Background
Research on dental caries in Nigerian children has been conducted for several decades. The prevalence of caries in the early 1980s was high [
1‐
4]. However, the prevalence of dental caries varies with the study location in Nigeria, ranging between 13.9% to 17.4% in the semi-urban settlement of Ile-Ife [
5‐
7] to between 11.2% and 48.0% in urban areas such as Benin [
4,
8,
9], Enugu [
10‐
12], Lagos [
1,
2,
13‐
21] and Ibadan [
3,
22,
23]. The prevalence of caries is higher in urban than in rural areas [
24‐
27], higher in Northern than in Southern Nigeria [
25] and higher in primary than in permanent dentition [
6,
22,
25]. This prevalence is of epidemic proportion because it is higher than the 5% epidemic threshold. See Table
1. Unfortunately, a trend analysis of the prevalence of caries over time has not been possible because studies were conducted in different age groups, using different methods, and in diverse populations. The only national data on the prevalence of dental caries in children in Nigeria was conducted in 1995, and showed prevalence as high as 30% and 43% in children aged 12 years and 15 years respectively [
27]. However, the evolving evidence points to the need for proactive action to address the dental caries epidemic among children in Nigeria, especially for caries affecting the primary dentition. A previous study conducted in Lagos, Nigeria showed that despite intervention, the prevalence of caries in primary dentition increased from 17.9% to 20.4% over a 3-year period, though there was a 34.8% decline in the prevalence of caries in permanent dentition over the same period [
21].
Table 1
Prevalence of caries in population-based surveys in Nigeria
1 | | Lagos | Urban | 1979 | 6 yrs | 40.0% |
2 | | Lagos | Urban | 1980 | 4 yrs and 5 yrs | |
3 | | Lagos | Urban | 2001 | 5 yrs and 12 yrs | 22.5%, 15.8% |
4 | | Lagos | Urban | 2004 | 3 yrs – 10 yrs | 24.0% |
5 | | Lagos | Urban | 2005 | 12 yrs | 5.7% |
6 | | Lagos | Urban | 2006 | 12 yrs | 24.6% |
7 | Umesi-Koleosho et al [ 17]. | Lagos | Urban | 2007 | 11 yrs - 16 yrs | 23.8% |
8 | | Lagos | Rural and urban | 2007 | 6 months - 5 yrs | 10.5% |
9 | | Lagos | Rural and urban | 2009 | 18 months – 5 yrs | 10.9% |
10 | | Lagos | Urban | 2012 | 5 yrs - 16 yrs | 13.1% |
11a | | Lagos | Urban | 2014 | 2 yrs -12 yrs | 2000 -17.9% |
11b | | Lagos | Urban | 2014 | 2 yrs -12 yrs | 2003 - 20.4% |
12 | | Benin | Urban | 1983 | 5 yrs – 14 yrs | 40% |
13 | | Benin | Urban | 2004 | 12 yrs - 15 yrs | 33.5% |
14 | | Benin | Urban | 2012 | 7 yrs – 15 yrs | 15.7% |
15 | | Ibadan | Urban (private schools) | 1981 | 6 yrs | 46.0% |
16 | | Ibadan | Urban (public schools) | 1984 | 6 yrs | 18.0% |
17 | | Ibadan | Urban | 2005 | 12 yrs - 14 yrs | 11.2% |
18 | | Ile-Ife | Semi-urban | 1984 | 8 yrs – 15 yrs | 32.2% |
19a | | Ile-Ife | Rural and semi-urban | 1990 |
1981:
| |
| Urban:6 yrs-8 yrs | 33.6% |
| Rural:6 yrs-8 yrs | 30.5% |
| Urban:9 yrs-11 yrs | 33.4% |
| Rural:9 yrs-11 yrs | 28.8% |
| Urban:12 yrs-14 yrs | 28.1% |
| Rural:12 yrs-14 yrs | 34.6% |
19b | | Ile-Ife | Rural and semi-urban | 1990 |
1986:
| |
| Urban:6 yrs-8 yrs | 42.7% |
| Rural:6 yrs-8 yrs | 5.8% |
| Urban:9 yrs-11 yrs | 38.4% |
| Rural:9 yrs-11 yrs | 14.8% |
| Urban:12 yrs-14 yrs | 29.8% |
| Rural:12 yrs-14 yrs | 9.2% |
20 | Adekoya - Sofowora et al [ 5] | Ile-Ife | Semi-urban | 2006 | 12 yrs | 13.9% |
21 | | Ile-Ife | Semi-Urban | 2013 | 4 yrs - 6 yrs | 17.4% |
| 7 yrs – 12 yrs | 10.1% |
| 13 yrs -16 yrs | 7.5% |
22 | | Enugu | Urban | 2009 | 12 yrs - 15 yrs | 24.1% |
23 | | Enugu | Urban | 2010 | 12 yrs - 15 yrs | 15.5% |
24 | | Enugu | Rural | 2011 | 11 yrs - 16 yrs | 35.5% |
The severity of caries is low in Nigeria. In the permanent dentition, the decayed-missing-filled teeth (DMFT) ranges between 0.02 and 0.85 [
5,
6,
8,
10‐
21]. While the severity of caries is also low in primary dentition, a dmft index of greater than 1.0 is often only recorded in the primary dentition [
3,
13,
21] in children from urban areas. An exception to this finding was found in the study by Ojofeitimi et al. [
28] who reported a dmft greater than 1.0 in children who resided in a semi-urban region of Nigeria.
Of major concern is the high level of untreated caries in the permanent dentition. The proportion of children with untreated caries ranges from 77.2% in Ile-Ife [
5], to 98.6% in Benin [
8] and 49.5% to 85.5% in Enugu [
10‐
12]. In Lagos, the restorative index is 1% [
17] and the Met Need index in Ibadan is 0.11 [
22]. The prevalence of untreated caries in the primary dentition is also high, with values above 80% in all parts of Nigeria [
6,
29].
Despite the high need for dental treatment, dental service use continues to remain low and is often prompted by oral symptoms such as pain, and the need for curative treatment [
30‐
36]. Perception about the need for dental service use for preventive oral healthcare and management of oral health problems that are not associated with pain is also low [
34]. However, there is little evidence-based information on how dental service use for preventive oral healthcare and prompt management of oral caries can be increased. Ola et al. [
36] showed that pupils whose parents had a university degree were 70.0% more likely to visit the dentist in the last year than those whose parents had no university degree. Pupils that attend non-fee paying schools are three times more likely to visit the dentist for preventive reasons than those that attend high fee paying schools. Additionally, pupils living with one or both parents visit the dentist more often for preventive reasons than those living with persons other than their parents. School programmes could also improve use of oral health care services for curative purposes [
34]. Referral from the paediatric clinic did not increase dental service uptake [
37].
The use of recommended oral self-care (twice-daily tooth brushing, use of fluoridated toothpaste and avoidance of consumption of refined carbohydrates between meals) for the prevention of caries is low with only 7.8% of children from Southern Nigeria practicing recommended oral self-care [
35]. A large number of children consume sugar in between meals and more than once a day, do not brush twice-daily and do not use dental floss [
35]. These statistics highlights the magnitude of the problem with caries prevention for children in Nigeria.
The vision of the revised national oral health policy [
38] launched in 2012 is:
To promote optimal oral and general health for all Nigerians, reduce the morbidity and mortality rate, as well as reverse the increasing prevalence and incidence of oral diseases; to meet the global targets on the elimination and eradication of oral diseases and significantly ensure the maintenance of complete set of dentition through life, thus promoting general health for all Nigerians.
To achieve this vision over time, a review of the current structure and systems for providing oral healthcare service for children in Nigeria is important. Therefore, we investigated models for providing oral healthcare services for children that would reduce the current prevalence of caries and promote the use of dental services for preventive care and prompt disease management.
To address the study objectives, we reviewed articles published in peer-reviewed journals, documents from international agencies, such as the World Health Organization, Internet resources and research uploaded in the Nigerian scientific database that provided insight into the epidemiology of caries among children in Nigeria and addressed the objectives of the study. Studies that were included were those that reported on the prevalence and severity of dental caries, and those that reported on dental service use. To ensure the validity and reliability of the information obtained, we examined the information for consistency, and whenever possible, verified it by triangulating it with data in other documents. Information that could not be fully substantiated was excluded.
The first strategy was a search of PubMed, Global Health and African Journal online databases for relevant information. The initial search resulted in over 12,000 references being identified using the search terms “caries”, “children”, “epidemic”, “prevalence”, “response” and “Nigeria”. A review of these articles showed some duplication, as well as inclusion of materials that were not relevant to the study. All of the data on the prevalence of caries for this study were limited to population-based studies. All hospital-based data were excluded from the analysis on caries prevalence. Only 49 of these articles were deemed relevant to the study objectives. One study was excluded from the analysis because we determined that the methodology was faulty [
39]. A second study was excluded because of inconsistencies in the data presented on the prevalence of caries for the study population [
40]. A third study was excluded because the data were derived from a secondary analysis of a prior data reported [
41]. A fourth study was excluded because it was a repeat publication [
42]. A fifth study was excluded because the study was not conducted methodologically and a detailed oral examination was not performed [
43]. Three further studies were excluded because efforts to retrieve them were unsuccessful [
44‐
46]. The prevalence of caries reported in the study by Kubota et al. [
7] was recalculated to be able to obtain the population level prevalence of caries. This also allowed for data comparison and analysis.
Searches were then performed on the websites of organisations, such as the Nigerian Federal Ministry of Health (
http://www.fmh.gov.ng), the WHO (
http://www.who.int/) and the World Federation of Dentists (
http://www.fdiworldental.org). We identified an additional 13 materials for inclusion in the appraisal. We then checked the reference lists of all documents and articles retrieved in the previous search strategies to identify relevant materials. This retrieved a further 36 papers that were not previously included. We used the generic search engine Scirus to source additional information as necessary.
Finally, the database of the National and West Africa Postgraduate Medical College Fellowship examination thesis on caries, caries prevention and caries management in children was reviewed.
To study service delivery models, search words included “health service models”. Where appropriate, the “related articles” search tool was used to retrieve more relevant materials.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
MOF initiated the idea for the manuscript, wrote the initial framework, and edited the manuscript. NMC and NO assisted in the writing of the manuscript. OO and AAA supervised and edited the manuscript. All authors have read and approved the final manuscript.