Dr. Eric Odhiambo
For a child, a toothache can mean a sleepless night, missed meals and a day away from school. Yet Kenya’s health system still struggles to bring oral healthcare into the primary-care services where prevention should begin.
A child does not need to understand Universal Health Coverage (UHC) to know what a toothache feels like.
The pain can wake them in the middle of the night. Eating becomes difficult. Concentration at school suffers. A parent may reach first for a painkiller, hoping the discomfort will pass.
But pain is often the point at which an oral-health problem has already progressed.
And for many families, the next challenge is finding a facility that can actually provide dental care.
This is where a seemingly ordinary toothache exposes a much bigger problem in Kenya’s health system: oral healthcare remains too often treated as a specialised service rather than an essential part of primary healthcare.
The numbers make that difficult to explain away.
Kenya’s first National Oral Health Survey found periodontal disease among 98.1 per cent of adults, while dental caries affected 34.3 per cent of adults. Dental fluorosis affected more than 40 per cent of children.
These are not the characteristics of a niche health problem.
They describe a common health problem whose response remains comparatively marginal.
‘The mouth cannot be separated from the rest of health’
The issue here is whether oral healthcare is properly recognised as part of the country’s wider health system.
KDA has been engaging the Ministry of Health on strengthening oral-health education, capacity building and the integration of oral health into primary healthcare. The Ministry has also acknowledged the need for collaboration with the dental profession on strengthening services at primary-care level.
The argument is significant because oral diseases do not exist in isolation.
They share risk factors with major non-communicable diseases, while patients living with conditions such as diabetes, cardiovascular disease, renal disease and cancer may require coordination between medical and dental teams.
Kenya’s National Oral Health Policy 2022–2030 already recognises this need, calling for oral health to be integrated into NCD programmes, primary healthcare and Universal Health Coverage.
The challenge is therefore less about recognising the problem on paper and more about changing how services are organised and delivered.
The child who reaches the dentist too late
Consider what happens when dental caries begins in a child.
Detected early, it may be managed through prevention, education, monitoring and relatively simple treatment.
But if the child never receives an oral-health assessment, the disease can progress unnoticed.
Pain eventually becomes the alarm.
By then, what might have been an early intervention can become an extraction, pulp therapy or more extensive treatment.
The same pattern can affect adults.
Someone may postpone treatment because there is no dental service nearby, because the immediate cost is unaffordable or because the problem does not initially appear serious enough to justify a visit.
When treatment finally happens, the disease may be more advanced and the intervention more complicated.
That is not simply a dental problem. It is a health-system design problem.
A disease burden without enough dental doors, is one of the clearest gaps in access.
The 2023 Kenya Health Facility Census found that only 13 per cent of health facilities provided dental services, with substantial gaps particularly in rural and primary-healthcare settings. The Ministry of Health has also reported a dentist-to-population ratio of 0.27 dentists per 10,000 people.
The problem, however, is not simply that Kenya needs more dentists.
It is also about where those professionals are located, whether facilities have functioning dental units and equipment, whether essential supplies are available and whether referral systems actually work.
The greatest opportunity to prevent disease is often before a patient reaches a hospital, yet that is precisely where oral-health services remain weakest.
The result is a familiar health-system paradox: a large burden of preventable disease at community level, but limited capacity to identify and manage it early.
Bringing oral health closer to the household
Rather than create another isolated programme, Kenya could use the structures it already has to bring oral-health prevention closer to households.
A pregnant woman attending an antenatal clinic is already in contact with the health system.
A child taken for immunisation or routine growth monitoring is already being seen by health workers.
A patient attending a Non-Communicable Diseases (NCD) clinic is already being monitored for a chronic condition.
Each encounter offers an opportunity for basic oral-health education, screening and referral.
Schools offer another.
So does the community-health system.
Community Health Promoters (CHPs) do not need to become dental practitioners. They could be equipped to provide basic oral-health education, identify obvious signs of disease or danger and connect households to appropriate care.
The electronic Community Health Information System (CHIS) could then help counties identify where oral-health needs are concentrated, where services are missing and where resources should be deployed.
This is broadly consistent with the direction KDA has been advocating.
In 2025, we said that empowering frontline health workers with oral-health skills could bring quality care closer to Kenyans.
The implication is straightforward: oral healthcare cannot remain something patients encounter only after disease has become painful.
But integration without capacity will fail
There is little value in identifying a child with a dental problem at household or school level if the referral facility has no dental professional, no functioning dental unit or no supplies with which to treat the child.
Integration therefore has to go hand in hand with investment.
National and county governments need predictable oral-health budgets.
Facilities need functioning equipment and supplies.
Dentists, community oral health officers and dental technologists need to be deployed according to population need and the level of care required.
The private sector also has a role.
Kenya already has significant dental capacity outside government facilities. Strategic purchasing and public-private collaboration could potentially make that capacity part of a broader response to population needs rather than leaving access largely dependent on where a person lives or what they can pay.
The central question is not who owns the dental chair.
It is whether a Kenyan who needs essential oral healthcare can reach one at the right time and at a sustainable cost.
Can UHC afford to ignore the mouth?
The transformation of Kenya’s health-financing system presents another opportunity.
The Ministry of Health has identified oral healthcare as part of the broader UHC conversation, while KDA has called for oral health to remain central to national health reforms. In its engagement with the Ministry, the Association advocated for implementation of the National Oral Health Policy and greater integration of oral health into NCD prevention and management.
The debate should not necessarily begin with whether every dental procedure can be financed.
A more practical question is: what essential oral-health services should every Kenyan be able to access?
A cost-conscious package could prioritise prevention, early diagnosis and essential treatment.
Children could be one starting point.
A child-focused package could support screening, prevention, early management of dental caries and treatment of common childhood oral conditions, alongside school-based oral-health education and screening.
That would not mean financing every possible dental procedure.
It would mean intervening before a preventable problem becomes a more expensive one.
Dr. Eric Odhiambo is a dental surgeon and healthcare management consultant
