shortfall of dentists by 2030

6,125: The number of general dental practitioners in SA in 2016

—  In numbers

Lead author Dr Ritika Tiwari, who specialises in studying inequities in healthcare staffing,  said her findings revealed a skills crisis that not only worsened the pain, discomfort and disfigurement associated with poor oral health but increased the risk of linked conditions such as cardiovascular diseases, cancer and diabetes.

Tiwari’s co-author, emeritus professor Usuf Chikte, said Cape Town was at the epicentre of the crisis and is “the tooth-loss capital of the world”.

The research findings indicated “high, sustained and unacceptable levels of extremely poor, ineffective oral healthcare services for the population dependent on the public sector, which is in stark contrast to the increasingly treatment dominated, hi-tech private sector services that are driven by profit motives and consumerism”, he said.

A Gugulethu woman, who asked not to be identified, said she had experienced the crisis firsthand when she left her home at 4am one morning last month hoping to see a dentist about four decayed and agonising teeth.

When she was screened at 8.30am by staff at the Cape Town community’s dental clinic, she was sent home because her case was not regarded as an emergency and the daily quota of 40 patients had already been reached.

“For a month I had to take pain tablets while waiting for my own appointment, which was this week. It’s been the longest wait as I’ve been in pain most of the time,” the unemployed mother of four said after recently having two of the teeth extracted. The other two will be removed next month.

But in one sense, the woman is fortunate because a quarter of all dentists work in the Western Cape. Gauteng and KwaZulu-Natal account for half of dentists, meaning the other six provinces share the remaining quarter. 

“The shortage is a result of a multitude of factors,” said Tiwari. “They include a decrease in production — there are only four dental schools in the country —  emigration to first world countries, and costs in training of dental personnel.”

The shortage is a result of a multitude of factors. They include a decrease in production — there are only four dental schools in the country —  emigration to first world countries, and costs in training of dental personnel.

Chikte, a member of the Lancet Commission on Oral Health, said over the past three decades tooth decay and its consequences were experienced by more than 90% of the population, “with little prospect of significant improvement, even though they are largely preventable”.

Many patients with oral health problems ended up having their treatment delayed and had teeth extracted unnecessarily, he said. “In the process they experience terrible pain and sepsis, with treatment costs, reduced quality of life, loss of school days, disruption of family life and decreased work productivity. 

“About 70% of adolescents, aged between 12 and 15, have untreated tooth decay. The burden of tooth decay is seen mostly in the poor areas and starts very early in life, with early tooth extraction and high levels of tooth loss later in adult life.

“Dental health conditions and access to care are so starkly inequitable between the rich and the poor that the social determinants of health approach is the only way to improve optimal dental health outcomes.”

According to the latest Child Gauge, published by the University of Cape Town Children’s Institute in February, poor diets that are high in sugar are to blame for the stunting and malnutrition among children.

Co-editor Lori Lake said SA needed to shift perceptions from saying: “If only people ate the right things and got enough exercise,” to seeing the broader context of food systems and living conditions.

Dr Tracey Naledi, deputy dean of health sciences at UCT, among children under two, one in four consumed  “unhealthy sugary food” such as processed breakfast cereals, snack bars, processed meats, biscuits, chips, fast foods and many other such products. “This sets dietary habits and preferences which are difficult to change later,” she said.

Tiwari said all new dentists’ compulsory community service should take place in rural areas to address the maldistribution of human resources. “Essential packages of oral health interventions need to be provided in school and community settings to improve people’s control over their oral health and prevent oral diseases,” she said.

SA Dental Association CEO KC Makhubele said the National Health Insurance plan must prioritise dental training and funding for more dentists and implement preventative care programmes.

Mark van der Heever, spokesperson for the Western Cape health department, said the Covid-19 pandemic worsened the oral health crisis because elective procedures were halted. “There is now a backlog that we have to work through, but now we are looking at how we enable these services again,” he said.