In Focus Eyitope Ogunbodede
Dental care: the role of traditional healers Dental services in Third World countries could be greatly improved by integrating the work of traditional and modern practitioners.
In Nigeria, as in many other developing countries, traditional healers are still providing dental care, but their work is not integrated with that of dentists. In general, traditional healers are open to the prospect of collaborating with the dental profession, whereas the reverse is not true. In Africa, caries and periodontal disease are the most prevalent dental problems. If untreated, both lead to painful episodes and loss of teeth. Malocclusion is also common. Less frequent are fractured teeth, hypoplastic teeth, tooth attrition and abrasion, fractured jaws, congenital abnormalities, and tumours. Modern dental services are diagnostic, preventive, curative and restorative. Most Africans, however, see the dentist exclusively as a tooth-puller. Traditional healers are more numerous than dental practitioners in Africa, and are widely accepted by the people. They can be trained The author is Head of the Department of Preventive Dentistry, Obafemi Awololo University, lIe-lfe, Nigeria.
in routine diagnostic procedures and encouraged to refer complicated cases to modern dental centres. There is a need to explain to them that considerable harm may result from delaying referral or denying patients the opportunity for modern treatment. One of the most effective ways of preventing dental disease is to remove plaque. In Western countries this is achieved by the use of toothbrushes and paste, often in conjunction with other aids such as dental floss and toothpicks. In Africa, however, and in some parts of Asia, the chewing stick is commonly used (1-3). As well as facilitating plaque removal, most plants used as chewing sticks contain fluoride ions and have antimicrobial, anticariogenic, anti-inflammatory, anti sickling, antihypertensive, antimalarial and astringent properties (3-5). Chewing sticks are readily available and inexpensive. They are a good example of appropriate technology and should be incorporated into primary oral health care programmes, at least in Africa. 443
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In Focus
In the area of curative dentistry, African traditional healers treat exposed pulps using concentrated solutions obtained from the leaves, bark or roots of trees. It would be
jaw fractures. Orthodontic treatment and restorative procedures have little or no place in African traditional dentistry. The WHO Regional Committee for Africa has proposed the following measures: registration of all traditional healers;
The deep-rooted confidence of non-Westernized Africans in traditional healers should be turned to the greatest possible advantage in the field of denta. health.
promotion of a corporate organization of traditional healers; legal recognition of traditional healers on the basis of tests of competence; further research on traditional medical knowledge; wherever possible, the integration of traditional healers into health teams (7).
worth investigating the efficacy and chemical composition of the plants employed. The extraction of loose teeth may continue to be done by traditional healers, especially in remote villages where there is little or no access to modern dental care. There is, however, a need to improve hygiene in traditional healers' practices. Another area that should be explored is that of fracture reduction by traditional healers. The effectiveness of traditional bone-setters has been demonstrated (6), although little work has been done on their management of
* ** Traditional healers are a particularly valuable asset in communities where modern dental care is not readily available. The deep-rooted confidence of non-Westernized Africans in traditional healers should be turned to the greatest possible advantage in the field of dental health. Traditional dental practices should be evaluated with a view to arriving at effective and efficacious modalities of treatment.
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References 1. Akpata, E. S. & Akinrimisi, E. O. Antibacterial activity of extracts from some African chewing sticks. Oral surgery, oral medicine, oral pathology, 44: 717-722 (1977). 4. Sote, E. O. The relative effectiveness of chewing sticks and toothbrush on plaque removal. African dental journal, 2: 48-53 (1987). 5. Hollist, N. O. The technique and use of chewing stick. Odontostomatologie tropicale, 4: 171-174 (1981). 6. Bellakhdar, J. A new look at traditional medicine in Morocco. World health forum, 10: 193-199 (1989). 7. Traditional medicine and its role in the development of health services in Africa. Brazzaville, WHO Regional Office for Africa, 1976 (unpublished document AFR/RC26/TD/1).
2. Olsson, B. Efficiency of traditional chewing sticks in oral hygiene programs among Ethiopian schoolchildren. Community dental and oral epidemioldgy, 6: 105-109 (1978). 3. Enwonwu, C. O. & Anyanwu, R. C. The chewing stick in oral health care. World health forum, 6: 232-234 (1985).
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