MEETING THE ORAL HEALTH

NEEDS OF RURAL INDIA

SUBTITLE
CONTENTS
1) Introduction
2) Common Problems With Oral Healthcare Delivery
3) Barriers To Oral Health Care In India
4) Prospective Ways To Improve Access To Oral Health Services
5) Conclusion
6) References

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INTRODUCTION
According to a 2012 World Health Organization fact sheet on oral health,
“Oral health is essential to general health and quality of life. It is a state of
being free from mouth and facial pain, oral and throat cancer, oral
infection and sores, periodontal (gum) disease, tooth decay, tooth loss,
and other diseases and disorders that limit an individual’s capacity in
biting, chewing, smiling, speaking, and psychosocial wellbeing”.
There are approximately 300 dental colleges in India, and annually 25,000
graduates pass out including 5000 specialists. But there is a concentration
of only 10% of dentists in rural areas where approximately 70% of the
Indian population resides.

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COMMON PROBLEMS WITH ORAL HEALTHCARE
DELIVERY (Plamping,1988)
o Insufficient resources
o Insufficient emphasis on prevention and public health
o Unclear goals
o Inadequate organization and management
o Inequality of distribution of services regionally
o Failure in manpower planning and use of auxiliaries

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o Inequitable access for people in certain localities and those with
disabilities and elderly.
o Method of payment of dentist not promoting high professional
standards.
o Lack of public accountancy and public involvement
o Dental training not oriented to health service goals (attachment to a
medical rather than a social model of health)
o Dental research not sufficiently oriented to health care needs and
prevention.
o Unclear strategies for implementing policies.

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BARRIERS TO ORAL HEALTH CARE IN INDIA

BARRIERS IN AFFORDABILITY
1. Inadequate Financial Coverage or High Cost

BARRIERS IN ACCESSIBILITY
2. Geographic Barriers
3. Age, Gender and occupation
4. Social and Cultural Barrier
5. Emotional barriers
6. Lack of Clear Information for Beneficiaries about Dental Benefits
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BARRIERS IN SUSTAINABILITY
1. Workforce Barriers
2. Barriers Within the Dental Profession

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BARRIERS IN AFFORDABILITY
Inadequate Financial Coverage or High Cost
• Financing dental services remains one of the most significant barriers to
afford necessary oral care.

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BARRIERS IN ACCESSABILITY

Geographic Barriers
• Even though the number of active private practitioners seems adequate,
disparity in the geographic distribution of these providers remains a
barrier to service
Age, Gender and occupation
• Age, gender, race, and ethnicity affect the prevalence of oral diseases
Social and Cultural Barrier
• A dentist who does not understand a rural culture, for instance, can
become a barrier to the successful delivery of oral health services in
these areas.

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Emotional barriers
• Feelings of low personal worth and that dental care is not ‘worth it’ may
be important barriers for many elderly people.

Lack of Clear Information for Beneficiaries about Dental Benefits

• One of the consistent challenges associated with raising dental utilization
rates has been the lack of awareness among beneficiaries of the
importance of oral health

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BARRIERS IN SUSTAINABILITY

Workforce Barriers
• Dentist to population ratio of 1:10271 which is less than that
recommended by WHO for rising nations (1:7500)

Barriers Within the Dental Profession

• The practice behaviors of dental professionals can have a considerable
impact on the oral health of populations, and practitioners can differ
greatly in their approaches to care of different populations

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PROSPECTIVE WAYS TO IMPROVE ACCESS TO ORAL
HEALTH SERVICES
Oral Health Workforce
• The inverse ratio of dentist to population is a major setback, especially in
the rural areas.
• A demand based calculation of dental manpower needs in India suggests
that one dentist would suffice for every 13,239 people, and this number
rises to 18,738 people when the assessment was made based on
effective demand. However, these projections do not consider the
geographical distribution of the services.
• Accessible, affordable, available, and appropriate oral healthcare

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Strengthening Public Health System

• Indian expenditure on health care was just 4.2% of its GDP, of which
public health spending is mere 1.2%.

Strengthening Dental Education in India

• No private dental colleges in India before 1966. These numbers changed
drastically by 2014, and 86% of dental colleges in India today are under
the ownership of private sector.

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Dental Homes
The AAPD first issued its support of the dental home concept in 2001 after
evaluating the success of the medical home policy put forth by the
American Academy of Pediatrics in 1992

The definition states:

“The dental home is the ongoing relationship between the dentist and the
patient, inclusive of all aspects of oral health care delivered in a
comprehensive, continuously accessible, coordinated, and family-centered
way. Establishment of a dental home begins no later than 12 months of
age and includes referral to dental specialists when appropriate.”

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Services provided by dental home:
1. Schedule early dental visits at approximately 12 to 18 months of age.
2. Assess the risk of the infant and toddler for future dental disease.
3. Evaluate the fluoride status of the infant and make appropriate
recommendations.
4. Demonstrate to caretakers the appropriate method for cleaning the
tooth.
5. Discuss the advantage/disadvantage s of non-nutritive sucking.
6. Be prepared to treat the infant/toddler if ECC is diagnosed or to make
the appropriative referral.
7. Be available 24 hours a day, 7 days a week to deal with any acute
dental problems.
8. Recognize the need for specialty consultation and referrals
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• The first level of intervention to be undertaken in implementing dental
home in India is to train Anganwadi and Accredited Social Health Activist
(ASHA) workers

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Dental Safety Net System

• The “Dental safety net system” is defined in different ways as the

facilities, providers, and payment programs that support dental care
specifically for “underserved populations”.
• Safety nets are conventionally community -based and are run by
physicians, hospitals, local authorities. There is a need for organized
dental safety net systems in India at least in the remote parts of the
country.
• Dedicated and committed, selfless health care providers who are ready
to donate their time and efforts for the betterment of oral health of the
underserved are highly required.

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Community Oral Health Programs

• Community participation is a major key to successful community oral

health programs.
• Highlighting the importance and magnitude of oral health needs in a
community, understanding the feasibility and acceptance of
interventions, creating trust among people are possible only with
community participation

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National Oral Health Programme
1. To improve the determinants of oral health
2. To reduce morbidity from oral diseases
3. To integrate oral health promotion and preventive services with
general health care system
4. To encourage Promotion of Public Private Partnerships (PPP) model for
achieving better oral health.
In order to achieve above listed objectives, Government of India has
decided to assist the State Governments in initiating provision of dental
care along with other ongoing health programmes implemented at various
levels of the primary health care system. Funding has been made available
through the State PIPs for establishment of a dental unit
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Public Private Partnerships

• A number of Public Private Partnerships (PPPs) have entered the arena of

healthcare delivery. These partnerships are based on different models.
• The efficiency of such partnerships needs to be assessed as it will help
formulate policies that can contribute in enhancing the role of such
partnerships in meeting the health goals of the country

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Mobile and Portable Dental Services
Mobile and portable dentistry is a potential method to deliver oral health-care
in the public sector. Practical application of mobile, portable or hybrid systems
may be performed in multiple situations, such as:
• Educating school children
• Screening of the population for various oral diseases.
• School and community dental health
• Providing both preventive and curative services in homebound settings
• Dental services to people who are homeless, temporarily displaced or
migrants.
• Supplementing the medical services in case of any emergency relief situation
or vaccination program.
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Dental health insurance
• Dental health insurance can bring about dental health care awareness
percolating at the gross root levels.
• It would serve as a good motivation to the people to regularly visit the
dentist and this in turn serves as an effective preventive measure.

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Oral health literacy and education
• As we address the training, cultural competency, and improved skills for
health professionals to serve rural, underserved, safety-net communities,
our aim should also promote the significance for oral health as a priority.
• Consistent messaging from healthcare practitioners will be critical to
reducing rural oral health disparities. Contextualizing these messages for
the safety-net is also key to building upon lessons learned around
culturally appropriate care.

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Faith-based initiatives
• Faith-based institutions are strong social networks that exist within rural
communities. In many rural regions, faith-based networks are the most
positive social fabric a community has.
• Many public health initiatives are leaning on faith-based networks to
improve the disparity gap, especially where there are strong racial
divides

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Conclusion
The profession of dentistry is still striving to establish its own identity in
certain parts of the country. With oriented efforts by governments and
policy makers, we could not only see an improvement in oral health status
of the rural populace but also ensure the graduating dentists a secured
career, since there is a humungous oral health need in rural India which
unfortunately is not being realized.

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Refernces
 

1. Singh CS, Srivastava A, Bhattacharya M, Dhar J, Shukla A, Rajput SS, Tiwari R, Dash
M, Singh S, Pattanaik M. Oral health inequality and barriers to oral health care in
India. Journal of Computational and Theoretical Nanoscience. 2014 Mar;11(3):1-8.
2. Chandu VC, Pachava S, Viswanath V. Strategies for improving accessibility to oral
health care services in rural India: an insight. Int J Oral Health Med Res.
2017;4(2):44-6.
3. Kharbanda OP, Dhingra K. Oral health inequality in India: Perspectives and solutions.
4. Jain A, Bhaskar DJ, Gupta V. Barriers to Oral Health Care Delivery System in India.
health care. 2013;1:5.
5. Kothia NR, Bommireddy VS, Devaki T, Vinnakota NR, Ravoori S, Sanikommu S,
Pachava S. Assessment of the status of national oral health policy in India.
International journal of health policy and management. 2015 Sep;4(9):575.

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