By Salam Saheed
A medical expert and President of the Noma Practitioners Association of Nigeria, Dr. Seidu Bello, has called for the employment of dental auxiliaries at the LG level and the establishment of functional community dental clinics across the 774 LGA in Nigeria.
The Medical Professioner, who is also the Chief Executive Officer of the Cleft and Facial Deformity Foundation (CFDF), made the call on Wednesday while delivering a lecture at the 6th International Association for Dental Research (IADR) Conference held at Barcelona Hotel, Abuja.
Speaking on the theme, “Integration of Noma and Other Oral Healthcare into Primary Healthcare in Nigeria,” Bello said the country could not effectively control noma without integrating oral healthcare into the primary healthcare system.
He said appropriately trained dental therapists, dental surgery assistants, dental nurses, community health workers, nurses and community health officers should form part of the workforce providing oral healthcare at the grassroots.
According to him, the absence of appropriate provisions for some oral-health cadres in the 2006 Local Government Scheme of Service had created a challenge to their employment at the local government level.
He said, “It is surprising that the 2006 edition of the Local Government Scheme of Service recognises several middle-level health personnel, but dental therapists, dental surgery assistants, dental nurses and dental technologists are not recognised.
“It means there is no legal framework to employ them at the local government level. Therefore, our objective should be to ensure that appropriately trained oral-health personnel are actually incorporated into the workforce that serves communities.”
Bello described noma as a severe and rapidly progressive necrotising disease of the mouth and face, which predominantly affects young children living in conditions of extreme poverty, malnutrition, poor hygiene and limited access to healthcare.
He noted that the World Health Organisation recognised noma as a neglected tropical disease in 2023, adding that the disease was preventable and should not be regarded as an inevitable consequence of poverty.
He said poverty created conditions in which malnutrition, infection, poor oral hygiene, inadequate sanitation and delayed access to healthcare combined to increase children’s vulnerability to the disease.
According to him, noma is not merely a surgical problem but a public health challenge that requires intervention at the community and primary healthcare levels.
He said acute noma predominantly affected children between two and six years, with mortality among severely affected children ranging between 70 and 90 per cent, while survivors could suffer severe facial deformity, trismus, loss of tissue, difficulty eating and speaking, breathing difficulties, psychological trauma and social stigma.
The expert said Nigeria remained one of the countries with a substantial burden of noma, adding that although the disease had traditionally been associated with northern Nigeria, evidence had shown that it also occurred in the North-Central region.
Bello cited a 2019 study on the estimated incidence and prevalence of noma in North-Central Nigeria, which, he said, estimated an incidence of 8.3 cases per 100,000 population and highlighted the need for greater awareness and training of primary healthcare providers.
He also referred to a 2025 study published in PLOS Neglected Tropical Diseases, involving Ramat Oyebunmi Braimah, John Adeoye, Seidu Bello and others, which examined cases managed at Noma Children’s Hospital, Sokoto, between 1999 and 2024.
He said the study further underscored the importance of surveillance, awareness and early detection of the disease.
Bello stressed that oral healthcare should no longer be treated as separate from primary healthcare, noting that primary healthcare was the level closest to the people and the appropriate point for health promotion, disease prevention, early diagnosis and health education.
He said oral healthcare should cover the prevention, recognition and management of dental caries, periodontal diseases, oral infections, oral cancer, noma, orofacial trauma, cleft lip and palate, congenital facial conditions and oral manifestations of systemic diseases.
He said, “There is no complete health without oral health. And there cannot be an effective noma-control programme without an effective oral-health component at primary healthcare level.”
On the proposed community dental clinics, Bello said each of the 774 local government areas should have access to functional oral-health services, stressing that the initiative would not require a specialist dentist or maxillofacial surgeon in every community.
He listed the functions of the proposed clinics to include oral-health education, basic preventive services, early recognition of oral diseases and noma, nutritional and hygiene education, community surveillance, referral and follow-up of patients.
Bello proposed a three-level model for integrating noma and oral healthcare into primary healthcare.
He said the first level should be the community, where community health workers, religious leaders, teachers, traditional leaders and other stakeholders would be trained to identify early warning signs.
At the second level, he said community dental clinics and primary healthcare centres should provide assessment, preventive and basic oral healthcare, surveillance and immediate referral of suspected cases.
The third level, according to him, should comprise secondary, specialist and tertiary facilities where patients requiring advanced care could be managed by maxillofacial surgeons, oral and maxillofacial pathologists, plastic surgeons, paediatricians, nutritionists, anaesthetists, physiotherapists, speech and language specialists, psychologists and other relevant professionals.
He said strengthening community dental services would also improve early detection, surveillance, referral pathways and the integration of nutrition into noma management.
He urged policymakers to move away from a healthcare system that relied heavily on late referrals to tertiary hospitals, saying early detection and intervention would prevent irreversible facial destruction and reduce the burden on specialist facilities.
He said, “A child should not have to travel hundreds of kilometres before somebody recognises that an oral lesion is dangerous.
“A child should not have to wait until the face has been destroyed before receiving treatment. And a child should not have to become a lifelong survivor of a disease that is preventable and treatable when detected early.”
He therefore urged governments and health authorities to bring oral healthcare and noma control into primary healthcare, train community health workers, empower dental therapists and dental surgery assistants, establish community dental clinics and strengthen surveillance and referral systems.
He said the ultimate objective should be to identify and treat children at risk before noma progressed to irreversible facial destruction.