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COMMENTARY
Year : 2014  |  Volume : 58  |  Issue : 4  |  Page : 267-269  

Time to implement national oral health policy in India


1 Reader, Department of Public Health Dentistry, People's college of dental sciences and research centre, Bhopal, Madhya Pradesh, India
2 Professor and Head, Department of Periodontics, RKDF Dental College, Bhopal, Madhya Pradesh, India
3 Associate Professor, SIMS college of Physiotherapy, Mangaldasnagar, Guntur, Andhra Pradesh, India
4 Assistant Professor, People's College of Pharmacy, People's University, Bhanpur, Bhopal, Madhya Pradesh, India

Date of Web Publication5-Dec-2014

Correspondence Address:
K Eshwar Reddy
Reader, Department of Public Health Dentistry, People's college of dental sciences and research centre, Bhanpur, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.146290

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How to cite this article:
Reddy KV, Moon NJ, Reddy K E, Chandrakala S. Time to implement national oral health policy in India. Indian J Public Health 2014;58:267-9

How to cite this URL:
Reddy KV, Moon NJ, Reddy K E, Chandrakala S. Time to implement national oral health policy in India. Indian J Public Health [serial online] 2014 [cited 2019 Aug 19];58:267-9. Available from: http://www.ijph.in/text.asp?2014/58/4/267/146290


   Summary Top


Oral disease patterns are changing in modern India as a nation is witnessing a major shift in the dietary habits of its countrymen. The reported facts about the various oral diseases are alarming and reflecting the state of oral health in our country. The lack of a well-organized oral health care delivery system due to the absence of an oral health policy could be one of the main reasons for an increasing oral disease load. Though, the blue print of the National Oral Health Policy that was drafted at developing an efficient oral health care delivery mechanism to address the oral health needs of its countrymen it still remains as a draft since last 15 years due to very poorly motivated policy makers. It is most unfortunate that until date, the efforts are meager to convert this draft into a policy and implement in spite of a reported hike in the oral disease load stating scarcity of qualified dental manpower as a major reason. However, the time has come to put a pause to such excuses and seriously look into its implementation. It lies in the hands of the government and the dental health regulating bodies in the country to take appropriate measures for the implementation of the policy thereby brightening the employment opportunities for the budding dentists as well as bringing smiles on millions of Indians.

Oral disease patterns are changing in modern India with an upsurge in their magnitude in the 21 st century [1] as the nation is witnessing a major shift in the dietary habits of its countrymen. The increase in the burden of oral diseases is justified by the findings of the only national oral health survey conducted in 2002-2003. [1] The survey reports that the prevalence of most common dental disease i.e., dental caries is in the range of 50-84.7% distributed among various age groups. The reported prevalence of another major dental disease i.e., periodontal disease is in the range of 66.2-89.2%. The oral cancers have a prevalence of 0.2-0.4%. The potentially malignant disorders constituted 0.9-10% of the total oral disease load. There are about 24% of the population who are into the habit of tobacco smoking that can predispose to a number of dental, as well as many systemic diseases. [1] The reported facts about the various oral diseases are alarming and reflecting the state of oral health in our country. There is also mounting evidence to substantiate the fact that there is an increase in the oral disease load in recent years. A community based study conducted among older adults in Delhi in 2013 by Srivastava et al. highlight a periodontal disease prevalence of 96.6%; The mean Decayed, Missing, Filled Teeth score for the study population was 14.4; There were about 47.7% of the elders who were into the tobacco use. [2] Munjal et al. in 2013 have reported dental caries prevalence in the range of 81.36-86.16% among school going children of Ludhiana city. [3] Chandra Shekar et al. in 2011 reported that the prevalence of oral cancerous and precancerous lesions was 5.2% among municipal employees of Mysore city. [4] Ferlay et al. in 2013 reported a 5 years oral cancer prevalence of 6.6% among Indian adults. [5] There is also enough evidence to substantiate an upward trend in the occurrence of new cases of oral cancers among Indians in recent times. A report of Indian Council of Medical Research in 2013 has shown that the age adjusted rate of oral cancer among males is as high as 17.1/1,00,000 population and among females is as high as 7.6/1,00,000 population. [6] Ferlay et al. in 2013 reported that the incidence of oral cancers among Indians is 7.6%, and mortality due to the same is 7.6% annually signifying the need for immediate action. [5] The International Agency for Research on Cancer has projected that oral cancer crude incidence will increase in India by 2020 and 2030 in both the genders.

The link between an individual's oral health and general health status is well documented. It is established that chronic infections like periodontitis can instigate cardiovascular diseases, cerebrovascular diseases, respiratory diseases, peripheral artery disease, diabetes, osteoporosis, rheumatoid arthritis, and preterm or low birth weight babies. [7] A study by Dietrich et al. in 2008 reported that chronic periodontitis is associated with the risk of coronary heart disease among young men. [8] A literature review by Arigbede et al. in 2012 revealed that periodontal infection results in higher systemic levels of C-reactive protein, interleukin-6 and neutrophils which may serve as predictors of present and future cardiovascular events and diseases. [7] Thus, role of oral health in influencing an individual's general well-being is justified.

The lack of a well-organized oral health care delivery system due to absence of an oral health policy could be one of the main reasons for an increasing oral disease load in addition to poverty, geographic isolation and lack of perceived need for dental care, especially among masses. The blueprint of the national oral health policy [9] that was drafted at the 4 th conference of central council of health and family welfare in 1995 at New Delhi aimed at developing an efficient oral health care delivery mechanism to address the oral health needs of its countrymen still remains as a draft since last 15 years due to very poorly motivated policy makers. It is most unfortunate that till date, the efforts are meager to convert this draft into a policy and implement in spite of a reported hike in the oral disease load stating scarcity of qualified dental manpower as a major reason. However, the time has come to put a pause to such excuses and seriously look into its implementation. As per the Dental Council of India's database, [10] currently there are 301 dental colleges offering dentistry in India and on an average approximately, 25,000 graduate students and 4,500 postgraduate students are passing out every year from various dental colleges in the country. This data is providing a very positive indication as far as availability of the dental workforce is concerned. The scarcity of dental auxiliaries can be compensated through deprofessionalization. The literate people with minimal basic education should be selected from rural and urban areas and be trained through certificate courses at the nearest primary health centers (PHCs), community health centers (CHCs) and dental colleges in prevention based dental education, basic oral hygiene, oral prophylaxis, recording the oral health status, identifying various oral diseases through screening and making appropriate referrals. In addition, there should be inclusion of dental health in the curricula of auxiliary nurse midwifes and accredited social health activist workers who serve as connecting link between community and governmental infrastructure. This workforce has to be utilized wisely and sensibly to fulfill the oral health needs of our people. The topography of the country is such that there is an unequal distribution of population with 68.84% [11] residing in rural areas with a very poor access to oral health care due to acute shortage of qualified dental manpower, and lack of transportation facilities. As per the current statistics, the dentist: Population ratio in the country is 1:15713 with the dentist: Population ratio in rural areas being 1:2,50,000 and in urban areas being 1:10,000. [9] This data reveals that there is concentration of 10% dentists where 68.84% [11] of the Indian population resides and 90% concentration of dentists where 31.80% [11] of population resides. How can this inequality be rectified? The policy makers and the dentistry regulating bodies of the country should have a commitment to improving the oral health standards of the rural people by creating employment opportunities to the dentists. There should be the creation of a general dentist posts at all the PHCs and dental specialist posts at all CHCs in the country. Full-fledged Mobile dental units should be made available to all the PHCs so as to provide dental services at remote and hilly areas of the country as Pradhan Mantri Gram Sadak Yojana Scheme is looking to eliminate the barriers of transportation to remote villages. The public health dentistry departments in various dental colleges with a predetermined catchment area should be made active and responsible to teach prevention based dental education and to implement preventive dental programs as it is cost-effective, suits well to the developing countries like India by not overburdening the government. There should be the implementation of compulsory rotatory internship programs at rural areas in order to serve the rural people better.

The next issue of concern as far as the implementation of the policy is a type of oral health care delivery system that suits our country. Out of four well-known models of oral health care delivery systems currently existing in the world, there is a strong recommendation for adoption of Beveridge model for developing countries like India. In Beveridge model, [12] the government is responsible for providing and financing of oral health care for its countrymen and funding for dental care is achieved through the taxes collected by the government, which is currently adopted in UK. The emphasis for Beveridge model can be strongly supported by a report of World Bank in 2005, which states that 41.6% of the total Indian population falls below the international poverty line of US$1.25 a day, [13] which would have increased in recent times due to high inflation rate reflecting a poor affordability by almost 50% of Indians toward oral health. The governments (central and state) should provide dental services to those people who are below the poverty line on priority basis. The dentistry regulating bodies in the country should take initiatives for allocation of a separate budget by both the central and state governments toward oral health that is a major challenge and a key issue for policy implementation.

At the end, it can be concluded that it is the commitment of the government and the dental health regulating bodies in the country, which can pave the path for the implementation of the National Oral Health Policy thereby brightening the employment opportunities for the budding dentists as well as bringing smiles on millions of Indians.

 
   References Top

1.
Bali RK, Mathur VB, Talwar PP, Chanana HB. National Oral Health Survey and Fluoride Mapping 2002-2003 India. New Delhi: Dental Council of India in Collaboration with Ministry of Health and Family Welfare, Government of India; 2004.  Back to cited text no. 1
    
2.
Srivastava R, Gupta SK, Mathur VP, Goswami A, Nongkynrich B. Prevalence of dental caries and periodontal diseases, and their association with socio-demographic risk factors among older persons in Delhi, India: A community-based study. Southeast Asian J Trop Med Public Health 2013;44:523-33.  Back to cited text no. 2
    
3.
Munjal V, Gupta A, Kaur P, Garewal R. Dental caries prevalence and treatment needs in 12 and 15-year-old school children of Ludhiana city. Indian J Oral Sci 2013;4:27-30.  Back to cited text no. 3
  Medknow Journal  
4.
Chandra Shekar BR, Reddy C. Oral health status in relation to socioeconomic factors among the municipal employees of Mysore city. Indian J Dent Res 2011;22:410-8.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
5.
Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://www.globocan.iarc.fr/Pages/fact_sheets_population.aspx. [Last accessed on 2014 Feb 28].  Back to cited text no. 5
    
6.
Indian Council of Medical Research. Three-year report of population based cancerregistries 2009-2011. Bangalore, India: NCDIR-NCRP (ICMR); February 2013. Available from: http://www.ncrpindia.org. [Last accessed on 2014 Feb 28].  Back to cited text no. 6
    
7.
Arigbede AO, Babatope BO, Bamidele MK. Periodontitis and systemic diseases: A literature review. J Indian Soc Periodontol 2012;16:487-91.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
8.
Dietrich T, Jimenez M, Krall Kaye EA, Vokonas PS, Garcia RI. Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease. Circulation 2008;117:1668-74.  Back to cited text no. 8
    
9.
National oral health policy, India. Prepared by core committee, appointed by the ministry of health and family welfare, government of India; 1995. Available from: http://www.aiims.edu/aiims/events/dental workshop/nohc-prog.htm. [Last accessed on 2013 Dec 20].  Back to cited text no. 9
    
10.
Dental council of India. Available from: http://www.dciindia.org. [Last accessed on 2013 Dec 23].  Back to cited text no. 10
    
11.
Park K. Preventive and social medicine. In: Demography and Family Planning. 22 nd ed. Jabalpur: Banarsidas Bhanot Publishers; 2013. p. 446.  Back to cited text no. 11
    
12.
Wallace LS. A view of health care around the world. Ann Fam Med 2013;11:84.  Back to cited text no. 12
    
13.
Venkateshwarlu C, Vijayalakhmi B, Siva Sankar M. Impact of poverty. Asian Acad Res J Soc Sci Humanit 2013;1:138-46.  Back to cited text no. 13
    



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