by Dr Bulela Vava, President of the Public Oral Health Forum
On 26 October 2025, the Eastern Cape Department of Health concluded a three-day oral-health blitz, a belated celebration of Oral Health Month. Partnering with Operation Smile, Colgate-Palmolive, and others, the campaign delivered oral healthcare services to nearly a thousand people, including life-changing cleft surgeries for children. These efforts deserve recognition. They shine a light on oral diseases and their human toll. But they also reveal something more uncomfortable: in South Africa, oral health is at risk of becoming a seasonal spectacle, not a routine service provided in a functional healthcare system.
Oral diseases affect an estimated 3.7 billion people worldwide, making them the most common noncommunicable diseases (NCDs). In Africa, more than 400 million people are affected. In South Africa, the WHO’s country profile shows that 41% of children aged one to nine have untreated caries, the estimate is 27.9% among those over five. Severe periodontitis (gum disease that results in bone loss) affects nearly a quarter of adults, while edentulism (toothlessness) impacts 8.4% of people over 20, rising sharply with age. According to the same country profile, lip and oral cavity cancers add around 1,933 new cases annually.
A system built on inequality
These figures reveal a silent epidemic. Yet oral health remains under-prioritised in policy, budgets, and staffing. Most of the country’s more than 6,365 dentists work in the private sector which serves a small fraction of the population; while the public sector, where over 80% of South Africans seek care, faces chronic vacancies and resource shortages.
The Eastern Cape is home to over 6 million people. Yet the province employs only two specialist maxillofacial oral surgeons, and no other oral healthcare specialist in the public sector. Their work extends far beyond cleft repair: they are critical to managing facial trauma, cancers, infections, and complex reconstructive surgery.
This is in a province burdened by high trauma rates. Data from the Road Traffic Management Corporation show that the Eastern Cape accounted for roughly 10% of fatal crashes in Q4 of 2024/25, more than 200 lives lost in a single quarter. Added to this are high levels of violent contact crimes. These realities drive maxillofacial trauma, but surgical capacity remains perilously thin.
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Despite this, the province has made a highly welcome investment in constructing its first dental laboratory to support specialised rehabilitative oral healthcare, including the fabrication of facial prostheses (such as artificial eyes and ears), dentures, dental crowns, and orthodontic appliances. However, without employing dental specialists in orthodontics and prosthodontics, and investing in the upskilling of its already limited dental workforce, the laboratory risks becoming little more than a monument to good intentions.
Outreach masks fragmented system
Outreach campaigns often lean heavily on extractions, the quickest and most visible form of care. 2022/23 DHIS data shows over 300,000 extractions performed in the Eastern Cape. In contrast, fewer than 3,000 people received prosthodontic care to replace missing teeth.
To be clear, there isn’t a one-to-one relationship between extractions and dentures. One person may have several teeth extracted, one denture can replace multiple teeth, and various visits may be recorded for a single prosthesis. Children’s primary teeth are also not replaced. But even accounting for these factors, the gap between loss and rehabilitation is staggering.
Tooth loss is not a benign outcome. It is linked to poor nutrition, frailty, and depression, particularly among the elderly. Young people living with missing teeth also face stigma, social withdrawal, and reduced opportunities. By focusing on short-term relief through extractions, we are quietly normalising lifelong disability.
Behind the photo opportunities, the tents, the cameras, the speeches, lies a public oral health system so fragmented it could make a jigsaw puzzle weep. Leadership and production level posts sit vacant. District oral health teams are skeletal. The availability of basic supplies is inconsistent. Preventive programmes barely exist outside occasional outreach efforts.
Need to build capacity
Outreach, in this context, becomes a paper fire: bright, warm, and fleeting. It does not build capacity. It does not reduce inequities. It does not guarantee that someone in James Calata can access comprehensive and quality oral care on a Tuesday morning when there is no marquee, no ribbon, and no applause.
If the Eastern Cape, together with its counterparts, want to be taken seriously on oral health, it must match its weekend enthusiasm with weekday governance:
- Fill leadership and production level posts and embed oral health in provincial strategic plans and programme budgets.
- Expand the oral health workforce by making investments in specialist and primary oral healthcare, taking into consideration the need to build this capacity proportionate to need.
- Prioritise prevention by scaling up school-based programmes like toothbrushing, fluoride applications, and minimally invasive dentistry.
- Treat rehabilitation as dignity, not luxury, by investing in comprehensive and inclusive rehabilitative care, with the Mthatha-based dental lab positioned to catalyse impact.
- Target trauma and oral cancer by integrating safety, violence prevention, tobacco and alcohol control measures into oral health planning.
- Earmark resources, including health promotion levy funds, for oral health.
- Measure relentlessly by monitoring performance and programmes, aligning these with national oral health priorities.
Operation Smile’s cleft work in the province is commendable. So are the efforts of many dedicated health workers who make do with very little. But these are not substitutes for a functioning oral healthcare system. Outreach can help, but it cannot carry the system.
The people of the Eastern Cape need more than seasonal care. They need year-round dignity. If oral health is to matter, it must matter every day, not just on weekends when the cameras are rolling.
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Dr Bulela Vava is an Atlantic Fellow for Health Equity based at Tekano and the Founder of the Public Oral Health Forum, a volunteer network of persons committed to advancing oral health equity in South Africa.
The views and opinions expressed in this opinion piece are those of the author, who is not employed by Health-e News. Health-e News is committed to presenting diverse perspectives to enrich public discourse on health-related issues.
