Dr Hlulani Alloy Nghayo during his graduation this week. Image: Shelley Christians/UWC

Poor oral health and gum disease have been linked to several serious conditions, including heart disease, respiratory infections and worsening diabetes, with the World Health Organisation (WHO) identifying it as a global public health concern. Yet, in some rural communities in South Africa, access to oral healthcare remains severely limited, with treatment often sought only once conditions have significantly worsened.

According to a new study by researchers at the University of the Western Cape (UWC), the shortage of dentists and oral hygienists, long distances to clinics and financial constraints are preventing many rural residents in Limpopo’s Vhembe District from accessing essential oral health services.

Study participants from several villages reported that the shortage of oral health professionals at clinics not only limited access to preventive services, but that insufficient training and a lack of oral health knowledge among clinic staff, such as nurses, often reduced care to pain management and tooth extractions rather than early care. This is despite many patients expressing a strong desire to preserve their natural teeth and maintain good oral hygiene.

South Africa is one of the countries facing an oral health crisis, with 41% of children under 10 years experiencing untreated tooth decay, and nearly 25% of people aged 15 and older living with severe gum disease in 2019.

Lack of oral health knowledge among clinic staff in rural SA often reduces care to pain management and tooth extractions instead of prevention. Image: Cottonbro Studio/Pexels

The WHO advocates a shift from curative dental care to preventive approaches such as reducing sugar intake and tobacco use, and regular brushing, and in November 2024, the world body adopted the “Bangkok Declaration - No Health Without Oral Health,” that calls for the integration of oral health into primary care to achieve universal health coverage by 2030.

The study was published in the peer-reviewed journal, BMC Oral Health. Lead researcher, Dr Hlulani Alloy Nghayo, who conducted the research as part of his PhD, graduated this week. Khabiso Jemima Ramphoma and Ronel Maart from the Faculty of Dentistry at UWC co-authored the study.

They found a complete absence of mobile oral health services in the communities studied. Participants highlighted significant gaps in oral healthcare, including an inefficient referral system that led to delayed treatment and high costs.

“For as long as it is related to dental issues, the nursing staff always write a referral letter to hospitals, even for minor issues,” one participant noted.

The shortcomings experienced by oral health patients were in contrast to the strong presence of other healthcare initiatives, such as HIV campaigns. Living far from healthcare facilities also emerged as a major barrier to oral healthcare, with participants often requiring extensive travel to the nearest dental facility using public transport - a challenge compounded by poorly maintained gravel roads.

Researchers said the study highlights the need for better coordinated action at clinic, community and health system levels, including making healthcare workers more mobile and strengthening awareness efforts to reduce oral health inequalities in rural South Africa.

Dr Nghayo said that in South Africa, oral health remains sidelined at clinic level despite a high burden of preventable disease. The findings call for policymakers to “move beyond awareness and introduce enforceable implementation frameworks, backed by stronger workforce capacity”.