King's College London

1. To explore key informants’ views on oral healthcare needs, workforce challenges, and approaches to building a sustainable oral health workforce.
2. To explore normative and perceived oral-health needs, oral-health behaviours, and access to care among children and adults.
3. To develop needs-based models of treatment and workforce requirements under different approaches to dental caries management.
4. To generate locally relevant evidence to inform national oral-health policy, workforce planning, and the development of population-level oral-health programmes and services in Sierra Leone.

The foundational research programme used a mixed-methods approach combining qualitative research, oral-health surveys, and needs-based workforce modelling.

First, semi-structured interviews were conducted with purposively selected key informants from dentistry, healthcare, and related sectors in Sierra Leone and internationally to explore oral-health needs, service provision, and workforce challenges.

Second, oral-health surveys were conducted among children and adults. The first national oral health survey in Sierra Leone included 6-, 12-, and 15-year-old schoolchildren across all four regions, using multistage cluster sampling and contemporary epidemiological approaches, including the International Caries Classification and Management System (ICCMS). An exploratory adult survey was conducted in parallel to examine perceived and normative oral-health needs, oral-health behaviours, service use, and impacts on daily life.

Third, a needs-based operational research model and scenario planning were used to estimate treatment needs and oral-health workforce requirements under different approaches to managing dental caries, drawing primarily on data from the national child oral-health survey.

Qualitative interviews with 21 key stakeholders, including dental professionals, health workers, and government officials, explored perceptions of oral-health needs in Sierra Leone, potential approaches to addressing them, and implications for developing a sustainable oral-health workforce. The study identified major service and workforce constraints and the need for context-appropriate models of care.

Building on this foundational work, Sierra Leone’s first national oral health survey, involving 1,174 schoolchildren aged 6, 12, and 15 years across all four regions was undertaken to examine normative and perceived needs at population level. More than 80% of children had clinical dental caries, which was largely untreated; no children had fillings, and at least one in five required one or more dental extractions. In parallel, an exploratory adult survey (n=161) conducted across Sierra Leone found substantial unmet need and limited access to dental care: 75% of participants had never visited a dentist and 40% reported toothache. Among those clinically examined, 84% had untreated dental caries into dentine.

To support ethical and accessible research participation, the research team co-developed a bespoke pictorial ‘information and consent’ (PIC) sheet with an illustrator and Sierra Leonean colleagues, with support from King’s Culture. Evaluation showed that participants rated the pictorial approach highly for helping them understand the research process.

The survey data subsequently informed development of a needs-based operational research tool to estimate national oral-health treatment needs and model workforce requirements under different approaches to care. Secondary analysis of the child survey also demonstrated that assessing only visible tooth cavities could underestimate earlier stages of dental caries.

Together, this body of research provided an evidence base for prevention, service development, and workforce planning, contributing to national oral-health policy development and approaches to expanding access through an appropriate skill mix, including mid-level dental providers.

The findings from the above research were vital to the development of Sierra Leone’s National Oral Health Strategic Plan, published in 2024. It sets out four priority objectives

1. To strengthen oral health leadership, governance, network, partnership, collaboration and administration.
2. To strengthen and expand oral health promotion and prevention activities in all health programmes at the national and community levels, targeting oral health risk factors.
3. To integrate oral health service into the primary care level using the preventive approach.
4. To train and equitably distribute the national oral health workforce.

The research also helped with providing critical evidence to support the creation of a bespoke dental therapist training programme.