Oral diseases have become a major burden on the national health care system over the years, according to experts. They attribute the increase in the number of cases to the lack of awareness among people.
For instance, 390,097 people or more than 51 percent of the population never availed oral health (OH) services in the entire year of 2019. In the same year, 194,366 oral morbidity cases were reported at health centres across the country.
Dental caries, cancers of lips and oral cavity, Periodontal diseases, tooth loss, precancerous lesion, gum diseases, crooked teeth, and oro-dental trauma are critical oral diseases prevailing in the country at present.
Dental caries, a major public health problem globally, is also a widespread form of non-communicable diseases (NCDs) in Bhutan. Currently, 2.3 billion dental caries and 560 million early childhood caries were reported globally. South-East Asia region alone accounts for more than 60 percent of these cases.
A Dental Surgeon at Tsirang hospital, Dr Tshewang Gyeltshen, said that in Bhutan dental caries is most common among school children (63 percent), preschool children (81 percent), and pregnant mothers (68 percent). Periodontal diseases are 60 percent. Cancers of the lips and oral cavity constitutes to be among the top causes of mortality from cancers.
He said that oral health was not perceived as a priority due to other daily competing priorities because of the low level of oral health literacy. “There is difficulty in obtaining affordable and appropriate transport to the health facility, especially rural communities, and lack of availability of specialised care needs in districts.”
Dr Tshewang Gyeltshen said that there was a lack of funding for an oral health programme and dental services and a lack of integration of oral health with other mainstream health programmes.
“Services are not commissioned based on oral health needs assessments, and workforce not trained to meet the population’s specific needs. There is limited adoption of prevention and oral health promotion activities,” he said.
The oral disease morbidity in the last 20 years was always on an increasing trend, he said. “Comparative trend of dental to other NCDs per 10,000 people are high.”
Dr Tshewang Gyeltshen said that to strengthen oral health service in Bhutan, there has to be faculty of dentistry and oral health in Khesar Gyalpo University of Medical Sciences of Bhutan (KGUMSB), a national dental hospital, and national programme for oral health. He also said that current dental service standards in referral hospitals and district hospitals needed revision.
Paedodontist at JDWNRH, Dr Sonam Ngedup, said that health centres provided 9,428 prophylaxis, 4,660 scaling, 49,993 fillings, 61,794 extractions, and 68,491 other services in 2019.
He said that between 2018-2020, 27 dental patients were sent to Kolkata and Vellore in India. Each patient costs Nu 0.15 million for referral between 7-21 days.
Dr Sonam Ngedup said that to prevent oral diseases, an evidence-based approach, network among dental personnel and alliances, and comprehensive health policy were necessary.
Human resource constraint remains a major issue.
In 2020, Bhutan had 68 dentists, three oral and maxilla facial surgeon, an oral medicine specialist, one pedodontist, two prosthodontists, four orthodontists, 76 dental hygienists, and 44 dental technicians.
Oral Medicine Specialist at JDWNRH, Dr Gyan Prasad Bajgai, said, “We have a shortage of specialists and sub-specialists.”
The dentist-patient ratio in 2021 as per the WHO is 1:7,500. However, in Bhutan, it is 1:11,500, and the specialist ratio is 1:194,000. “Doctor to patient ratio is even higher,” said Dr Gyan Prasad Bajgai.
Oral disorders rank first in the world in 1999 and 2019, according to experts. At least half of the world’s population still does not have full coverage of essential health services. About 100 million people still pushed into extreme poverty, and over 800 million people spent at least 10 percent of their household budget on buying health care.
Professor OP Kharbanda from AIIMS, India, said that the poorer section of people is a victim of OH diseases. “Treatment for oral health conditions is expensive and usually not part of universal health coverage (UHC). In most high-income countries, dental treatment averages 5 percent of health expenditure and 20 percent of out-of-pocket health expenditure.”
The draft resolution on oral health was proposed by Bangladesh, Bhutan, Botswana, Eswatini, Indonesia, Israel, Japan, Jamaica, Kenya, Peru, Qatar, Sri Lanka, Thailand, and the EU member states, which will be discussed in the 74th World Health Assembly.
Health Minister Dechen Wangmo said that for a resource challenge country like Bhutan, the government must invest in public health prevention. “We can focus on fundamentals, that is, prevention. The unit cost return on investment on prevention is much higher than that of the curative aspect.”
Lyonpo said that there was a huge gap in knowledge of oral health. “Investment in building the competency and capacity of our professionals will be a priority to deliver effective services. The government has passed the legislative on taxing heavily on sugary drinks and tax-free commodities that promote health and well-being. We’re integrating oral health into our MCH screening tool to address knowledge and service gap.”
KGUMSB, JDWNRH, and the health ministry marked World Oral Health Day on March 20 with a webinar on ‘oral health and dentistry in Bhutan: call for action to address a public health urgency’.