INTRODUCTION

On the 11-13 December 1996, the National Association of Dental Surgeons of Senegal held its Second Annual Congress, in the Meridian-President Hotel in Dakar. The meeting, at which were present dental surgeons from 15 African countries as well as their counterparts in France and Switzerland, focused on how the new techniques which are used all over the world, could be adapted to the oral-dental problems encountered in Africa and particularly in Senegal

The Congress proved, if that was necessary, that oral-dental health in African is a public health problem. People's oral- dental problems can be reduced to two factors: tooth decay and para-odontopathy (gum disease, loose and falling teeth). The Congress tried to focus on those problems in order to adapt the new costly and sophisticated procedures used everywhere in the world, to African countries with very little resources. In his communication on the evolution of public health in African countries, Professor Ndioro Ndiaye, head of the Department of Odontostomatology in the faculty of medicine in Dakar, shared some reflections with those attending the Congress: "The integration of odontology into the public health system in our countries, continues to be a problem, in spite of our leaders' efforts. Why? Is it a question of lack of competence on the part of professional dentists at every level? What must be done to find fitting short or long term solutions?

Interesting Discussions

The reflections of Professor Ndiaye gave rise to a very interesting debate! Poor buccal-dental health. Twenty years ago, the World Health Organization (WHO) attained its objectives in matters of buccal dental hygiene, in 90 of the 150 member countries of the organisation. There has been a significant decline in some diseases like tooth decay, in Europe and developed countries. By contrast, in Africa, gum disease and the predominance of tooth decay continues to be a serious problem, especially in the two to twelve age group. This observation led the specialists to devote a large part of their discussions to finding solutions to this problem. Preventive measures.

Preventive measures can be taken to avoid some dental diseases. However, to attack the problem, it is imperative to use modern means of communication to teach dental hygiene. There is a lack of an uniform policy to make people aware of what preventive means are available. In Senegal, for example, studies on dental care have highlighted the active elements contained in some plants or roots, which protect the gums or the surface of teeth. The results of these studies showing economic and efficacious means of dental hygiene, are not always publicised, unlike new procedures in dental care which are very expensive. Relationship between quality and price. In Africa, losing your teeth can means losing ones "good looks". This may result in the patient involving himself in costly "aesthetic" dental surgery which probably he can't afford.

If the dental profession is going to do something about simplifying techniques or reducing costs, then there's the whole problem of equipment or materials to be used: a) for making and fitting false teeth; b) for implanting fixed dentures into the bone of the jaw by means of an artificial root made of titanium; c) for primary dental treatment. Concerning the latter point, it should be noted that the two great buccal-dental problems identified (dental decay and paradontopathy) have their origins in an infection: it is a problem of microbes which can become aggressive and pathogenic. Bacteriological research.

A good part of the discussion was devoted to the means of combatting infection, following the outstanding contribution by Dr.Paulette Agboton Mignon, of the faculty of Medicine of Dakar. She spoke about "The bacteriological study of the seat of buccal-dental infection". The results of this study reveal a strong connection between buccal-dental health and the presence of infection of the endocardium. This means that bacterial flora and especially streptococci are seated in dental infections which in turn cause infection of the endocardium!

Brown colouring of the teeth or fluorosis. This phenomenon which affects some sectors of the population of Senegal, is connected with the fact that water in some areas contain a lot of fluorine. This strengthens the bones and the teeth, provided it is used in measured proportions. Without a certain amount of fluorine, bones and teeth become fragile, and then you've got major problems!

Senegal's dental situation

All subjects on the programme were treated extensively. Then Congress participants turned their attention to Senegal's dental situation. As in all other countries with limited dental health means, Senegal is faced with an imbalance between lack of resources and the increasing need for adequate health provision - a permanent challenge in Africa!

Professor Ndiaye does not shirk the problem: "We don't have enough dentists or the necessary auxiliary services such as senior qualified dental technicians. Community workers able to organise necessary dental health education programmes among the people, are also woefully lacking"!

Senegal's situation is an indicator of what's happening in other African countries (with some notable exceptions in the Maghreb and South Africa). Senegal has only 200 dentists for eight million inhabitants, or one for 40,000 people. However, the capital Dakar, with 2 million inhabitants, has 100 practitioners. The other three quarters of the population, or six million people spread over nine regions, has to make do with 43 dentists. And even then, about 20 of them are unemployed!

The political will is clear. Two years ago, by using the Fund for Economic Development, the government set up 65 consulting rooms for dentists. However, this initiative which needs to be continued and intensified comes up against three obstacles:

- All dentists want to practice in Dakar, even though the need for dentists is much greater in the interior. Even those who are established in the interior want to move to Dakar, because the people in the countryside do not have much money.

- Caution and optimism. Even though Senegal has a ratio of one dentist for every 40,000 people, the academic authorities are very cautious: they know that dentists are needed but they don't want to skimp on the training of students, because that would be against the best interests of the people. This cautious attitude contrasts with the relative optimism of the government, for now the situation is less dire than in 1975, when there were only ten dentists and a handful of dental technicians in Senegal. Since then, two institutes for the local training of those two professions have been established.

- The demand for dental care is constantly on the increase. Demographic growth (3% per year) means there is a large section of young people under 30 years of age, who suffer from dental ailments of all sorts. Some have to visit a dentist twice a month. Dental care has become more and more accessible thanks to dental insurance at an affordable price, available through public institutions. But side by side with that, there are private surgeries who thrive on competition. There are the "large surgeries" serving a clientele of some standing, who are attracted by the quality of the equipment used. Then there are the "small surgeries" which charge small fees in order to attract clients!

This Second Congress was an opportunity for delegates to assess their human, material, technological and financial needs against available resources. However, it is one thing to study the problems arising from dental diseases and quite another to do something about them. The main concern is to make these disorders less costly, less painful and less incapacitating for the people. But lack of resources remains a serious problem!

Yacinthe Diene, Dakar, Senegal, 30 January 1997