Oral health is essential for overall health, well-being and good quality of life.  According to World health Organization (WHO) Oral health implies being free of chronic oro-facial pain, oral and pharyngeal (throat) cancer, oral tissue lesions, birth defects such as cleft lip and palate, and other diseases and disorders that affect the oral, dental and craniofacial tissues, collectively known as the craniofacial complex. Oral health affects general health by causing considerable pain and suffering by changing what people eat, their speech and their quality of life and well-being.

Optimal oral health is necessary for physical, mental and social wellbeing of an individual. Oral health and disease are continuum of a spectrum which is influenced by individual and community’s experience, perceptions, expectations and ability to adapt to different circumstances. 

Oral diseases encompass a range of diseases and conditions including dental caries, periodontal disease, tooth loss, oral cancer & precancerous lesions, oral manifestations of HIV infection, Oro-dental trauma and birth defects such as cleft lip and palate. Dental caries and periodontal disease can be considered as most common chronic diseases and are important public health problems because of their prevalence, their impact on individuals, society, and the expenses incurred towards treatment. 

Diet, dental plaque, tobacco use in different forms, alcohol, stress and trauma are some of the causes and risk factors for the common oral diseases. These factors are also common to a number of other chronic non-communicable diseases (NCDs) such as cardiovascular diseases (CVD), cancer, diabetes and stroke. Also, Oral diseases have been linked to a number of other systemic conditions like preterm low birth weight, bacterial endocarditis, Chronic Obstructive Pulmonary Diseases, atherosclerosis. Periodontal disease has direct links to Diabetes. Therefore, the compartmentalization involved in viewing oral health and diseases separately from the rest of the body must cease and an integrated approach to promote and prevent oral health along with general health should be used. 

Oral diseases affect individuals across all age groups and all geographical areas and pose a major health burden. It is estimated that oral diseases affect nearly 3.5 billion people across the world. Untreated dental caries in permanent teeth is the most common health condition according to the Global Burden of Disease 2017. More than 530 million children suffer from dental caries of primary teeth. Severe periodontal disease, which may result in tooth loss, is also very common, with almost 10% of the global population affected. Oral cancer is one of the three most common cancers in some countries of Asia and the Pacific.

Thus, Government of India initiated National Oral Health Programme (NOHP) in the year 2012-13 to strengthen the public health facilities of the country for an accessible, affordable & quality oral health care delivery. The NOHP has also initiated integration with other health care programs of Government of India to incorporate promotion of oral health along with general health. 

In the year 2012-2013, oral health was categorized as newer initiative under NRHM and the genesis of National Oral Health Programme started during this time and initial operational guidelines were made. 

Goals and Objectives of NATIONAL ORAL HEALTH PROGRAM

Goal:

To improve the oral health status of the population across all age groups by reducing the oral disease burden (incidence, prevalence and impact) through provision of accessible, affordable, acceptable, appropriate and comprehensive oral health care. 

Objectives:

1. Strengthening the oral healthcare delivery system at all levels to render promotive, preventive, curative and rehabilitative services. 
2. Providing support for generating evidences, innovations, and implementation of oral health policy to control and reduce the risk factors and prevent oral diseases.
3. To build the capacity of service providers and also public health facilities for availability of skilled oral health care professionals and provision of essential oral healthcare services. 
4. To ensure integration of oral health with relevant national programmes under NHM in line and convergence with National Health Policy and commitments under National Oral Health Policy.
5. Identifying centres of excellence at National, Regional and State levels for generating research innovations and evidences to strengthen oral health programme in the country
6. Supporting Centres of excellence in various activities including capacity building of service providers in the states.
7. To ensure regular monitoring and periodic evaluation of oral health program for improving the implementation and outcome envisaged under NOHP.

Implementation Framework

National Oral Health Programme (NOHP) shall be implemented through a strengthened oral health care delivery system at community, primary, secondary and tertiary level. A coordinated and collaborative approach between various stakeholders shall be adopted to reach the last mile of the society with special focus on socially, geographically, economically disadvantaged, children, pregnant women, elderly, individuals with special heath care needs etc.

Capacity of Programme Management at National State and district levels shall be appropriately augmented for providing effective guidance and take-up the responsibility of implementing the commitments under NOHP. 

Services at Primary level

At the primary level, services shall be delivered through Health and Wellness Centres (HWC) at Sub-centres and Rural Medical Dispensaries. CHOs at HWC-SHC shall be trained to conduct screening of oral lesions and shall be able to provide first aid for dental trauma, pain etc. before referral. Whereas, if a dental surgeon is available, they should be treating all common oral health problems, extraction and restoration of teeth, drainage of abscess, and also should be able to provide training to CHOs and other health workers. 

Services at Secondary level

At the secondary level, services shall be delivered through First Referral Unit – Primary Health Centres (PHCs), Community Health Centres (CHCs), Sub-district hospitals (SDHs) and District Hospitals (DHs). Besides the services being given at community and primary level, dental surgeons will provide curative services like minor oral surgical procedures, minor periodontal surgeries & preventive and interceptive orthodontic treatment etc. However, specialized work like dental implants, crown & bridges and fixed orthodontic treatment etc shall be provided at district hospital level if subject specialist is available and augmented with sufficient laboratory support. They should also be able to provide training to health workers for providing oral health services in the district. 

Services at Tertiary level

Oral health services at tertiary level shall be delivered through medical/dental colleges. These services are more specialised in nature and include complex procedures. Being the tertiary centres, they are responsible for in-service training of oral health care staff. In addition to the services available at the secondary level services, they will be the institute responsible for knowledge sharing, operational research, training, handholding and acting as referral centres for patients from District Hospitals and below.

The essential and desirable services at various levels is placed at Annexure 1.

Sanctioned  Strength of Dental cell, Directorate of Health Services

Besides the above, Various other activities are carried out under National Oral Health Program.

Oral Cancer Screening  is done in collaboration  with NCDC section. Out of all patients screened, 192 patients have been detected with pre- cancerous lesions/oral cancer. Early detection helps in early treatment. This results in reversal of the pre-cancerous lesion to healthy tissue.

Camp by PHC Siolim

Camp by UHC Panaji

Tobacco 633 patients are detected using tobacco from those that attend the OPD. Both smoking and smokeless forms of tobacco. These patients are counseled to help them stop. If required they are subsequently referred to our Tobacco Cessation Centres at both our District Hospitals or Goa Dental College & Hospital.

Tobacco Counselling at CHC Canacona

Camps are held in the villages under the respective Primary Health Centres. All the patients are examined and recalled on further appointments to complete their treatment. 155 camps were held. Total of 8442 patients were examined.

Camp held under PHC Candolim

World Oral Health Day is observed on 20th March every  year. Various activities in the form of camps, IEC in school, etc are organized during the week to create additional awareness on the importance of Oral Hygiene & its maintenance.

Skit Competition organized by SDH Ponda

Free tooth brushes and pastes were distributed to children of Anganwadi by PHC Cortalim

Talk on Oral hygiene by PHC Loutolim

Poster competition by PHC Porvorim

Camp Conducted for Special Children at Gujarati Samaj School, Margao

School Health activities are conducted twice a week, wherein the dentist visits the schools/anganwadis for check up of the students. Those requiring treatment are referred back to the PHC for further treatment.  586 schools were visited in the year 2022-2023 and a total of 20691 students were examined .Talks are given to the students on brushing & hygiene. 14 anganwadis were visited for check up, and   1477 children examined.

School visit by CHC Sankhalim

Tooth brushing technique demonstrated to student at school visit by PHC Colvale

School Visit by PHC Betki

Anganwadi visit by PHC Navelim

Anganwadi visit by PHC Shiroda

Old Activities

Oral Cancer Screening is done in collaboration with NCDC section. Out of all patients screened, 213 patients have been detected with pre- cancerous lesions/oral cancer. Early detection helps in early treatment. This results in reversal of the pre-cancerous lesion to healthy tissue.

Tobacco – 3970 patients are detected using tobacco from those that attend the OPD. Both smoking and smokeless forms of tobacco. These patients are counseled to help them stop. If required they are subsequently referred to our Tobacco Cessation Centres at both our District Hospitals or Goa Dental College & Hospital.

Counselling on tobacco Cessation under North Goa Dictrict Hospital, Mapusa at the Dental Clinic

Camps are held in the villages under the respective Primary Health Centres. All the patients are examined and recalled on further appointments to complete their treatment. 540 camps were held. Total of 17,723 patients were examined.

Camp held under PHC Curtorim

Camp held under UHC Mapusa

World Oral Health Day is observed on 20th March every year. Various activities in the form of camps, IEC in school, etc are organized during the week to create additional awareness on the importance of Oral Hygiene & its maintenance.

Brushing Technique being shown to school students with the help of a model

Free toothpastes distributed to the school children under PHC Cortalim under World Oral Health Day Program

Talk being given to all patients at SDH Ponda for World Oral Health Day

School Health activities are conducted twice a week, wherein the dentist visits the schools/anganwadis for check up of the students. Those requiring treatment are referred back to the PHC for further treatment. 578 schools were visited in the year 2018-019 total of 58,142 students were examined .Talks are given to the students on brushing & hygiene. 460 anganwadis were visited for check up. 11083 children examined.

A school boy demonstrating brushing technique to see if he has grasped it correctly.

School Check up under CHC Bicholim.

Talk given to a school under UHC Panaji as a PPT

Anganwadi visit under PHC Cansarvanem

Trainings for school teachers conducted with Goa Dental College. These were then supposed to train the students in their respective schools .