Oral health system in India needs a makeover

Oral health is a neglected public health issue in India with little political priority. Oral diseases are chronic, non-communicable diseases, affecting a large population with a significant effect on overall health and carrying a large socio-economic burden. The 2016 Global Burden of Diseases study revealed 3.9 billion people suffer from some form of oral disease worldwide. In India, the data from the Institute of Health Metrics and Evaluation says that there is an 0.83% increase in oral diseases every year. The last national-level oral health survey was carried out in 2004. However, without an updated oral health survey, it is difficult to estimate the oral disease burden and therefore challenging to plan programmes. Despite the high prevalence, there is a perception from people and policymakers that oral health is not as important as other health issues. This attitude affects oral health care delivery.

Oral health services are one of the highly commodified health services which means that oral healthcare is expensive. The treatment expenses drive poor patients to opt to knock their teeth off instead of saving them leading to early toothlessness. While the affluent can afford to go to private dental clinics, the poor rely on charity and government services. The affordability is further affected by the availability of oral health services at all government health facilities. There are no dentists posted at primary healthcare centres (PHC) at village levels where primary care is needed the most. Further, the dental human resource is unequally distributed with a high urban concentration.

Oral health receives poor budgetary allocation as compared to the high oral disease burden. The central government allocated 139 crores for oral health in 2021-22. The National Oral Health Program (NOHP) came into existence in 2016 which has increased the dental funding to states. Along with this, there are very few programmes by state governments exclusively for oral health. For example, Karnataka is providing free dentures to the elderly from the below poverty line under the ‘Danta Bhagya Yojane’. Oral health has to compete for budget and policy consideration among other bigger diseases. Often, policymakers quote the need to address bigger health issues such as Tuberculosis, Cardiovascular diseases among others.

While this is a valid point in terms of managing what is perceived as bigger issues, but, oral health cannot be neglected because oral health contributes to overall systemic health. Poor oral hygiene is linked to premature delivery among pregnant women and low birth weight of newborn babies. Gum diseases are linked to causing cardiovascular diseases. Crooked teeth lead to low self-esteem, therefore linked to mental health and performance. The link between oral and systemic diseases is established and therefore maintaining good oral health requires societal recognition of its importance. This can be achieved by raising awareness on a scale that is possible by the government alone.

At present, oral health is delivered in a top-down manner through a dentist-centred system. This status quo needs to shift towards a community-centred system where there is natural encouragement to maintain good oral health thus also shifting the paradigm from curative to preventive efforts. A community-centred approach places people at the Centre while formulating policies and planning effective programmes. For example, given that multiple visits to a dentist are required for certain dental treatments by patients, a good oral health program would consider the patient’s employment, transport facilities available to reach the dental clinic, social insurance or other financial protection to avoid out of pocket expenditure as much as possible.

The Central government’s National Health Mission (NHM) has already proved that a community-centred approach is effective in delivering accountable health services responding to the people’s needs. The oral health component of NHM needs further strengthening by increasing the budget to NOHP, posting dentists at PHCs, giving financial powers to state oral health directorate which can prevent divulging the funds that are meant for oral health, assessing the oral disease burden periodically and planning tailor-made programmes catering to the oral health needs of people, selling affordable mouthwash and toothpaste at Jan Oushadi pharmacy stores and tapping the unrecognised potential of alternative systems of medicine in treating oral diseases. Oral health needs a comprehensive strategy to bring it to the forefront of the issues.

There is no overall health without oral health. Newer policies should be inclusive of oral health and framed with social justice and equity as guiding principles.

(The writer is a community
dentist from Bengaluru, associated with Society for Community Health Action, Research and Awareness (SOCHARA))