1. Introduction
Oral cavity diseases are the most common global diseases and are associated with social and behavioral factors. The most common oral diseases are caries and periodontitis [
1]. The prevalence and severity of dental caries are still lower in the non-urban regions of East Africa than in industrialized Western countries [
2]. The World Health Organization (WHO) recognizes that poor oral health, systemic diseases, inequality, and increased poverty are the major factors contributing to periodontal diseases [
3]. Currently, the WHO estimates that approximately 50% of the global population (close to 3.5 billion people) suffer from a reduced oral health status [
4].
Since the 1980s, there has been a rise in the consumption of refined sugar, which has increased the prevalence of dental caries in Tanzanian communities [
5]. The number of oral health professionals per 10,000 people in Tanzania was 0.1 as of 2014–2019 [
4].
An additional challenge in dental care is that the density of dental professionals differs greatly between urban and non-urban regions [
2,
6]. However, the limited number of dentists is not the only problem affecting dental care. In addition, the level of training of dental practitioners in non-urban areas is often lower than that in urbanized areas. This causes restricted access to high-quality healthcare services in rural parts of low-income nations, such as Tanzania [
7]. Given this background, the observed continuous increase in the consumption of high-sugar foods must be viewed critically for the development of general oral health [
8].
The implementation of community-based caries prevention programs in rural areas could sensitize the population to caries prophylaxis [
9]. In principle, hospitals and hospital staff in non-urban areas are of particular importance as general points of contact for the population regarding health matters [
10]. However, even in local health facilities, such as rural hospitals in Tanzania, there is a shortage of adequately qualified dental staff [
5].
As the density of dental care is particularly low in non-urban regions of Tanzania, an increased incidence of caries with all its consequences, including tooth loss, is possible in the long term [
1]. In Tanzania, dental treatment facilities, if they are available in non-urban regions, are often locally linked to existing hospital facilities [
2]. This means that hospital facilities such as the Ilembula Lutheran Hospital (ILH) act as a point of contact for the population in the event of oral disease [
10]. Given the lack of prophylaxis options available to the local population, it is important to keep an eye on the population’s oral health situation. As these hospitals are a point of contact for oral diseases, it is important to determine the level of individual oral health of healthcare workers, as they are seen as the logical point of contact by the population in the absence of specialist dental staff. Available data on the oral health status of general healthcare workers are very limited [
2]. One recent study has been published on the oral health status of nursing staff in the non-urban regions of southwestern Tanzania [
2].
At the time this study was conducted, the global COVID-19 pandemic was prevalent. Thus, this study was conducted under COVID-19 conditions [
11]. The design of this study was such that this study could have been conducted at any time, and it was not directly related to the pandemic [
12].
The current study aimed to assess the oral health status and the resulting conservative, surgical, and prosthetic treatment requirements of healthcare workers at a hospital in a non-urban area in southwest Tanzania. This study examined a closed cohort under COVID-19 conditions.
4. Discussion
This research included 134 healthcare workers from ILH. The sexes were evenly represented. This was unexpected, given that the majority of practicing healthcare workers in Tanzanian villages are women [
6]; however, it bolstered the investigation into sex-specific dependence.
None of the participants had suffered from a SARS-CoV-2 infection or COVID-19 disease in the past 12 months [
17]. It should be noted that recent SARS-CoV-2 infection or COVID-19 disease was only queried anamnestically. No tests were carried out regarding the pathogen in relation to this study. The interpretation of this result means that a connection to the global pandemic cannot be made, as this study was only conducted under COVID-19 conditions. Thus, this study does not provide any objective evidence of an effect of a SARS-CoV-2 infection or COVID-19 disease on oral health. The majority of participants (
n = 92, 68.7%) stated they were free of general diseases. This may be related to the general medical background of the research participants, who may have been focused on maintaining improved general personal health. However, the high general health ratings could also be explained by the anamnestic data collection technique. This may be especially true for the spread of infectious diseases. The proportion of HIV-positive participants was much lower than Tanzania’s average infection rate (0% vs. 4.8%) [
18]. A total of 4.5% of the surveyed participants took medications. Questions about the usage of specific drugs were not asked.
The majority of the healthcare workers who took part in this study (
n = 94; 70.1%) used toothpaste and owned their own toothbrushes (
n = 76; 56.1%) [
19,
20]. The research did not inquire as to whether the toothpaste contained fluoride as an active component. The majority of healthcare workers cleaned their teeth twice a day (
n = 76; 56.7%). Male healthcare workers were more likely than female healthcare workers to clean their teeth more than twice per day (0.75% vs. 0.70%) [
21,
22]. The differences between the sexes were minimal and insignificant. In general, women demonstrated higher health awareness than men, which might be regarded as reflective of the individual use of dental care products [
23]. Interdental cleaning was performed by only a few participants [
2,
6]. This would require increasing the density of dentists, not only throughout Tanzania but especially in non-urban areas, such as Ilembula, to counsel adults with individualized oral health instructions. Almost two-thirds of the participating healthcare personnel stated they had not had an acute toothache at the time of the inquiry. These results imply that toothache was an irrational complaint. Additionally, societal and cultural factors influence how people perceive pain [
24]. Gum bleeding was reported in a small number of participants (
n = 8, 6.0%) [
25]. More male healthcare workers suffered from gum bleeding than their female counterparts. This may be because men are less effective than women at providing home-based oral care [
23]. Misuse of the toothbrush is a typical cause of increased gingival bleeding during home dental care. The use of broken or outdated toothbrushes can exacerbate gum disease, even if the DMF/T index is low [
25]. Older healthcare workers showed increased susceptibility to periodontal disease. This finding is consistent with observations in Western industrialized countries, where the prevalence of periodontal disease is correlated with age [
26,
27].
More than half of the participants stated that they had not undergone a dental checkup in the last 2 years [
28]. Tooth extraction was the most commonly performed treatment [
29]. However, this frequent form of treatment had been administered to only 7.4% of the participants in the last 2 years. Nearly one in five participants had undergone a dental examination two years prior to the study visit. This is half the average for other parts of Tanzania, where approximately 40% of the respondents had annual dental checkups [
19]. The main reason for the low frequency of dental consultations was the very low density of fully trained dentists in Tanzania, with a ratio of 0.1 dentists per 10,000 people in the current WHO Oral Health Country Profile [
30]. This figure is even lower in non-urban regions, such as Ilembula [
7]. Therefore, the majority of the Tanzanian population primarily seeks dental care for pain management [
28,
31,
32].
Most of the study participants (
n = 88, 65.7%) ate three meals per day [
25]. The consumption rate of sweet beverages, sugar-sweetened tea, and soft drinks was similar to that of the average adult population in rural areas [
25]. In East Africa, sugar-sweetened food consumption was greater in cities than in rural regions [
5,
33]. Increased daily intake of soft drinks, sugar-sweetened tea, and sweet beverages has been associated with poor oral health [
5,
34]. In this study group, alcohol and tobacco use was much lower than the Tanzanian average [
20]. This may be a result of Tanzania’s ban on smoking in public places and the rigorous prohibition of drinking alcohol on ILH property. Another possible explanation for this finding is that the research participants were healthcare workers, making them more aware of the health risks associated with alcohol and tobacco use [
35,
36].
The overall prevalence of caries in the study population was
n = 62 (46.3%). Compared to previous studies of dental caries in adult Tanzanians, this was significantly higher [
30,
37] Nonetheless, compared to nations with greater incomes, the frequency of dental caries was lower, as indicated by the DMF/T index [
34]. The research participants’ overall mean DMF/T index agreed with the results of other adult Tanzanian populations that have been published [
28]. Therefore, the DMF/T index scores in this study were based on the increased number of missing teeth.
It is not uncommon for non-urban regions in countries with a low gross domestic product (GDP) to have a higher proportion of adults with missing teeth that have not been prosthetically restored. A low dental density results in inadequate conservative care, which usually leads to tooth loss [
30,
38]. Furthermore, caries was discovered visually in this investigation. Further dental testing or radiography might provide a more complete description of the degrees of individual caries cases and individual treatment needs. Caries risk is often correlated with the kind and frequency of sugary food consumption, with increased frequency being associated with an increased risk of caries [
39]. The prevalence rate of caries has been linked to rising sugar consumption in low-income nations, and sugar consumption is rising in Africa [
34,
38]. Consequently, it is not only the younger generation that consumes sugary foods. The industry’s general advertising campaigns portray the Western lifestyle imitated by many East African population groups [
34,
40].
Although not as excellent as that reported in other rural locations, the current study’s observations of personal oral hygiene were nonetheless good [
6]. This result could, however, be explained by the research participants’ greater mean age. In the current investigation, soft plaques were observed in both men and women. This resulted in high simplified debris index (DI/S) ratings, which contributed to the overall OHI/S scores. Knowledge of personal oral hygiene is reduced in the wider population of Tanzania [
6]. Nonetheless, it may be presumed that the research participants participated in Tanzania’s primary school oral health program, which was adopted by the government in 1982 [
19]. It was thus anticipated that research participants would be familiar with the fundamentals of oral health. Low DMF/T index values in the worldwide comparison indicated good oral hygiene among the research participants [
5]. The effects of personal oral hygiene should be documented in future research, using a coloring solution to depict the participants’ soft plaque regions.
The incidence of midline diastema in a population varies depending on the study region [
41]. In the present study, midline diastema of the upper jaw was recorded in one-fifth of the participants (
n = 28; 20.9%). Midline diastema with a hereditary component, in the absence of other oral malformations and oral health limitations, does not require dental or surgical treatment [
41]. Nearly one in five subjects (
n = 30; 22.4%) showed gingival recession, with a higher percentage in men [
42]. Gingival recession may be related with dental calculus and plaque, increasing the risk of periodontal disease [
42]. This study’s subjects maintained acceptable personal oral hygiene. Due to their poorer overall personal oral hygiene, this may have contributed to the typically low incidence of gingival recession in this research, and the higher prevalence of gingival recession in males.
Average tooth loss was high among research participants. At least one tooth—including the wisdom teeth—was missing in almost two-thirds (
n = 90; 67.2%) of the participants. The similarity of these outcomes is contingent upon the research participants’ median age [
32]. Consequently, it is anticipated that the number of missing teeth will rise as the population’s median age rises, and as eating patterns potentially change in the future [
1,
6,
20]. Single-tooth gaps (Kennedy class III) were detected in most of the research participants [
1,
22,
43]. The mandible was more commonly identified as the primary partly edentulous arch. Kennedy class IV was not found in this study, which might be attributable to the participants’ relatively youthful median age compared to Western developed countries [
43]. Tooth loss occurred roughly similarly in both sexes [
20]. This also applied to women’s DMF/T index scores when compared to men’s. Untreated carious lesions are the basis for an elevated DMF/T index score, which might lead to early personal tooth loss. In Tanzania’s rural communities, tooth extractions are the most prevalent dental treatment [
1,
2]. Generally, healthcare workers face greater and more stressful workloads during a pandemic [
44]. Therefore, it could be assumed that the oral health of health workers was neglected during the pandemic, and that a higher incidence of oral health-related diseases could be observed in this cohort. However, this statement cannot be made in this descriptive study. The data did not differ noticeably from the general oral health data of adults [
45], and there are currently no comparative data available on the results of this descriptive study.
This study focused on healthcare personnel at the ILH in Ilembula, Tanzania, which might be the main limitation of this study. This study was performed in a hospital in a rural region without any randomization. Consequently, it should be taken into account that there is no discernible difference between the oral health status of the general population and that of rural or urban areas. Furthermore, because healthcare professionals may have different socioeconomic origins, educational backgrounds, and access to medical and dental treatments than the general public, it might be difficult to extrapolate this study’s findings to the oral health conditions of the surrounding community [
2]. Therefore, the promotion of oral hygiene from an early age, both by school systems and within the family, may be the greatest and least expensive method for lowering the worldwide burden of dental illnesses, as self-care and regular dental hygiene are the most effective variables in avoiding dental diseases. This statement also applies to healthcare workers at the ILH, as most of them come from non-urban regions and were not able to participate in a structured oral health prophylaxis program during their youth. A further limitation of this study is that no testing for the SARS-CoV-2 virus was carried out on the study participants, and a connection to the pandemic could only be established anamnestically. During the global COVID-19 pandemic, there have been massive restrictions on regular health care [
12]. Nevertheless, this study was performed in February 2022, during the worldwide COVID-19 pandemic situation.