AMRITA SCHOOL OF DENTISTRY

1. Oral Healthcare Delivery in India
Seminar 19

2. 2
Introduction
Burden of oral diseases in India
Dental Workforce
Health System Administration In India
Levels of Oral Health Care System
National Oral Health Programme
Strategies for Oral Health Care of Children
Barriers In Oral Health Delivery System
The Basic Package of Oral Care (BPOC)
Need For Dental Insurance
Tele Dentistry
Conclusion
References
Contents

3. 3
Health Care System
All organizations, people and actions whose primary intent is
to promote, restore or maintain health. This includes efforts
to influence determinants of health as well as more direct
health-improving activities.
(WHO, 2007)
FDI’s definition of oral health
Oral health is multi-faceted and includes the ability to speak,
smile, smell, taste, touch, chew, swallow and convey a range of
emotions through facial expressions with confidence and
without pain, discomfort and disease of the craniofacial
complex (head, face, and oral cavity).

4. 4
Demographic Details: India
Population: 1.42 billion
Population Growth Rate: 0.8%
Dentists: 24,403 (1.2%)
Density: 2.4 per lakh
Dental Colleges: 313
Student Positions: 30,570
Private Sector: 84.34%
Public Sector: 15.65%
Urban- rural disparities: 9.9
Dentist Population Ratio (Current): 1:5,015
Source:
1. Pandya VS, Sampath N, Yadav R, Mahuli AV, Kapadiya J, Singh S, Chaudhary P. Dental manpower in India: Changing trends upto 2020. Journal of Xidian Univ. 2021;15(7):15-37.
2. Workforce in India- WHO

5. 5

6. 6
Oral cancer – 0.09% (SEAR)
Periodontal disease – 17-22%
Dental caries – 40-45%
Edentulism- 3-10%
Malocclusion – 30% of children
Endemic fluorosis – 17 out of 32 states affecting 66 millions
Burden of Oral Diseases in India

7. 7
Dental Workforce in India
Maharashtra (14.22%)
Uttar Pradesh (9.34%)
Kerala (9.22%)
Arunachal Pradesh
(0.09 %)
Sikkim (0.07%)

8. 8
Oral Health Policy in India
Manpower shortage
•Although the Indian
government
sanctioned the
establishment of
dental institutes to
address the
workforce shortage,
there has been a
failure in distributing
dentists equally in
urban and rural areas.
This has resulted in a
lack of dental services
in rural India. Efforts
to utilize the dental
workforce effectively
include the need for
dental hygienists and
dental lab
technicians.
Shortage of dental
instruments and
materials
•District government
hospitals face
challenges in
providing adequate
dental care due to a
shortage of dental
instruments and
materials. The
substandard
maintenance of dental
equipment further
complicates the
delivery of oral health
services.
Insufficient funding
•The allocation of
funds for medical and
dental education and
research, as well as
for oral health
services, has been
inadequate. The
budget for oral health
in the health budget
of most states is not
separately allocated.
The Indian
government's
spending on the
health sector is
considered one of the
lowest in the world,
with only 3% of the
gross national product
allocated to
healthcare.
Need for increased
public spending
•Based on
recommendations
from the High-Level
Expert Group, the
Indian government
should double public
spending on the
health sector to 3% of
the gross domestic
product by 2022. This
would require a
decline in private
spending from 2.1% to
1.5% by the same
year. Although the
current total expense
on the health sector
is 4.5% of GDP, there
is a need for
increased allocation
specifically for oral
health.
Community programs
and rural areas
•Dental colleges
should allocate a
certain budget for
community programs
conducted in rural
areas. Maximizing the
funds allocated for the
health sector should
prioritize providing
primary healthcare to
the rural population.
Source: Singh A, Purohit BM. Addressing oral health disparities, inequity in access and workforce issues in a developing country. Int Dent J. 2013 Oct;63(5):225-9. doi:
10.1111/idj.12035. Epub 2013 May 17. PMID: 24074015; PMCID: PMC9375013.

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Overview of Oral Healthcare Delivery System

10. 10
Objectives of Oral Health Care Delivery Systems
Management and elimination of dental emergencies
Treatment of existing diseases
Elimination of progression of diseases
Prevention of future diseases
Finding new ways in preventing and treating diseases (Research)
Improved use of new and existing preventive and treatment approaches

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Factors Influencing The Development Of Health Care Systems
Changing demographics of the population
Evolving patterns of disease and their impacts
Expectations and demands of the public
Technology
Globalization
Economy

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Integration With The Rest Of The HealthCare System
Emphasis On Health Promotion And Disease Prevention
Monitoring Of Population Oral Health Status And Needs
Evidence-based
Effective
Cost-effective
Sustainable
Equitable
Universal
Comprehensive
Ethical
Includes Continuous Quality Assessment And Assurance
Culturally Competent
Empowers Communities And Individuals To Create Conditions Conducive To Health

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• Union ministry of health and family welfare
• The Directorate general of Health services
• The central council of Health and Family Welfare
Central level
• State Ministry of Health and Family Welfare
• State Health Directorate and Family Welfare
State level
Peripheral/local level
Health System Administration In India

14. 14
Directorate General Of Health Services

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Levels of Oral Health Care Delivery System
The primary level is normally
the first point of contact
between an individual and
the oral health care system.
• General Medical
Practitioners (GMPs),
nurses, pharmacists, and
General Dental Practitioners
(GDPs) are all regarded as
part of the primary care
workforce.
The secondary level –
specialized care workers
operate on diagnostic
services
• The Consultant grades -
found at this level.
The tertiary level is where
centers of excellence, -multi-
disciplinary activity
• These centers tend to play a
major role in teaching and
training as well as research.

16. 16
National Oral Health Programme (2012-2017)
Objectives:
a. To improve the determinants of oral health
b. To reduce morbidity from oral diseases
c. To integrate oral health promotion and preventive services with the general health care system
d. To encourage the Promotion of Public Private Partnerships (PPP) model for achieving better oral health.
Organizational Structure of the NOHP:
National Oral Health Cell
•The National Oral Health Cell
comprises of Technical and
Administrative personnel under the
overall guidance of Deputy Director
General (NCD) in DGHS and Joint
Secretary (NOHP) in the MoHFW.
They will be assisted by a Chief
Medical Officer in charge of NOHP
and a National Consultant. Joint
Secretary in charges will oversee the
implementation of the programme
management with the help of a
designated Deputy Secretary and
Under Secretary.
State Oral Health Cell (SOHC)
•The identified State Nodal Officer
would be in charge of the NOHP cell
at the State level. He may be the
Nodal Officer in charge of the NCDs
in the State or a separate program
officer as per requirement of the
individual states. This cell would
work in liaison with the State NCD
cell existing for other NCD programs.
District Oral Health Cell
•The District Oral Health Cell will be
headed by an identified District Oral
Health Officer who would liaise with
the other NCD program cells. They
will share the manpower available
with the district for NPCDCS, NTCP
etc.

17. 17
• The Ministry of Health & Family Welfare, Government of India, under the National Health Mission
Objectives:
• To improve the overall quality of life of children
• To provide comprehensive care to all the children in the community
Rashtriya Bal Swasthya Karyakram (RBSK)
Source: https://nhm.gov.in/index1.php?lang=1&level=4&sublinkid=1190&lid=583

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Core services provided by DEIC
Dental services – for problems of teeth, gums and oral hygiene in children from birth to 6 years esp.
“Early Childhood Caries” (Dentist)
List Of Dental Equipment & Consumables
Typical design of dental examination room
Required qualification of dentist and dental
technician

19. 19
• In 2018, the Government of India has launched an ambitious health-care scheme known as “Ayushman
Bharat”, widely projected to be a progressive step toward Universal health coverage (UHC) in India.
• This scheme has two components: Pradhan Mantri Jan Arogya Yojana (PMJAY) and Health and Wellness
Centres (HWCs).

20. 20
• Basic oral health care is introduced as one of the
elements of this scheme delivered through HWCs to
expand the availability of preventive, promotive, curative
and rehabilitative aspects of dental health including
referral to appropriate health facilities.
• Care at community level and at HWCs is provided by
creating awareness about ill effects of tobacco, oral
hygiene education, screening for gingivitis, periodontitis,
malocclusion, dental caries, dental fluorosis and oral
cancers with referral, tobacco counselling at cessation
centres.
• At referral sites, diagnosis and management of oral
cancer, management of malocclusion, trauma cases,
tooth abscess, dental caries, surgical and prosthetic care
with hospitalization cover is included under this scheme

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22. 22
Strategy to Improve Oral Health of Children
Source: Chahar P, Jain M, Sharma A, Yadav N, Mutneja P, Jain V. Schools as opportunity for oral health promotion: Existing status in India. Indian
Journal of Child Health. 2018 Aug 25:513-7.

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The Basic Package of Oral Care (BPOC) developed by the WHO Collaborating Centre in Nijmegen, describes a package
of basic oral care activities which can be provided within the framework of the existing first line care, the Primary
Health Care System.
Rationale
• Traditional western oral health care should be replaced by a service that follows the principles of PHC.
• This implies that more emphasis should be given to community-oriented promotion of oral health.
The Basic Package of Oral Care (BPOC)
Source: Dr. H. Faizunisa, Dr. S. Vaishnavi and Dr. Preetha Chaly Elizabeth India”, International Journal of Current Research, 8, (08), 37131-37135.
Elements of BPOC
• OUT (Oral Urgent Treatment)
• Relief of oral pain
• First aid for oral infections and dento-alveolar trauma
• Referral of complicated cases
• Affordable FluorideToothpaste (AFT) is an efficient tool to create a healthy and clean oral environment
• ART approach is entirely consistent with modern concepts of preventive and restorative oral care, which stress
maximum effort in prevention and minimal invasiveness of oral tissues.

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• Dental insurance refers to the cover provided for dental procedures (generally excluding cosmetic dentistry) that are
deemed necessary by a dental professional.
• 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 people to regularly visit the dentist and this in turn serves as an effective
preventive measure.
• If we have to create the oral health awareness across the society, dental profession should impress on to the policy
makers to have beneficial dental insurance schemes for the masses.
• India- nascent stage with very few insurance companies providing the service.
• Dental insurance in India is mostly clubbed with health insurance and available under the general health insurance
plans.
• Cost of dental treatment has become a hindrance that deprives people from readily availing services from qualified
clinicians.
Need for Dental Insurance

25. 25
Types of health insurance plans that offer dental insurance cover in India:
• Individual Health Plans -cover the dental expenses of an individual under
basic coverage, additional benefits or premium add-on covers. In the case of
add-on covers, the customers will have to pay an additional premium to
acquire this benefit.
• Critical Illness Plans: cover dental surgeries that fall under critical medical
procedures.
Routing of Funds For Oral Health Care
• Family Floater Health Insurance Plans: covers the dental expenses of the entire family
• OPD Health Plans: covers outpatient medical expenses of the insured, including dental OPD consultations,
diagnostic tests and medicines.
• Personal Accident Plans: cover dental expenses resulting from an accident that may have caused injury to the
person’s teeth

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Health Insurance Policies Available in India that Accommodate Dental Insurance Cover

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• Recently launched India’s first “Dental Insurance Plan”.
• Ocare’s plan was initially launched in Maharashtra at village level, through respective gram panchayats,
with a view to make dental treatment accessible and affordable to all
• It is a group insurance product, offering insurance up to 25,000/- a year with 1699/- annual premium and
100% tax benefit on the premium amount paid.
• It covers 2 dental check-ups per year plus a loyalty card redeemable on dental services.
• Presently it is offered only to corporate, schools, colleges, institutes etc
Ocare Health Insurance

28. 28
Government Schemes
• ESI -Employees State Insurance
• CGHS
• Pradhanmantri Suraksha Bima Yojna –accident
insurance scheme
• Rajeev Gandhi Jeevandayee Arogya Yojna –
hospitalization benefits
• Yashaswini Card –cost effective medical facility for
farmers
• West Bengal Health Card
• Kerala- Arogyasanjeevini
• Employees with institutions like the State Bank of India,
Government colleges, Judges and other court officials
etc., also benefit from reimbursement of dental
treatment expense.
Source: Dr. Bhavna Singh. “Scope of Dental Insurance In India. ” IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), vol. 17, no. 10, 2018, pp 59-63.

29. 29
An oral health policy
called “Affordable
Care Act” was
formulated by
American Dental
Association to
include a dependent
coverage policy that
extends parents’ or
guardians’ health
insurance to adults
aged 19-25
This dependent
coverage policy was
associated with an
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.
As part of state-
wide health reform
in 2006,
Massachusetts
expanded dental
benefits to all adults
ages 19-64 whose
annual income was
at or below 100% of
the federal poverty
level
This experience
provides evidence
that providing
dental benefits to
poor adults through
Medicaid can
improve dental care
access and use.
Under a reform of
Israel's National
Health Insurance
Law in 2010, free
dental services were
offered to children
up to age 12.
Oral Health Care Reforms in Developed Countries

30. 30
Source: Ramanarayanan V, Janakiram C, Joseph J, Krishnakumar K. Oral health care system analysis: A case study from India. J Family Med Prim Care 2020;9:1950-7.

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• Tele dentistry -remote facilitating of dental treatment, guidance, and education via the use of information
technology instead of direct face-to-face contact with patients.
• Teleconsultation, telediagnosis, tele triage, and telemonitoring are subunits of tele dentistry that have important
functions relevant to dental practice
• Collaborative Digital Diagnosis System (CollabDDS) was developed in India for tele-consultation, diagnosis, remote
education and as a data repository.
• It is a remote expert dental programme served between three dental schools with the Centre for Dental Education
and Research at the All India Institute of Medical Sciences in New Delhi.
Major challenges
• Lack of government initiatives, reimbursement schemes, data protection laws, technical infrastructure, advanced
biological sensors, bandwidth support, orientation among doctors, and linguistic diversity.
Tele-dentistry
Source: Kharbanda, O., Priya, H., Balachandran, R., & Khurana, C. (2019). Current Scenario of Teledentistry in Public Healthcare in
India. Journal of the International Society for Telemedicine and EHealth, 7, e10 (1-8).

32. 32
Socioeconomic
Barriers
• Limited
financial
resources and
lack of dental
insurance
coverage can
prevent
individuals
from seeking
regular oral
healthcare.
Geographic
Barriers
• Inadequate
availability of
dental care
services,
especially in
rural or
underserved
areas, can
hinder access
to oral
healthcare.
Provider
Shortage
• Insufficient
numbers of
oral
healthcare
providers,
such as
dentists and
dental
hygienists,
can limit
access to
care,
particularly in
areas with
high
population
density or low
provider-to-
patient ratios.
Cultural and
Language
Barriers
• Cultural
beliefs,
language
barriers, and
low health
literacy can
impact
communicatio
n between
patients and
oral
healthcare
providers,
leading to
disparities in
access and
understandin
g of oral
health
information.
Fear and Dental
Anxiety
• Dental fear
and anxiety
can deter
individuals
from seeking
oral
healthcare,
leading to
delayed or
neglected
treatment.
Systemic
Barriers
• Fragmented
healthcare
systems, lack
of integration
between oral
and general
healthcare,
and limited
coordination
of care can
create
barriers to
comprehensiv
e oral
healthcare
delivery.
Barriers in Oral Health care Delivery

33. 33
• Improper distribution of dentists between urban and rural areas is a significant challenge in providing oral
healthcare.
• Barriers include lack of observation of oral healthcare services, absence of dentists in decision-making roles, and
inability to create a quality dental workforce based on societal needs.
• Addressing salary inequality and job opportunities between rural and urban areas is a critical issue for dentists in
India.
• Hurdles in promoting oral health include low priority given by policymakers, neglect of oral disease risks, high
treatment costs, and insufficient awareness among dental professionals.
• Intervention programs should reach underprivileged populations and address both behavioral and socio-economic
factors.
Challenges of oral health services
Source: Siddharthan S, Naing NN, Wan-Arfah N, Assiry AA, Adil AH. Oral health and services in India. Int J Pharm Res. 2021;13(1):3786-90.

34. 34
Oral health policy is needed to promote prevention, reduce oral disease
burden, and eradicate misconceptions.
Lack of oral health policy in India hinders the implementation of measures like
water fluoridation.
It improves accessibility and affordability of oral healthcare, addresses the
shortage of dental workers, reduces rural-urban disparities, and enhances
infrastructure and data recording.
Proper oral health policy also ensures better dental education and allocation
of appropriate budget.
Need for Oral Health Policy

35. 35
STRENGTH
• Organized healthcare system
Mention of oral health in state’s health policy
Affordable oral care in PSU’s
Essential medicines provided free of cost in PSU’s
Approx. 15,000 registered dentists
25 dental teaching institution with an output of 2000
dentists/year
Healthy DPR-1:2200
•WEAKNESS
• Absence of oral care in grass-root levels (sub-center,
PHC)
• Limited government hospitals offering oral care
(approximately 8%)
• Meager financial allocation for oral health activities
• No government sponsored oral health programs
• Uneven distribution of dentists and private dental
facilities and high costs
• Low perceived need for oral care
•THREATS
• Low priority of oral health in health system
• Rising burden of oral diseases
• Lack of political will to employ dentists in primary
levels of care
• Poor knowledge and attitudes of oral health among
public
• Absence of an Oral Health Policy at national level
• Lack of vertical oral health programs
•OPPORTUNITIES
• Appointing a dentist in every PHC-effective use of
large manpower
• Planning a comprehensive school oral health program
• Training allied workforce
• Introduction of public dental health insurance
• Effective utilization of dental teaching institutions as
centers for oral health promotion
• Enhancing community participation
Source: Ramanarayanan V, Janakiram C, Joseph J, Krishnakumar K. Oral health care system analysis: A case study from India. J Family Med Prim Care 2020;9:1950-7.
SWOT Analysis

36. 36
Conclusion
• Implementation of dental insurance schemes, decentralization
exercises can make the oral health system more efficient and
improve the quality of the health care delivery.
• Lack of importance towards oral health with high occurrence of
oral conditions are because of improper or absence oral health-
care services.
• Dentist and people percentage is too low in the rural region
which is an important barrier for an individual to get an oral
health service.

37. 37
1. Global burden of disease 2019 (GBD 2019) results [online database]. Seattle: Institute of Health Metrics and Evaluation (IHME);
2020
2. Singh, A., & Purohit, B. M. (2014). Targeted interventions in oral health: Indian context. International Journal of Health System and
Disaster Management, 2(4), 221-225.
3. Karan, A., Negandhi, H., Nair, R., Sharma, A., Tiwari, R. and Zodpey, S. Size, cmposition and distribution of human resource for health
in India: new estimates using National Sample Survey and Registry data. BMJ open.2019;9(4), p.e025979
4. Siddharthan S, Naing NN, Wan-Arfah N, Assiry AA, Adil AH. Oral health and services in India. Int J Pharm Res. 2021;13(1):3786-90.
5. Watt RG, Daly B, Allison P, Macpherson LMD, Venturelli R, Listl S et al. Ending the neglect of global oral health: time for radical
action. Lancet. 2019;394(10194):261–72. doi:10.1016/S0140-6736(19)31133-X.
6. Patel J, Wallace J, Doshi M, Gadanya M, Yahya IB, Roseman J et al. Oral health for healthy ageing. Lancet Healthy Longev.
2021;2(8):e521–7. doi:10.1016/S2666-7568(21)00142-2.
7. Guarnizo-Herreño, C. C., Watt, R. G., Pikhart, H., Sheiham, A., & Tsakos, G. (2015). Socioeconomic inequalities in oral health in
different European welfare state regimes. Journal of Epidemiology and Community Health, 69(5), 426-432.
8. Nasseh, K., & Vujicic, M. (2018). Dental care utilization steady among working-age adults and children, up slightly among the elderly.
Health Policy Institute Research Brief, 18(1), 1-12.
9. Institute of Medicine (US) Committee on Oral Health Access to Services. (2011). Improving Access to Oral Health Care for Vulnerable
and Underserved Populations. National Academies Press (US).
10. Do, L. G., Luzzi, L., Ng, C., & Waters, E. (2018). Parenting practices and oral health-related quality of life in preschool children: A
systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 15(12), 2729.
11. Armfield, J. M. (2010). Development and psychometric evaluation of the Index of Dental Anxiety and Fear (IDAF-4C+). Australian
Dental Journal, 55(5), 570-577.
Reference

38. THANK YOU
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Oral health Care System in India
Government organisations
Govt. dental colleges
Govt. medical colleges and dental
wing
DH
CHC
PHC
Non- government organisation
Private dental colleges
Private medical colleges and dental
wing
Corporate hospitals with dental
unit
Private practitioners
Private dental practitioners
Private dental hospitals
Private medical hospital with
dental unit
Indigenous systems
Ayurveda
Unani
Sidda
Homeopathy