A new lab promises to improve access to dental prostheses in the Eastern Cape, restoring thousands of smiles in the process. Dr Bulela Vava of the Public Oral Health Forum welcomes the development and argues that oral health should not be a privilege of the few.
It is 08:05 on a Tuesday morning, and the usual hustle and bustle from the early morning traffic rush fills the air, as workers and patients trickle through the gates of Nelson Mandela Academic Hospital in Mthatha, the Eastern Cape's only academic and central hospital. In the distance, on what was once a patch of grass and empty land, construction workers and vehicles are abuzz. Reason? Construction is underway on the province's first-ever Maxillofacial and Dental Lab.
Much like her rural sister provinces, the Eastern Cape is characterised by a high oral disease burden, unmet treatment needs and an oral health workforce that barely copes with the ever-increasing demand for care. The oral health service in the province offers a limited care package whose main, and in many instances only, focus is the relief of pain and sepsis by tooth removal.
While tooth extraction and limited oral health promotion programmes have helped thousands avoid hospitalisation and even death by the provision of dental extraction services as part of the primary oral healthcare package, this approach to oral healthcare has led to an increasing population of people who have few or no teeth left with varying impacts on their health and quality of life.
Life with few or no teeth
Our ability to effectively ingest food, communicate and participate fully in our daily social interactions depends a lot on the quality of our oral health, or more aptly put, the quality of our smile.
Tooth loss through natural or healthcare interventions has a profound impact on quality of life and a general sense of well-being. Having one or more teeth missing, or needing teeth removal due to injury or disease, is linked to poor nutrition outcomes, mental health challenges, poor systemic health outcomes (particularly in the elderly), and even unemployment. In a province where preventive efforts are not as widespread as they should be, it is not just the elderly who are effected, but younger people as well.
However, access to maxillo-facial rehabilitation remains a privilege of the few, with those from rural and low-income households often excluded. Left on the margins, many accept their disfigurement and give up all hope for receiving a chance to fully integrate into the world of work and society.
Oral prostheses in the public sector
Enter Ms Angel Ntentesa and her colleagues. Ntentesa is a qualified dental technologist who has been at the forefront of the Eastern Cape Department of Health's rehabilitative oral health programme. She is responsible for designing and fabricating thousands of removable and fixed oral prostheses for clients in need. As the Chief Dental Technologist, her lab and her team, operating from a small space in the Maxillofacial and Oral Surgery department at Nelson Mandela Academic Hospital have been quietly at work restoring the dignity of the people of the Eastern Cape.
Ntentesa and her team, working closely with the province's dentists spanning 4 major, but rural districts have managed to deliver prostheses to nearly 5 000 people in the space of only 4 years. Being the only dental lab of its nature in the province, it was not surprising that soon enough, demand outstripped supply and a larger and more suitable space was required and the construction of the new lab was commissioned.
The new lab is meant to support the fabrication of dental and maxillofacial prostheses and support the clinical service delivery of specialised oral health services ranging from patients who require reconstructive facial prosthesis post-surgery, those who suffer from several conditions of malocclusion (when the teeth are not aligned properly) and those who require the preservation of their dentition through the use of various fixed prosthesis. The lab will also serve as a satellite training facility to support the training of oral health professionals, including supporting the undergraduate training of dental technologists. There is only one other dental lab outside the country's major metros and it is located in Polokwane where it is supporting specialist oral health service delivery in Limpopo.
April is Oral Cancer Awareness month and we at the Public Oral Health Forum, have embarked on a month-long campaign to raise awareness about oral cancer. Oral cancer is predominantly treated surgically, however depending on the severity of the disease, oral function and aesthetics are compromised, leading to impairment and social isolation. Many of those who undergo surgical intervention, more often than not, require oro-facial prosthesis to help restore oral function, facial aesthetics and improve quality of life - precisely the type of services the new lab will help with.
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'A welcome development'
The building of the lab in Mthatha is a welcome development in a country where access to oral healthcare has largely been defined by socioeconomic status and geography. Nelson Mandela Academic Hospital and the Eastern Cape Health Department are at the heart of making a meaningful investment in realising the dignity of the people of the Eastern Cape. A people for whom much of life is characterised by navigating systems and a world that barely sees them beyond their poverty or strife.
For the naysayers, I remind them, that an investment in oral health is an investment in health. Declassifying oral health as a privilege of the few, should be as important a mandate for any provincial health department as it now is for the Eastern Cape Department of Health.
*Vava is President of the Public Oral Health Forum, a network of oral health professionals committed to the advancement of oral health equity, dignity and wellbeing for all.
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