The interpretation of the data reported in this study should be done with the following methodological limitations in mind: First, probability sampling was not used to obtain study clusters. Secondly, only adults who were present at their homes during the study hours were interviewed. Although random sampling was used to obtain regions for inclusion into the study and the study hours adjusted to suit times when most of adults were expected to be present at their homes, one cannot say with certainty that the data is representative of adults in Tanzania. Nevertheless, the strategy of moving from one household to another and interviewing adults at their homes minimized the selection bias that would arise from calling respondents to one location in a street. Calling respondents to one location in a street would have included, in the study, only adults who were enthusiastic and ready to participate in joint street activities, while leaving out adults who were less receptive. This also controlled the selection bias that could have arisen from street leaders selecting the households of their interest. In addition, the fact that each administrative zone was represented took care of the possible variations between zones. Furthermore, the predetermined number of respondents in each sex and age-group ensured that both sexes and age-groups were fairly represented in the study. Given all these control measures, the authors were satisfied that the findings reported in the present study were reliable enough to be used for planning purposes.
The prevalence of oral pain reported in the current study (58.8%) was higher than those reported in Brazil, Nigeria, and Burkina Faso which were 39.9%, 34%, and 27.7% respectively [4, 13, 14]. The proportion of respondents (26.5%) who used the emergency oral health care facilities following an episode of oral pain in the present study is similar to that reported among adults in Burkina Faso (27.7%) [14]. In the present study, lack of money was the most frequently reported barrier to seeking emergency oral care. This finding is similar to that reported among rural villagers in Tanzania, adult population in Burkina Faso and among University students in Kenya [10, 14, 15]. Similar findings were also reported among underserved communities in USA [16–18]. These findings indicate that cost may be a major barrier for seeking oral care in many communities whose earnings just meet the bare minimum of life.
The finding that 58.8% of all respondents had experienced some episodes of oral pain or discomfort during the 12 months preceding the interview, indicate that oral health problems are common among adults in Tanzania. Since only 26.5% of those who experienced some episodes of oral pain or discomfort sought emergency oral care in oral health care facilities, it can be extrapolated that if all adult Tanzanians who experience oral pain or discomfort would seek emergency oral care in oral health care facilities, the current workload in these facilities would triple, and would necessitate an increase in the facilities and human resources to meet such demand.
About a third of respondents who had not sought emergency oral care despite having experienced oral pain or discomfort during the last 12 months leading to the study, gave no substantial reasons for not seeking such service. These might have had only mild discomfort that did not require emergency oral care. It might also mean that pain disappeared before they were able to seek treatment. Similar response could also have been elicited from adults who tolerated oral pain due to other competing needs that involved time and finances. It is on this account that it is worth noting that the questionnaire did not adequately capture the reasons why some respondents did not have 'substantial reasons' for not seeking emergency oral care. It is hereby recommended that future studies on reasons for not seeking emergency oral care should be undertaken to address this shortfall.
About a third of the respondents could not seek emergency oral care because of financial reasons. The Ministry of Health should make people aware of the provision for exemption for those who cannot pay for these services. This will allow more people who cannot afford the treatment fees to access emergency oral care. It is hoped that the current government's efforts aimed at reducing poverty and increasing the economic growth for all Tanzanians are likely to reduce the identified barriers for seeking emergency oral care. This is because higher economic status has been shown to correspond with high utilization of oral health services [14]. There is also a need to raise awareness among Tanzanians on the importance of prompt seeking of oral care to prevent adverse sequel of advanced oral diseases. This is particularly important because, as already mentioned, 1/3 of those who had had pain or discomfort reported to have no substantial reasons for not seeking emergency oral care. In addition, a study among the people in one region in Tanzania did reveal that not all people in Tanzania who report to have not utilized health services due to financial reasons are actually unable to pay for the service. Rather, they use the pretext of being poor as a convenient way of explaining away their negligence [19].
The findings that women were more likely to report that they had experienced oral pain than men is likely to be due to cultural traditions. In Tanzania, men tend to shy away from reporting pain because it is generally taken as 'normal' for a man to tolerate pain. This observation conforms to what has been reported in other countries [20–22]. This may also explain why more men than women did not seek emergency oral care on the assumption that pain would disappear spontaneously.
People who live in rural areas were disadvantaged in relation to accessing the emergency oral care from oral care facilities compared to those who live in urban areas. In the present study, respondents from rural areas were more likely than respondents from urban areas to give reasons such as distance from their home, lack of money for transportation to dental clinics; being treated by traditional healers; and using medicines at home for not seeking emergency oral care from oral care facilities. Since oral pain and discomfort were equally prevalent among rural and urban residents, there is a need for establishing oral health care services in rural health centres and dispensaries.