5
International Dental Journal (1 997) 47, 21-25 Dental education in Africa with special I S.O. Jeboda Lagos, Nigeria Summary Over the years, the dental profession in most of the developing countries of the world has given the education of the dentist greater priority over the education of dental auxiliaries. There has also been a great tendency on the part of the profession in these countries to think that dental education involves the training of dentists alone. The training of dental auxiliaries forms an important core of dental education for the training of oral health workers in the developing countries. The training of dentists in the developing countries, especially Africa, seems to have been lopsided with excessive emphasis on restorative procedures. The dental undergraduate training programme in a representative Nigerian dental school is investigated and suggestions made on the appropriate mode of training needed for the future Nigerian, and indeed the future African dentist. The need for effective parallel training of dental auxiliaries, especially in large numbers, is also emphasised. Dental education involves the training of dentists and dental auxiliaries with the ultimate aim of produc- ing an oral health team which will work together harmoniously in the provision of oral health care to communities it is intended to serve. The dental profes- sion in Nigeria, like in most of the African countries, has tended to think only of the training of the dentist when considering the subject of dental education and the profession has failed to appreciate that the training of para-dental staff, especially dental auxiliaries, forms an important core of dental education. The reason for the relevance of the education of the dental auxiliaries is obvious. The dentist, when finally produced from the dental school, cannot successfully practise without effective assistance from his para-dental staff, especially the dental auxiliaries. Also there are certain procedural functions which can be conveniently and effectively delegated to the dental auxiliaries to the time-saving advantage of the dentist, thereby affording him time to perform managerial and administrative functions. The dental profession in most African countries, with a few exceptions, has also wrongly assumed that only dentists can effectively provide oral health care for the community and the profession has therefore over- concentrated on the education of the dentist. The successful training, employment and utilisation of dental auxiliaries in the provision of oral health care has been well doc~mentedl-~. 0 1997 FDINVorld Dental Press 0020-6539/97/01021-05 Not only has the profession in Africa wrongly over concentrated on the training of dentists, we have also done so in serious defiance of the oral health status of the communities for which we have been training them. It is in recognition of this misconception that there is a need to seriously and very objectively review our dental undergraduate training curricula in Africa so as to assess their relevance to the oral health needs of the African communities. There is also a need to look at the training of dental auxiliaries, both the operating and non-operating types, so as to determine their relevance to the oral health needs of the society. There are currently 16 dental schools in the whole of sub-Saharan Africa as against seven for the whole of the continent about 26 years agoh.Of these 16 dental schools, four (25 per cent) are in Nigeria and they are all located in the South-Western region of the country. These are the dental schools in Lagos, Ibadan, Ife and Benin. The Lagos dental school was the first to be started, having been established in 1966. Indeed it was the first dental school in black Africa. The teaching curricula in the four dental schools have been fashioned after the British pattern and they are therefore very similar with slightly different contact-time allocation for the various subjects in the curricula. For the purposes of the present study, one of the dental schools, Lagos, which is truly representative of the dental schools in Nigeria, is being investigated. The objective of this study is to critically

Dental education in Africa with special reference to Nigeria

Embed Size (px)

Citation preview

International Dental Journal (1 997) 47, 21-25

Dental education in Africa with special

I S.O. Jeboda Lagos, Nigeria

Summary

Over the years, the dental profession in most of the developing countries of the world has given the education of the dentist greater priority over the education of dental auxiliaries. There has also been a great tendency on the part of the profession in these countries to think that dental education involves the training of dentists alone. The training of dental auxiliaries forms an important core of dental education for the training of oral health workers in the developing countries. The training of dentists in the developing countries, especially Africa, seems to have been lopsided with excessive emphasis on restorative procedures. The dental undergraduate training programme in a representative Nigerian dental school is investigated and suggestions made on the appropriate mode of training needed for the future Nigerian, and indeed the future African dentist. The need for effective parallel training of dental auxiliaries, especially in large numbers, is also emphasised.

Dental education involves the training of dentists and dental auxiliaries with the ultimate aim of produc- ing an oral health team which will work together harmoniously in the provision of oral health care to communities it is intended to serve. The dental profes- sion in Nigeria, like in most of the African countries, has tended to think only of the training of the dentist when considering the subject of dental education and the profession has failed to appreciate that the training of para-dental staff, especially dental auxiliaries, forms an important core of dental education. The reason for the relevance of the education of the dental auxiliaries is obvious. The dentist, when finally produced from the dental school, cannot successfully practise without effective assistance from his para-dental staff, especially the dental auxiliaries. Also there are certain procedural functions which can be conveniently and effectively delegated to the dental auxiliaries to the time-saving advantage of the dentist, thereby affording him time to perform managerial and administrative functions.

The dental profession in most African countries, with a few exceptions, has also wrongly assumed that only dentists can effectively provide oral health care for the community and the profession has therefore over- concentrated on the education of the dentist. The successful training, employment and utilisation of dental auxiliaries in the provision of oral health care has been well doc~mentedl-~. 0 1997 FDINVorld Dental Press 0020-6539/97/01021-05

Not only has the profession in Africa wrongly over concentrated on the training of dentists, we have also done so in serious defiance of the oral health status of the communities for which we have been training them. It is in recognition of this misconception that there is a need to seriously and very objectively review our dental undergraduate training curricula in Africa so as to assess their relevance to the oral health needs of the African communities. There is also a need to look at the training of dental auxiliaries, both the operating and non-operating types, so as to determine their relevance to the oral health needs of the society.

There are currently 16 dental schools in the whole of sub-Saharan Africa as against seven for the whole of the continent about 26 years agoh. Of these 16 dental schools, four (25 per cent) are in Nigeria and they are all located in the South-Western region of the country. These are the dental schools in Lagos, Ibadan, Ife and Benin. The Lagos dental school was the first to be started, having been established in 1966. Indeed it was the first dental school in black Africa. The teaching curricula in the four dental schools have been fashioned after the British pattern and they are therefore very similar with slightly different contact-time allocation for the various subjects in the curricula. For the purposes of the present study, one of the dental schools, Lagos, which is truly representative of the dental schools in Nigeria, is being investigated. The objective of this study is to critically

22 International Dental Journal (1 997) Vol. 47/No.l

examine and analyse the Lagos dental undergraduate training programme and to establish its relevance to the oral health needs of the country.

Materials and methods The dental undergraduate training curriculum in a repre- sentative Nigerian dental school was reviewed. The contact hours in both the pre-clinical and clinical subjects were calculated and the total contact hours for each subject were tabulated. Comparisons of subject contact hours were made and the insufficiency, sufficiency or over-sufficiency of such contact hours discussed.

Results

Table 1 Contact hours for non-dental subjects from year 2 to year 6 at the Lagos dental school.

Non-dental subjects Contact hours per centage

Anatomy 520 12.7 Physiology 494 12.0 Biochemistry 400 9.7 Medical Sociology 56 1.4 General African Studies 80 1.9 Psychology 26 0.6

Morbid Anatomy 238 5.8 Pharmacology 228 5.6 Microbiology 174 4.2 Clinical Pathology 146 3.6 Statistics 50 1.2 Clinical Psychology 32 0.8 Community Health 64 1.6 Basic Clinical Skill 160 3.9

Basic Therapeutic Skills 160 3.9

General Medicine (Actual 150) **400 9.7 General Surgery (Actual 150) “400 9.7 General Anaesthesia 160 3.9 Primary Health Care 320 7.0 Total 4108 100.0

**Even though 400 hours are allocated to medicine and to surgery in the Nliculum, only 150 hours (3.7 per cent) are used for each of them, the remaining time being for dental practice.

Table 2 Contact hours of the various dental subjects from year 2 to year 6 at the Lagos dental school.

Dental subjects Contact hours per centage

Introduction to Dentistry Oral Biology Dental Materials Prosthetic Technique Operative Technique Introduction to Dental Clinics Local Anaesthesia Oral Medicine Peridontology Dental Practice Conservative dentistry Oral Radiology Oral Pathology Oral & Maxillofacial Surgery Orthodontics Paedodontics Community Dentistry Electives Total

26 120 80

314 356

30 18 66 62

934 104 32

150 84 54 72

140 320

2962

0.9 4.0 2.7

10.6 12.0 1.0 0.6 2.2 2.1

31.5 3.5 1.1 5.1 2.8 1.8 2.4 4.7

10.8 100.0

Discussion

There is no doubt that dental education, be it at the undergraduate level, postgraduate level or at the dental auxiliary level, must conform with the oral health needs of the society. Oral health needs are determined by the oral health status of the society. We therefore must ensure that we train oral health personnel whose skills will be relevant to the needs of the society. The tendency in most developing countries, especially in Africa, is to adopt Western-oriented types of dental undergraduate training programme that will end up producing dentists for other regions of the world. Even in some of the African countries where dental auxiliaries are trained, policy makers tend to pattern their job descriptions, designations and training programmes after those of industrialised countries’. Dental education in Africa needs to go through a drastic revolutionary stage in which severe deviation from the Western-oriented training programmes should be implemented. Apart from our training programmes being fashioned after oral disease patterns in our societies, available resources in terms of finance, manpower and infrastructures should be taken into consideration. There must be proper prioritisation of interests and the stage of societal deveI- opment must be taken into consideration.

Caution needs to be exercised in starting new dental schools in the African region. In establishing these schools, certain questions come to mind and they must be properly addressed:

Are the numbers of dentists being trained in the African region necessarily needed for the oral health needs of the various African countries? Can the countries afford to employ all the dentists on completion of their training? Is there a serious need in the continent for the sophisticated dental procedures on which a major part of dental undergraduate training has concen- trated? What percentage of the total populations have a demand for these sophisticated procedures? What percentage of the society can afford the cost? What percentage of the cost can the Government take care of? What in general are the oral disease patterns in the populations we are caring for? Should we then not start thinking of more concentra- tion on training of dental auxiliaries and less concen- tration on the training of dentists? This is not to say that we are not going on with the - -

training of dentists but that we have to train a few that will be fully and effectively utilised and also effectively assisted by properly trained dental auxiliaries.

Most of the dental undergraduate training programmes in the developing countries, and especially in Africa, have been fashioned after those in the developed countries and the curricula in these schools are exactly the same as those from the developed countries. It is certain that oral disease patterns in these developing countries are different from those in the

Jeboda: Nigerian dental education 23

developed countries. The oral health needs in these two environments must therefore be different and hence there is no scientific justification for using the same training programme for dentists intended to practise in the two different environments.

A review of some of the dental undergraduate training programmes in the African region reveals that far too much emphasis has been placed on the teaching of restorative procedures and its associated subjects thus leaving fewer hours for other dental clinical subjects and the teaching of medicine, surgery and other associ- ated clinical subjects8. The representative Nigerian dental school investigated in this study reveals that 28.8 per cent of the clinical contact period is allocated to dental materials, prosthetic technique, operative technique and conservative dentistry all of which constitute restorative dentistry (Table 2 ) . A further 31.5 per cent is allocated to dental practice but it is regretta- ble to mention that a greater portion of the period is used for the practice of restorative dentistry to the disadvantage of other clinical postings. In the study of a representative example of South African dental schools, it was observed that restorative dentistry and its associ- ated subjects are responsible for approximately half of the time available for clinical dentistryh.

In most African countries, Nigeria included, larger proportions of the communities, usually more than 80 per cent, stay in the rural areas and the most prevalent oral diseases among them are periodontal diseases. Even among the city elites, periodontal disease still exists in unexpectedly large amounts. It is pertinent to realise that the natural history of the disease suggests that it develops in a linear progression throughout an indi- vidual's life time and the severity or otherwise of the disease will depend on the oral hygiene of the individual. While periodontal disease is the most preva- lent oral disease among Nigerian rural populations, many studies have shown that dental caries is the most common oral disease in the Nigerian urban populations and that it is steadily increasing particularly among children from affluent socio-economic homesy. The important conclusion to draw from all these is that preventive dentistry should be the bedrock of the dental undergraduate training programme for the future African dentist and hence the need for the prominence of community dentistry in the dental undergraduate training programme. This approach will be more cost- beneficial and more cost-effective for the developing countries with lean budgetary allocations for oral health care more so as the cost of maintaining curative oral health services has been found to outstrip the financial resources of even the most prosperous countries of the worldl". The cost-effective utilisation of both operating and non-operating dental auxiliaries in the prevention and treatment of these two major oral diseases has been mentioned2J,5.

The dental undergraduate curricula in most African

countries have been fashioned after those in the devel- oped countries despite the fact that these curricula have been found to be too technically restorative-oriented and there is ample evidence to prove their failure even in the developed countries2,i,1'-2". The significantly observable lack of sufficient preventive care in dental practice has also been and it has been advised that programmes for oral health care must recognise the paramount importance of prevention if they are to be effective and economical2".

Since the typical African dentist is also confronted with all sorts of medical ailments, especially when practising in the rural areas, he must have a good knowledge of general medicine and general surgery8. The contact hours provided for medicine and surgery in the representative Nigerian dental school are too small to achieve this objective (Table 1) . A similar obser- vation has also been made in the case of South African dental schoolsh. With the current HIV/ AIDS pandemic in some African countries, the importance of teaching Dental Medicine to dental undergraduates cannot be over-emphasised. It is suggested that African dental schools should embark on well-structured Dental Medicine undergraduate training programme. It is also being proposed that more time be devoted to medicine and surgery and other related subjects in the dental undergraduate training programme. This helps to make the products of the dental schools very alert wherever they may practise.

Finally, it is being proposed that close contact should exist between the dental and medical undergraduate during their training for sharing of knowledge. The advantage in training these cadre together has earlier been empha~ised?~. It is also being proposed that the dental undergraduate undergoes a compulsory rural area posting during his training so as to make him familiar with the community eventually to be served. His train- ing should also bring him in contact with primary health care workers so as to achieve a proper integration of oral health care into primary health care". In addition, more importantly, his training should be alongside the training of dental auxiliaries28.

Conclusion

There is a need to ensure that the nature and type of dental education provided in developing countries is related to the oral health needs of those countries. The cost of such training must not be so high as to embarrass the financial purse of dental education. The present dental undergraduate training in most developing countries, and more especially in Africa, is too Western- oriented and needs to be reviewed. Emphasis should be seriously focused on the improvement of the training and utilisation of dental auxiliaries in the African region.

24 International Dental Journal (1 997) Vol. 47/No.l

L'enseignement dentaire en Afrique, en particulier au Nigeria

Resume

Pendant des annees, la profession dentaire dans la plupart des pays en voie de developpement du monde a donne B l'education du chirurgien-dentiste une priorite plus grande qu'B l'education des auxiliaires dentaires. La profession dentaire de ces pays avait Cgalement tendance B penser que l'enseignement dentaire ne comprend que la formation des chirurgiens-dentistes. La formation des auxiliaires dentaires forme une partie essentielle de l'education dentaire pour les travailleurs de santC bucco-dentaire dans les pays en voie de developpement. La formation des chirurgiens-dentistes dans les pays en voie de dhveloppement, en particulier en Afrique, semble Ctre desequilibree B cause de l'insistance mise sur les procedures de restauration. Le programme de formation dentaire universitaire d'une &ole dentaire nigerienne representative fait ici l'objet d u n e etude et des suggestions sont faites quant au mode de formation necessaire, non seulement pour le futur chirurgien-dentiste nigerien, mais aussi pour le futur praticien africain. On insiste egalement sur la necessite d u n e formation parallele efficace pour auxiliaires dentaires, specialement en nombre important.

Zahnmedizinische Ausbildung in Afrika - unter besonderer Beriicksichtigung der Situation in Nigeria

Zusammenfassung

Im Laufe der Jahre hat der zahnmedizinische Berufsstand in den meisten Entwicklungslandern der Welt der Ausbildung von Zahnarzten zunehmende Prioritat eingeraumt verglichen mit der Ausbil- dung von zahnarztlichem Hilfspersonal. Entsprechend machte sich unter den Zahnarzten dieser Lan- der zunehmend die Tendenz breit, daB zahnarztliche Ausbildung einzig und allein die Ausbildung von Zahnarzten betrifft. Dabei ist die Ausbildung zahnmedizinischer Hilfskrafte ein sehr bedeutender Aspekt der Ausbildung von Mundgesundheitserziehern in den Entwicklungslandern. Die Ausbildung von Zahnarzten in diesen Regionen der Welt - speziell in Afrika - scheint einseitig auf die Unterrich- tung restaurativer Verfahren ausgerichtet. Das Curriculum an einer durchschnittlichen nigerianischen zahnmedizinischen Fakultat wurde untersucht und es wurden Vorschlage gemacht fur eine angemes- sene Ausbildung, die mit Blick auf die Zukunft fur afrikanische Zahnarzte im allgemeinen und nigerianische Zahnarzte im einzelnen als notwendig erachtet wird. Die Notwendigkeit einer effektiven Parallelausbildung einer groBen Anzahl zahnarztlicher Hilfskrafte wird ebenfalls betont.

Educaci6n odontol6gica en Africa con especial referencia a Nigeria

Resumen

Durante aiios la profesi6n odontol6gica de la mayoria de 10s paises en desarrollo ha dado una mayor prioridad a la educaci6n de 10s odont6logos que a la del personal dental auxiliar. Tambien ha habido una gran tendencia en la profesi6n de estos paises a considerar que la educaci6n dental s610 implicaba la preparaci6n de odontdlogos. La preparacion de 10s odont6logos en 10s paises en desarrollo, espe- cialmente en 10s del Africa, parece demasiado desequilibrada con un enfasis excesivo en 10s procedi- mientos restauradores. Aqui se investiga el programa de preparaci6n odontol6gica de pregrado de una escuela dental representativa de Nigeria y se hacen sugerencias sobre la preparaci6n apropiada para el futuro odont6logo de Nigeria y por cierto, para el futuro odont6logo de todo el Africa. Tambien se enfatiza especialmente la necesidad de una preparaci6n paralela eficaz, y en grandes cantidades, de personal dental auxiliar.

References

1. Ana J R. Dental manpower needs in a developing commu- nity: A critical analysis of the West African scene. Int Dent J 1976 26: 411-420.

2. Jeboda S 0. The role of dental auxiliaries in the prevention of

oral diseases. Odontostomatol Trop 1982 5: 163-169. Sheiham A, Jeboda S 0. Periodontal disease in Nigeria - the problem and possible solutions. Trop Dent J 1981 4: 211-219. Dreyer W G P. The training of dental manpower in South

3.

4.

Jeboda: Nigerian dental education 25

Africa. J Dent Assn S A 1988 43: 311-314. 5. Jeboda S 0. An appraisal of Botswana’s approach to provi-

sion of dental health services Trop Dent J 1984 7: 75-78. Dreyer W P. Dental education trends in Africa with special reference to Southern Africa. Int Dent J 1989 39: 211-215. Adewakun A. The challenge of providing rural care. Africa Health 1995 17: 14-15. Hollist N 0. Dentistry in the developing countries. Africa - a study. Trop Dent J 1985 8: 23-28.

9. Jeboda S 0. The magnitude of dental caries in Nigerian Populations - A retrospective review. Nig Dent J 1982 3: 54- 61.

10. Barmes D E. The world wide distribution and significance of oral diseases. Int Dent J 1977 27: 270-272.

11. Freedman H L, Williams C H M, Grainger R M. Prevalence and severity of periodontal disease in adu1ts.J Canadian Dent

12. Gray P G, Todd J E, Slack G L. et al. Adult dental health in England and Wales in 1968. HMSO London 1970.

13. Todd J E, Whitworth A.Adult dental health in Scotland in 1972. HMSO London 1974.

14. Holst D. Dental caries in school children in some Danish communities with and without dental service. Comm Dent and Oral Epid 19753: 237-243.

1976 26: 340-345.

6.

7.

8.

ASS 1965 31: 779-786.

15. Baerum P, Arnljot H. Oral health care in Norway. Int Dent J

16. Barnard PD, Clements F W. Oral health care in Australia. Int

17. Hunter P BV, Davis P B. Oral health care for Canterbury, Dent J 1976 26: 320-326.

New Zealand 13-14 years old students. Int Dent J 1976 26: 334-339.

18. Sheiham A. International collaboration and research in the organisation of the dental education of dentists and the pub- lic. Int Dent J 1977 27: 164-168.

19. Murtomaa H, Ainamo J. Role of health education among services rendered by dental personnel in Finland. Comm Dent and Oral Epid 1977 5: 164-168.

20. Jeboda S 0. Lagos dental practitioners and prevention - an attitude survey. Trop Dent J 1985 8: 101-109.

21. Young M A C. Dental health education of adults. In Richands N D, Cohen, L K. (ed) Social Sciences and Dentistry. 1971. FDI.

22. Goldhaber P. Report of a working group on objectives of curricula. Int Dent J 1973 23: 1-17.

23. Freedman J W. A consumer advocates’ view of community dentistry. J Dent Edn 1977 41: 656-659.

24. Greene J C, Suomi J D. Epidemiology and public health aspects of caries and periodontal disease. J Dent Res 1977 56:

25. Rodda J C. Restorative dentistry - A dental dilemma . N Z Dent J 1978 74: 21-25.

26. FDI. Dental health policy statement of the Federation Dentaire Internationale. The General Assembly in the 6th Annual Dental Congress. Athens. 1976.

27. Jeboda S 0. Integrating oral health care into primary health care in Nigeria. Nig Dent 11990 9: 50-54.

28. Jeboda S 0. Opinions of British Dental providers on the train- ing, employment and utilisation of dental therapists in the United Kingdom. Trop Dent J 1983 6: 91-105.

20-26.

Correspondence to: Dr. S.O. Jeboda, Department of Preventive Dentistry, College of Medicine, University of Lagos, P. M. B. 12003, Lagos, Nigeria.