Table 1 Social Determinants that affect oral health outcomes of Adolescents in West Africa

Oral health literacy

Low literacy rates in sub-Saharan African countries, such as Burkina Faso, Chad, Gambia, Guinea Bissau, Mali, Niger, and Senegal, below 50%, impacting the ability to read and engage with health information.

Low education and literacy levels can result in the following poor health behaviors:

Infrequent tooth brushing.

Non-use of fluoridated toothpaste.

Low dental service utilization.

Frequent consumption of refined carbohydrates.

Cigarette smoking.

Socioeconomic status

Low income in West African families, with all but four countries in West Africa listed as low-income countries, impacts access to oral health-promoting materials like toothbrushes and fluoridated toothpaste.

Socioeconomic status affects oral hygiene practices.

Adolescents in resource-limited settings are more affected by chronic oral diseases.

Low-income families have less access to essential oral health services and may seek alternative treatments.

Urban–rural differences

Oral diseases are most significant in rural and poor areas of West Africa, with people in rural locations being more likely to be poorer, less health-aware, have more caries, have fewer teeth, lack health insurance, and have less money to spend on dental treatment.

Rural and poor populations experience higher rates of oral diseases and

Limited access to dental care, health insurance, and education.

These disparities are also linked to lesser health literacy and poor utilization of medical services.

Healthcare systems

The existing gaps in the healthcare system in West African countries influence access to oral healthcare, with structures, workforce training, laws, regulations, and accepted practices impacting individuals' and populations' oral health.

Complexities in accessing quality and affordable oral healthcare. Health-seeking behaviour for oral diseases are unplanned and ad hoc.

Regular teeth cleaning and dental visits less common among rural adolescents.

Early childhood nutrition

Unhealthy food choices, including high free sugar intake for children and adolescents and undernutrition/nutritional deficiencies in Western Sub-Saharan Africa, impact oral health by increasing the risk of dental caries and gum diseases and affecting dentition development.

Excessive consumption of sweets and beverages leads to dental decay even in high social classes.

Compromised nutrition impacts oral development and contributes to oral diseases in the long term.

Environmental factors

Access to piped water in urban regions, especially in Ghana, Mali, and Senegal, is a significant determinant of oral health.

Physical environmental factors such as exposure to air pollution and access to oral health-detrimental substances, like recreational drugs, can impact oral health behaviour.

Periodontal decay and oral deterioration can impact oral health outcomes, extending into adulthood.

Social support

Family, ethnicity, and childhood experiences influence oral health beliefs.

Promoting oral care behaviours in children through observed practices and attitudes improves their oral health.

It establishes lasting oral hygiene habits into adulthood.

Adverse childhood experiences such as physical and mental abuse and bullying can diminish self-esteem and increase the likelihood of poor oral health.

Culture

Chewing sticks for cleaning and traditional medicine as the first call for oral services is prevalent.

Traditional medicine, is affordable, socially and culturally acceptable, and accessible.

It plays a crucial role in relieving acute dental pain in underserved rural areas and performing other practices like tooth extractions.