Ibadan is a city of contrasts. It is one of the largest cities in West Africa by geographical area, a sprawling metropolis that is home to one of Africa's oldest and most respected universities, the University of Ibadan. It is a city of scholars, traders, civil servants, and artisans. Yet for all its size and significance, oral health awareness in Ibadan remains remarkably low.
During my time practicing at the University College Hospital (UCH), Ibadan, I encountered patients from across the city and the wider Oyo State. The clinical cases were diverse, but a common thread ran through many of them: the patients had waited far too long to seek dental care. Teeth that could have been saved with early intervention had deteriorated beyond repair. Gum disease that could have been managed with regular cleanings had progressed to the point of tooth loss. The reasons for delay were varied — but the most common one was simply a lack of awareness about the importance of oral health.
Cultural Beliefs and Misconceptions
In Ibadan, as in many parts of Nigeria, several cultural beliefs create barriers to dental care. One of the most persistent is the idea that tooth decay is caused by a "tooth worm." This belief, which has historical roots in many cultures worldwide, leads some patients to seek traditional remedies — herbal rinses, chewing sticks treated with specific bark extracts, or visits to traditional healers — rather than professional dental treatment.
While traditional chewing sticks (like the ones made from the Salvadora persica tree) do have some evidence-based antimicrobial properties, they are not a substitute for professional dental care when decay or infection is already present. The delay caused by relying solely on traditional remedies often means that by the time a patient arrives at UCH, a simple filling has become a root canal or an extraction.
Another common misconception is that dental visits are only necessary when there is pain. Many patients I treated at UCH had never had a dental check-up in their lives. They came only when a toothache became unbearable or when a swelling appeared on their face. The idea of preventive dental visits — seeing a dentist every six months even when nothing hurts — was foreign to most.
Economic Barriers
Ibadan's population includes a large proportion of people living on modest incomes. For a family struggling with the costs of food, housing, school fees, and basic medical care, dental treatment is often seen as a luxury rather than a necessity. The out-of-pocket cost of dental care, even at a subsidized teaching hospital like UCH, can be a significant barrier.
This economic reality creates a vicious cycle. Patients avoid the dentist because of cost. Small problems that could have been treated inexpensively become large problems that require expensive interventions. By the time they finally seek care, the treatment options are more complex, more painful, and more costly — reinforcing the perception that dentistry is expensive and unpleasant.
The Role of UCH in Dental Education
The University College Hospital plays a vital role not just in providing dental care but in educating the community. During my time there, I participated in several outreach programs aimed at improving oral health awareness. These included school visits where we taught children proper brushing techniques, community health fairs where we provided free screenings, and health talks at local markets and community centres.
These outreach efforts were eye-opening. In many of the schools we visited, children had never owned a toothbrush. Some did not know what toothpaste was. The basic message — brush your teeth twice a day, avoid excessive sugary snacks, visit a dentist regularly — was genuinely new information for many of these communities.
The response was always encouraging. Parents were interested. Children were enthusiastic. Community leaders were supportive. The challenge was sustaining these efforts — outreach programs require funding, time, and human resources, all of which are in short supply at a teaching hospital already stretched thin by clinical demands.
The Chewing Stick vs. The Toothbrush
One of the most interesting aspects of practicing in Ibadan was navigating the relationship between traditional oral hygiene practices and modern dentistry. The chewing stick, known locally as "orin" in Yoruba, has been used for centuries and remains popular, particularly among older residents and in rural communities.
Rather than dismissing traditional practices outright, I found it more effective to acknowledge their value while educating patients about their limitations. A chewing stick can be effective for mechanical plaque removal, but it does not provide the fluoride protection that toothpaste offers. It cannot reach the interdental spaces as effectively as floss or interdental brushes. And it certainly cannot treat a cavity or reverse gum disease.
The most receptive patients were those who felt their existing practices were respected rather than dismissed. This taught me a valuable lesson about patient communication that I carry to this day: meet people where they are, acknowledge what they are already doing right, and build from there.
What Needs to Change
Improving oral health awareness in Ibadan — and in Nigeria more broadly — requires a multi-faceted approach. It requires integrating oral health education into primary school curricula, so that children grow up understanding the importance of dental hygiene. It requires training community health workers to include basic oral health screening in their activities. It requires making preventive dental services more accessible and affordable. And it requires sustained public health campaigns that address cultural misconceptions with sensitivity and respect.
My time in Ibadan showed me that the desire for better health exists in every community. What is often missing is the knowledge and the access. As dental professionals, we have a responsibility to bridge that gap — one patient, one school, one community at a time.
