A traditional healer is a person who has no formal medical training, but is recognized by the community in which he/she lives as being competent to provide health care by using plant, animal and mineral substances and certain other methods based on social, cultural and religious background as well as the knowledge, attitudes and beliefs that are prevalent in the community regarding physical, mental and social well-being and the causation of the disease and disability . According to the World Heath Organization (WHO), more than 80 percent of Africans rely on traditional medicine and indigenous knowledge to meet their health needs . This is due to the fact that traditional medicine is accessible, affordable, culturally and socially acceptable and most people prefer it to the 'exorbitantly priced' conventional Western medicine. With the legalization of traditional medicine as a complimentary health care service to primary health care in Cameroon, the role of the traditional healer will be vital in the promotion of health especially in resource poor settings and rural areas where they may be the only source of health care .
Since colonial times, Western medicine was the only formally accepted medicine in Cameroon. Traditional medicinal practices were condemned as witchcraft or sorcery and discouraged. Despite this, the practice of traditional medicine has survived clandestinely in Cameroon. One of the main reasons Cameroonians still favor traditional medicines is financial - they resort to traditional medicine because they cannot afford pharmaceutical medicaments or conventional medical care .
The oral health care work force in Cameroon consists of 220 dentists all trained abroad. Nearly all are located in the two big cities of Douala and Yaoundé serving just 20% of the country's population. On the other hand, it is estimated that there are more than 20 000 traditional healers (TH) in the country serving both the rural and urban population. Rural populations do not have access to the services of trained oral health personnel due to cost constraints and poor accessibility. Today, seven per cent of the average household health budget is spent on traditional medicines. Nearly twice as many people from poor households rely on traditional medicine as do people from rich households . The recognition and integration of traditional medicine into the health system of Cameroon was officially proposed in 1981. Since then, traditional medicine has been recognized, but not regulated by the Ministry of Health. In 1995, a presidential decree no. 95-040 of July 3, 1995 gave TH in Cameroon, the authorization to create associations at both provincial and national levels to manage their activities .
In recognition of the fact that traditional medicine is "the most affordable and accessible system of health care for the majority of the African rural population," the Organization for African Unity (now the African Union) declared the years 2001-2010 to be the 'Decade for African Traditional Medicine'. The aim of this declaration was to bring together all the stakeholders in health care in an effort to make traditional medicine "safe, efficacious, affordable and available to the vast majority of African people" . One of the tasks of the WHO (Africa Region) is to assist countries in ensuring that the African population enjoys improved levels of oral health and function through a significant reduction of all oral diseases and conditions that are prevalent in the region, with equitable access to cost-effective quality oral health care and adoption of healthy lifestyles.
Despite much research in recent times regarding health (medical) sector collaboration with TH, there is paucity of literature with regard to the role of TH in the provision of oral health care and in the diagnosis and management of the common oral problems including the oral manifestations of HIV/AIDS. Given shrinking health budgets, economic constraints and the diminishing capacity for oral health personnel to handle the burden of oral diseases throughout much of Sub-Saharan Africa, it would seem logical to develop and enhance co-operation and collaboration between the formal oral health services and TH to bring available resources in the health sector to serve the population for better oral health and HIV/AIDS prevention.
Traditional healers are considered to be effective agents of change as they command authority in their communities, function as psychologists, marriage and family counselors, physicians and legal and political advisors . They are also the legitimate interpreters of customary rules of conduct, morality and values. TH provide client-centered, personalized health care that is culturally appropriate and tailored to meet the needs and expectations of the client paying special respect to social and spiritual matters .
Lewis et al.  reported on the oral health care knowledge and practices of African TH from two communities: Zonkizizwe and Dube in the Gauteng Province, South Africa. According to their findings, more than 90% of TH from both areas correctly identified photographs of gingival inflammation, dental caries and oral candidiasis. More than half reported patients presented with mouth problems such as toothache, swollen gums and oral candidiasis. Considering that oral candidiasis has been reported as the most prevalent oral manifestation of HIV/AIDS and the fact that almost all TH can recognize oral candidiasis suggests that TH could play an essential role in the efforts to address early diagnosis of the oral manifestations of HIV/AIDS [7, 9].
A study carried out in Nigeria  found that TH were providing dental care, but their work was not integrated with that of a dentist. He reported that while TH were open to collaborating with dental professionals, the reverse was not true. TH are more numerous than dental and medical practitioners and are widely accepted by a large proportion of the population, therefore it is logical that their work be integrated with that of dental and medical practitioners. In Africa and some parts of Asia chewing sticks are used for plaque removal [11, 12]. Most plants used as chewing sticks contain fluoride and/or have antimicrobial, anti-cariogenic or anti-inflammatory properties [12, 13].
Ngilisho et al.  reported that sixty per cent of the villagers in Tanga region, Tanzania who suffered from toothache sought treatment from TH. They were treated with local herbs and obtained pain relief for more than six months. The authors concluded that the presence of modern health facilities did not influence the villagers' use of TH. Hence, it could be surmised that TH play an important role in the relief of acute pain, in underserved rural areas.
Therapeutic methods used by African TH include psychosocial counseling, simple surgical procedures, rituals and symbolism . The types of medications used by TH can be classified as preventive and prophylactic medications , treatment for ailments  and medications used to "destroy the power in others" [18–22]. The need to identify and recognize the beneficial effects of traditionally used plants and medicaments has been recognized .
Hamza et al.  investigated the antifungal activity of traditionally used Tanzanian plants and found good correlation between traditional therapeutic use and in vitro antifungal activity and corroborated the importance of ethnobotanical surveys for screening plants as a potential source for bioactive components that may have preventive, prophylactic or treatment properties for oral and other diseases. Sarita and Tuominen  investigating the pattern of utilization of medical and dental health care services in rural Tanzania reported that indigenous home remedies were the only treatments used for managing dental problems, while for medical problems a TH was the most commonly used. Since the pattern of utilization of health care services differed for medical and dental problems, it should be taken into account when planning comprehensive health care services for rural African societies.
However, one needs to be aware that some traditional practices may be harmful for example, the practice of extracting tooth buds and of rubbing herbs on to the gingivae of children to treat fevers and diarrhea, as has been documented in countries such as Tanzania and Uganda . There is a need for health education programmes . Discouraging the adoption of deeply rooted traditional practices that are potentially hazardous to health and oral health needs to be made a public health priority . This could be achieved by educating not only the general public, but also the TH and community leaders that convey the knowledge to their people.
There have been many instances where TH have collaborated with the health sector. Wilkinson et al.  investigated the potential for TH to act as tuberculosis (TB) treatment supervisors. Although only four per cent of the study population believed that TH could cure TB, 84% stated that they would consider choosing a healer as a treatment supervisor. Eighty eight per cent of healers reported having referred patients with suspected TB to hospitals for treatment and all the healers were keen to collaborate with health services and to act as treatment supervisors.
In an earlier report investigating the relationship between traditional and modern medicine Edwards  found that while traditional and modern practitioners worked from different theoretical orientations, they were in significant agreement as to both diagnosis and treatment of patients when faced with the same limited choice of options. Furthermore, patients perceived both the traditional and modern practitioners as being more or less equally helpful.
In Uganda, THETA (Traditional and modern health practitioners together against AIDS and other diseases), is promoting collaboration between traditional and biomedical health workers in the prevention and care of sexually transmitted infections (STIs) including HIV/AIDS. Projects involve collaboration in clinical trials to study the effectiveness of herbal treatments for opportunistic infections and to empower traditional medicine practitioners to offer counseling and education on STIs/AIDS.
A study by Homsy and King  concluded that traditional healers could be trained as counselors and educators to disseminate HIV/AIDS information and prevention practices between their peers and communities. Case studies indicate that TH are capable of performing at least as well as their biomedical counterparts as AIDS educators and counselors. Of concern to Homsy and King  however, was the failure of many projects to provide systematic follow-up to healers after their initial training. Such follow-up is essential to support healers in dealing with unfamiliar issues such as condom use and death and dying. Masauso Nzima et al.  carried out a similar study in four Copperbelt towns in Zambia whereby TH received AIDS training and how to counsel clients on safe sex behaviors, together with follow-up monthly meetings.
A qualitative investigation by Abdool Karim  exploring potential preventative health roles that TH could play with regard to HIV prevention, recommended that TH be incorporated into AIDS prevention programmes where they can play a role in community-based AIDS education. There is increasing recognition on the role of TH in preventing and controlling HIV/AIDS and other sexually transmitted infections (STIs) .
Green  made some important recommendations for one to consider when planning collaborative work with TH:
Be fair and democratic in selecting healers for training
Try to identify and train motivated healers who are respected in their communities
Do not make membership of a TH's association a requirement for participation in HIV/AIDS training
Encourage healers to promote sexual abstinence among youth, and fidelity within marriage among adults.
The World Health Organization (WHO) and other official groups have acknowledge the potential effectiveness of TH as primary caregivers and the potential efficacy of their treatments in the fight against HIV and AIDS, sexually transmitted disease, and other infectious diseases . The WHO also supports the integration of Western medicine and traditional healing and encourages referrals between the two groups. In South Africa, TH have their own organization (Board of TH) that is recognized by the Department of Health and by the Ministry of Health respectively. Among the Zulu population, TH serve many functions in the community, such as the role of a minister of religion, legal advisor, healer, custodian of history and tradition and community organizer [17, 31, 32].
Traditional healing has always been a component of health care in Cameroon but the actual contribution of TH to oral health care in the Bui Division of Cameroon is not known.
The aim of the present study was to assess the knowledge and practices of TH and determine the extent to which TH can diagnose oral conditions and how they can be incorporated into oral health care and prevention of oral diseases.