NATIONAL ORAL

HEALTH POLICY
NAME : M MOHITHA SAI
ROLL NO : 40
HALL TICKET NO : 17081060
CONTENTS
 Background
 National and health policy
 10 point resolution
 Need for oral health policy
 Objectives
 Short term goals - pilot project
 Long term goals
 Plan proposals
 Mobile and portable dental services
 Economic burden of oral disease
 Role of dental colleges
 Oral health care reforms in developed countries
 Dental insurance policy
 Dental workforce
 Five year plans
 IEC material publication and distribution
 Challenges
 references
BACKGROUND
 In recent times, economic at the world bank and the International Monetary
Fund(IMF) have tentatively suggested that within a year or two, Indian’s economy
might be growing more quickly that than of china.
 Inspite of its tremendous potential, manpower resource and growing economy, India
stands behind in terms of education, standard of living and in particular health.
 Over decades, health in India is gaining less importance and oral health, the least.
 India is predominantly rural covering about 69% of the population.
 Prevalence of oral disease is very high in India with dental caries and periodontal
disease as the 2 most common oral diseases.
Prevalence of dental caries in Indian Prevalence of predontal caries in Indian
population population
Age group Prevalence (%) Age group Prevalence (%)
5 50 12 34.4
12 52.5 34-44 89.2
15 61.4 65-74 79.4
35-44 79.2
65-74 84.7
NATIONAL ORAL HEALTH POLICY
 Government of India put a step forward to enhance the health care systems
by introducing “National Health Policy” (1983) which was refferd to lay down
a new policy structure for the speed achievement of the public goals in 2002
and recently in 2015
 The National oral health policy has been formulated by the “Dental Council of
India” through the input of the national workshop.
 The workshop organised in
 1991- Delhi
 1994- Mysore
 1984- Bombay- National workshop on oral health goals for India
 1986- A draft oral health policy prepared by Indian dental Assocoation
 The core committee appointed by the ministry of health and family welfare
could succeed to move the resolution in the fourth conference of the central
council of health and family welfare in the year 1995
10 POINT RESOLUTION
 There is an urgent need for an oral health policy for the nation as an integral part
of the National Health Policy
 Special well coordinated, National oral health program be launched to provide oral
health care, both in the rural as well as in the urban areas due to deteriorating
oral health conditions in the country as revealed by various epidemiological
studies. Dentist/Population ratio in the rural areas is only 1:3,00,000, where as
80% of the children and 60% of the adults suffer from dental caries. More than 90%
of the adult community after the age of 30 years suffer from periodontal disease
which also has its inception in childhood. In addition, 35% of all body cancers are
oral cancers. A large segment of the adult population is toothless due to the
crippling nature dental diseases and about 35% of the children suffer from
misaligned teeth and jaws affecting proper functioning. In view of these facts, it is
important to launch preventive, curative and educational oral health care program
integrated into the exiting health and educational infrastructure in the rural,
urban and deprived areas.
 A post of fulltime dental advisor at appropriate level in the directorate general of
health services should be created as a first step towards strengthening the
technical, wing of the Die.G.H.S.
 Studies have revealed that dental diseases have been increasing both in
prevalence and severity over the last few decades. There is, therefore, an
urgent need to last few rising trend of dental diseases in India. The method
used for primary prevention of dental diseases aim at achieving primary
prevention of periodontal disease and oral cancers.
 The council, therefore, resolves that preventive and promotive oral health
services be introduced from the village level onwards and accordingly a pilot
project on oral health care may be launched by the ministry of health and
family welfare during 1995-96 In 5 districts, one each in 5 states.
 The council further resolves that legislative measures be adaptive to ensure a
statutory warning on the wrappers and advertisement of sweets, chocolates
and other retentive sugar eatables TOO MUCH EATING SWEETS MAY LEAD TO
DECAY OF TEETH. Similar measures are also called for tobacco and pan
masala related products.
 The council recommends that a national training centre be established or the
existing centres be strengthened for oral health care personnel.
 The council also resolves that all district hospitals and community centres
have dental clinics. All dental colleges should have courses on dental hygiene
and dental technician.
 The council further resolves that the pilot project may be extended to all the
states at the role of one district in every state.
 The council also resolves that there is an urgent need to have a national
institute of dental research to guide oral health research appropriate to the
needs of the country.
 In pursuance to national oral health policy, a national oral health care program has
been launched as “pilot project” to cover five states (Delhi, Punjab, Maharashtra,
Kerala and north eastern states) for its implementation.
 Singe district from each above- mentioned were selected to trial the strategies
generated through 2 national and 4 regional workshops held in collaboration with
AIIMS, New Delhi, in different areas of the country.
 Proposed plan for oral healthcare programme
Oral health education Preventive programme Cumulative service programmes
Training of the Promotion of fluoride Oral healthcare setup
trainers tooth paste
Oral health education Legislation against School dental health programs
chapters in school tobacco products
curriculum
Oral health education Manufacture of sugar Manpower requirements
through mass media free chewing gums
Sugar substitutes in Equipment requirements
medical syrups
NEED FOR NATIONAL ORAL HEALTH POLICY
 Increasing prevalence and safety of dental diseases
 Dental caries:
 1940’s- prevalence rate 40-50% average DMFT 1.5
 1980’s- prevalence rate 80% average DMFT 5- urban, 4- rural under the age of 16 years
 Prevalence in 10-12 years children in Delhi- 39.2% and DMFT was 2.61
 Global oral data (WHO) prevalence- 89% and DMFT-1.2 to 3.8
 Periodontal diseases:
 95-100% of adult population suffering from this disease- painless, chronic, self destructive
and gradual loss of teeth.
 30-35% of all cancers- diagnosed are oral concern with buccal mucosa 15%
 Prevalence ranges from 0.02-0.03.
 Malocclusion:
 30% of children are suffering from malaligned teeth and jaws effecting proper functioning.
 To decrease the burden of oral diseases
 Taboos, myths or misconception of the preventive measures for dental caries was
recommended in the 12th 5-year plan without any proposed strategies for its implementation
 To narrow the rural urban gap in oral health care
 As there is inaccessibility, non-affordability of oral health care services and deficiency of
dental manpower in primary health care education
 For quality dental education
OBJECTIVES
 Oral health education to mass-network system
 Information, education and communication(IEC) material
 Guidelines to strength oral health set-up

Short term goals – pilot project:

 Accessible, low cost, substainable oral health
 Frame and develop training module for master trainer
 IEC-material, oral health awareness
 Guidelines for strength oral health care

Short term goals – pilot project:

 Bring down DMFT to < 2
 85% should retain teeth-18 years
 Periodontal prevalence should be reduced
 Achieve 50% reduction in edentulousness - 35 to 44 years
 Achieve 25% reduction in edentulousness – 65 years
 Achieve 50% reduction in malocclusion.
 Reduce incidence of oral cancers or precancerous lesions from 19|LAKHS
 Oral health care for all by 2010 AD
 PLAN PROPOSALS
PRIMARY HEALTH CARE

Village level Sub centre level

(cone for every 5000 population)

Village Training ICDS scheme

health guide of local 100 One male One female
scheme dais Anganwadi health health
workers per worker worker
scheme

PRIMARY HEALTH CARE

Primary health (centre level) Community health (centre level)

One for 30,000 population staff Population covered 1,00,000
One medical officer
Block extension educator
Male and female assistant
 Plan for rural India
 Preventive package
 Oral health education
 Oral cancer and potentially pre-cancerous lesions health worker should educate
community and insist for regular check-up
 Infant dental care
 Information on importance of nutrition, balance diet for pregnant women
 Babies mouth should be free of bacteria
 Health workers much teach feeding mothers
 Children health care
 Children encouraged to get habit of chewing before teeth erupts
 Take care of deciduous teeth
 Geriatric dental care
 Should educate dental disease are not age related
 Even elderly people need preventive and restorative oral health care
 Edentulous elderly should have dentures – counteract the nutritional deficiency
 Clean and massaging of the ridges
 Care of dentures
 Plagues control programme
 In small groups children and parents – demonstrated plague in their mouth
 Demonstration of proper brushing technique
 Frequency of brushing – 2times a day
 IDA and colgate (2003) – ‘Bright Smiles and Bright Future’
MOBILE AND PORTABLE DENTAL SERVICES
 The distribution of dental manpower between rural and urban areas reflects a
glaring contrast
 About 80% of dentists work in major cities catering the oral health needs
around 31% of urban population
 In rural India, one dentist is serving over a population of 2,50,000
 Mobile and portable dental services may offer a viable option to address the
issues of oral health care delivery for an extensive underserved population in
developing country like India
 The successful implementation and execution of oral health care delivery
using the mobile and portable dental services rely largely on collaborative
effort of the following
 Professional dental organization
 Non government organization
 Government sector
 Local civil society
ECONOMIC BURDEN OF ORAL DISEASES
 Treatment cost:
 Population of India is about 10 billion
 The children in age range of 3 to 16 years – 26 crores
 Total number of cavities – 52 crores
 Cost of filling per cavity (approx. – 10rs each) – 520 crores
 If each dentist is filling 6 cavities per day then total fillings done per day – 6x36000
=216000
 The days required to fill 52 crores cavities –
52,00,00,000/216000 = 24070 days = 66 years
 Loss of man days:
 In 1988, USA an average 8 working hrs/person
 In India, no exact statistical data – 255 to 30% of people are below poverty ine and
depend on daily earnings
 Public health expenditure:
 Till now, there is no separate budget allocation in national and state health budget
 In India – Increase level of dental diseases, limited resources and manpower –
seems practically impossible to provide curative services

ROLE OF DENTAL COLLEGES

 Adopt one whole district – rural and urban communities
 Interns should be posted compulsorily
 Dental college – explore and utilize the special provision of funds with
planning commission
ORAL HEALTH CARE REFORMS IN DEVELOPED COUNTRIES
 The public health outcomes framework(2013 - 2016) of England includes
“tooth decay in 5 years old children” as an outcome indicator
 National health service outcome frame work (2014- 2015) includes indicators
related to patient experiences of NHS services
 An oral health policy called “Affordable care Act” was formulated by
American dental association to include a dependent coverage policy that
extends parents health insurance to adult ages 19-25
 It is associated with increase in private dental benefits coverage and dental
care utilization and a decrease in financial barriers to dental care among
young adults aged 19-25
DENTAL INSURANCE POLICY
 Unlike most western countries, specific dental insurance plans are not
common in India
 IDA has been striving to bring out care workers are capable to reach every
class and village across the country
 Dental health insurance can also bring about dental health care awareness
percolating at the gross root levels
 It would serve as a good motivation to the population to regularly visit the
dentist and is an effective preventive measures

DENTAL INSURANCE POLICY

 India is ahead in the world with 301 dental colleges
 The surplus production of dental surgeons in the past 10 years made a current
figure of 1,17,825
 Dentist to population ratio of 1:10,271 which is less than that recommended
by WHO for rising nations (1:7500), the budding dental surgeons in India get it
hard to establish a private practise
FIVE YEAR PLANS