Thinley Namgay

Oral health problems have been on the rise in the country but investment in terms of budget, policy, and human resources has remained far behind according to health experts. 

Experts flagged these issues at a recent webinar on Oral Health and Dentistry in Bhutan marking World Oral Health Day. 

Oral medicine specialist from Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Dr Gyan Prasad Bajgai, said the country was facing a shortage of specialists and sub-specialists. 

The country in 2020 had 68 dentists, three oral and maxillofacial surgeons, one oral medicine specialist and pedodontist each, two prosthodontists, four orthodontists, 76 dental hygienists and 44 dental technicians. 

The required human resources per 50,000 people, he said, were 13 oral and maxillofacial surgeons, 15 oral medicine specialists, 12 orthodontists, 14 prosthodontists and 15 pedodontists excluding other oral health professionals. 

Bhutan has three oral and maxillofacial surgeons, one oral medicine specialist, four orthodontists, two prosthodontists, a pedodontist and no specialists in other dental fields.

He said that five dentists, four dental hygienists, and four dental technicians resigned in the past few years.

Three doctors are undergoing specialisation courses in Thailand and Malaysia. 

According to him, there is no provision for long-term training in dentistry in the current Plan. “We need a pool of experts,” he said, adding that the Khesar Gyalpo University of Medical Sciences of Bhutan ( KGUMSB) should produce specialists in the field.

He said that a division for oral health services in the health ministry should be created and a dental hospital established.

Dr Gyan Prasad Bajgai also said that there were discrepancies in in-service conditions of KGUMSB. He explained that MD (Doctor of Medicine), MS (Master of Science) and PhD candidates are preferred for teaching positions over those with equivalent degrees such as MDS (Master of Dental Surgery) and MSD (Master of Science in Dentistry).

“As a consequence, dental specialists are placed one grade lower than our colleagues (in other departments), which is a loss of four years. They need to serve at least six years at the associate professor level to get promoted to the professor level,” he said.        

Citing a recent letter from the RCSC, he said that all graduates except MBBS would be placed at P5A level from 2024. “It is unfair for dental graduates who in the region are placed at par with MBBS graduates,” he said. 

JDWNRH provides common oral health services such as consultations, demonstrations of oral hygiene measures, oral health education (diet and visits), tooth extraction, biopsies, fillings, root canal treatments, mouth X-ray, sealants and fluoride applications and dental prosthesis.  

Hospitals also provide specialised oral health services including cleft lip and palate repairment, constructive surgeries of face and bones, caps, feeding devices for cleft palates, root canals and oral medicines.

Dental Surgeon Dr Tshewang Gyeltshen from Tsirang district hospital said oral hygiene was neglected in rural areas. 

He said that 43 years after the adoption of the 1978 Alma Ata declaration, which expressed the need for urgent national and international action to protect and promote the health of all, people were much happier and healthier. “But certain aspects of health services have been neglected. For instance, there is no equity in terms of policies and their implementation globally when it comes to dentistry.”

Major victims of oral health problems in Bhutan are children. About 84 percent of children aged between five and six years suffer from oral health problems in Bhutan.

“Health assistants and nurses in our communities are doing an excellent job, but they lack knowledge in precancerous examinations. People have to wait in queue at JDWNRH,” Dr Tshewang Gyeltshen said, adding that oral diseases were more common than other diseases.  

To improve oral health services, Dr Tshewang Gyeltshen said that the government should come up with proper human resource mappings. “We should make oral health service coverage, screening and visits to BHUs by dzongkhag-level dental health officials mandatory part of the performance reporting system,” he said.

Dr Tshewang Gyeltshen also said that a dental hospital was required in the country.

However, Health Minister Dechen Wangmo said that dental services were covered in the government’s essential health services package.

“Bhutan is one of the few countries that have included dental services in the essential health services list as per the Alma Ata Declaration of 1978. The government is focusing on developing a multi-disciplinary hospital where a separate unit for dentistry will be instituted to provide advanced services,” Lyonpo said. 

Professor OP Kharbanda from the All India Institute of Medical Sciences (AIIMS) said oral health services were expensive and was not part of the universal health coverage globally in the past. According to him, the cost of a dental implant in India varied from INR 35,000 to 45,000.

He said that there was a need for Bhutan to institute an oral health commission and draft policies on oral health, smoking and chewing of betelnut. 

The country recorded a total of 194,366 oral morbidity cases in 2019.

Common oral diseases in the country are dental caries, lip cancers and oral cavity, tooth loss, gum diseases, crooked teeth and oro-dental trauma. Oral diseases are linked to diet, alcohol, stress, tobacco and betel nut, according to health experts.