Oral health disparities are a significant public health issue across Africa, with oral diseases affecting 1 in 3 persons in the World Health Organisation's Africa Region (1). The risk for poor oral health is exacerbated by the poor access to preventive and therapeutic dental care in the region (2). The limited availability of resources, combined with systemic healthcare challenges, has further left many African communities underserved by oral health care services (3). Yet, Africa's oral health landscape is uniquely shaped by rich and diverse cultural practices, beliefs, and values that can have a profound impact on health (4), influencing how individuals approach oral hygiene, dietary habits, and the utilization of dental services (5).

Culture is often understood as the shared patterns of beliefs and behaviors within specific groups, offering frameworks that shape social norms, relationships, and rules of conduct (6). Modern discourse tends to emphasize its observable components—tangible elements shared and transmitted within societies (7). However, because these aspects are mutable and no cultural trait is exclusive to any group, culture encompasses far more than its visible elements. In today's global cultural “market,” where traits are freely adopted and adapted, the essence of culture extends beyond what is observable (8).

A key dimension of culture lies in the structured ways individuals interpret their world, shaped by both conscious and unconscious beliefs, expectations, and practices. The essence of culture is not found in artifacts or tangible elements but in the values, symbols, and perspectives that define a group's identity. As noted, “the essence of a culture is not its artifacts, tools, or other tangible elements but in how group members interpret, use, and perceive them. It is the values, symbols, interpretations, and perspectives that set one people apart from another in modernized societies; not the material objects or other tangible aspects of societies (8).”

Hence, it is essential that the intrinsic elements of culture reveals its deeper essence, which imbues visible expressions with meaning. These core elements enable a culturally conscious individual to recognize, embrace, and defend their culture's visible expressions. Integral to this inner essence are the beliefs, shared mental states, and values shaped by a community's traditions and passed down through generations. They act as the nonhereditary memory of a community, expressed through systems of constraints and prescriptions (9). So, an understanding of culture as the patterned way individuals interpret their world, relying on both conscious and unconscious assumptions, expectations, and practices, forms a theoretical framework for this paper. These cultural frameworks influence how groups perceive illness and approach healthcare, sometimes facilitating access to services but occasionally creating barriers (10, 11).

Arthur Kleinman's “explanatory model” highlights that each culture has its own ways of understanding health and illness, encompassing biological, social, spiritual, and moral dimensions (12). These beliefs are “embodied” in physical practices and expressions, making oral health a cultural expression. Embodiment of oral health can be understood as an act of “doing oral health,” as it involves learning, adapting, and performing practices related to maintaining oral hygiene and care. Embodiment is not a static concept; rather, it is “a life process that requires the learning of body techniques such as brushing, flossing, chewing, and speaking (13).” It is through the integration of these oral health practices that one constructs and sustains the sense of bodily care and health within everyday life. In many African societies, the details of the mouth such as the appearance of teeth, influences social perceptions, like associating white, well-maintained teeth with beauty, health, and status.

Despite the significance of cultural beliefs for oral health, and the need for cultural sensitivity to improve access and uptake of oral health services (14), oral health policies in Africa have often neglected to meaningfully incorporate this cultural consciousness, leading to a gap in culturally resonant health strategies. Culturally competent health care providers are better equipped to meet the needs of community members, who are often underserved, by respecting their unique beliefs, values, language, practices, and health behaviors (15).

The gap may be due, in part, to a longstanding influence of colonial healthcare models, which historically marginalized traditional and indigenous African healthcare systems and replaced them with Western-centric perspectives (16). The transition diminished the use of local remedies and community-based health practices, valuable knowledge, cultural heritage, and self-sufficiency in oral health care, resulting in poor integration of indigenous and local knowledge, fostering dependence on biomedical models that prioritize symptom treatment over a holistic indigenous approach that considers physical, mental, and spiritual well-being (17).

The legacy of these shifts often resulting from colonisation and reinforced by settler colonisation practices, have shaped current public health policies and healthcare education, often creating a bias toward Western approaches at the expense of cultural relevance (18, 19). In many cases, oral health professionals and policymakers lack training in culturally sensitive care and may have limited understanding of the sociocultural contexts within which communities interpret and manage their health, including oral health (20).

Fifty-five countries are members of the African Union (21) with many more ethnic groups and their unique cultures and ethnicities. It is unrealistic to talk about the “African” culture or to generalise the intricate tapestry of cultural beliefs of one group to all Africa. In this respect, we focus on one ethnic group in West Africa, the yorùbá people, to demonstrate the complexity of the interaction between cultural beliefs, traditional practices and oral health, and the possible impact of their unique worldview on oral health. This paper discusses rituals and embodied culture practices surrounding oral health, and links this discussion to the implications for oral health policies and interventions in Africa.

The yorùbá are one of West Africa's prominent ethnic groups, primarily residing in southwest Nigeria and parts of neighboring countries like Benin and Togo (22). They are renowned for their rich cultural heritage, which encompasses a complex social structure, language, religion, literature, and arts. Yorùbá culture is deeply rooted in spirituality and cosmology, with the traditions passed down for centuries through oral histories, art, and the sacred Ifá corpus—a system of divination that provides philosophical insights on various aspects of life, including health and wellness (23). The yorùbá, like all cultures, find metaphysical explanations for anything they cannot rationally explain, but are also more likely than other ethnic groups in Nigeria to link metaphysical causes to oral diseases (24).

In yorùbá society, the mouth holds a profound symbolic importance, reflecting not only a physical but also a spiritual dimension. It is seen as the “gateway” to expressing one's inner character, used for speech, prayers, and blessings (25). The yorùbá worldview on health centers around a holistic approach, with the concept of personhood comprising ara (the body), ẹ̀mí (the life force or soul), and orí (the inner head or spiritual essence). Each element is thought to contribute to an individual's health, fate, and balance in life. As a result, the mouth's care is seen as integral to nurturing the ẹ̀mí and harmonizing the orí with the physical self (26). This reverence is reflected in proverbs and maxims, which emphasize the mouth's role in maintaining personal integrity, reputation, and aligning one's inner and outer worlds (25).

Furthermore, an ẹsẹ-Ifá (Ifá divination poem), the Òdí Méjì, foregrounds the importance of the appearance of the teeth in determining the state of human health. Òdí Méjì emphasizes that dazzling white teeth is synonymous with good health which is manifested in a healthy body. Since the yorùbá worldview on health centers on maintaining balance among ara, ẹ̀mí, and orí (particularly because it also houses the teeth), Òdí Méjì emphasizes that healthy teeth are a physical manifestation of spiritual balance of the three elements, and that only dazzling and sparking appearance fits the teeth (funfun niyì eyín) (27).

This belief in the spiritual and physical balance evident in the healthy teeth, encourages yorùbá people to engage in regular oral health rituals. The need for these rituals is reinforced through the yorùbá verbal arts for indigenous health management. Verbal arts keep people well-informed of the beliefs, convictions, and the aspiration of the yorùbá traditional setting (28). Among the verbal arts, folksongs have been identified as a medium of continuity in preserving the traditional values and norms in African society and culture (29). Traditional yorùbá songs, proverbs, and chants carry messages that celebrate good health practices, including oral hygiene, and link these practices to overall balance and harmony in life. Through their rhythm, repetition, and cultural significance, these songs remind individuals of the importance of maintaining healthy mouth, teeth, and tongue—not only for physical health but also for spiritual and mental wellness.

In many yorùbá songs, bright, clean teeth and a well-cared-for mouth are associated with good fortune, spiritual clarity, and respectability. They often echo the belief that physical appearance, such as dazzling white teeth, reflects inner spiritual balance and strength. For instance, lyrics might emphasize that “eyín funfun” (white teeth) are a source of “iyì” (honor or dignity), suggesting that oral health is both a visible sign of personal integrity and a reflection of one's spiritual and mental state.

One of such songs known and popularly sung among the yorùbá people is titled “wẹ̀ kó o mọ́.” Jí ko rorín, wẹ̀ kí o mọ́, ré èékánná rẹ, jẹun tí ó dára lásìkò má jẹun jù (Wake up and clean your teeth, have a bath to stay clean, cut your fingernails, eat good food at the right time, but do not overeat). The lyrics is shown in Figure 1.

The song reflects personal integrity by linking physical hygiene, discipline, and well-being to yorùbá values of dignity and self-care. It emphasizes daily practices like bathing, brushing, and nail-cutting as symbols of inner discipline and respect for oneself and others. In the yorùbá culture, outward cleanliness represents inner values, aligning physical care with moral and social responsibility. The call to “eat good food and don't be a glutton” highlights moderation as a core yorùbá virtue. Balanced eating reflects self-control and thoughtful living, resonating with the philosophy of ìwà pẹ̀lẹ́ (gentle and disciplined character). Overindulgence, by contrast, signifies a lack of restraint.

In yorùbá cosmology, the body (ara) houses the spirit (ẹ̀mí) and is guided by the spiritual essence (orí). Caring for the body fosters spiritual and mental clarity, maintaining harmony and balance, aligning with cultural expectations of purity and holistic health. Songs like this educate by embedding values of self-care, moderation, and responsibility, transmitting yorùbá cultural norms that connect health, morality, and spirituality. These kinds of songs are often used in communal gatherings, serve as tools for educating children and adults alike, and encourages listeners to reflect on how their daily habits align with their personal values and communal expectations. It preserves and transmits yorùbá cultural norms, emphasizing the interconnectedness of health, morality, and spirituality, thereby creating a harmonious state that honors the yorùbá understanding of total wellness.

Thus, the yorùbá worldview of the mouth is that of both a physical and spiritual symbol, connecting oral health to broader concepts of personhood. Oral health is, therefore, a holistic embodiment of spiritual balance and inner harmony. The mouth becomes a “gateway” reflecting character and spiritual health, embodying cultural values beyond physical care. The culture reinforces the mouth's role in maintaining personal integrity and aligns physical health with moral and spiritual ideals. This may clarify why the yorùbá people place considerable value on oral health practices as the mouth's care is not simply a matter of hygiene or aesthetics but an essential practice for maintaining physical, spiritual, and social balance.

Despite the cultural reverence for the mouth and the need to keep it healthy, dental service utilization remains low in southwest Nigeria, where the yorùbá population is concentrated. A rapid review of the literature was applied for publications in English addressing dental service utilization in Nigeria was conducted. A search was conducted in Pubmed utilizing keywords and Medical Subject Headings (MeSH) terms. The first set of terms include “dental service”, “oral health care” separated by Boolean operator OR. The second set included the term “access”, “utilization” separated by Boolean operator “OR” and the third set included the term “Nigeria.” Primary studies focusing on dental service utilisation in any of the six states in southwest Nigeria (Lagos, Ondo, Ekiti, Ogun, Osun and Oyo States) were eligible for inclusion in the review. The references of the included studies were further reviewed for additional publications. The primary outcome assessed was the percentage of study participants that utilised dental services. After abstract screening and full text reviews, 14 articles were identified (30–43). The data on author and year of publication, target and age of the target population for the study, and the sample size were extracted and summarized shown in Table 1.

The included studies encompass diverse demographic groups, spanning different ages, social structures, and health conditions, with sample sizes ranging from 139 to 1,549 participants. These studies offer insights into dental service utilization across varied populations. Several studies highlighted low utilization rates among younger populations: only 8.8% of children and adolescents aged 6–18 years in Ibadan utilized dental services (30), and the rate was even lower at 5.9% among children aged 1–5 years in Ile-Ife (43). This underscores significant barriers to access and utilization in paediatric populations, particularly for vulnerable groups like children with special needs, who had utilization rates of less than 5% (32).

Utilization among secondary school students ranged from 14.9% in Lagos (33) to 15.8% in Ile-Ife (37). University students reported even lower rates, with only 7.8% utilizing dental services (31). Special populations also exhibited low rates of utilization, including people living with HIV (7%) (40) and mothers of young children (21.9%) (41). In contrast, studies focusing on adults, particularly professionals, reported higher utilization rates. For example, 65.3% of resident doctors (36), 39% of civil servants (38), and 39.2% of the general adult population (42) accessed dental services.

Overall, the findings reveal that dental service utilization in Southwest Nigeria remains generally low, with significant disparities among population groups. Children, adolescents, and economically disadvantaged groups are particularly underserved, while professionals and individuals with greater financial and educational resources are more likely to access dental care. Identified barriers include socioeconomic status and family structure, both of which significantly influence utilization (34, 35).

Intervention efforts showed limited impact, as demonstrated by the modest 11.2% utilization rate following a school-based oral health education program (39). This suggests that while such interventions may be beneficial, broader structural changes and enhanced support systems are necessary to achieve meaningful improvements in dental service utilization. A deeper understanding of how culturally tailored interventions can provide structural changes and enhanced support systems may help address this persistent problem that had been observed since 1994 and still persists till date.

Oral healthcare among communities with deep rooted cultures may require culturally sensitive health policies that consider the cultural perspectives of oral health. As the study of the yorùbá culture may suggest, public health campaigns can benefit from involving local leaders, traditional healers, and respected community figures to bridge cultural beliefs and modern dental practices. For example, educational programs that frame oral hygiene within the context of spiritual balance and respect for one's orí could resonate with yorùbá individuals, encouraging preventive dental practices without dismissing cultural values.

Culturally resonant musical approaches can bridge gaps in dental awareness, making oral health practices more relatable and accessible within these communities. Songs play a vital role in conveying health messages to people, helping them to remember those messages, inspiring them to take action. Songs have been used to enhance public health knowledge and behaviors (66, 67), and their sustained use to improve dental service utilisation in culturally rooted societies holds great potential.

Health policies should, also, consider integrating traditional healers into oral health awareness programs, enabling them to provide basic oral health information or refer individuals to dental clinics when necessary. Integrating traditional and modern dental practices can significantly improve access and utilization of oral health care in culturally rooted communities. By involving respected traditional healers in oral health awareness, policymakers create a model that respects community norms and supports preventive and curative care. Traditional healers' endorsement of practices like fluoride use and timely referrals for complex issues can increase the acceptability of modern dental care, bridging cultural gaps and fostering trust. This collaboration encourages earlier clinic visits and reduces health complications, promoting a holistic, culturally aligned approach to oral health that validates traditional practices while enhancing preventive and professional care.

In addition to provision of care, healthcare professionals (HCPs) have to consider the cultural background while estimating the prevalence of oral diseases. This prevalence is bound to be an underestimation of the true level since people will under report oral diseases and practices that are not socially accepted or that are associated with stigmas. HCPs also have to keep the cultural background in mind while providing oral health instructions and offering advice by acknowledging the cultural background and finding culturally-appropriate solutions to the problems.

Furthermore, acknowledging, respecting, and supporting self-care practices while promoting the complementary benefits of professional dental services can improve individual oral health outcomes. Public health campaigns can help convey messages that promote modern dental care practice as enhancers rather than replacement of these valued practices. In addition, incorporating culturally competent training for HCPs may foster greater understanding of the role self-reliance plays in health behaviors, helping to encourage earlier utilization of preventive and curative services in a way that resonates with cultural values.

Finally, addressing socioeconomic barriers is essential. Subsidizing dental care for underserved communities, improving access to affordable dental care, and ensuring that dental clinics are accessible in rural and urban areas can help reduce financial and logistical barriers. Providing mobile dental services or community-based oral health screenings could also improve access in areas where traditional beliefs are strong and healthcare infrastructure is limited.

Oral health service utilization in Africa may be influenced by a complex interplay of cultural beliefs, economic constraints, and structural barriers. As the reflection of the yorùbá tradition portrays, though the mouth has spiritual and social significance that highlights the need for its care, the poor uptake of dental care services in the region inhabited by the yorùbá population in Nigeria does not reflect the prime importance the culture seems to place on oral health. This discordance may reflect a preference for traditional oral remedies and, in some cases, reluctance to seek professional dental care based on cultural nuances poorly captured in the narrative about dental service utilisation by the population. By understanding and respecting cultural nuances that may influence the use of orthodox dental care services, healthcare policies and interventions can be better tailored to meet the needs of the populations in Africa where health behaviors are deeply rooted in cultural beliefs and practices. Such an approach may foster a more inclusive approach to oral healthcare that uses traditional practices to support modern dental care.