National oral health care programme

NATIONAL ORAL HEALTH CARE
PROGRAMME
(A Pilot Project)
www.indiandentalacademy.com

CONTENTS:
• Introduction
• Need For a National Oral Health Policy
• Objectives
• Existing Oral Health Services
• Integration of Oral Health Services into the
existing Health Infrastructure
• Economic Burden of Oral diseases
• Plan of Extending Minimum Oral Health Care
to Entire India
• Conclusion & References

INTRODUCTION

Need for National Oral Health
Policy
Increasing Prevalence and Severity of
Dental diseases
Dentist : Population ratio
Crippling Nature of Oral diseases
Impelling Economic reasons for early
recognition and prevention of diseases
Prevention of disease–Only alternative

Dental Caries
• 1940’s –Prevalence rate 40-50% average DMFT 1.5
• 1980’s – Prevalence rate 80 % average DMFT 5 –in
Urban ,4- Rural Under the age of 16 Years
• Prevalence in 10-12 year children in Delhi -39.2%
and DMFT was 2.61 (Prakash et al 1992)
• Global Oral data (WHO) prevalence -89% & DMFT-
1.2 to 3.8
Increased Prevalence and Severity

Periodontal disease
95- 100% of Adult Population suffering from this
disease- painless, Chronic, self-destructive and
gradual loss of teeth
Oral Cancer
30 – 35% of all cancers –diagnosed are oral
cancers – 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

Dentist: Population ratio
44,000 dentists – 100 crores
90% clustered in Cities, 10% in Rural
1:30,000 for Urban
1:1.5 lakhs in Rural
Organized community efforts
DMFT in Norway 12.5, Newzealand-10.7 ,
Sweden 14.1 – Declined to 70-80%

Crippling nature of Oral diseases
80% - 85% Children- DMFT 4 in Rural and 5-
urban areas Under age of 16 years
Loss of function- Leading to Malnutrition
Pus oozing from Periodontal pockets – as focus
of infection for Kidney, Heart, Lungs Brain etc.

Impelling Economic reasons for early
recognition
1970 , USA – $ 4,383,000 spent in carious
teeth– 1% of national income & 10% nations
health bill
1977 , UK – 250 million Pounds England &
Wales alone
51 million hours per Year
In India, 1 to 1.5% total national budget on
Health
No Separate allocation for Oral Health

Prevention of Oral diseases-Only
alternative
10 Years back- DMFT in USA – 11.6, Norway
12.5 , Sweden 14.1, England & Wales 10.5 ,
New Zealand 10.7 , Japan 8.7
It has reduced to 60% - 80%

OBJECTIVES
Oral health Education to masses- network
system
Information, Education & Communication
(IEC) material
Guidelines to strengthen Oral Health set-up

SHORT TERM GOALS-PILOT PROJECT
Accessible, Low Cost, Sustainable Oral
health
Frame and Develop Training module for
Master Trainers
IEC- material, Oral health awareness
Guidelines for strengthen Oral health Care

LONG TERM GOALS
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 &
Precancerous lesions from 19/ lakhs
Oral Health Care for all by 2010 AD

Existing Oral Health Services
Oral health Available at District, Sub Division, Tahsil
level hospital and 20% in CHC’s
44,000 dentists serving in India
39,720- registered ‘A’ Class
4,280 – registered ‘B’ Class

Integration of Oral health Services
into Existing health Infrastructure
1027 million population(2001)
District – Principal unit of administration – 3.5 to 4
million
About 439 districts Consists of blocks known as
Community Development Blocks
1,36,815 –Subcentres, 26,952- PHC’s ,3708- CHC’s
7,000 dentists/ annum
No dental surgeons posted
72%-Rural, 28%- Urban

Treatment Cost
• Population of India - 10 billion
• Children in Age range 3-16 years - 26 Crores
• Total Number of Cavities(DMFT-2) - 52 Crores
• Cost of filling/cavity(10 Rs each) - 520 Crores
• If each dentist filling 6 Cavities/day
then total filling done/day - 2,64,000
• Days required to fill 52 crores - 19700 days
(54 Years)
Economic burden of Oral diseases

Loss of Man days
1988-In USA an average 8 working hours/person
In India-No exact statistical data – 25 to 30% of
people are below poverty line (BPL) & 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.
Only alternative approach is – Preventive
Approach which is simple, cost effective

Plan of Extending Minimum Oral Health
Care to Entire India
Plan for Rural India
• Preventive Package
• Methodology of instituting primary
prevention
• Training of Trainers (TOT)

Preventive Package
Oral Health Education
- MPW’ s (Multipurpose Workers), Anganawadi
Workers, Health Guides, School teachers and
Doctors at CHC’ s and PHC’s
- Oral Cancer & Potentially Pre-cancerous lesions
Health worker should educate community &
insist for regular check up.

1. Information on importance of nutrition, balance
diet for pregnant woman
2. Pregnant Women – consult qualified doctor
3. Babies mouth is free of bacteria – Not to Kiss
babies
4. Health workers must teach feeding mothers
5. When First teeth erupt in mouth
6. Children encouraged to get habit of chewing
before teeth erupts
7. Take care of Deciduous teeth
Infant dental care

1. Should educate dental diseases are not age
related
2. Even elderly people need preventive and
restorative oral health care
3. Edentulous elderly should have dentures -
counteract the nutritional deficiency
4. Clean & massaging of the ridges
5. Care of dentures
Geriatric Dental care

1. Contact sports, Speed of Vehicles on
roads, injuries to children during play
2. Promotion of safety rules using helmets,
mouth-guards, seat belts and trauma
units in specified areas
Dentofacial injuries due to accident

1. In small groups children & parents – demonstrated
plaque in their mouth.
2. Demonstration of proper brushing technique
3. Frequency of brushing – Stressed 3 times a day after
each meal
4. Low economic status people – insist to use Chewing
sticks
5. IDA & Colgate (2003)- Bright Smiles & Bright future
Plaque Control Programme

1. Fluoride – can be used in various forms for preventing
the dental caries
Use of Chemico Prophylactic & Therapeutic agents

1. Rural masses – to reduce sugar food stuffs <3
times
2. Avoid snacking in between meals
3. Avoid retentive sugars
4. Education – Hidden Sugars in Cough Syrup, tonic
5. Total diet – not to exceed 5 times/day
6. Government – issue instructions to put statutory
warning on all sugar snacks – Chocolates, Toffees
“To much eating sweets leads to decay of teeth”
7. Fruits & Vegetables – Vitamins and minerals
Dietary Counseling

Methodology of Instituting Primary Prevention
in Rural areas
1. MPW’ s, Health assistants, Medical Officers, Health
guides, Health volunteers and School teachers -
should be trained
2. Knowledge about use of fluorides
3. The whole medical team & school teachers can be
educated about plaque.
4. Handling of minor dental emergencies & referrals
5. Diagnosis of Oral cancer

National Training Centre – Training of
the Trainer (TOT)
1. Calibrate the trainers e.g., dentists from – various
states & Union territories in India should be
assigned duty of various health teams.
2. Doctors, MPW’ s , Health Guides, School teachers
should be standardized various education material,
courses

Provision of at least one dentist at PHC
with efficient equipment
- Need to stress for dental surgeon, dental hygienists
& auxiliary oral health workers
- Role of dental surgeons – broadened
DCI Workshop of September, 1991
1. Sub Center
Oral Health Worker - 1 under Public Health
dentist/trained dental
surgeon for 3,000-5,000
population

2. Primary Health Center
Dental surgeon - 1
Dental Hygienist - 1
Chair side Assistant - 1 (Population of 30,000)
3. Community Health Center
Dental surgeon - 2
Chair side Assistant - 2
Dental Technicians - 1

4. Upto 100 Bedded Hospitals or Referral Centers
Dental surgeon - 3 (With 1 Specialist)
Dental Assistants - 4 (Dental lab & X-ray facility)
5. District Hospital
Dental Specialist - 4 (Chief Dental Surgeon)

6. Referrals/State Hospital/Medical College Hospital( >750
beds)
Dental Specialist Surgeon - 9
7. State Directorate
DGHS with other hierarchical staff with independent
charge & separate budget head
8. Central Health Ministry
Additional Director General Oral Health with
independent charge and separate budget head

Mobile Dental Clinics
Provide Dental health curative & restorative
services along primary prevention of dental
diseases
Rural masses to the door-steps, remote &
inaccessible areas
2 dental chair with working units , aerotor, micro
motor, ultrasonic scalers
3 dental surgeon, 1 dental assistant,1 dental
technician, 3 chair side assistants

Continuing dental education Programme
in each state
Each state – 2 training centers in state
Conduct – atleast 1 CDE Programme every 6
months
CDE Programme – recent concepts preventive &
curative
Directorate – also conduct same Programme for
private practitioner also

Role of Dental Colleges
Adopt one whole district – rural & Urban
communities
Interns should be posted compulsorily
Dental college – explore & utilize the special
provision of funds with Planning Commission

Strategies for Oral Health Care in
Urban Areas
Involvement and reorientation of dentists working
in Urban areas
Implementation of Primary Preventive Package
through the school health schemes in the different
Urban areas

Involvement, education & motivation of teachers in
the various colleges and other educational
institutions in Urban areas for delivery or Primary
Preventive Package to School/College going
children & Young adults
Exploration & involvement of other voluntary
(Rotary Club, Lions Club etc.., ) and Health
Organizations working in different urban areas in
achieving the oral health targets.

Utilization of the Mass Media
In India widespread – Audio Visual aids with cable
network
Ensure in spreading the right message
Take help of Ministry of Mass Communication, Short
2-3 minute films projected on television at peak
hours
Clearly defined radio messages and flashes
NOHCP workshop (2002)- “Kripaya Muskaraiye”

Oral health education materials like Charts, Posters,
Pamphlets, Models and comics – in Communities &
schools
Special Plays, Skits, Poems & Songs on Oral Health
developed as part of folk media – spreads Oral
health

Reorientation of Dental Education in
India
Dept of Community Dentistry – in Dental College
should be given more power, dynamic, active and
viable
From Planning Commission special funds can be
allocated to each dental college
Basic dental curriculum should be preventive &
Community need based

Involvement of other Allied Departments
- Department of Education & Social Welfare
should be involved to impart correct oral health
- Chapters giving adequate knowledge about oral
diseases & their prevention in text books of
Class 4th
, 7th
, and 9th
standards

Setting up of Apex Bodies of Dental
Education and Research
Set up in Post graduate dental education &
research on the pattern of NIDR (National
Institute of Dental Research) in USA & in INDIA
AIIMS – in New Delhi, PGI – Chandigarh

Conclusion

Thank Youwww.indiandentalacademy.com

National oral health care programme

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