Oral health-related quality of life in the East African community: a scoping review

Abstract

Introduction

Limited access to oral healthcare and substantial untreated cases raises concerns about the rising burden of oral conditions in East Africa. This scoping review aimed to map the existing evidence on oral health status in relation to oral health-related quality of life (OHRQoL) across the East African Community (EAC).

Methods

This scoping review was conducted based on the recommendations of Arksey and O’Malley’s guidelines and reported based on the PRISMA-ScR checklist. Ten electronic databases were searched, using relevant keywords informed by the PCC (Population-Concept-Context) framework. The retrieved articles were deduplicated and screened for eligibility. Twenty-eight eligible articles were finally included in this review. The data charted from the included articles were collated, summarized, and reported thematically.

Results

Oral health conditions were highly prevalent in East Africa, ranging from 15.8 to 83.0%, with dental caries being the most common. Prevalence and impact varied across socio-demographic factors, including age, gender, education, and place of residence. Clinical factors such as DMFT/dmft scores and pain levels, and knowledge of preventive practices, also played a crucial role in influencing oral health outcomes. While many reported satisfactions with their oral health, oral conditions significantly impacted their quality of life, disrupting essential activities like eating, sleeping, hygiene, relaxation, and social interaction. Despite the widespread occurrence and associated discomfort, the majority failed to seek dental care, resulting in persistent daily challenges and diminished overall well-being.

Conclusion

A high prevalence of oral conditions with serious impacts on quality of life and wellbeing was observed in the EAC. Given the satisfaction with oral health and the poor attitude towards seeking help for oral issues despite experiencing pain, we recommend future research to explore, identify, and implement contextually and culturally relevant interventions that will be tailored to the specific oral health needs of East African populations.

Introduction

The East African Community (EAC) comprises seven [7] partner states: Burundi, the Democratic Republic of the Congo, Kenya, Rwanda, South Sudan, Uganda, and the United Republic of Tanzania. Its headquarters are in Arusha, Tanzania [1]. The EAC region is home to an estimated 283.7 million citizens and boasts a combined Gross Domestic Product of US$ 305.3 billion [1]. It is recognized as one of the rapidly expanding regional economic blocs globally, characterized by increasing cooperation among partner states in political, economic, and social domains. The acceleration of the journey towards an East African Federation highlights the strong commitment of East African leaders and citizens to establish a robust and enduring economic and political alliance in the region [1].

The incidence and prevalence of oral cavity diseases are on the rise in the African region, leading to higher morbidity rates. Disparities in oral health exist across various regions within the EAC. While dental caries prevalence is generally lower in many East African countries compared to developed nations, the substantial number of untreated cases underscores limitations in both human and physical resources and discrepancies in access and affordability of essential oral healthcare services [2]. The overall pooled prevalence of dental caries in East Africa was reported as 45.7% with an overall mean DMFT score of 1.941 and dmft score of 2.237 [3].

Considerable variations exist in the prevalence and incidence of untreated dental caries between regions and countries [4]. Many industrialized countries have experienced a decline in the prevalence of dental caries over the past decades associated with improved measures for oral hygiene, and effective use of fluorides and remineralizing agents [5]. Fluoride preparations including toothpaste in different concentrations, mouthwashes, and professional application products such as varnish, gels and CPP -ACP, pit and fissure sealants have shown promising results in a reduction of dental caries [6,7,8,9]. Owing to various concerns regarding fluoride-containing oral products, there is a growing discussion to find effective fluoride-free alternatives such as biomimetic hydroxyapatite (HAP) as an active ingredient in oral care products to help prevent dental caries [10]. However, the affordability of high cost remineralizing dental products in the EAC is a significant concern, especially given the ongoing challenges of combating HIV infection, poverty, and insufficient sanitation issues in many areas which further could lead to compromised QOL mainly in children.

In numerous East African countries, gingival inflammation is highly prevalent across all age groups. Among congenital oral conditions, orofacial clefts rank as one of the most frequently occurring birth defects. Also, data on human immunodeficiency virus/AIDS is limited, mirroring the situation in many developing nations [2].

As seen in many developing countries, the heavy burden of oral conditions is affected by issues of politics, poor health behaviors, underdeveloped health systems, and low oral health literacy [11]. The high levels of poverty in some regions in the EAC and the low gross domestic product in most countries in the EAC make it difficult to fund high-quality, affordable, accessible oral health services [11]. Moreover, the region’s relatively high prevalence of HIV-infected adults and children adds an extra burden, given that HIV has been associated with an increased risk of dental caries, periodontal diseases, and oral mucosal lesions [12]. Further, the affordability of quality oral health care, especially for people belonging to disadvantaged communities is challenging [13]. Oral health care in the urban territory is focused basically towards palliative care and management of emergencies rather than a preventive approach which leads to the failure of long-standing continuous health care maintenance in the populations [13]. For example, the National Oral Health Survey report of 2021 in Rwanda, a member state of the EAC, highlighted that the healthcare system’s primary focus has shifted towards pain relief, thereby overlooking the valuable contributions of health services such as oral health promotion, preventive care, and the management of oral conditions [14].

In the present context, there is a greater emphasis on subjective assessments of oral health in relation to quality of life, utilizing measures such as Oral Impacts on Daily Performance (OIDP), Oral Health Impact Profile (OHIP), and Early Childhood Oral Health Impact Scale (ECOHIS), among others, rather than solely relying on objective evaluations of the presence and severity of oral conditions by healthcare professionals [15]. Further, oral health-related quality of life (OHRQoL) measurements and socio-dental and oral indicators have demonstrated validity as instruments for evaluating both oral health and the quality of dental services provided to groups of individuals [16].

In the EAC, multiple studies have assessed varying dimensions of oral health on the quality of life of the individuals which includes frequency and severity of functional, psychological and social impacts associated with oral conditions [17,18,19]. The first National Oral Health Survey in Rwanda highlights that data on OHRQoL indicators exhibited notable variations based on sex, age, education level, and geographical location, where pain did not show significant variation with location or education level, and difficulty in speaking [14]. A study in Tanzania reports that the Child-OIDP inventory can identify oral impacts among school children with pain-related dental caries and shows greater responsiveness to changes after treatment, particularly following atraumatic restorative technique (ART) and tooth extraction, compared to treatment with ART or oral health education alone [18]. In a study employing the ECOHIS scale, findings indicated that self-reported oral health status, presence of gingival bleeding, dental caries experience, receipt of oral health-related information, and oral impacts on children and families were more favourable among HIV-negative mothers compared to HIV-positive mothers in Uganda. Nevertheless, in general, OHRQoL did not differentiate between the two groups [20].

Oral conditions and their impacts on OHRQoL provide valuable support in the planning and evaluation of oral health education programs [21]. Further, in resource-scarce regions, providing one-on-one oral health education alone can be beneficial in enhancing OHRQoL [22]. Moreover, a multidisciplinary approach to patient care would be advisable to enhance OHRQoL in individuals [23].

While there are individual data points on OHRQoL from various countries within the EAC, it is challenging to find comprehensive information with empirical evidence. It is advisable to analyse oral health status in relation to OHRQoL collectively across the community since many countries share similar socioeconomic, cultural, and behavioural patterns. Furthermore, conducting a scoping review of this nature would offer insights into various facets of oral health, thereby facilitating improved planning of oral healthcare systems commonly in the region. It would further support the sharing of limited resources for improved healthcare in the community. Further, a collective approach would be beneficial in enhancing public health research and practice in the region. Considering all these facts, this scoping review aimed to map the existing evidence on oral health status in relation to OHRQoL across the EAC.

Methods

Research design

This scoping review adopted the research design proposed by Arksey and O’Malley [24]. Arksey and O’Malley, in 2005, proposed a stepwise approach for conducting scoping reviews, which are as follows: research question identification (step 1); literature identification (step 2), literature selection (step 3), data charting (step 4), and data collation, summarization, and presentation (step 5). In addition to the above-mentioned recommendations, this scoping review was also reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) [25].

Research question identification

In this scoping review, the research question is: What is the oral health-related quality of life of the people in the East African community?

Literature identification

Search framework

The Population-Concept-Context (PCC) framework was used to develop the search strategy [26]. The population of interest is the East African community, which comprises the following countries: Burundi, Congo, Somalia, Kenya, Rwanda, South Sudan, Uganda, and Tanzania [27]. The concept of interest is quality of life while the context of interest is oral health.

Literature source

Ten electronic research databases were utilized to retrieve all literature relevant to the scoping review. These databases include PubMed, SCOPUS, AMED – The Allied and Complementary Medicine Database, APA PsycArticles, APA PsycINFO, Child Development & Adolescent Studies, CINAHL Ultimate, Dentistry & Oral Sciences Source, Psychology and Behavioral Sciences Collection, and SPORTDiscus with Full Text.

Search terms and combinations

The terms used for the database searches were keywords identified from the Medical Subject Heading (MeSH) dictionary, Thesaurus, and the official website of the East African Community (Table 1).

Table 1 The search terms used for the literature search

With the aid of Boolean operators (“OR” and “AND”) and the “*” truncation, search strings were developed, based on the PCC framework, to retrieve all literature relevant to the research question from the selected databases. The database searches were conducted on 15 January 2024 and Tables S1 to S3 (Supplementary file) depict the search strings used for the searches.

Literature selection

The bibliometric records of all literature obtained from the database search were downloaded and imported into the Rayyan web-based application for deduplication and screening. The screening of all deduplicated literature was performed by three independent reviewers (JM, MC, and EN). In cases where there were conflicts in the decisions of these three reviewers, two additional reviewers (JO and KKK) were invited to jointly resolve the conflicts.

The screening was performed in two stages and based on a set of eligibility criteria. The first stage involved the screening of the title and abstract (prima facie evaluation) of the deduplicated literature to exclude all those articles that appeared non-relevant at face value. The second stage involved the full-text evaluation of those articles that were non-excluded in the first screening stage. Only those articles that met the review’s inclusion criteria were finally included in the review. The inclusion criteria in this scoping review are as follows:

• Peer-reviewed journal articles.

• Articles published in English.

• Articles reporting empirical findings on the OHRQoL among people living in the EAC area.

• Articles with accessible full text.

On the other hand, the exclusion criteria in this scoping review are as follows:

• Grey literature (e.g., books, book chapters, websites).

• Articles published in non-peer-reviewed journals.

• Articles published in a language other than English.

• Articles reporting empirical findings on the OHRQoL among people living outside the EAC area.

• Articles without accessible full text (an article is considered to have inaccessible full text if it is not open access and if after two weeks from the time of contacting the corresponding author of such article, the corresponding author did not respond or could not provide a copy of the article).

Data charting

Relevant data, including author names, year of publication, country of study, study setting, sample size, sample characteristics, relevant findings, and conclusions were charted from the included articles using a bespoke data extraction sheet that was developed through insights obtained from existing scoping reviews and consensus from the reviewing team [28,29,30].

Data collation, summarization, and presentation

The charted data were collated, summarized, and presented as the review findings. The data collation, summarization, and presentation process were done thematically using the narrative synthesis approach [31].

Risk of bias assessment

Risk of bias assessment, also known as appraisal of quality, was done for all the included articles using the 2018 version of the Mixed Methods Appraisal Tool (MMAT). The MMAT evaluates original research articles of diverse research designs using a set of seven questions—these questions are peculiar to each research design. For each appraisal question, there are three possible responses, which are: “Yes”, “I can’t tell”, and “No”. To quantify the risk of biased assessment outcomes, a response of “Yes” was scored one [1] point each, a response of “I can’t tell” was scored half (0.5) point each, and a response of “No” was scored zero (0) point each. Based on this scoring, each of the evaluated articles was graded on a scale of zero (0) to seven [7] points. Any article with an aggregate score above 3.5 was graded to have “above average” quality, any article with an aggregate score of 3.5 was graded to have “average” quality, and any article with an aggregate score below 3.5 was graded to have “below average” quality.

Results

Two hundred and eleven articles were retrieved from the database search, of which SCOPUS yielded the highest volume of outputs. After deduplication and two-stage screening, only 28 articles were finally included in the scoping review (Fig. 1; Table S4 [Supplementary file]).

Fig. 1

PRISMA 2020 flow chart of included literature

Different types of research designs were utilized by studies screened in this scoping review (Table 2). The majority adopted cross-sectional research design (64.3%); others utilized cohort, follow-up, quasi-experimental, and survey research designs (Fig. 2). The most reported research approaches in these studies are survey/personal interviews and clinical oral examination. Only 5 studies introduced intervention in their research, such as health education intervention [32,33,34] some of which focused on knowledge and prevention of oral conditions [33]. Various forms of clinical treatment [18, 35, 36], including infant prophylaxis for HIV-exposed children [35], and surgical intervention [36] were likewise introduced.

Fig. 2

Distribution of studies on OHRQoL in East Africa by study design

The risk of bias assessment outcomes of the included articles are shown in Fig. 3. All the assessed articles were found to have above-average quality.

Fig. 3

Outcomes of the risk of bias assessment of the included articles

The included articles on OHRQoL in the Eastern Africa subregion were concentrated in a few countries. Half (50.0%) of the eligible studies reported data from Tanzania [18, 19, 22, 23, 32, 34, 36,37,38,39,40,41,42,43]. About 17.8% were conducted in Uganda [17, 20, 35, 44, 45], this was followed by Kenya which accounted for 14.3% of the publications [23, 33, 46, 47]. About 7.4% of the reviewed documents were from Rwanda [14, 48], while 10.7% were from multi-country studies [49,50,51].

Data reported in the reviewed articles have been synthesised and the findings classified into 6 sub-headings: prevalence of oral health-related conditions in the EAC; factors associated with oral health problems in East Africa; satisfaction with oral health conditions; oral health impacts on daily performance and quality of life; factors associated with oral health-related quality of life; and oral health-related behaviours in the EAC (Table 2).

Table 2 Summary of the articles on oral health-related quality of life in the EAC

Prevalence of oral health-related conditions in the EAC

The percentage of study participants in the EAC who had at least one oral problem ranged from 15.8% [43], to 28.6% in Tanzania [42], 30.7% in Uganda [51], and 48.2% (before intervention) in Kenya [33]. In Tanzania, approximately 49.1% was recorded among adults [38], while 51.0% was observed among university students [52]. However, the highest prevalence (83.0%) of oral conditions was reported within the population of children and adolescents with HIV in Tanzania, which is the most represented country in the studies reviewed [47].

Specifically, about 28.6% of elementary school students in Tanzania reported at least one oral impact on performance [42], while a prevalence of 36.2% [39], was recorded in a similar population. Students from urban areas had problems with eating, social contact, and smiling [39], some regional variations were also noticeable [42]. Some of the common dental problems reported among underaged children in Tanzania are visible plaque (93.2%), tooth pain (23.0%), pain with eating cold or hot food (18.5%), and dental caries (30.2%) [22].

The most reported oral conditions by university students are tooth loss (37%) and tooth decay (34%), both of which affected their daily performance [52]. In Kenyan children, dental caries was prevalent in 65.0% (permanent dentition-30.9% vs. primary dentition-50.0%) of the sample. Some had a severe toothache (13.2%), and 25.0% sometimes experienced toothache [23]. However, decayed teeth were common in both children and adults, a few had their permanent teeth restored (2.8%) prior to the study. The dmft (missed, filled or decayed primary tooth) score (1.75) was higher than DMFT (missed, filled or decayed permanent tooth) score (1.08) [23].

Adolescents in Tanzania had a lesser prevalence (15.8%) of at least one oral condition affecting their daily performance. The most common being severe dental fluorosis (48.6%) [43]. The prevalence of tumor-like lesions (Dermoid cyst; Odontogenic Myxoma; Fibrous dysplasia; Dentigerous cyst; Giant Cell Tumour, Pleomorphic Adenoma; Ossifying Fibroma; Ameloblastoma and others) was 52.8% while ameloblastoma (32.5%) was the most prevalent histology of these lesions among patients in Tanzania [36]. With a high prevalence of ss (83.0%), cases of untreated dental caries (66%), dry mouth (28%), enamel hypoplasia (10%), and ulcers (not HSV and aphthous ulcer) (7%) were found among children and adolescents living with HIV in Kenya. These oral problems varied by age [47]. At least one tooth with plaque (81.1%), calculus (74%) and bleeding (33%), were recorded in secondary school students [40].

Only a few studies reported early child caries. This was found to be common in Ugandan children [45]. Also in Tanzania, toothache, mouth ulcers, bleeding and swollen gums, eating and cleaning teeth were more frequently reported by schoolchildren [42]. Likewise, not less than one missed, filled or decayed primary tooth (dmft) was prevalent (48.0%) among HIV-exposed uninfected (HEU) children and a similar proportion had untreated dental caries. In HIV unexposed uninfected (HUU) children, the prevalence of both conditions was higher (60.0% and 57.0%) [17].

The prevalence of oral conditions (overall and specific) also varied in the adult population depending on their health condition. The aggregate prevalence of oral conditions among pregnant women in Uganda was 30.7% [51]. About 32.2% of HIV-negative and 29.2% of HIV-positive mothers reported at least one oral impact on daily performance [20]. Differences between rural (30.6%) and urban (25.5%) residents who reported at least one oral condition were apparent [51]. The highest prevalence for specific oral problems was reported for dental caries among HIV-infected (81.0%) and uninfected mothers (71.0%) [17]. More than half of Rwandans (63.9%) interviewed had throbbing oral pain; others had untreated caries and calculus [14]. This was followed by bleeding gums (49.8%), toothache (31.8%), problems chewing (31.4%), and painful gums (24.2%) as reported in Ugandan pregnant mothers. Tooth loss prevalence varied among pregnant women living in urban (42.5%) and rural (33.8%) communities of Uganda [51].

In some follow-up studies in Tanzania, an increase in the prevalence of oral impact was observed from baseline (48.2%) to follow-up (50.3%). Eating difficulty prevalence increased from 34.5 to 39.7%. Caries was the most reported in permanent teeth and varied from 43.5 to 53.4% within the period. Hence, some students indicated that their daily performance worsened (33.5%), improved (41.3%), and remained unchanged (25.2%) from baseline to follow-up [32]. In another study, no improvement was recorded before and post-treatment intervention [18]. Conversely, following oral health education intervention in Kenya, a significant drop in prevalence was reported for painful mouth ache, chewing discomfort, and sleep disruption [33].

Just a few studies collected data on oral conditions in patient population. In Tanzania, lesions were major oral conditions among surgical patients (52.8%) who had experienced these less than 2 years before the study. Out of 46 patients, 51.7% had lesions in the mandible. The most common histologies were ameloblastoma (32.5%) and ossifying fibroma (16.9%) [36]. The majority (64.9%) of Rwandan population had caries experience of which 54.3% were untreated; 32.4% experienced substantial oral debris while calculus was found in about 60.0%. The highest prevalence of oral conditions was recorded among those aged 20 years and older. Low prevalence of dental trauma (2.0%), dental abscess formation (2.0%) and suspicious intra-oral lesions (1.3%) and extra-oral lesions (3.0%) were reported [48].

Only one study focused on oral conditions caused by cultural practices. This was found in Kenya where the majority (61%) of adolescents had experienced Infant Oral Mutilation. Almost all (95%) participants had lost their two mandibular central incisors. Teeth disruption and dental occlusion were common oral problems also documented. More maxillary teeth were present than mandibular teeth, while the number of missing mandibular incisors and canines were more than the missing maxillary incisors and canines in the group [46].

Oral health-related behaviours in the EAC

Reviewed articles reported some behaviours that are associated with oral health. Some of these behaviours are positive and promote good oral health while others are negative and are risk factors for oral conditions. Such as intake of sugared snacks between meals (at least 3 times) daily and tobacco smoking as reported among primary school pupils in Tanzania. Positive behaviours include visits to dentists (55.6%), brushing teeth, and use of fluoride toothpaste [19].

Negative oral health-related behaviours include eating sugared snacks between meals (52.8%). Eating sugared snacks and previous visits to dentists were both significantly associated with oral impact on daily performance among adolescents. In this group, individual behaviour rather than social differences was significantly associated with oral challenges [19].

The frequency of daily tooth brushing was high (main study-76.5%; sub-study-74.5%) among secondary school students in Tanzania. Whereas in the same study, about 44.8% of the students reported fair to poor oral hygiene. The majority of the students (main study-87.4%; sub-study-88.7%) had not visited a dentist in recent months. Other oral health-related behaviours are smoking (5%) and weekly consumption of sugar-sweetened soft drinks (50%). These behaviours differed by age, gender, mother’s educational status, place of residence, family wealth and economic status [40].

In Rwanda, the majority (70.6%) of participants did not visit a dental clinic despite experiencing pain and having medical and dental insurance coverage [48]. Another study indicated that 55.3% of Rwandans had poor attitudes towards cleaning their teeth. The rate of tooth cleaning was significantly influenced by gender (female), age (20–39 years), geographic location (urban), level of education (higher education) and occupation (skilled employment). Also, the majority (62.7%) did not use a toothbrush and 7 out of every 10 (70.0%) did not use toothpaste. The use of a toothbrush and toothpaste was significantly associated with age, geographic location, education, and occupation. Gender did not influence this behaviour [14].

In Uganda, toothpaste was used by the majority (77.0%) of caregivers of children. Many revealed that their child consumed sugary drinks (82.4%) and brushed their teeth (58.9%) at least once a week [45]. A previous study in the country revealed that 56.0% of adolescents did not visit a dentist [44].

Consumption of alcohol and sugared snacks, recent visits to a dentist, are some of the risk factors for oral conditions in Tanzania. Factors connected with oral health-related behaviours are education, and place of residence [38].

Satisfaction with oral conditions in the EAC

The level of satisfaction and self-rating of oral health status varied across studies that reported this information. Most preschool students in Tanzania were satisfied or happy with their teeth appearance and were not ashamed of smiling (98.2%), although some experienced mockery due to the appearance of their teeth [22]. The majority (80%) of Kenyan adolescents also had satisfactory feelings about their teeth status despite their missing or disrupted teeth [46]. Similarly, the majority of HIV-negative (67%) and HIV-positive (56%) mothers in Uganda described their oral health status as good regardless of their caries experience (81% versus 71%) [20]. In Rwanda, 63.3% and 15.3% rated their oral health as fair and poor, respectively [14].

Some HIV-positive children had good (35.9%) and very good (4.1%) perception of their oral health. Others rated this as average (27.3%) and poor (32.3%). The majority (89.5%) were satisfied with their teeth appearance. Whereas, due to their teeth appearance, 9.1% were ashamed of smiling and laughing, while 5.9% had been ridiculed by other children because of their teeth [23]. Additionally, educational level (low) and place of residence (rural) were associated with poor rating of teeth and gingival conditions by adults in Tanzania [38]. Perception of oral condition was also influenced by having experienced at least one oral impact on daily performance. For both untreated and treatment groups, satisfaction with oral health was associated with experience of oral impact [18].

Factors associated with oral health problems in the EAC

Varying socio-demographic and clinical factors were responsible for the key oral conditions recorded in the reviewed articles. Socio-demographic factors such as age, gender, education, place of residence, occupation, and family parent’s characteristics were associated with oral health problems in this scoping review. In addition, clinical characteristics, knowledge of preventive measures, health behaviour, and environmental factors were important determinants. This was the case in Rwanda [14, 48], Tanzania [19, 39, 42], and other countries.

In Tanzania, gender (being male), age (less than 12 years), parents’ educational status (elementary education or less), and family economic status (poor) influenced the reportage of oral impact [19]. Those who were 40 years and older reported the highest cases of caries (65.6%) and calculus (69.7%), especially people who were residents of rural areas [14]. Place of residence (urban) also determined DMFT score, prevalence of dental pain and other oral conditions. Apart from smiling and social contact, place of residence had strong effects on every other aspect of oral impacts on daily performance (OIDP) [39].

Similarly, age, gender, and visible plaque influenced the occurrence of caries in Tanzania. Experience of decayed teeth was also determined by age, oral hygiene, presence of visible plaque, experience of toothache and being ridiculed because of teeth appearance. So was the experience of DMFT associated with the occurrence of dental pain and other oral conditions [22]. Location [42] and place of residence (Urban) [39] likewise played significant factors.

Compared to untreated caries, cases of calculus were associated with level of education and occupation among some age groups (20 years and above) in Rwanda [14]. Oral conditions including decayed, missing, and filled status of permanent teeth varied by age, educational status, and geographical location [48].

In Tanzania, the perceived need for dental treatment was statistically linked with gender, geographical location, problems eating and tooth cleaning [39]. Furthermore, being a medical student, regular visits to dental clinics, dissatisfaction with general health, and lack of knowledge about sugar restriction all determined the frequencies of oral impact on daily performance (OIDP), additive scores (ADD), and simple count (SC) scores [52]. OIDP had a significant relationship with dental caries, pain, and oral problems. Experience of pain, caries, and oral conditions were all bearing on oral impacts [39].

Among children, the prevalence of early child caries differed by location and amount of fluoride in water [50]. Children’s caries experience was significantly associated with caretakers’ DMFT. While impacts of OHRQOL were associated with caretaker’s self-perception of oral health status and that of the child, as well as a child’s dmft status. Oral health impacts on a family’s quality of life were associated with the child’s gender and the presence of early child caries [45]. In another study, caries in children was statistically associated with their experience of toothache, dental care, and caretakers’ caries experience. Others are mothers’ tooth brushing, income, and mother’s DMFT [17]. Caries in caretakers of under-aged children in Uganda determined early child caries [45].

Oral health impacts on daily performance and quality of life in the EAC

In the reviewed studies, the impacts of oral health on quality of life and/or daily performance were measured using a variety of tools. Such as condition-specific (CS) and generic oral-health-related quality-of-life (OHRQoL) inventory [41], oral Impacts on Daily Performance (OIDP) frequency inventory [32, 49], abbreviated version of the Oral Impacts on Daily Performances (OIDP) and the Life Satisfaction scale [52], University of Washington Quality of Life (UW-QoL) questionnaire version 4 [36].

Emotional, economic, social, functional, and psychological impacts of oral health conditions on daily performance were identified in the current scoping review. Oral health problems affected the quality of life in most of the studies appraised, the most mentioned impacts by all the studies are problems with eating, cleaning, sleeping or relaxing and speaking. Among 51.0% of Tanzanian students who experienced at least one oral problem, the most mentioned oral conditions are tooth decay (34%) and tooth loss (37%). Specifically, tooth decay affected eating and the ability to enjoy food as well as tooth cleaning. Being a medical student, regular visits to a dental clinic, dissatisfaction with general health, and lack of knowledge about sugar restriction all determined the OIDP frequency ADD and SC scores [52]. Difficulties in eating (27.9%) were the most mentioned by primary school pupils in Tanzania followed by difficulties in cleaning teeth (17.3%), difficulties in performing major work (17.0%), and difficulties in having or maintaining social contacts (11.7%) [19].

For both HIV-exposed and unexposed children, impacts of oral health include toothache (16.0%), swollen/bleeding gums (10.0%), crying due to pain in the mouth (12.0%), inability to sleep due to pain in mouth (10.0%), refusing to eat due to pain in the mouth (10.0%), and refusing to play (8.0%) [17].

Common impacts of oral challenges on secondary students’ life quality include difficulties with eating (36.8%), problems with tooth cleaning (28.9%), and problems speaking (14.5%). Problems with schoolwork (9.9%) were not as common. Age, parents’ educational qualifications, socio-economic status, and parent’s unwillingness to pay for dental care influenced these conditions. Occurrence of oral impacts is also determined by a low frequency of tooth brushing, less consumption of sugar-sweetened soft drinks, frequent visits to a dentist, and high rate of smoking [40].

Impacts on daily activities of secondary school pupils include problems with eating (44.0%), difficulties with cleaning teeth (35.0%), sleeping and relaxing (33.0%), and emotional stress (33.0%). Others had problems with speaking and carrying out major schoolwork (34%) and showing their teeth (30.0%) [44]. In Tanzania, 36.2% of school children had at least 1 oral impact on daily performance. Students from urban areas had problems with eating, social contact, and smiling. Those from rural communities found cleaning, schoolwork, smiling, emotion and speaking to be difficult. Mouth ache, problems eating, tooth cleaning and other oral conditions were linked with family economic status [39].

Oral problems interrupted sleep (urban: 28.8% and rural: 37.6% residents), and affected eating (urban: 34.6% and rural: 42.1% residents) among Tanzanian adults [38]. Similarly, oral conditions affected children’s daily performance in Tanzania and Uganda. The most reported oral impacts on children include problems with eating and crying. They also experienced mouth aches due to decayed teeth [22].

Adolescents in Tanzania mentioned major effects of oral conditions including Temporomandibular Disorder pain (11.8%), problems with teeth cleaning (10.5%), eating and enjoying food (7.9%), speaking, and pronouncing clearly (4.4%). Others are challenges with sleep and relaxation (3.9%), performing major schoolwork or social roles (2.2%), maintaining the usual emotional state (2.1%), contact with people (2.1%), smiling and laughing (2.0%). The impacts mentioned were influenced by different factors such as age, ethnicity, oral hygiene status, self-reported TMD pain, caries experience, district of residence, oral hygiene status, wealth index, and experience of dental fluorosis [43].

The aspects of life of Ugandan pregnant mothers impacted are eating, cleaning, and sleeping [51]. Among Ugandan adolescents, difficulty with emotional stability was significantly related to social factors. Its association with the psychological factors was comparably lower [49]. The majority of the caretakers of under-aged children in Uganda remarked their own oral health (53.4%) and that of their child (83.0%) as good. The overall impact of oral health on quality of life was 24.2%, with a greater impact on a child’s (23.5%) than a family’s (8.7%) life quality. Specifically, children’s interest in play (7.8%), toothache (17.8%), and male children were more affected [45].

The overall oral health-related quality of life score was influenced by caretakers’ and children’s DMFT/dmft status (decayed missing filled teeth status) [45]. Whereas dmft in children was influenced by parent’s marital status. Oral health impact on quality of life was associated with the presence of caries in child and caretakers. Family and child quality of life was a function of the self-reported oral health status of children and caretaker [45].

In Rwanda, painful mouth ache was the most reported impact (63.9%). Other disruptions to quality of life are difficulty doing usual jobs, problems with chewing and self-awareness. These impacts varied by age, gender, education and location [48]. Another study in Rwanda reported that oral health impacted participants’ QoL, especially those 20 years and older (50%) were more impacted [14].

The major oral conditions among HIV patients in Kenya include painful oral aches (35.7%), poor sense of taste (25.4%), and sleep disruption (24.2%). A shift in some oral conditions such as psychological disability, psychological discomfort, and handicap was significantly associated with the modification of gingival inflammation [33]. Oral health impacts experienced by HIV-negative mothers in Uganda include challenges with eating, speaking, and cleaning teeth. Differences in these challenges were observed based on their age, income, experience of gingival bleeding, caries, information received on oral health, and self-reported oral health status. All oral impacts varied among HIV-positive mothers based on their self-ratings of good and poor oral health. For HIV-negative mothers, problems with eating, speaking, and cleaning teeth were significantly associated with their self-ratings of oral health status [20].

Effects of oral conditions on social activities and functioning of Kenyan children are problems biting hard food (27.7%), missed school days (10.0%), and chewing discomfort (7.7%) [23]. Children with oral conditions such as dry mouth and dental caries had comparatively worse oral health-related quality of life (OHRQoL) than children who had no oral conditions. Multiple concurrent burdens of oral problems had a strong association with lower OHRQoL [47]. The most prevalent child impacts reported in Uganda are difficulties eating and crying, which varied by age. Family impacts such as taking time off of work and financial burdens were mentioned more [50].

Only a few participants mentioned the impacts on family such as taking time off work (6.0%), feeling upset (4.0%), guilt feeling (5.0%), and financial difficulties (3.0%) [17]. Child and family oral impacts varied significantly between HIV-positive and negative mothers as HIV-negative mothers reported the highest number of impacts. However, HIV positive mothers had received oral health-related information more. Impacts such as difficulty in eating and enjoying contact with people were mentioned by both HIV-positive and -negative mothers.

At both baseline and follow-up, the impacts of oral problems on the daily performance of secondary school students either worsened (33.5%), improved (41.3%) or remained the same (25.2%) [32]. For the study duration, the most common oral condition was eating difficulty (baseline-34.5%; follow-up-39.7%) [32]. This was not true in another study as significant changes were recorded in the aspect of Child-OIDP, reported oral problems, and satisfaction with oral health from baseline to follow-up [18].

The experience of social, psychological, and functional dimensions of OIDP is common across Tanzania. Gender, family socio-economic status, parental ability to afford dental care, and bleeding scores, had a significant relationship with depressive symptoms. Self-efficacy was associated with experience of oral impact, gender and age. At all-time points, parents’ ability to afford dental care and family socio-economic status had connected with OIDP and depressive symptoms. Self-reported oral impacts were statistically linked with depressive symptoms at both baseline and follow-up [32].

Many participants in another study reported the impacts of oral conditions on quality of life, although this varied. The occurrence of caries differed by location and age. The overall generic Child-OIDP (oral impact on daily performance) and prevalence varied significantly between students’ caries experience, oral hygiene status, decayed teeth, poor plaque scores, and missing teeth. Overall condition-specific Child-OIDP caries scores also varied by DMFT experience, and missing teeth. The oral health impact (OHI-S) score varied along with treatment needs for periodontal problems. Mean CS Child-OIDP score for malocclusion varied along with the need for malocclusion treatment. The global and prevalent oral impact scores differed depending on whether the CS Child-OIDP or the generic Child-OIDP was utilized [41].

In both Tanzania and Uganda, problems with eating and crying were the most reported oral impacts on children mentioned by caretakers. In Uganda, impacts on family include taking time off from work (36.2%) and financial burden (38.2%) [50]. Child and family impacts varied by age, with reports of poor child health and bad oral health [50]. Impacts on eating were the most reported impairment in Temeke (35.3%), followed by cleaning teeth (26.9%) and smiling without embarrassment (13.0%). Visits to dentists constitute a major indication of oral problems [19].

Factors associated with oral health-related quality of life in the EAC

Furthermore, varying clinical and sociodemographic factors were found to be significantly associated with oral health-related quality of life in this scoping review. Some of these factors are directly related to certain dimensions of quality of life and not necessarily the overall quality of life or oral health-related quality of life.

Students whose teeth were missing had a 3–4 times risk of having problems sleeping and relaxing and 1.8 times risk of experiencing problems with speaking compared to those whose teeth were complete [44]. Experience of pain due to decayed teeth and waking up at night has strong effects on preschool children’s quality of life [22]. While child impact of oral conditions was more prevalent among HUU (22.0%) than HEU (12.0%) children [17]. In addition, sub-domains of pain, swallowing, appearance, chewing, mood, anxiety, and financial problems varied. All times, experience of pain differed with age, while financial difficulties were linked with low income status and educational qualification [36].

Only one of the reviewed studies assessed the perceived causation of oral problems and quality of life. Toothache was the most popular causation believed to be affecting quality of life (Kinondoni), also bad breadth, teeth colour and teeth position were mentioned (Temeke). Residents of both Kinondoni and Temeke believed swollen gums, bad breath and mouth bleeding as causations of oral problems [42].

Discussion

The current study appraised scientific literature on oral health and quality of life in the EAC. Half of the twenty-eight articles that satisfied the selection criteria reported findings on samples from Tanzania while only a few other countries in Eastern Africa were represented. This reveals that scholarly contribution to oral health and quality of life in East Africa is dominated by Tanzanian scholars. The synthesised data reflects varying degrees of oral conditions prevalence across the countries. This ranged between 15.8% as reported in Kenya to 83.0% in Tanzania. Notably, population and local differences in the prevalence of oral health-related conditions were evident. This finding is a confirmation that the burden of oral health problems in East Africa is very high. It also aligns with existing statistics which put the burden of oral health problems in African population at nothing below 480 million [53]. Despite being preventable and treatable, the region has recorded about 257 million new cases in the last 3 decades. Hence, the continent is labelled as home to the ‘largest global increase of oral conditions’ [54]. This sad reality is partly attributable to oral health negligence and poor funding by international and local funders and the national governments in Africa [53, 54]. In addition, skilled personnel are limited (3.3 dentists: 100,000 patients), while oral health policy is not prioritized by the national governments in most parts of Africa [54] whereas the World Health Organization (WHO) recommends a dentist-to-population ratio of 1 dentist per 7,500 people as a general guideline [55].

The most common oral condition in this scoping review was visible oral plaque (93.2%) which was detected in underaged children in Tanzania [22]. Even when similar oral problems were reported by other authors, the nature and characteristics of the sampled population varied, such as differences in age which made comparison impossible. In addition to age, characteristics of the study group including sample size, and underlying health conditions (such as pregnancy and HIV status) in some of the studies also affected comparison. For instance, in Kenyan children, the prevalence of dental caries was 65.0%. This rate was for caries identified in both permanent and primary dentition [23], whereas in Tanzania, a prevalence of 30.2% was reported for under-aged children [22]. A recent systematic review likewise found dental caries to be prevalent in the region. This was attributed to socioeconomic and other factors [3].

Other oral conditions identified in this scoping review are untreated dental caries, early child caries, tooth pain, severe toothache, decayed tooth (primary and permanent), dry mouth, missing tooth, enamel hypoplasia, ulcers (not HSV and aphthous ulcer), plaque, and calculus. Others are mouth ulcers, bleeding, swollen gums, intra-oral lesions and extra-oral lesions. Multiple oral problems were also reported to be prevalent at varying proportions in a Nigerian study [56]. Some of these conditions are classified as priority oral problems [53] while dental caries has been identified as a non-communicable disease (NCD) since 2019 [57].

Aside from dental caries, many oral problems may sometimes be comorbid with non-communicable diseases (NCDs) [58], which is a major health burden in EAC [59]. Although, behavioural factors are common determinants of NCDs and most oral conditions, genetic factors and exposure to environmental materials correspondingly play major roles in their occurrence [60, 61]. For instance, chronic respiratory disease, cardiovascular disease, diabetes, and cancer are the 4 major non-communicable diseases to which common oral conditions are strongly associated [58]. These health conditions are so linked because they share some similar risk factors such as consumption of alcohol, sugar, tobacco, and unhealthy diets [62, 63], as well as molecular and immunological characteristics [58]. Therefore, predisposed social and environmental factors need urgent redress. Likewise, preventive measures such as oral health promotion should be institutionalised across poor resource countries, specifically EAC where these conditions are highly prevalent.

In the current scoping review, age, gender, education, place of residence, occupation, and parents’ characteristics are some of the socio-demographic variables associated with oral health problems. Other significant determinants include clinical characteristics, knowledge of preventive measures, health behaviour, and environmental factors. This corroborates a study in Nigeria that identified similar variables such as tobacco use, unhealthy diets, place of residence, and others as significant determinants of oral conditions [56]. Other researchers also identified behaviour or social determinants of health as some of the major risk factors for oral conditions [53, 62].

Notwithstanding the prevalence of oral problems identified in this scoping review, the extent of satisfaction with oral health among the participants was high. The majority of the respondents (between 63.3% and 98.2%) had a good judgement of their oral health, although some variations were identified due to the diversity of the population. A study among children in Nigeria that reported a high rate of satisfaction with dental conditions (83.0%) validates this finding [64]. On the contrary, a study in India revealed a lower rate of satisfaction (48.7%) with oral health status [65]. Poor self-rating of oral health status was also high in Australia (73.7%) [66] and low in Kenya (13.7%) [67]. Experience of oral impacts on performance, oral health condition and some sociodemographic factors were interrelated with satisfaction and rating of oral health condition in this scoping review. This is in accordance with some of the findings in Kenya and India where experience of oral health conditions such as tooth loss, oral pain, dentures [67], and absence of dental caries and good periodontal status [65], influenced self-rating of oral health status. In addition, age and behavioural factors were significantly connected with high satisfaction with oral health status in India [65]. Whereas in Kenya, age, chronic health conditions, and non-use of fluoride toothpaste were significant determinants [67].

This review found that the majority of oral health problems reported in the selected studies affected the daily performance and oral health-related quality of life of the participants. The nature of these impacts is grouped into economic, social, emotional, functional, and psychological impacts of oral health conditions on daily performance varied across the studies [19, 37, 68]. Social impacts include challenges with interpersonal relationships, economic impacts are the direct and indirect costs of oral conditions and financial burden of care as well as disruption of economic activities. Functional impacts cover the inability to perform daily tasks of living such as schoolwork, eating, cleaning, and others. Psychological impacts include depressive symptoms and other mental effects on the affected persons, while emotional impacts reflect the feelings that people develop towards their oral health such as feeling happy or sad.

Problems with eating, tooth cleaning, sleeping or relaxing and problems speaking are the impacts on quality of life mentioned by all the selected studies. The ability to enjoy food, show teeth, social contact, smile and laugh, pronounce clearly, perform major schoolwork or social role, maintain the usual emotional state, poor sense of taste, psychological disability, and psychological discomfort were reported in the studies. Eating and crying are common impacts on children’s quality of life. The result on OHRQOL further corroborates that of previous studies which found a strong relationship between the experience of oral conditions and poor quality of oral health [67, 69, 70].

A multiplicity of factors was found to be related to oral health-related quality of life in this scoping review. They include sociodemographic characteristics (age, parents’ educational qualifications, socio-economic status) [20, 40], and behavioural factors such as the attitude of parents towards paying for dental care, oral hygiene, less consumption of sugar-sweetened soft drinks, frequent visit to a dentist, and high rate of smoking [40]. Furthermore, knowledge of healthy diet or information received on oral health [20, 52], frequency of visit to dental clinic, and dissatisfaction with general health [52], modification of gingival inflammation [33], treatment need for periodontal problems, type of tool utilized to measure impacts of oral health [41], the experience of multiple burdens of oral problems concurrently [47], the experience of gingival bleeding, dental caries, and self-reported oral health status, HIV status, self-ratings of oral health status [20], as well as caretakers’ and child’s DMFT/dmft status (Birungi et al., 2016), were all indicated as significant determinants of OHRQOL. A study in Asia similarly found child dmft scores and parents’ oral health impact to be statistically related to OHRQOL [71]. Another study also found a significant relationship between early child caries and impacts on the quality of life for both the family and the child, especially older children [70].

Considering the high incidence of dental caries across all ages which affects oral health-related quality of life, future objectives in the region should consider caries prevention programs rather than replacing missing teeth with prosthetic and implant options. A variety of professional and home use agents act in prevention of dental caries via topical effect with supersaturated fluorhydroxyapatite which speeds up the process of remineralization and provides antimicrobial action [72]. Toothpaste primarily works by physically removing dental plaque and debris (biofilm) while aiding in the remineralization of teeth [73]. Further, a systematic review describes that 5% NaF varnish and 1.23% APF gel prevent root caries, whereas 38% SDF arrests root caries in older adults [74]. Chlorhexidine, available in mouthwashes, gels, and chips, offers antimicrobial properties, making it an ideal prophylactic option even when mechanical debridement is not feasible [75]. In addition, CPP-ACP is widely available at an affordable cost, making it accessible to many communities in the EAC and supporting a stronger focus on caries prevention. Findings from this review affirm that oral health is important for good quality of life as it shapes physical, emotional, and social wellbeing [62], hence oral health is central to general health [54].

Strength and limitations

There is a notable lack of published data on oral health and its impact on OHRQoL in certain countries, such as Burundi, South Sudan, and the Democratic Republic of the Congo, limiting insight into the broader regional situation in the EAC. Additionally, there is comparatively limited data available on specific oral health concerns, such as oral cancer and geriatric dental health, relative to the more extensively documented conditions in children and adults. Nonetheless, this scoping review comprehensively addressed various aspects of oral health across most countries in the EAC. It thus serves as an overview of the key oral health indicators, associated risk factors, and measures implemented by individual countries to mitigate the negative impact of insufficient oral healthcare in EAC. The consequences of poor oral health are widely shared across the EAC, and this review offered a comparative framework for examining the prevalence and effects of oral diseases across these countries.

Conclusion

This review summarizes the significant impact of oral health conditions on the OHRQoL in the EAC, highlighting a considerable public health burden. Oral health issues in this region have far-reaching consequences, affecting not only individuals’ quality of life but also their overall well-being. There are marked challenges in access to and affordability of oral healthcare services, which contribute to these adverse effects on OHRQoL. Addressing these disparities is essential for improving the oral health and general welfare of EAC. Furthermore, analysing the cost-effectiveness of different dental caries preventive strategies would lead to more favourable outcomes to minimize the burden of oral health on top of other health and economic challenges in the region. Future research should focus on identifying and implementing targeted interventions that are culturally and contextually relevant to the unique needs of EAC populations, ensuring that strategies are both effective and sustainable.