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DENTAL SERVICES IN NEPAL
Shekhar kumar mandal
Usha kharel
BDS III
College of Medical Sciences, Bharatpur,Nepal
Introduction
 Health is a basic right of every people. Dental health is a
significant component of a general health.
 The World Health Organization (WHO) has defined oral
health as “A standard of the oral and related tissues which
enables an individual to eat, speak and socialize without
active diseases, discomfort or embarrassment and which
contributes to general well-being”.
 Dental health means more than just an attractive smile.
 Health problems are often neglected and only treated if
pain or another problem arises
Contd….(Intro…)
”Oral disease shares common risk factors with the four leading
chronic diseases: cardiovascular diseases; cancer; chronic
respiratory diseases; and diabetes. Also, it shares risk factors with
unhealthy diets, tobacco use, and alcohol use. Poor oral hygiene is
also a risk factor for disease. Dental caries is the most prevalent
oral disease in several Asian and Latin American countries.”
A/C to World Oral Health Report 2003
Globally dental health is a major public health problem affecting a
large population and is most common in developing countries.
Approx 5-10 % of public health expenditures relate to oral
health.
The prevalence of dental decay worldwide is 60-90% in school
children. More than 50 million school hours are lost annually
due to oral health problems, which affect children’s’ school
performance and success in later life.
contd...(Intro
…)
In developing countries like Nepal, Oral health has been a neglected
field. The majority of Nepalese seek dental treatment only when
they have pain. Nepal has one dentist per 20,000 people, with just
over 1400 total dentists, including about 100 dental specialists.Most
of the dentists practice in the major cities.
Nepal dental health service is still in its infancy. According to some
recent studies, 65% of schoolchildren are suffering from dental
caries and a significant number of children miss their classes
because of dental pain. The government is not able to extend oral
health service even up to the district level. Private dental hospitals
and clinics are only based in some of the major cities of Nepal;
people must travel hours for simple dental treatment.
History of Dental services in
Nepal:-Kathmandu, the historical and traditional city compromises of various temples and
deities at its every nook and corner. Bangemudha is one among such locations where
Washya Dyo or Danteshwori Devi shrine (meaning `Goddess alleviating toothache'
according to local Newari Language) is located. The shrine has been in existence since
the period of Lichchhavi era. The gold caved idol was however stolen about thirty
years ago.
In proximity to such deity, a traditional street Na:ghal; meaning 'iron vessel' is
located, where many traditional and few newer dental clinics are situated. According
to local respondents, some clinics at Na:ghal are in existence for more than seventy
years, and served by more than three generations of practitioners. Many of the
concerned localities recall the history of Late Rana Prime Minister Chandra
Shamsher, who sent Asta Man Rajbhandari and Ghana Man Rajbhandari of Na:ghal to
India for training of dentistry more than one hundred years ago. Later qualified
dentist Dr. Dwarika Man Rajbhandari commenced his practice in Na:ghal, which is
followed by second and third generation of qualified dentist. Later various other
organization like NDA(1990), Dental Hygienist’s Nepal Association(DHAN) in 2006 etc
were established in order to enhance the dental services of Nepal.
Major Dental Health problems in Nepal :-
Dental caries/toothache
 Periodontal diseases (gum)
Oral ulcer, mucosa and other related
diseases
Oral Maxillofacial Injuries
Barriers to Dental Heath services
in Nepal :-
Articles published in the British Dental Journal state
that barriers to accessing and accepting dental care
are made up of psycho-social determinants.
Financial costs, especially in a poor country like Nepal,
is a significant barrier to accessing dental care.
Barriers referring to individuals including:-
 Lack of perceived need
 Anxiety or fear
 Financial considerations
 Lack of access
Contd…(Barriers to Dental
…..)
Barriers referring to the dental profession including:-
 Inappropriate manpower resources
 Uneven geographical distribution
 Training appropriate to changing needs and
demands
 Insufficient sensitivity to patient attitudes and
needs
Contd…(Barriers to Dental
…)
Barriers referring to society including: -
 Insufficient public support of attitudes conducive to health
 Inadequate oral health care facilities
 Inadequate oral health manpower planning
 Insufficient support for research
Other possibilities may include:-
 Cultural beliefs and rituals, especially within ethnic groups
 Lifestyle changes in modern world
 Influences of neighbouring countries
 Low value of oral health to the public Conditions within the clinic
in relation to professionalism
Contd…(Barriers to Dental …)
There is no governmental official dental council in Nepal,
therefore there is no legislation that governs the practise of
dentistry within the country. This allows many “dentists” to open
up their “daat banaune thau” in place of proper dental clinic on
the high streets and offer some unorthodox and outdated
treatment. Because of the huge religious belief in Nepal,
patients may wish to visit a witch doctor, also known as a
dhami-jankari, to perform an elaborate offering to the gods and
the jankari to take away the pain. There is even a “toothache
god” idol in Nepal where people would go and hammer a coin
believing that the toothache pain shall be transferred into the
coin as an offering to the god.
Because of these large religious and cultural beliefs, the patients
are often hesitant to try anything “new” and prefer to keep their
faith in the old traditions.
Thank you….cont….
Dental treatments available in Nepal
Private services
 Endodontic treatment
 Orthodontics treatment
 Oral medicine and
radiology
 Maxillofacial treatment
 Prosthodontic treatment
 Periodontal treatment
 Pedodontics treatment
 Plastic surgery
 Implantology
 Community dentistry
Only limited dental services are
given in governmental hospitals
of Nepal like:
Endodontics treatment like
RCT and Restorations,
Forensic dentistry
Prosthodontic treatment
Periodontal treatment
Orthodontics treatment
Pedodontics Treatment
Oral medicine and radiology
Community dentistry
Governmental services
Number of Oral health
professionals
Number of Different Oral Health Professionals
Category Total
Number Year Source
Dentists 705 2008 1)
Dental
Therapists
7 2000 2)
Chairside
Assistants
80 2000 2)
Dental
Hygienists
234 2008 3)
Dental
Laboratory
Technicians
2 2000
2)
Source:-
1) Nepal Medical Council ,Oral Care Nepal (NGO),
2) Zillén PA & Mindak M. World Dental Demographics, Internat Dent J, 2000
3) Council for Technical Education and Vocational Training (CTEVT) and Nepal Health
Professional Council .
1. In 2011, Nepal’s Ministry of Health and Population (MoHP)
developed its Human Resources for Health (HRH) Strategic Plan
(2011–2015).
A/C to which:
 1 dentists per 1,00000/population.
 But 1 dentist per 20,000 a/c to recent data.
 A total of 230 dentist were working in various hospitals of Nepal by 2011.
[ excluding……]
2. A/C to Nepal health Professional Council 2011,
 There were 37 PCL dental assistant and 356 TSLC dental assistant
with permanent registration.
 There were over 1000 dental hygienist in Nepal by 2012.

3. A/C to NMC
Total dental students in 2012 was 560 as announced by the Nepal
Medical Council in Dec. 2012. .(NMC 2012).
Total registered dentist and specialist by NMC:
Year Nos of dentist[BDS] Nos of dental
specialist[MDS]
Male Femal
e
Total Male Femal
e
Total
2003 - - 105 - - -
2007 662 30 13 43
2008 284 421 705 - - -
2012 507 715 1222 148
2013 597 843 1440 92 74 166
Year
Governme
nt
Service %
Private
Practice %
Universities% Other%
2000
14 78 4 4
Demographics of Dental
manpower
A/C to HRH Assesment 2012:
In a total of 230 dentists by 2011
 140 dentists were female and 90 were male. 176 worked in private hospitals.
 Proportion of female for both sectors: 61%
 Proportion of female for public sector only 42%.
Governmental dental manpower: Private dental manpower:
Developme
ntal Region
Ea
st
er
n
Ce
ntr
al
We
ste
rn
Mid
west
ern
Farw
ester
n
Nos of
dentists
5 38 12 2 0
AGE
GROU
PS
<30ye
ars
30-40 41-50 >51 N.A.
Nos.of
Dentist
10 10 12 - 25
AGE
GROUP
S
<30
year
s
30-40 41-50 >51 N.A.
Nos.of
Dentist
63 33 10 1 66
Develop
mental
Region
Eas
tern
Centr
al
Weste
rn
Midw
estern
Farwe
stern
Nos. of
dentists
9 136 23 4 1
Distribution of dental manpowers by
facility type in governmental hospitals
A/C to HRH assessment 2012,
Hospital
s
PHC,
SHP
Central
Jail
Centr
al
Hospit
als
Distric
t
hospit
als
Zonal
hospit
al
Regio
nal
hospit
als
Teachi
ng
hospit
al
Total
Nos of
dentists
0 0 19 2 15 4 17 57
NO GOVERNMENTAL DENTAL HOSPITAL.
DISTRIBUTION OF DENTAL
MANPOWER BY ECOLOGICAL
ZONE
 A/C to HRH assessment 2012,
 Major dentists are enrolled in major cities area of
hilly region.
Regions Terai Hill Mountain
Nos of dentist 54 176 0
HUMAN RESOURCES FOR
HEALTH PRODUCTION
 A/C to HRH assessment 2012,
Institute Public dental
training
Private dental training
provider[for profit]
Private dental
training
provider[for Non-
profit
Nos. 1 5 1
Dental schools in nepal
Because of the establishment of dental colleges in
Nepal, the number of specialists has increased
markedly. The dental manpower mainly
produced by major universities and organisation
in nepal are:-
 Kathmandu university- BDS program
 Tribhuvan university-BDS and MDS program
 BPKIHS, Dharan-BDS and MDS program
 CTEVT- PCL and TSLC dental assistant and
hygienist program.
 Bir hospital [MDS program}
Kathmandu university
KU School of Medicine
Science, Kavre
College of medical
sciences, Bharatpur
Kantipur Dental College,
Basundhara
Nepal Medical College,
Jorpati
Nobel Medical College,
Biratnagar
Tribhuvan University
People’s Dental
College, Kathmandu
KIST dental college,
Lalitpur
Universal college of
medical sciences,
Bhairahawa
M.B. Kediya Dental,
Birjung
Chitwan medical
college, Bharatpur
Institute of Medicine,
Maharajgunj [MDS
program]
Number of students enrolled and
graduated from programmes
 A/C to HRH assessment 2012,
 But due to recent establishment of major dental institute in Nepal
nos. of students enrolled and graduated per year have increased
markedly over 500 .
 There were over 1000 dental hygienists in nepal by year 2013.
 Production capacity for dental training courses as of 2011/12 :
production capacity per year was 370 while enrollement per year
was 321 and graduation per year was 296. (Source: Extracted from
presentation by Rajendra Prasad Gupta, HRH Conference, June
2013).
YEAR Students enrolled Graduated
2009 318 195
2010 315 203
2011 190 198
Dental services and Nepal Health
Care System
 Oral health conditions are estimated by WHO to account for 0.6% of
DALYs lost in Nepal, and account for 3% of Outpatient Department
(OPD) visits recorded in DoHS’s 2007-08 Annual Report.
 More than 57% of Nepalese children at six years of age and 69%
of adults above the age of 50 suffer from untreated dental caries
affecting more than three teeth.
 Untreated dental caries is the most prevalent childhood disease in
Nepal – more prevalent than malnutrition (53%) and vitamin
deficiency (56%).
 Nepal ranks among the top 15 countries in the world where
periodontal disease in the age group of 35-44 years is prevalent.
 However, GoN has made significant progress formulating an
Oral Health Policy (2004) and has an Oral Health Strategic Plan.
It also has advocated for fluoridation of toothpastes that are
produced in Nepal.

 There have also been changes to health care legislation in
some provinces affecting the scope of practice of dental
hygienists and denturists, but nothing significantly altering
the funding of dental care services in the Nepal health
care system.
 There are different divisions working under the Department of
Health Services, but not the Oral Health Division.
 The second long term health plan (1999-2017) has put oral
health into essential health care services and oral health for
the first time into a primary health care approach.
 Although the oral health policies and strategies are
established, the limited fund resources and manpower are
a constraint to implementation.
 No insurance policy has been made regarding dental checkup
for patients.
 A/C to a recent tourist who visited Nepal “My recommendation for those
coming to Nepal for long enough is to get your trip off to a great start by
getting your dental work done first in your own country.Everyone comes
early and sits there patiently waiting. I see it as a waste of time to wait
more than hours.” (http://frugaltravelsnepal.blogspot.com/2014/05/dental-
values-in-nepal-seriously.html
Expenditures of GoN on Dental
Services
 GoN has been allocating 5-6% annual budget in
Health sector. And few part of this budget is
allocated for Oral health in Nepal:
[source: NSHP 2010]
Oral Health budget 2010/11 2011/12 2012/13 2013/14 2014/15
Proposed Budget for
NHSP-2 (2010-2015) -
NPR IN 100,000
85 93 98 108 119
Patients Expenditure
Comparison of patient expenditures on oral health
services in Nepal and USA:-
[source: WHO report on oral health 2013]
YEAR NEPAL USA
PRIVATE 2000 75.1% 56.8%
2008 62.3% 52.2%
GOVERNMENT
AL
2000 24.9% 17.1%
2008 52.2% 18.7%
 To treat 9.3 million Nepalese children from the
age of 6 to 14 years using western technology
would cost the heath care system more that $US
5 million a year.
 It is also costly for Nepalese families. The
estimated cost to treat a 6-year-old child with 3
decayed teeth is approximately 800NRs, not
including loss wages, travel and
accommodations. This is enough money for food
for a month in nepalese family.
Number of Dental Patients
 Annually, among total cases visiting to opd, 3 % cases are of oral
health problems.
Annual report
on
Dental
caries/tootha
che
Periodontal
cases
Oral ulcer,
other disease
of mucosa
Other cases
2009/2010 3,92,831 73,309 1,13,819 62,747
2010/2011 4,02,142 75,099 1,16,174 57,348
2011/2012 4,21,033 77,360 1,24,328 65,246
2012/2013 4,33,282 76,547 1,24,368 62,545
2014/2015 4,44,088 94,130 1,13,819 73,224
Economic Burden of Oral Health
Disease
 It is estimated that 2.26 million school days and 4.15
million working days for adults are lost annually due to
dental visits or dental sick-days. An estimated 40.36
million hours are lost from normal activities, school or
work on an annual basis due to check-ups or problems
with teeth.
 . In Nepal condition is more severe.
 The number of dentists in Nepal is incredibly low at 1
dentists per 100,000 of the population.[HRH 2011]
 Nepalese workforce, age 15-49 years (13 million) lost
one hour per person per annum due to oral diseases or
conditions, total lost days per annum is estimated to be
541,666. Improvements in the oral health of the Nepalese
people will have a direct impact on Tenth Plan to alleviate
poverty and improve prosperity.
Health Indicators in Nepal
of Nepal live in rural areas, where there is lack of
essionals as well as dental clinics. These all
o a bad oral heath.
y national oral health survey was conducted in
l Pathfinder Survey shows that 58% of 5–6 –year- old
fer from dental caries . More prevalent that
itamin A deficiency which is reported to affect 53%
ild population.
ted pain and discomfort due to untreated dental caries
ar-olds and 64% in older adults.
ducted in Nepal among 9–11 years old schoolchildren
45% of children suffered from tooth pain.
y, it was reported that 93% of children had never
and the decayed component constituted almost
T index.
 About 61% of children reported to have
received oral health education.
 More than 82% children did not know about
fluoride and its benefits on dentition.
 Only 56% school children brushed their teeth
daily.
 The study reported 80% children rinsing mouth
with water. The most common aid used for
maintaining oral hygiene was toothbrush and
toothpaste.
 Tooth brushing once a day is a norm in
Nepal. Low dental visit and 100%
untreated caries could be due to lack of
access to affordable health care services
Policy for development of Dental
services in Nepal
 The development of Human Resources for Oral
Health
 Strategy 1. The prevention of dental caries and
periodontal disease.
 Strategy 2. The strengthening of quality assurance
programmes to ensure the proper practice of
infection control and occupational health and safety
protocols.
 Strategy 3. The development of infrastructure for oral
health.
 The Development of Public/Private Sector
Cooperation
Oral Health Promotion and the Prevention of Oral
Disease
 Strategy 1. The prevention of dental caries and periodontal
disease
 Strategy 2. The strengthening of community oral health
education
 Strategy 3. The prevention or oral cancer, oral submucous
fibrosis, developmental defects, and oral trauma.
 Strategy 4. The establishment of data collection and
research procedures needed to support evidence based
oral health policy development.
Appropriate Curative Care of Oral Disease
 Strategy 1. The expansion of basic oral health care to rural
communities.
 Strategy 2. The strengthening of quality assurance
programmes to ensure the propwe practice of infection
control and occupational health and safety protocols.
provide quality dental services in
Nepal
Nepal dental association
Ministry of Health and Population
Dental hygienist association of Nepal
World health organization
American dental
association
Federation Dentaire
Internationale
Different surveys and projects in
Nepal
 National oral Health survey, 2004
 Human resources for health assesment 2013
 Global dental relief
 Kaski oral health care project
 World alliance for murcery free dentistry(WAMFD)
 Eva Nepal
 Dental Himalayan health project
 Hasilo Nepal dental project
 Netherlands oral health society for Nepalese
people
Conclusion
From all above datas and analysis we can say that dental
health services in Nepal is still in its infancy stage. In low
income countries like ours, there is no proper
governmental budget allocated for dental services to have
sound development.
There is no sufficient data to make a proper plan and
project, that forces us to carry out the important project
based on community or locality rather than national based.
Major dental manpower are centralized toward central
development region whereas FWR have only few dentist.
Even in such circumstance, more than 75% dentist are
involved in private clinics. They are focused in earning
more money. This trend has led to find a data in which more
than 60% of dentist works less than 48 hours per week in
Public hospitals. This shows that dental services in Nepal is
totally for rich and well incomed people but more than 80 %
people in Nepal are still poor.
 Its quite strange to listen that there has not even been a single dental
hospital or maxillofacial trauma center run by our Government.
 Dental caries has also been major problem in Nepal although various steps
for its prevention has been adopted.
 Major focus is should be prevention rather than cure of the oral
disease.
 Government has been trying to focus in its development but in a glacial
speed. Government has included the oral health care in the list of primary
health care.
 Nepali culture of rinsing mouth and brushing early in morning has played
important role in preventing oral disease.
 Many more national and international agencies are involved in
development of the oral health of Nepalese people in both rural and urban
areas of Nepal.
 More man power are being produced due to increase in more teaching
hositals.
 As Brain drain is major problem in field of dentistry in Nepal, gov. should
focus to prevent that and from our side, as a future dentist, we should try to
References National Oral health policy
 Annual report 2066/67, 2067/68, 2068/69,2069/70,2070/71 by DoHS
 Central Bureau of Statistics, by GoN
 World Health Organisation Website www.who.org
 WHO Oral Health Country/Area Profile Programme
http://www.whocollab.od.mah.se
 Report on global oral health by FDI
 World Health Organisation Website www.who.org
 2World Gazeteer Webiste www.world-gazetteer.com
 WHO Estimates of Health Personnel
http://www3.who.int/whosis/health_personnel/health_personnel.cfm
 Health Situation in the South-East Region, 1994-1997. www.whosea.org
Health Situation in South-East Asia Region http://w3.whosea.org.
 Freeman R. Barriers to Accessing and Accepting Dental Care. British Dental
Journal 199911. WHO Oral Health Country/Area Profile Programme
http://www.whocollab.od.mah.se
 Orthodontic Journal of Nepal, Vol. 3, No. 1, Global goals for oral health 2020.
International Dental Journal 2003;
 Teachers note
Dental services in nepal
Dental services in nepal
Dental services in nepal

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Dental services in nepal

  • 1. DENTAL SERVICES IN NEPAL Shekhar kumar mandal Usha kharel BDS III College of Medical Sciences, Bharatpur,Nepal
  • 2. Introduction  Health is a basic right of every people. Dental health is a significant component of a general health.  The World Health Organization (WHO) has defined oral health as “A standard of the oral and related tissues which enables an individual to eat, speak and socialize without active diseases, discomfort or embarrassment and which contributes to general well-being”.  Dental health means more than just an attractive smile.  Health problems are often neglected and only treated if pain or another problem arises
  • 3. Contd….(Intro…) ”Oral disease shares common risk factors with the four leading chronic diseases: cardiovascular diseases; cancer; chronic respiratory diseases; and diabetes. Also, it shares risk factors with unhealthy diets, tobacco use, and alcohol use. Poor oral hygiene is also a risk factor for disease. Dental caries is the most prevalent oral disease in several Asian and Latin American countries.” A/C to World Oral Health Report 2003 Globally dental health is a major public health problem affecting a large population and is most common in developing countries. Approx 5-10 % of public health expenditures relate to oral health. The prevalence of dental decay worldwide is 60-90% in school children. More than 50 million school hours are lost annually due to oral health problems, which affect children’s’ school performance and success in later life.
  • 4. contd...(Intro …) In developing countries like Nepal, Oral health has been a neglected field. The majority of Nepalese seek dental treatment only when they have pain. Nepal has one dentist per 20,000 people, with just over 1400 total dentists, including about 100 dental specialists.Most of the dentists practice in the major cities. Nepal dental health service is still in its infancy. According to some recent studies, 65% of schoolchildren are suffering from dental caries and a significant number of children miss their classes because of dental pain. The government is not able to extend oral health service even up to the district level. Private dental hospitals and clinics are only based in some of the major cities of Nepal; people must travel hours for simple dental treatment.
  • 5. History of Dental services in Nepal:-Kathmandu, the historical and traditional city compromises of various temples and deities at its every nook and corner. Bangemudha is one among such locations where Washya Dyo or Danteshwori Devi shrine (meaning `Goddess alleviating toothache' according to local Newari Language) is located. The shrine has been in existence since the period of Lichchhavi era. The gold caved idol was however stolen about thirty years ago. In proximity to such deity, a traditional street Na:ghal; meaning 'iron vessel' is located, where many traditional and few newer dental clinics are situated. According to local respondents, some clinics at Na:ghal are in existence for more than seventy years, and served by more than three generations of practitioners. Many of the concerned localities recall the history of Late Rana Prime Minister Chandra Shamsher, who sent Asta Man Rajbhandari and Ghana Man Rajbhandari of Na:ghal to India for training of dentistry more than one hundred years ago. Later qualified dentist Dr. Dwarika Man Rajbhandari commenced his practice in Na:ghal, which is followed by second and third generation of qualified dentist. Later various other organization like NDA(1990), Dental Hygienist’s Nepal Association(DHAN) in 2006 etc were established in order to enhance the dental services of Nepal.
  • 6. Major Dental Health problems in Nepal :- Dental caries/toothache  Periodontal diseases (gum) Oral ulcer, mucosa and other related diseases Oral Maxillofacial Injuries
  • 7. Barriers to Dental Heath services in Nepal :- Articles published in the British Dental Journal state that barriers to accessing and accepting dental care are made up of psycho-social determinants. Financial costs, especially in a poor country like Nepal, is a significant barrier to accessing dental care. Barriers referring to individuals including:-  Lack of perceived need  Anxiety or fear  Financial considerations  Lack of access
  • 8. Contd…(Barriers to Dental …..) Barriers referring to the dental profession including:-  Inappropriate manpower resources  Uneven geographical distribution  Training appropriate to changing needs and demands  Insufficient sensitivity to patient attitudes and needs
  • 9. Contd…(Barriers to Dental …) Barriers referring to society including: -  Insufficient public support of attitudes conducive to health  Inadequate oral health care facilities  Inadequate oral health manpower planning  Insufficient support for research Other possibilities may include:-  Cultural beliefs and rituals, especially within ethnic groups  Lifestyle changes in modern world  Influences of neighbouring countries  Low value of oral health to the public Conditions within the clinic in relation to professionalism
  • 10. Contd…(Barriers to Dental …) There is no governmental official dental council in Nepal, therefore there is no legislation that governs the practise of dentistry within the country. This allows many “dentists” to open up their “daat banaune thau” in place of proper dental clinic on the high streets and offer some unorthodox and outdated treatment. Because of the huge religious belief in Nepal, patients may wish to visit a witch doctor, also known as a dhami-jankari, to perform an elaborate offering to the gods and the jankari to take away the pain. There is even a “toothache god” idol in Nepal where people would go and hammer a coin believing that the toothache pain shall be transferred into the coin as an offering to the god. Because of these large religious and cultural beliefs, the patients are often hesitant to try anything “new” and prefer to keep their faith in the old traditions.
  • 12. Dental treatments available in Nepal Private services  Endodontic treatment  Orthodontics treatment  Oral medicine and radiology  Maxillofacial treatment  Prosthodontic treatment  Periodontal treatment  Pedodontics treatment  Plastic surgery  Implantology  Community dentistry Only limited dental services are given in governmental hospitals of Nepal like: Endodontics treatment like RCT and Restorations, Forensic dentistry Prosthodontic treatment Periodontal treatment Orthodontics treatment Pedodontics Treatment Oral medicine and radiology Community dentistry Governmental services
  • 13. Number of Oral health professionals Number of Different Oral Health Professionals Category Total Number Year Source Dentists 705 2008 1) Dental Therapists 7 2000 2) Chairside Assistants 80 2000 2) Dental Hygienists 234 2008 3) Dental Laboratory Technicians 2 2000 2) Source:- 1) Nepal Medical Council ,Oral Care Nepal (NGO), 2) Zillén PA & Mindak M. World Dental Demographics, Internat Dent J, 2000 3) Council for Technical Education and Vocational Training (CTEVT) and Nepal Health Professional Council .
  • 14. 1. In 2011, Nepal’s Ministry of Health and Population (MoHP) developed its Human Resources for Health (HRH) Strategic Plan (2011–2015). A/C to which:  1 dentists per 1,00000/population.  But 1 dentist per 20,000 a/c to recent data.  A total of 230 dentist were working in various hospitals of Nepal by 2011. [ excluding……] 2. A/C to Nepal health Professional Council 2011,  There were 37 PCL dental assistant and 356 TSLC dental assistant with permanent registration.  There were over 1000 dental hygienist in Nepal by 2012. 
  • 15. 3. A/C to NMC Total dental students in 2012 was 560 as announced by the Nepal Medical Council in Dec. 2012. .(NMC 2012). Total registered dentist and specialist by NMC: Year Nos of dentist[BDS] Nos of dental specialist[MDS] Male Femal e Total Male Femal e Total 2003 - - 105 - - - 2007 662 30 13 43 2008 284 421 705 - - - 2012 507 715 1222 148 2013 597 843 1440 92 74 166 Year Governme nt Service % Private Practice % Universities% Other% 2000 14 78 4 4
  • 16. Demographics of Dental manpower A/C to HRH Assesment 2012: In a total of 230 dentists by 2011  140 dentists were female and 90 were male. 176 worked in private hospitals.  Proportion of female for both sectors: 61%  Proportion of female for public sector only 42%. Governmental dental manpower: Private dental manpower: Developme ntal Region Ea st er n Ce ntr al We ste rn Mid west ern Farw ester n Nos of dentists 5 38 12 2 0 AGE GROU PS <30ye ars 30-40 41-50 >51 N.A. Nos.of Dentist 10 10 12 - 25 AGE GROUP S <30 year s 30-40 41-50 >51 N.A. Nos.of Dentist 63 33 10 1 66 Develop mental Region Eas tern Centr al Weste rn Midw estern Farwe stern Nos. of dentists 9 136 23 4 1
  • 17. Distribution of dental manpowers by facility type in governmental hospitals A/C to HRH assessment 2012, Hospital s PHC, SHP Central Jail Centr al Hospit als Distric t hospit als Zonal hospit al Regio nal hospit als Teachi ng hospit al Total Nos of dentists 0 0 19 2 15 4 17 57 NO GOVERNMENTAL DENTAL HOSPITAL.
  • 18. DISTRIBUTION OF DENTAL MANPOWER BY ECOLOGICAL ZONE  A/C to HRH assessment 2012,  Major dentists are enrolled in major cities area of hilly region. Regions Terai Hill Mountain Nos of dentist 54 176 0
  • 19. HUMAN RESOURCES FOR HEALTH PRODUCTION  A/C to HRH assessment 2012, Institute Public dental training Private dental training provider[for profit] Private dental training provider[for Non- profit Nos. 1 5 1
  • 20. Dental schools in nepal Because of the establishment of dental colleges in Nepal, the number of specialists has increased markedly. The dental manpower mainly produced by major universities and organisation in nepal are:-  Kathmandu university- BDS program  Tribhuvan university-BDS and MDS program  BPKIHS, Dharan-BDS and MDS program  CTEVT- PCL and TSLC dental assistant and hygienist program.  Bir hospital [MDS program}
  • 21. Kathmandu university KU School of Medicine Science, Kavre College of medical sciences, Bharatpur Kantipur Dental College, Basundhara Nepal Medical College, Jorpati Nobel Medical College, Biratnagar Tribhuvan University People’s Dental College, Kathmandu KIST dental college, Lalitpur Universal college of medical sciences, Bhairahawa M.B. Kediya Dental, Birjung Chitwan medical college, Bharatpur Institute of Medicine, Maharajgunj [MDS program]
  • 22. Number of students enrolled and graduated from programmes  A/C to HRH assessment 2012,  But due to recent establishment of major dental institute in Nepal nos. of students enrolled and graduated per year have increased markedly over 500 .  There were over 1000 dental hygienists in nepal by year 2013.  Production capacity for dental training courses as of 2011/12 : production capacity per year was 370 while enrollement per year was 321 and graduation per year was 296. (Source: Extracted from presentation by Rajendra Prasad Gupta, HRH Conference, June 2013). YEAR Students enrolled Graduated 2009 318 195 2010 315 203 2011 190 198
  • 23. Dental services and Nepal Health Care System  Oral health conditions are estimated by WHO to account for 0.6% of DALYs lost in Nepal, and account for 3% of Outpatient Department (OPD) visits recorded in DoHS’s 2007-08 Annual Report.  More than 57% of Nepalese children at six years of age and 69% of adults above the age of 50 suffer from untreated dental caries affecting more than three teeth.  Untreated dental caries is the most prevalent childhood disease in Nepal – more prevalent than malnutrition (53%) and vitamin deficiency (56%).  Nepal ranks among the top 15 countries in the world where periodontal disease in the age group of 35-44 years is prevalent.  However, GoN has made significant progress formulating an Oral Health Policy (2004) and has an Oral Health Strategic Plan. It also has advocated for fluoridation of toothpastes that are produced in Nepal. 
  • 24.  There have also been changes to health care legislation in some provinces affecting the scope of practice of dental hygienists and denturists, but nothing significantly altering the funding of dental care services in the Nepal health care system.  There are different divisions working under the Department of Health Services, but not the Oral Health Division.  The second long term health plan (1999-2017) has put oral health into essential health care services and oral health for the first time into a primary health care approach.  Although the oral health policies and strategies are established, the limited fund resources and manpower are a constraint to implementation.  No insurance policy has been made regarding dental checkup for patients.  A/C to a recent tourist who visited Nepal “My recommendation for those coming to Nepal for long enough is to get your trip off to a great start by getting your dental work done first in your own country.Everyone comes early and sits there patiently waiting. I see it as a waste of time to wait more than hours.” (http://frugaltravelsnepal.blogspot.com/2014/05/dental- values-in-nepal-seriously.html
  • 25. Expenditures of GoN on Dental Services  GoN has been allocating 5-6% annual budget in Health sector. And few part of this budget is allocated for Oral health in Nepal: [source: NSHP 2010] Oral Health budget 2010/11 2011/12 2012/13 2013/14 2014/15 Proposed Budget for NHSP-2 (2010-2015) - NPR IN 100,000 85 93 98 108 119
  • 26. Patients Expenditure Comparison of patient expenditures on oral health services in Nepal and USA:- [source: WHO report on oral health 2013] YEAR NEPAL USA PRIVATE 2000 75.1% 56.8% 2008 62.3% 52.2% GOVERNMENT AL 2000 24.9% 17.1% 2008 52.2% 18.7%
  • 27.  To treat 9.3 million Nepalese children from the age of 6 to 14 years using western technology would cost the heath care system more that $US 5 million a year.  It is also costly for Nepalese families. The estimated cost to treat a 6-year-old child with 3 decayed teeth is approximately 800NRs, not including loss wages, travel and accommodations. This is enough money for food for a month in nepalese family.
  • 28. Number of Dental Patients  Annually, among total cases visiting to opd, 3 % cases are of oral health problems. Annual report on Dental caries/tootha che Periodontal cases Oral ulcer, other disease of mucosa Other cases 2009/2010 3,92,831 73,309 1,13,819 62,747 2010/2011 4,02,142 75,099 1,16,174 57,348 2011/2012 4,21,033 77,360 1,24,328 65,246 2012/2013 4,33,282 76,547 1,24,368 62,545 2014/2015 4,44,088 94,130 1,13,819 73,224
  • 29. Economic Burden of Oral Health Disease  It is estimated that 2.26 million school days and 4.15 million working days for adults are lost annually due to dental visits or dental sick-days. An estimated 40.36 million hours are lost from normal activities, school or work on an annual basis due to check-ups or problems with teeth.  . In Nepal condition is more severe.  The number of dentists in Nepal is incredibly low at 1 dentists per 100,000 of the population.[HRH 2011]  Nepalese workforce, age 15-49 years (13 million) lost one hour per person per annum due to oral diseases or conditions, total lost days per annum is estimated to be 541,666. Improvements in the oral health of the Nepalese people will have a direct impact on Tenth Plan to alleviate poverty and improve prosperity.
  • 30. Health Indicators in Nepal of Nepal live in rural areas, where there is lack of essionals as well as dental clinics. These all o a bad oral heath. y national oral health survey was conducted in l Pathfinder Survey shows that 58% of 5–6 –year- old fer from dental caries . More prevalent that itamin A deficiency which is reported to affect 53% ild population. ted pain and discomfort due to untreated dental caries ar-olds and 64% in older adults. ducted in Nepal among 9–11 years old schoolchildren 45% of children suffered from tooth pain. y, it was reported that 93% of children had never and the decayed component constituted almost T index.
  • 31.  About 61% of children reported to have received oral health education.  More than 82% children did not know about fluoride and its benefits on dentition.  Only 56% school children brushed their teeth daily.  The study reported 80% children rinsing mouth with water. The most common aid used for maintaining oral hygiene was toothbrush and toothpaste.  Tooth brushing once a day is a norm in Nepal. Low dental visit and 100% untreated caries could be due to lack of access to affordable health care services
  • 32. Policy for development of Dental services in Nepal  The development of Human Resources for Oral Health  Strategy 1. The prevention of dental caries and periodontal disease.  Strategy 2. The strengthening of quality assurance programmes to ensure the proper practice of infection control and occupational health and safety protocols.  Strategy 3. The development of infrastructure for oral health.  The Development of Public/Private Sector Cooperation
  • 33. Oral Health Promotion and the Prevention of Oral Disease  Strategy 1. The prevention of dental caries and periodontal disease  Strategy 2. The strengthening of community oral health education  Strategy 3. The prevention or oral cancer, oral submucous fibrosis, developmental defects, and oral trauma.  Strategy 4. The establishment of data collection and research procedures needed to support evidence based oral health policy development. Appropriate Curative Care of Oral Disease  Strategy 1. The expansion of basic oral health care to rural communities.  Strategy 2. The strengthening of quality assurance programmes to ensure the propwe practice of infection control and occupational health and safety protocols.
  • 34. provide quality dental services in Nepal Nepal dental association Ministry of Health and Population Dental hygienist association of Nepal World health organization American dental association Federation Dentaire Internationale
  • 35. Different surveys and projects in Nepal  National oral Health survey, 2004  Human resources for health assesment 2013  Global dental relief  Kaski oral health care project  World alliance for murcery free dentistry(WAMFD)  Eva Nepal  Dental Himalayan health project  Hasilo Nepal dental project  Netherlands oral health society for Nepalese people
  • 36. Conclusion From all above datas and analysis we can say that dental health services in Nepal is still in its infancy stage. In low income countries like ours, there is no proper governmental budget allocated for dental services to have sound development. There is no sufficient data to make a proper plan and project, that forces us to carry out the important project based on community or locality rather than national based. Major dental manpower are centralized toward central development region whereas FWR have only few dentist. Even in such circumstance, more than 75% dentist are involved in private clinics. They are focused in earning more money. This trend has led to find a data in which more than 60% of dentist works less than 48 hours per week in Public hospitals. This shows that dental services in Nepal is totally for rich and well incomed people but more than 80 % people in Nepal are still poor.
  • 37.  Its quite strange to listen that there has not even been a single dental hospital or maxillofacial trauma center run by our Government.  Dental caries has also been major problem in Nepal although various steps for its prevention has been adopted.  Major focus is should be prevention rather than cure of the oral disease.  Government has been trying to focus in its development but in a glacial speed. Government has included the oral health care in the list of primary health care.  Nepali culture of rinsing mouth and brushing early in morning has played important role in preventing oral disease.  Many more national and international agencies are involved in development of the oral health of Nepalese people in both rural and urban areas of Nepal.  More man power are being produced due to increase in more teaching hositals.  As Brain drain is major problem in field of dentistry in Nepal, gov. should focus to prevent that and from our side, as a future dentist, we should try to
  • 38. References National Oral health policy  Annual report 2066/67, 2067/68, 2068/69,2069/70,2070/71 by DoHS  Central Bureau of Statistics, by GoN  World Health Organisation Website www.who.org  WHO Oral Health Country/Area Profile Programme http://www.whocollab.od.mah.se  Report on global oral health by FDI  World Health Organisation Website www.who.org  2World Gazeteer Webiste www.world-gazetteer.com  WHO Estimates of Health Personnel http://www3.who.int/whosis/health_personnel/health_personnel.cfm  Health Situation in the South-East Region, 1994-1997. www.whosea.org Health Situation in South-East Asia Region http://w3.whosea.org.  Freeman R. Barriers to Accessing and Accepting Dental Care. British Dental Journal 199911. WHO Oral Health Country/Area Profile Programme http://www.whocollab.od.mah.se  Orthodontic Journal of Nepal, Vol. 3, No. 1, Global goals for oral health 2020. International Dental Journal 2003;  Teachers note