National oral health policy
Dr. preyas joshi
Published on: Mar 3, 2016
Transcripts - National oral health policy
National Oral Health Policy
3rd Year Postgraduate
Deptt. Of Public Health Dentistry
Rajasthan Dental College & Hospital
• National oral health policy
• Recent affairs
• Need for oral health policy
• The Ten(10) point resolution
• Dental workforce
• Primary Oral Healthcare
• Five(5)-Year Plans
• In recent times, economists at the World Bank and the
International Monetary Fund (IMF) have tentatively
suggested that within a year or two, India’s economy
might be growing more quickly than that of China.
• In spite 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.
• Oral diseases remained still a public health problem for
developed countries and a burden for developing
countries like India especially among the rural population.
• India is predominantly rural covering about 69% of the
• Prevalence of oral diseases is very high in India with
dental caries and periodontal diseases as the 2 most
common oral diseases.
Prevalence of Dental caries in Indian population
Age group Prevalence
Prevalence of periodontal diseases in Indian population
Age group Prevalence
• Every country develops its own health policy aimed
at defined goals. Government of India (GoI) put a step
forward to enhance the healthcare system by introducing
National Health Policy (1983) which was reformed to lay
down a new policy structure for the speedy achievement
of the public health goals in 2002 and recently in 2015.
However, to reduce the morbidity of the oral-related
diseases, no much work has been done till date.1
National Oral Health Policy
• In 1984, national workshops were organized in Bombay on
oral health targets for India and in the year 1986, oral health
policy was conscripted by Indian Dental Association (IDA).
Based on the recommendation of IDA, 2 more national
workshops were organized, one at Delhi in 1991 and the
other at Mysore after 3 years. Through the input of these 2
workshops, national oral health policy has been developed
by Dental Council of India (DCI).
• It is the same time when World Health Organization (WHO)
had given importance to dental health by selecting the theme
“Oral Health for Healthy life” for global health for the year
• In continuum of this, the core committee appointed by
Ministry of Health and Family Welfare (Central Council of
Health & Family Welfare), accepted national oral health policy
as a component of NHP and moved a 10 point resolution in its
fourth conference in the year 1995.1
The 10 Point Resolution
1. There is an urgent need for an Oral health Policy for the nation as an
integral part of the National Oral Health Care Programme Health Policy.
2. Special, well coordinated, National Oral Health Care Programme be
launched to provide Oral Health Care, both in the rural as well as urban
areas due to deteriorating oral health conditions in the country as revealed
by various epidemiological studies. Also, it is important to launch
preventive, curative and educational oral health care programmes
integrated into the existing system utilizing the existing health and
educational infrastructure in the rural, urban and deprived areas.
3. A post of full time Dental Advisor at appropriate level in the Dte. G.H.S.
should be created as a first step towards strengthening the technical wing
of the Dte.GHS in this regard.
4. Studies have revealed that dental diseases have been increasing both in
prevalence and severity over the last few decades. There is an urgent
need to prevent the rising dental diseases in India.
5. 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 &
Family Welfare during 1995-96 in five districts, one in each in five states.
6. The Council further resolves that legislative measures be adopted
to ensure a statutory warning on the wrappers and advertisement of
sweets, chocolate and other retentive sugar eatables ‘TOO MUCH
EATING SWEETS MAY LEAD TO DECAY OF
TOOTH’. Similar measures are also called for tobacco and Pan
Masala related products.
7. The Council recommends that a National Oral Health Care
Programme Training Centre be established or the existing centres
be strengthened for training of various categories of Oral Health
8. All District Hospitals and Community Health Centres have dental
clinics. All Dental Colleges should have courses on Dental
Hygienists and Dental Technicians.
9. The Council further resolves that the Pilot Project may be extended
to all the States at the rate of one District in every State.
10. The Council resolves that there is an urgent need to have a
National Oral Health Care Programme Institute for Dental
Research to guide oral health research appropriate to the needs of
• After 3 years(1999), National Oral Health Care Program
(NOHCP), a project of Directorate General Of Health
Services (DGHS) and Ministry of Health and Family
Welfare was initiated and launched on a pilot basis.
• Later the Department of Oral and Maxillofacial Surgery,
All India Institute of Medical Sciences (AIIMS) was
given the charge to execute it.
• NOHCP, initiated as a “Pilot Project” in 5 states (Delhi,
Punjab, Maharashtra, Kerala, and North Eastern states), in
the process of achieving the goals of national oral health
• Single 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.
• The strategies of this program include oral health education
with information, education and communication (IEC)
materials by involving health workers, school children,
teachers and mass media, formulation of basic package on
rural healthcare, man-power and infrastructure
development, mobile dental clinic services for rural people,
public health as well as research monitoring.1
Proposed Plan for Oral Healthcare Program
Oral Health Education Preventive programs Curative service programs
Promotion of fluoride
Oral healthcare setup
Oral health education
School dental health
Oral health education
Manufacture of sugar
free chewing gums
Sugar substitutes in
The project was reviewed by The National Institute of Health and Family Welfare
• In 2006, a collaborative program between GoI and
WHO was held and this workshop suggested methods
to expand the role of dental work force in NRHMs.
• Apart from these, National Cancer Control Program,
National Tobacco Control Program, National Rural
Health Missions, and School Health Program are giving
negligible importance to oral health.
• Oral health policy - phase 1 was initiated with
an objective to provide free dentures to the
needy senior citizens of Karnataka who were
below poverty line and a draft was prepared
proposing 5 recommendations. It was
implemented in March 2014.1
Need for Oral Health Policy
1. For oral health promotion through prevention considering
the fact that oral diseases are almost preventable by simple
and cost effective means.
2. To decrease the burden of oral diseases.
3. Taboos, myths or misconceptions need to be eradicated.
4. Water fluoridation, one of the preventive measures for
dental caries was recommended in the 12th 5-year plan
without any proposed strategies for its implementation.
5. As there is inaccessibility, non-affordability of oral
healthcare services and deficiency of dental manpower in
6. To narrow the rural-urban gap in oral healthcare.
7. As there is lack of proper public oral healthcare
8. There is no organized data recording system.
9. For quality dental education.
10. Definite budget allocation for oral health, seen in
developed countries is lacking in India. 1
• India is ahead in the world with 301 dental colleges, 25 270
BDS and 5014 MDS positions. Even with this unrestricted
growth of dental colleges from decades, oral health progress in
this country did not reach to the expectation.
• The surplus production of dental surgeons in the past 10 years
made a current figure of 117 825.
• Even with a dentist to population ratio of 1:10271 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 practice.
• There is faulty development of the manpower and no
forecasting for the prospective changes in the disease pattern.
• In order to assess the true health manpower availability, the
Central Bureau of Health Intelligence (CBHI) started gathering
appropriate district-wise data on the number of medical, dental,
Indian System of Medicine and Homeopathy (ISM & H)
professionals, nursing and Para professionals and institutions
(government, private or voluntary sector).1
Primary Oral Healthcare
• Not even 20% of the rural PHCs around the country have a
• The proposed plan of placing no less than a single dental
graduate per PHC to cover 30 000 populations is a practicable
• However, appointing a dental specialist at every community
health center (CHC) looks like a distant dream as government
is struggling to ascertain CHC’s basic infrastructure and as
half of the CHCs are not functional.1
• Manpower, material, and money are the 3 basic requirements
for any program to flourish. By anticipating the need for dental
manpower, planning commission of GoI continued suggesting
the multiplication of dental colleges and succeeded in
increasing the number of dentists but failed to achieve their
evenly distribution between urban and rural areas.
• This led to inadequate oral health services to the rural India. It
is equally important to utilize the dentists effectively in
addition to increase their number.
• In the fourth 5-year plan, the total outlay for both medical and
dental education and research was only 13.92 million dollar.
• As there is an inequitable distribution of dental schools across
the nation, in the 11th 5-year plan it was proposed to set up
new dental colleges in the underserved areas.
• In the 11th plan, the budget allocated for oral health schemes
or programs is 4.07 million dollars.
• In the 12th 5-year plan no major discussion was made on oral
health except for that at present no more dental colleges are
• As recommended by WHO, health for all is possible only
when every country spends 5% of gross national product
(GNP) for healthcare but India is spending only 3%. Health
expenditure by the GoI is amongst the lowest in the world
where as that by the private sector is one of the highest.
• Till today, there is no separate budget allocation for oral health
in national or in most of states’ health budget.1
• Educating all including those in most deprived areas with
“facts of oral health” remained a challenge even today.
• Production of eligible dental healthcare planners with
necessary training is one of the challenges for expanding oral
• Other challenges include absence of surveillance of oral
healthcare services which is helpful to direct planners; lack of
dentists in the government decision-making bodies, inability to
generate manpower of good quality according to the changing
needs of the society.
• It is very much essential to provide the new dentists with adequate,
reputable, and good salaried job opportunities devoid of rural-urban
inequality which appear to be the root of all issues the dental
profession is facing today in India.
• Barriers in rural health promotion include least priority to oral health
by policy-makers, possibility of negligible risk to human life
because of oral diseases, inadequate information about burden of
oro-dental problems, expensiveness of oral treatments, lack of
awareness in dental graduates in their responsibilities towards the
society, underutilization of internship program by dental colleges,
lack of resources to the fastest growing population, overlooking of
• It is time that the responsibility of oral healthcare of citizens are to
be in the hands of governments. For discharging their obligation of
assuring healthy smiles to their public, governments require a policy.
• All the queries in attaining oral health for all can be answered by
oral health policy. There is an urgent need for implementation of the
drafted oral health policy with modification that suits the rapidly
changing oral health system of this country.
• Indian government needs to set up a committee by involving dental
professionals to plan to reduce the oral disease burden of the country
in a more comprehensive and practical approach.
1. Kothia NR et al. Assessment of the Status of National Oral Health
Policy in India. Int J Health Policy Manag 2015;4(9):575–581
2. National Oral Health Care Programme. All India Institute of
Medical Sciences website.
Accessed December 19, 2015
3. Peter Soben. Preventive and community dentistry. 4th Edition, New
Delhi, Arya (Medi) Publishing House 2009.