The State of Orthodontic Care in East Africa: A Scoping Review of Access, Inequity, and Future Directions
Twisibilege Chalton Mwakasungula, Josephat Bakega, Hassan Mohamed Kawia.
Background: Malocclusion is a highly prevalent oral disease with significant functional, aesthetic, and psychosocial consequences. In East Africa, orthodontic care is characterized by a profound mismatch between high population need and extremely limited, inequitable access. This scoping review synthesizes current evidence to map the landscape of orthodontic service provision, identify systemic barriers, and highlight innovative models for expanding care in the region.
Methods: We conducted a scoping review following the Joanna Briggs Institute (JBI) framework. We systematically searched PubMed, Scopus, African Journals Online (AJOL), and institutional repositories for literature published between 2000-2025. Crucially, grey literature was restricted to publicly accessible online documents from official sources, including Ministry of Health websites, WHO databases, East African Community portals, and digital repositories of regional universities and dental associations.
Findings: The review included 71 sources. Epidemiological studies indicate 20-35% of adolescents have a measurable orthodontic treatment need. The region averages <0.5 orthodontists per 1 million people, with nearly all specialists practicing in urban private clinics. Key barriers are: 1) Catastrophic out-of-pocket costs, 2) Critical specialist shortage and urban concentration, 3) Absence of orthodontics from public health and insurance priorities, and 4) Low public awareness of functional impacts. Promising innovations include early-stage training programs for orthodontic therapists, pilot tele dentistry projects for remote consultation, and the introduction of digital aligner technology.
Interpretation: Orthodontic care in East Africa is a luxury good, inaccessible to the majority. The traditional specialist-dependent model is unsustainable. We propose a fundamental shift towards a public health-oriented, tiered care model. This requires: legislating mid-level orthodontic workforce roles; integrating basic interceptive care into national health benefit packages; investing in regional teledentistry hubs; and prioritizing context-specific health systems research. Achieving equity requires committed collaboration between educators, policymakers, and professional associations.
