Moroni ‒ In the Comoros, an oral health project supported by World Health Organization (WHO) and involving thousands of children aged 5–12 years, has provided free dental care and consultations to detect any associated heart disease. 

Oral diseases increase the risk of heart disease due to inflammation of the gums, as bacteria in the mouth can spread through blood vessels and cause serious infections such as endocarditis, or cardiovascular diseases such as atherosclerosis and cardiac arrest.

A national survey conducted in 2013 revealed that 90% of children aged 4–8 years suffered from oral diseases. Children in remote areas, where consultations are costly and professionals rare, were at particular risk. 

The oral health situation in the Comoros reflects a challenge that is shared by many Member States in the African Region. In 2019, nearly 70% of sub-Saharan African countries allocated less than $US 1 per person every year to oral health care, while 44% of the population suffered from related diseases. This has been exacerbated by a shortage of qualified staff, with only 3.3 dentists per 100 000 population, which is roughly one tenth of the ratio recommended globally.

In 2022 and 2023, a non-governmental organization funded by WHO, Action for Sustainable Development and the Environment (ADDE), deployed a team of cardiologists and dental nurses to schools in Mutsamudu and Koni. Over 5000 pupils benefited from free dental treatment, while 3500 received hygiene kits and 10 000 were taught how to prevent tooth decay. 

“My 7-year-old daughter was able to see a dentist and a cardiologist free of charge,” said Zainabou Bourhani, a mother of five. “I had no money to travel to the health centre or for treatment. So when I heard about the project, I jumped at it.”

In Koni, 153 children underwent Doppler ultrasound scans – a medical examination that shows the flow of blood through the arteries and veins and detects problems such as blockages or abnormalities in the heart. Sixty-eight per cent of them had heart disease and were treated thanks to additional WHO funding.

“This morning alone, I detected 48 cases of heart disease among 69 children seen,” says cardiologist Daniel Oirdi. “I am quite shocked that so many children present signs of heart disease directly linked to poor oral health. If we don't act, these children might develop advanced heart disease and lose their independence and quality of life. One has just one heart after all,” he adds.

“Before our intervention, most children had never heard of toothpaste or even seen a toothbrush,” Dr Kamariat Abdouroihamane, ADDE Project Manager explains. “The project was so successful with the parents and schools that that we had to revise our initial estimates.”

To ensure sustainability post project, the schools have set up their own programmes to raise awareness about healthy eating habits and oral hygiene. Quarterly consultations with a dental surgeon have also been introduced by the regional health department, in collaboration with the Koni municipality and community leaders.

“This initiative has transformed the lives of the beneficiary schoolchildren and can improve the oral health of all children if extended to all health districts in the country,” says Dr Diarra Abdoulaye, WHO Representative in the Comoros. “Oral health must be integrated in the fight against chronic diseases and is also crucial for improving overall health.”

The project also managed to fill an institutional data gap. Before 2022, oral health problems were not documented by the Ministry of Health. “Thanks to the results obtained, the ministry has incorporated statistics on oral risks, particularly clarifying the link between oral health and heart disease among children with cavities,” says Loub-Yakouti Attoumane, Comoros’ Health Minister until June 2024.

“I'm delighted to have my kit with toothpaste and a toothbrush,” says Soirfata, a pupil at Koni. “Now I take good care of my teeth so they never hurt again.”