India's oral health needs intervention

It is heartening to see a new push to oral health by the Union Health Ministry, and this is important for many reasons.

A Nature report, quoting Indian National Cancer Registry Programme, had pointed out that there has been a worrying rise in cancers of the upper aero-digestive tract (mouth, tongue, oro-pharynx, hypopharynx, larynx and oesophagus) among both sexes. The Global Adult Tobacco Survey India, conducted in 2009-10, revealed that 35% of adults used tobacco. Tobacco-related cancers are expected to constitute 30% of the total cancer burden by 2020.

What makes it alarming is the fact that chewing tobacco is fast acquiring a notorious proposition with the youth and elderly getting addicted to it in equal measures. The situation is grim both in urban and rural areas. The prevalence of oral ailment has been high in the country with dental caries and periodontal diseases being the two most common diseases.

It is also a well-known fact by now that oral health is associated with various systemic conditions like diabetes, cardiovascular disorders and pregnancy, and therefore impacts the quality of our lives. Lack of awareness coupled with infrastructure gaps, including equipment and machinery are definite roadblocks and have hurt the health of oral care in the country.

But things seem to be changing. The health ministry is formulating an oral health policy focussed on dental health promotion, prevention and treatment. It is learnt that considering the weak policy framework on oral healthcare, the government is keen on having a stronger policy in order to promote prevention, streamline data collection and registration, enhance quality of dental education, eradicate myths, eliminate rural-urban divide in oral healthcare and reduce morbidity caused by oral-related diseases.

Priority areas

There are four priority areas that the government must consider. First and foremost, quality has been a big area of concern, and more so in rural areas. Since oral care requires the best of sterilisation and hygiene protocols, it is essential that a national framework is developed in consultation with different stakeholders, most notably dentists and dental students.

Second, the government must push for a national agenda on highlighting how significant oral care is for overall well-being. There is a massive need to step up awareness by involving all stakeholders including schools, colleges, gram panchayat, district administration, dental colleges, voluntary groups and private sector.

As part of the National Oral Health Policy (2014-15), the Centre for Dental Education & Research (AIIMS) had conceptualised and developed a Training Manual on Oral Health Promotion for School Teachers. This was issued by the Dental Council of India. There may be merit in translating it into regional languages.

We may also consider using audio-visual tools and social media platforms to widely disseminate the message on the significance of safeguarding our oral health. The HRD Ministry may also consider including a small chapter on oral health in primary classes.

Third, it is imperative to create a system where dental doctors are encouraged to necessarily serve in rural areas. Despite being home to a surplus of over 1.2 lakh dentists, our rural deployment of dentists is very poor. Against a WHO-recommended dentist to population ratio of 1:7500, our ratio is 1:10271.

With less than 25% of our Primary Health Centres having a dentist, I am of the view that the proposition of placing a dentist per 30,000 population is highly desirable. While as per the Tenth Five Year Plan, we have managed to increase the number of dental colleges in India, the spread of dental specialists in rural areas has always been a matter of concern.

Fourth, we must work on strengthening infrastructure to support wide and uniform access to oral healthcare. Other than specialist practitioners, oral health is also intricately linked to a basic infrastructure. The ‘Make in India’ programme can be leveraged to encourage local manufacturers to create a robust machinery and equipment. We must also work on creating an adequate pool of dental auxiliaries, including oral hygienists and dental lab technicians to ensure all-round service.

I am hopeful that with the government’s very ambitious Ayushman Bharat project underway, and the new policy guideline in the works, oral care would soon become a top priority for our public health system. Failing this, we may be staring at a silent crisis.

(The writer, a Harvard Business School alumnus, is founder & CEO of Clove Dental)