Dr. Preyas Joshi Deptt. Of Public Health Dentistry Rajasthan Dental College & Hospital Jaipur, Rajasthan

1. DENTAL MANPOWER PLANNING IN INDIA
Guided by:
Dr. Girish R Shavi
Dr. Mayank Agrawal
Presented by:
Dr. Preyas Joshi
Second year postgraduate student
Public health dentistry
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2. Manpower
 The number of people working or available for work or service.1
 All the people who are available to do a particular job or to work in a particular place.2
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•Manpower surplus: there are more people than
available jobs.
•Manpower deficit: available people are fewer than
jobs.

3. Planning
 A detailed scheme, method, etc, for attaining an objective. a proposed, usually tentative idea
for doing something.3
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4. MANPOWER PLANNING
 Thomas H. Patten(1971) defines manpower planning as "the process by which an organisation
ensures that it has the right number of people and the right kind of people at the right place at
the right time, doing things for which they are economically most useful“.4
 In the words of Filppo(1976), "A manpower planning programme can be defined as an
appraisal of an organisation's ability to perpetuate itself with respect to its management as a
determination of measures necessary to provide the essential talent.“5
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5. H E A LT H M A N P O W E R P L A N N I N G
 Health “manpower” planning is the process of estimating the number of persons and the kind
of knowledge, skills and attitudes they need to achieve predetermined health targets and
ultimately health status objectives. Such planning also involves specifying who is going to do
what, when, how and with what resources for populations, groups and individuals. It must be a
continuing and not a sporadic process, and it requires continuous monitoring and evaluation.
- Mejia and Fülöp (1978)
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6. T H E P R I N C I P L E S O F O R G A N I S AT I O N A N D M O D E L S O F D E L I V E RY O F
O R A L H E A LT H C A R E 6
Oral health care system includes:
 Health policies to promote oral health.
 Resources including personnel and facilities.
 Strategies that organise those resources to provide services.
(Andersen et al, 1995)
There are no definitive models of different types of oral health care delivery and various countries
have developed a range of systems.
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7. T H E S Y S T E M S C O N C E P T A P P L I E D T O O R A L H E A LT H
A system is a set of elements, actively interrelated which operates in a bounded unit.
A systems approach is valuable for examining the organisation of oral health care delivery.
(Andersen et al,1995; Edelstein, 2002)
Oral health care systems usually have a goal to attain freedom from diseases and
impairments for the population served.
(Baker, 1970; Scott, 1987)
Systems are influenced by society structure and cross-cutting social policies.
(Thomson et al,2002)
• Generally, oral health care systems seek to improve the quality of life of the population
through research, education, provision of services, and through the promotion of policies such
as fluoridation.they are made up of health policies, resources and strategies available to
provide care.
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8. Oral health care systems respond to:
 Changes in population demographics.
 Changes in patterns of oral diseases.
 Impact of oral diseases in relation to other systemic diseases.
 Social, political or economic structure and societal norms as reflected in national policies,
legislation, regulations, and payment system.
 Characteristically, system analysis includes:
 Who provides
 What service/functions
 For whom
 In what location
 With what resources.
 By what payment mechanisms
 With what effects
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9. C H A R A C T E R I S T I C S O F T H E O R A L H E A LT H C A R E S Y S T E M
Oral health care systems worldwide can be described by:
• Policy
• Organisation
• Payment mechanisms
• Outcomes
Oral health care systems respond to specific oral diseases and policies that focus on
identified populations such as age groups.
(andersen et al, 1995; boerma et al, 1998)
• A different system will develop in a nation that has stated objectives for school age children
than in a country that targets infants or no specific age group.
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10. • Worldwide, systems differ in the focus placed on the range of functions.
• The appropriateness of organisations to carry out system functions varies.
• Universities and governments are logical components of the system to carry out functions of
administration, policy, and research.
• Often oral health care systems have been described on the basis of only one or two
characteristics, perhaps reflecting what is more unique to that country:
 New Zealand – School-based system employing dental nurses
 British – National health service
 U.S.A – Fee-for-service private practice system
Each system should be understood for all its characteristics, since systems are not
unidimensional, and most have adapted over the years.
(Hancock et al, 1999; Wang et al, 1998)
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11. 5/4/2015 11
TA X O N O M Y F O R S Y S T E M AT I C C R O S S - N AT I O N A L C O M PA R AT I V E A N A LY S I S
O F O R A L H E A LT H C A R E S Y S T E M S
Personnel
•Dentist
•Dental hygienist
•Dental therapist
•Expanded-duty assistant
•Dental assistant
•Oral health community worker
•Community worker
•Other health care and social work
professionals (e.g., physicians, nurses)
Structure/Location
•Government facilities
•Universities
•Worksites
•Hospitals, institutions
•Schools
•Health/dental clinics
•Mobile units
•Individual dental offices
•General community facilities
Financing
•General government revenue
•Specific taxation
•Compulsory insurance
•Insurance or prepayment supported by
employer or individual
•Direct payment, private income
•Reimbursement
•Fee-for-service
•Capitation
•Contract
•salary
Target population
•Infants
•Preschool children
•School-age children
•Young adults
•Adults
•Older adults
•Special care populations
•Identified occupational groups
Functions
•Policy development & implementation
•Administration
•Quality control
•Research
•Professional education
•Public oral health education
•Preventive services
•Emergency services
With what effect(examples)
•Appropriate dental care
•Improved knowledge, values, opinions and
behaviors regarding oral health
•Less dental caries among adults
•Reduced tooth loss
•Improved oral health

12. O V E R V I E W O F T H E O R A L H E A LT H C A R E D E L I V E R Y S Y S T E M
SOCIO-POLITICAL AND ECONOMIC ISSUES AT SOCIETAL LEVEL
↓ ↑
POLICIES
↓ ↑
ORAL HEALTH CARE DELIVERY SYSTEM
Personnel Target population(s) Financing
Functions Structure Reimbursement
↓ ↑
ORAL HEALTH OF POPULATION
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13. P O L I C I E S A N D O B J E C T I V E S
Goals & objectives:
 Some countries have neither clearly articulated oral health objectives nor a well defined
system of care (or have one but not the other).
 Other countries have oral health objectives that appear to have been developed independentaly
of the organisation of care, with a system that is unresponsive to those objectives.
 Yet others have clearly stated objectives and a system designed to response to those objectives,
both of which are outdated.
‘ At the very basis of the system of oral health care are the goals and objectives – the
purposes and expected outcomes of care’
(WHO, 2003)
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14. Oral health systems may have one or any combination of the following objectives:
 Management and elimination of dental emergencies
 Treatment of existing diseases
 Elimination of progression of diseases
 Prevention of future diseases
 Finding new ways of preventing and treating diseases (research)
 Improved use of new and existing preventive and treatment approaches (education)
Often uncoordinated programs and appearances of ambivalence about oral health care as a
‘social good’ result when there is no clearly articulated policy.
WHO has developed conceptual models and strategies to facilitate evaluation of and
planning of system performance.
(WHO, 2003)
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15.  Systems of oral health care are influenced by societal policies and have policies of their own
that affect the organisation of the system and services provided.
 Policies,set for meeting the objectives of the oral health system, provide guidelines for
securing and organising resources and may be either explicit or implicit.
 Policies might be represented by national nutrition guidelines or mandated governmental
sponsored research, provision of care, or school education and service programmes, among
others.
the facilities, numbers, types and distribution of personnel, sources of revenue, and
reimbursement procedures are representative of resources in the oral health care system
that are influenced by policy
(Gift, 1993;Boerma, 1998; kallestal et al,1999)
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16. National policies influence:
 Who is entitled to care
 Which age group are emphasised
 What type of care are received
 Who provides the care
 Where the care is provided
Recognising the complexity of the many combined issues, the world health
organisation(WHO) and other organisations are increasingly encouraging evaluations.
(WHO, 2003)
Major evaluations have been undertaken in many countries during the past decade.
(Neenan et al, 1993; IOM, 1998; Hancock et al, 1999; Seldin, 2001; Seldin and brown, 2002; Van Palenstein Heldermann, 2002)
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17. O R G A N I S AT I O N
 Generally, the organisation of the delivery system has been described using a medical model,
limited to the oral health care professionals associated with dental schools, clinics, individual
dental practices, and government components directly associated with policy, remuneration, or
delivery of oral health care.
More recently, comprehensive community/public health models have gained favour over the
medical model
(Andersen et al, 1995; Chen et al, 1997)
Using this expanded model, pharmacists, physicians, nurses, school teachers, and water
work supervisors become part of the oral health care delivery system. Similarly,
worksites, hospitals, nursing homes, and institutions are appropriate facilities for care.
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18.  The following description focuses on more traditional oral health care facilities and personnel.
 Structure
a) National level
At the national level, oral health care may be:
• Entirely centrally organised
• Partly decentralised
• Completely decentralised.
Oral health care may also be:
• Well identified with defined structures and leadership
• Integrated with other medical services
• Not acknowledged as part of a national agenda at all.
b) Practice level
The most frequently observed structures for delivery of oral health care are independent
practices with one or more dentist (owner or employed associates), clinics (public or
private), and community outreach programmes in mobile units or any available and
convenient facility.
(Arnljot et al,1985; Neenan et al,1993; Andersen et al, 1995)
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19. S T R U C T U R E O F O R A L H E A LT H C A R E S RV I C E S
Much of the current oral health care approach has developed from
• The demands of treating caries in children and
• Providing restorations for dental caries and treatment for periodontal diseases of healthy,
mobile young adults
However, the traditional structure of dental practices may be less suitable for case of
• Older adults
• Individuals in remote locations
• Provision of many health promotion and disease prevention initiatives, particularly for people
who do not routinely visit a dentist
(Boerman et al, 1998; Mertz and O’Neil, 2002; Pacza et al, 2001)
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20. O R A L H E A LT H C A R E P E R S O N N E L
EDUCATION AND TRAINING:
• The education and training of oral health care personnel set the stage for the
organisation of the oral health care delivery system.
(Weaver et al,2000)
• The time devoted to education and training of dentists usually is more than that for other
oral health personnel, and the system is organised through licensing and credentialing to
produce competent professionals.
(Jeffcoat and clark, 1995; Kress, 1995; Tedesco, 1995)
• There has been continued pressure to increase training of dentists for preventive
approaches and care of specific groups such as young children and medically
compromised patients.
(Atchison et al, 2002; Crall, 2002; Valachovic, 2002)
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21. F I N A N C I N G , R E I M B U R S E M E N T, A N D R E M U N E R AT I O N
Financing reflects how money gets into the system
The most common approaches being
 General government revenues
 Specific taxation
 Insurance or prepayment premiums paid by individuals and/or employers
 Out-of-pocket direct payment by individuals.
Reimbursement, including remuneration, is the mechanism for payment for services, e.g. fee-for-
service, capitation, contract, or salary
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22. Dental Manpower7
• DENTIST - A dentist is a person licensed to practice dentistry under the law of the appropriate state
province territory or nation. These laws ensure that to become licensed, a prospective dentist must
satisfy certain qualifications. Dentist are concerned with the prevention and control of diseases of the
oral cavity and the treatment of unfavorable conditions resulting from these diseases, from trauma or
from inherent malformations. They are legally entitled to treat patients independently, to prescribe
certain drugs and to employ and supervise auxiliary personnel. Dentists must be registered.
Dentist must satisfy,
 Completion of an approved period of professional education in an approved institution.
 Demonstration of competence.
 Evidence of satisfactory personal qualities.
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23. D E N TA L A U X I L I A RY / A N C I L I A RY
• A dental auxiliary is a person who is given responsibility by a dentist so that he or she can help
the dentist render dental care,but who is not himself or herself qualified with a dental degree.
• The duties undertaken range from simple tasks such as sorting instruments to relatively
complex procedures.
CLASSIFICATION(WHO, 1967)
• Non-operating auxiliaries:
1) Clinical: This is a person who assists the dentist in clinical work but does not carry out
any independent procedures.
2) Laboratory: A person who assists the dentist by carrying out certain technical laboratory
procedures.
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24. • Operating auxiliary:
person who not being a professional can carry out procedures under the supervision of a
professional.
REVISED CLASSIFICATION
• Non operating auxiliaries:
 dental surgery assistant
 dental receptionist
 dental laboratory technician
 dental health educator
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25. • Operating ancillaries:
 school dental nurse
 dental therapist
 dental hygienist
 expanded function dental ancillaries
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26. DENTAL SURGERY ASSISTANT
• Dental assistant is a non operating auxiliary who assists the dentist and the dental hygienist in
treating patients, but who is not legally permitted to treat patients independently.
• Dental assistant may work under the supervision of a licensed dentist, carrying out duties
prescribed by the dentist or by a dental hygienist employed by the dentist.
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27. D E N TA L S E C R E TA RY / R E C E P T I O N I S T
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• This is a person who assists the dentist with his secretarial work and patient reception duties.

28. D E N TA L L A B O R AT O R Y T E C H N I C I A N
• A dental laboratory technician is a non operating auxiliary who fullfills the prescription
provided by dentist regarding the extra oral construction and repair of oral appliances and
bridge-work.
• This category of personnels have also been known as dental mechanics.
• As per the dentist act of 1948, dental mechanic is a person who makes or repairs dentures and
dental appliances.
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29. D E N T U R I S T
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 Those dental laboratory technicians who are permitted to fabricate dentures directly for the
patients without a dentists prescription. they may be licenced or registered.

30. T H E D E N TA L H E A LT H E D U C AT O R
• This is a person who instructs in the prevention of dental disease and who may also be
permitted to apply preventive agents intraorally.
• In sweden, two additional weeks of training is given, after which ancillaries are allowed to
conduct fluoride mouth rinsing programmes.
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31. T H E S C H O O L D E N TA L N U R S E
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 This is a person,who is permitted to diagnose dental disease and to plan and carry out certain
specified preventive and treatment measures, including some operative procedures in treatment
of dental caries and periodontal disease in defined group of people, usually school children.
 dental nurses are presumed to provide care more cheaply than dentist.They are less expensive
to train unlike dentist and their salaries are similar to those of physical therapist and school
teachers.

32. T H E D E N TA L T H E R A P I S T
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 This is a person who is permitted to carry out to the prescription of a supervising dentist,
certain specified preventive and treatment measures including the preparation of cavities and
restoration of teeth.
 The training of the therapist is about 2 yrs involving both reversible and irreversible
procedures.
 Their duties include,
 clinical caries diagnosis.
 Cavity preparation in deciduous and permanent teeth.
 vital pulpotomies using rubber dam in deciduous teeth.
 Extraction of deciduous teeth under local anaesthesia.

33. T H E D E N TA L H Y G I E N I S T
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 The dental hygienist is a person licensed and registered to practice oral hygiene under the laws
of appropriate state, province, territory or nation. The dental hygienist works under the
supervision of the dentist.
 Who does oral prophylaxis, gives instructions in oral hygiene and preventive dentistry, assists
the dental surgeon in chairside work and manages the office.
 As per the Indian dentist act of 1948, a dental hygienist means a person not being a dentist or a
medical practitioner, who scales, cleans or polishes teeth, or gives instruction on dental
hygiene.

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 Dental council of India’s norms for dental hygienists:
1) The course of studies should extend over a period of two academic years and lead to the
qualification of dental hygienist certificate.
2) The candidate should be at least 15 years of age at the time of admission or within 3 months
of it and should be medically fit.
3) the candidate must have passed at least matriculation examination of a recognized university
taking science subject or an equivalent recognized qualification.

35. E X PA N D E D F U N C T I O N D E N TA L A U X I L I A RY ( E F D A )
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 An EFDA is a dental assistant or a dental hygienist in some cases, who had received further
training in duties related to direct treatment of patients, though still working under the direct
supervision of a dentist.
 They take reversible procedures i.e which can be corrected or redone without any undue harm
to the patient. They do not prepare cavities or make decisions as to pulp protection after caries
has been excavated, but work along side dentist and take over routine restorative procedures,
as soon as cavity preparation and base have been completed.

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They Perform following Duties:
• placing and removing rubber dams.
• Placing and removing temporary restorations.
• placing and removing matrix bands.
• condensing and carving amalgam restorations.
• placing of acrylic restoration in previously prepared teeth.
• Applying the final finish and polish to the previously listed restorations.

37. F R O N T I E R A U X I L I A R I E S
 In developed countries, dentists remain in urban centers and a large number of areas are too distant
from public or private dental offices for the inhabitants to receive regular comprehensive care or
emergency pain relief.
 Nurses and former dental assistants can in such areas, provide valuable service with minimum
amount of training.
 Functions:
 Simple dental prophylaxis.
 Basic dental health education.
 Dental first aid can be rendered in cases with pain and patients can be referred to the nearest dentist
more intelligently than would be possible by untrained people.
 They can also organize fluoride rinse programs.
 Simple denture repairs.
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38. N E W A U X I L I A RY T Y P E S
 The expert committee on auxiliary dental personnel of the WHO(1959) has suggested two new
types of dental auxiliaries:
1) The dental licentiate - He is a semi-independent operator, trained for two yrs to perform
dental prophylaxis, cavity preparations and filling of deciduous and permanent teeth,
extrations under L.A, drainage of abscess, treatment of most prevalent diseases of
supporting tissues, early recognition of more serious dental conditions.
2) The dental aide - The duties performed are extraction of teeth under local anaesthesia,
control of haemorrhage, recognition of dental disease which is important enough to
justify transportation of the patient to a center where proper dental care is available.
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39. H E A LT H W O R K F O R C E I N I N D I A 8
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40.  Health-worker availability
Table 1 shows the absolute numbers and category-wise density (per 1000 population) of
doctors, dentists and nurses including midwives at the national and state levels. In 2009,
India had 761 806 doctors, 104 603 dentists and 1 650 180 nurses and midwives. At the
national level, the aggregate density of doctors, nurses and midwives was 2.08 per 1000
population, which was lower than WHO’s critical shortage threshold of 2.28.[9] There
were gross inequalities in the availability of these health workers at the subnational level.
For example, states such as Bihar, Uttar Pradesh, Uttarakhand, Jharkhand and
Chhattisgarh had especially severe shortages of health workers [less than 1 per 1000
population].
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41. D E N TA L H E A LT H W O R K F O R C E I N I N D I A
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[Table/Fig-1]
shows the
absolute numbers
and category-
wise density (per
1000 population)
of dentists at
national and state
levels. In 2009,
India had 104603
dentists. There
were gross
inequalities in
the availability of
these health
workers at the
sub national
level.[10]

42. 5/4/2015 42
Three important
developments highlighted:
First is the recent rapid
expansion in the training
capacity of dentists.
Between 1991 and 2013,
the number of admissions
to dental institutions
expanded from 3100 to 23
800, i.e. by 66.8%[11].
There were clear
inequalities in the
distribution of these
training institutions
among states. Although
the Empowered Action
Group states account for
almost half of the
country’s population, they
house approximately a
quarter of the dental
institutes [8].
Second, there has been a
notable increase in the
private sector’s
involvement in Dental
education. Before 1991,
there were only 49 dental
colleges, of which 23
(47%) were government
owned. As of 2013, 246
new dental institutions
recognized or approved by
the DCI have been added to
the existing list, of which
almost all (229) are in the
private sector [8,11]. Third,
despite the consistent
increase in dentist’s
production, posts in public
health sectors/government
are still questionable.

43. 5/4/2015 43
[Table/Fig-3]
shows an
inter-state
inequality
among
public health
dentists.

44.  As India strives to achieve universal health coverage, improvement in oral health care delivery
with skilled and motivated dental health workforce is necessary. Human resource shortages
hinder scale up of health services and limit the capacity to absorb additional financial
resources [12]. A clear understanding of the dental health-workforce situation is very critical to
develop effective policies.
 Strength: In the past two decades, there has been drastic progress in increasing the training
capacity [13]. This review shows that key finding regarding workforce production is the
increase in training capacity because of the growth in private sector involvement in dental
education. This trend seems likely to increase, since incentives and regulation relaxations have
been introduced to encourage private investment in dental education.
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45.  Weakness: The primary data used in this review are the numbers of dental health personnel
registered with the Dental Council of India & Dental Public Health Association and therefore
have several limitations. These councils do not maintain live registers, except for doctors in
Delhi. The information they provide may be inaccurate owing to non adjustment for deaths,
migrations and retirements, or double counting of workers registered in more than one state.
Furthermore, not all state councils follow the same procedure for registration, which may
compromise direct comparisons. In spite of these limitations, this review is an attempt to
highlight some key issues that the Government of India and development partners should
consider when addressing the health human resource crisis. There is gross inadequacy in
availability of the current stock of dentists [13,14] & public health dentist’s and significant
inequalities in their distribution between the different states. Poorly performing states, in terms
of health outcomes, have a greater shortfall in the number of dentists.
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46.  Threats:
 1. Privatization of dental education has helped to overcome the shortcomings resulting from
inadequate expansion of the training capacity in the public sector, but also raised questions on the
quality of dental training. An example was an initiative to standardize the quality of medical & dental
education by MCI’s decision to introduce a single National Eligibility and Entrance Test for
undergraduate admissions at all government and private dental colleges. This test has not yet been
implemented and there is scepticism as to how it might be transparently and fairly applied to the
800,000 students who would take the test each year [8,15].
 2. The gross inequality in the distribution of the training institutes among the different states. These
institutes are primarily clustered in states with high GDPs, where the issues related to shortages of
dentists are relatively less acute.
 3. Increased mismatch between dentists production and job opportunity in government
hospitals/public health sector. This finding suggests that increases in the production and overall
supply of dental graduates will not necessarily address the public sector shortages. Other
strategies will need to be introduced to encourage dental health workers to serve in the public
sector.
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47.  4. Immigration & migration of dentists, changing disease pattern & treatment needs along with
numerous challenges for expanding oral health care in India. The biggest challenge is the need
for dental health planners with relevant qualifications and training in public health dentistry.
There is a serious lack of authentic and valid data for assessment of community demands, as
well as the lack of an organized system for monitoring oral health care services need to guide
planners [13].
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48.  The most important resource of the country is its 1027 million population (2001 census),
distributed in 28 States, 7 Union Territories, 5564, tehsils/talukas, 640,000 villages and 5161
towns and cities.14
 India is predominantly rural, as over 72% of people continue to live in rural areas.15
 Rural health infrastructure has been well designed to cover rural population through 136815
subcentres (SCs), 26952 Primary Health Centres (PHCs) and 3708 Community Health Centres
(CHCs).
 Oral health care of necessity has to be delivered through primary health care infrastructure,
because of limited resources and manpower of dentists.
 Though the country is producing 7000 dentists per annum, the dentist: population ratio is
1:30000, the distribution of dentist to population requirement is grossly uneven. More than
90% of doctors are available in urban settings and only 10% available to 72% of rural
population.16,17
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NATIONAL ORAL HEALTH POLICY16

49.  National Oral Health Policy has been formulated by the "Dental Council of India", through the
inputs of two national workshops organized way back in 1991 and 1994 at Delhi and Mysore
respectively.
 These workshops considered the recommendations of national workshops on oral health goals
for India, Bombay 1984 and a draft oral health policy prepared by Indian Dental Association in
1986.
 As a follow up measure of these efforts, the core committee appointed by Ministry of Health
and Family Welfare, could succeed to move the resolution in fourth conference of Central
Council of Health and Family Welfare in the year 1995.
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50. 1. There is an urgent need for an Oral Health Policy for the nation as an integral part of the
National Health Policy.
2. Special, well coordinated, National Oral Health Programme be launched to provide Oral Health
Care, both in the rural as well as in urban areas due to deteriorating oral health conditions in
the country as revealed by various epidemiological studies. Dentist/population ratio in the rural
areas is only 1:300,000. Whereas, 80% of the children and 60% of the adults suffer from dental
caries, more than 90% of adult community after the age of 30 years suffer from periodontal
diseases which also has its inception in childhood. In addition, 35% of all body cancers are
oral cancers. Large segment of the adult population is toothless due to the crippling nature of
the dental diseases and about 35% of the children suffer from malaligned teeth and jaws
affecting proper functioning. In view of these facts, it is important to launch preventive,
curative and educational oral health care programme integrated into the existing system
utilizing the existing health and educational infrastructure in the rural, urban and deprived
areas.
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Ten points resolution has been brought out by the Councill7:

51. 3. A post of full time Dental Advisor at appropriate level in the Dte.G.H.S. should be created as a
first step towards strengthening the technical wing of the Dte.G.H.S.
4. Studies have revealed that dental diseases have been increasing both in prevalence and severity
over the last few decades. There is, therefore, an urgent need to prevent the rising trend of
dental diseases in India. The method used for primary prevention of dental diseases aims at
achieving primary prevention of periodontal diseases and oral cancers.
5. The council, therefore, resolves that preventive and promotive Oral Health Services be
introduced from the village level onwards and accordingly a pilot project on Oral Health Care
may be launched by the Ministry of Health and Family Welfare during 1995-96 in five
districts, one each in five States.
6. The Council further resolves that legislative measures be adopted to ensure a statutory warning
on the wrappers and advertisement of sweets, chocolates and other retentive sugar eatables
TOO MUCH EATING SWEETS MAY LEAD TO DECAY OF TOOTH’. Similar measures are
also called for tobacco and Pan Masala related products.
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52.  7. The Council recommends that a National Training Centre be established or the existing
centres be strengthened for training of various categories of oral health care personnel.
 8. The Council also resolves that all District Hospitals and Community Health Centres have
dental clinics. All Dental Colleges should have courses on Dental Hygienists and Dental
Technicians.
 9. The Council further resolves that the Pilot Project may be extended to all the States at the
rate of one District in every State.
 10. The Council also resolves that there is an urgent need to have a National Institute for
Dental Research to guide oral health research appropriate to the needs of the country.
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53.  Fourth Conference of Central Council of Health & Family Welfare in October 1995, New Delhi resolved
that:
 There is an urgent need for an Oral health Policy for the nation as an integral part of the National Oral
Health Care Programme Health Policy.
 Special, well coordinated, National Oral Health Care Programme be launched to provide Oral Health Care,
both in the rural as well as urban areas due to deteriorating oral health conditions in the country as revealed
by various epidemiological studies. Dentists/population ratio in the rural areas is only 1:300,000 whereas
80% of the children and 60% of the adults suffer from dental caries, more than 90% of adult community
after the age of 30 years suffer from periodontal diseases which also have its inception in childhood. In
addition, 35% of all body cancers are oral cancers. Large segment of the adult population is toothless due to
the crippling nature of the dental diseases and about 35% of the children suffer from mal-aligned teeth and
jaws affecting proper function. In view of the above facts, it is important to launch preventive, curative and
educational oral health care programmes integrated into the existing system utilizing the existing health and
educational infrastructure in the rural, urban and deprived areas.
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54.  A post of full time Dental Advisor at appropriate level in the Dte. G.H.S. (Directorate General
of Health Services) should be created as a first step towards strengthening the technical wing
of the Dte.GHS in this regard.
 Studies have revealed that dental diseases have been increasing both in prevalence and severity
over the last few decades. There is, therefore, an urgent need to prevent the rising dental
diseases in India. The method used for primary prevention of dental diseases aims at
achieving primary prevention of periodontal diseases and oral cancers.
 The Council, therefore, resolves that preventive and promotive Oral Health Services be
introduced from the village level onwards and accordingly a pilot project on Oral Health Care
may be launched by the Ministry of Health & Family Welfare during 1995-96 in five districts,
one in each in five states.
 The Council further resolves that legislative measures be adopted to ensure a statutory warning
on the wrappers and advertisement of sweets, chocolate and other retentive sugar eatables
‘TOO MUCH EATING SWEETS MAY LEAD TO DECAY OF TOOTH’. Similar measures
are also called for tobacco and Pan Masala related products.
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55.  The Council recommends that a National Oral Health Care Programme Training Centre
be established or the existing centres be strengthened for training of various categories of
Oral Health Care Personnel.
 The Council also resolves that all District Hospitals and Community Health Centres have
dental clinics. All Dental Colleges should have courses on Dental Hygienists and Dental
Technicians.
 The Council further resolves that the Pilot Project may be extended to all the States at the
rate of one District in every State.
 The Council resolves that there is an urgent need to have a National Oral Health Care
Programme Institute for Dental Research to guide oral health research appropriate to the
needs of the country.
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56.  For the purpose of Implementation, the Programme is divided into three phases,
 Developing the Implementation Strategies:
During 1999-2000, four regional and two National Workshops were organized to sensitize
the dental personnel in various parts of the country. The outcome of these workshops has
been compiled in the form of Implementation Strategies.
 Training and Re-orientation of Dental Surgeons:
In order to train the Health Workers at various levels and the Schoolteachers, the Dental
Surgeons from various Govt. Hospitals, Training and Re-orientation Programmes are
being conducted in pilot states. So that the Dental Surgeons can act as Master Trainers for
the National Oral Health Care Programme. Till now 11, workshops for the master
trainers have been conducted for Delhi, Assam, Meghalaya, Maharashtra, Punjab,
Arunachal Pradesh, Manipur and Tripura states and Indian Railways.
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57.  Training of Health Workers:
As a part of background material for training of health workers, an educative video film on
oral health “Kripaya Muskuraiye” and pictorial training manual on oral health for health
workers have been produced. Till now 13 training programmes in the Delhi, Meghalaya,
Punjab, Maharashtra, Arunachal Pradesh, Manipur and Tripura have been conducted for the
health workers and Schoolteachers.
Apart from these, symposiums are conducted in various professional workshops and
conferences to involve more and more Dental Professionals in the National Oral Health Care
Programme. Till now, five symposia have been conducted in Delhi, Bhubaneshwar,
Allahabad, Kochi and Vijaywada.
The nodal agency conducts Free Oral health Camps for the lower socio-economic population at
various places. Till now, about 43 oral health camps and awareness programmes have been
organized under the aegis of National Oral Health Care Programme.
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58.  IEC Material Publication and Distribution
Following IEC aids have been produced as a part of this programme and are distributed to
various Govt. Organization, State Health Education Bureau, Dental Colleges, IDA Branches
and NGO’s for Oral Health Awareness programmes.
1. National Oral Health Care Programme: Implementation Strategies – 2001
2. Training Manual on Oral Health for Health Workers – in Hindi and English in the year 2001
3. Educative video film on Oral Health entitled “Kripaya Muskuraiye” – in Hindi and English in
the year 2002
4. Single Sheet colored Oral Health Information for Health Workers in Hindi for their Ready
Reference in the year 2002
5. Training Manual on Oral Health for Schoolteachers – in Hindi and English in the year 2003
6. Posters on Oral Health “Dant fit to Life Hit” series of four posters in English and Hindi in
2003.
7. Educative Poster Series of five posters for schoolchildren “Swastha Muskan Aapka Vardan” in
Hindi and English in 2004.
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59. B A R R I E R S I N O R A L H E A LT H P R O M O T I O N I N T H E C O U N T R Y
 During the implementation of the National Oral Health Care Programme in the pilot phase, it
was perceived that most of the times our policymakers give oral health last priority. They are
inadequately informed about burden of oro-dental problems and its connection with the
systemic health and possibly minimal threat to human life due to oro-dental problems makes
step motherly treatment for dental public health programmes. One of the major disadvantages
is that in India, health is a state subject and most of the states in the country are suffering from
financial burden even for subsistence rather than providing quality health care. Mostly the
health care is looked after by the private sector and individual practices including non-formal
medical facilities. However, the treatment cost for oral diseases is enormously expensive and it
has not been possible for any Govt. setup to provide dental services to all.
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60.  Moreover, our country lacks experts in dental public health. The curriculum for graduation is
outmoded with very little importance to prevention. The dental graduates are unable to
perceive the importance of learning prevention of oro-dental problems for the community and
they are not aware of their responsibilities towards the society. The internship programme is
also underutilized by the dental colleges for services to the grass root level and dental health
needs of our geriatric population are overlooked. We do not have organized school oral health
education programmes so that children may learn right oral health practices from the
beginning. Over and above fastest growing population, rapid westernization and lack of
resources are increasing the burden of oral diseases in our country. Tobacco abuse is further
causing menace for not only the poor and disadvantaged but also civilized population. Early
initiation of tobacco habits in children is causing havoc in terms of morbidity and mortality of
our younger generations.
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61. N AT I O N A L O R A L H E A LT H C A R E P R O G R A M M E [ 2 0 ]
 National Oral Health Care Programme a project of DGHS and Ministry of Health & Family
Welfare was initiated in 1998 with aim of providing oral health care in the country through
organized primary prevention and strengthening of Oral health setup as per the
recommendations made in National Oral Health Policy. Later on the Department of Dental
Surgery, All India Institute of Medical Sciences was chosen as the nodal agency to implement
it.
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62.  Ministry of Health and Family Welfare, Govt. of India accepted in principle National Oral
Health Policy in the year 1995 to be included in National Health Policy. In pursuance to
National Oral Health Policy 'National Oral Health Care Programme' has been launched as
"Pilot Project" to cover five States (Delhi, Punjab, Maharashtra, Kerala and North eastern
States) for its implementation. To begin with, one district in each of these States has been
chosen to test run the strategies evolved through 2 national and 4 regional workshops
organized in the country, to achieve the following goals20 :
1. Oral Health for all by the year 2010.
2. To bring down the incidence of oral and dental diseases to less than 40% from the existing
prevalence of 90%.
3. To bring down the DMFT in school children between 6-12 years of age to less than 2 which is
approximately 4 at present.
4. To reduce high prevalence of periodontal diseases to lower prevalence.
5. At the age of 18 years, 85% should retain all their teeth.
6. To achieve 50% reduction in edentulousness between the age of 35-44 years.
7. To achieve 25% reduction in edentulousness at the age of 65 years and above.
8. To achieve 50% reduction in the present level of malocclusion and dento-facial deformities.
9. To reduce the number of new cases of Oral Cancers and precancerous lesions from the existing
levels.
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63. ELEVENTH FIVE-YEAR PLAN (2007-2012)21
Time-Bound Goals for the Eleventh Five Year Plan:
• Reducing Maternal Mortality Ratio (MMR) to 1 per 1000 live births.
• Reducing Infant Mortality Rate (IMR) to 28 per 1000 live births.
• Reducing Total Fertility Rate (TFR) to 2.1.
• Providing clean drinking water for all by 2009 and ensuring no slip-backs.
• Reducing malnutrition among children of age group 0–3 to half its present level.
• Reducing anaemia among women and girls by 50%.
• Raising the sex ratio for age group 0–6 to 935 by 2011–12 and 950 by 2016–17.
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64. Expected achievements and goals (oral health related) :
 Establishment of national,state & district oral health cells for proper monitoring, planning of
dental public health, interventional measures and research activities.
 Strengthening manpower and infrastructure at PHC/CHC & district hospitals and providing
basic oral health care to the rural population.
 To reduce the prevalence and incidence of oral diseases in the country.
 To reduce the mortality and morbidity of oral diseases.
 Early detection of oral cancer from stage 3&4 to stage 1&2.
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65. 1 2 t h F I V E Y E A R P L A N (2012-2017)22
Core strategies (oral health related) :
 1. Promote access to improved oral healthcare
 2. At PHC level, either specially trained dental hygienist or staff nurse may deliver simple
preventive, interceptive and curative oral health services (like pain relief, ART, early diagnosis
of oral cancer and HIV/AIDS related oral lesions and their referral) in addition to giving oral
health education.
 3. Strengthening existing CHCs and formulation of Indian Public Health Standards, defining
personnel, equipment and management standards for oral health care provision.
Supplementary strategies:
 1. Promotion of public private partnerships for achieving public health goals.
 2. Reorienting dental education to support rural health issue.
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66. H E A LT H C A R E AT P R I M A RY H E A LT H C E N T R E ( P H C ) 2 2
• PHC is the first contact point between village community and the Medical Officer.
• The PHCs are established and maintained by the State Governments under the Minimum needs
Programme (MNP)/ Basic Minimum Services Programme (BMS).
• They are established on the basis of national norm of one PHC for every 30,000 rural population in
the plains, and one PHC for every 20,000 population in hilly, tribal and backward areas for more
effective coverage.
• There are 22,370 PHCs functioning as on March 2007 in the country, achieving an average coverage
of 33,191 population per PHC.
• At present, a PHC is manned by a Medical Officer supported by 14 paramedical and other staff. It
acts as a referral unit for 6 Sub Centres. It has 4 -6 beds for patients.
• The functions of the primary health center include the 8 "essential" elements of primary health care
including medical care, Maternal and Child Health (MCH) including family planning, safe water
supply and basic sanitation, prevention and control of locally endemic diseases, collection and
reporting of vital statistics, health education, National Health Programmes, referral services, training
of village health workers and basic laboratory services.
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67. • Primary Health Centre is the cornerstone of rural health services- a first port of call to a
qualified doctor of the public sector in rural areas for the sick and those who directly report or
referred from Sub-Centres for curative, preventive and promotive health care.
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68. • With an average prevalence of dental caries of 50% in all the age groups, approximately
15,000 people in a catchment area of a PHC would require restorations/extractions. About 45%
of adults (60% of the population) i.e. 8100 persons would require oral prophylaxis. As many as
7% of the population i.e. up to 2100 people may suffer from oral premalignant and malignant
lesions.
• Oral health care with emphasis on preventive and promotive aspects needs to be provided at
PHC level.
• This would include oral health education, tobacco cessation counseling, oral prophylaxis, and
pain relief, early identification of oral precancer/ cancer and other common oral diseases and
referral. Also, a minimally invasive procedure using hand instruments – Atraumatic
Restorative Technique (ART) may be carried out to restore carious teeth.
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O R A L H E A LT H C A R E AT P R I M A RY H E A LT H C E N T R E ( P H C ) 2 2

69. • These services can be provided by an extended-duty dental hygienist. Till the time enough
number of extended-duty hygienist can be produced, these services can be provided by trained
nurses. Also, adoption of suitable number of PHCs (minimum 3) by each dental institution for
carrying out oral health education and screening should be made mandatory. Existing PHCs
need to be upgraded with respect to equipments and materials for carrying out the above
procedures.
• The monitoring and evaluation would include process indicators such as percentage of PHCs
with dental hygienist/ trained nurse and dental equipments. Outcome indicators such as
number of times IEC activity and oral prophylaxis performed in a given time-period and
number of referred dental patients/ dental hygienist need to be evaluated.
• This would require maintenance of records and its monthly submission to District HQ. Annual
survey of oral health knowledge, attitude, practices and oral hygiene status of the catchment
area would be useful impact indicators.
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70.  Service Delivery23:
 From Service delivery angle, PHCs may be of two types, depending upon the delivery case
load –
Type A PHC: PHC with delivery load of less than 20 deliveries in a month,
Type B PHC: PHC with delivery load of 20 or more deliveries in a month.
 All “Minimum Assured Services” or Essential Services as envisaged in the PHC should be
available. The services which are indicated as desirable are for the purpose that we should
aspire to achieve for this level of facility.
 Appropriate guidelines for each National Programme for management of routine and
emergency cases are being provided to the PHC.
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71. 5/4/2015 71
Dental health care services are not provided at PHC level

72. I N D I A N P U B L I C H E A LT H S TA N D A R D S F O R C O M M U N I T Y H E A LT H C E N T R E S [ 2 2 , 2 4 ]
• The Community Health Centres (CHCs) constitute the secondary level of health care, were
designed to provide referral as well as specialist health care to the rural population. Indian
Public Health Standards (IPHS) for CHCs have been prescribed under National Rural Health
Mission (NRHM) since early 2007 to provide optimal specialized care to the community and
achieve and maintain an acceptable standard of quality of care.
• CHCs are being established and maintained by the State Government under MNP/BMS
programme.
• Each CHC covers a population of 80,000 - 1.20 lakh population (one in each community
development block).
• As on March 2007, there are 4045 CHCs functioning in the country.
• It is manned by four medical specialists i.e. Surgeon, Physician, Gynecologist and Pediatrician
supported by 21 paramedical and other staff.
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73. • One anesthetist and one Medical Health Administrator are also employed on contractual basis.
Recently, an Opthalmic surgeon has been added at CHC level. It has 30 in-door beds with one
OT, X-ray, Labour Room and Laboratory facilities. It serves as a referral centre for 4 PHCs and
also provides facilities for obstetric care and specialist consultations.
• Unfortunately, dental care has not been included under the Assured Services to be provided at
CHC. However, if the oral disease burden of the population served at CHC is considered, it is
tremendous.
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74. O R A L H E A LT H C A R E AT C O M M U N I T Y H E A LT H C E N T R E ( C H C ) 2 2
• With an average prevalence of dental caries of 50% and average DMFT of 1 in children (34%
of population), 40,800 restorations would be required.
• With an average prevalence of dental caries of 50% and average DMFT of 3 in adults (60% of
population), 2,16,000 restorations would be required.
• 28,800 children would require preventive therapy in the form of fluoride varnish and pit and
fissure sealing, if provided to children up to 9 years of age (24%).
• About 45% of adults (60% of the population) i.e. 32,400 persons would require oral
prophylaxis. 30% of geriatric population (8% of the population) i.e. 2880 persons would
require prosthetic care.
• As many as 7% of the population i.e. up to 8400 people may suffer from oral premalignant and
malignant lesions.
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75. • Therefore, there is a need to provide routine an emergency care in dental surgery at CHC level.
• This would include oral health education and School Health Education Programme as an
outreach activity, identification of oral pre cancer/cancer and other common oral diseases, oral
prophylaxis, dental extractions, biopsy of oral lesions, restorations and application of topical
fluorides.
• 1 dental surgeon along with 1 chair-side assistant is a necessary requirement to provide the
above mentioned services. Also, public-private partnership should be considered for providing
removable prosthesis.
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76. • Service Delivery :
 Unlike Sub-centre and PHCs, CHCs have been envisaged as only one type and will act both as
Block level health administrative unit and gatekeeper for referrals to higher level of facilities.
 The revised IPHS (CHC) has considered the services, infrastructure, manpower, equipment
and drugs in two categories of Essential (minimum assured services) and Desirable (the ideal
level services which the states and UT shall try to achieve).
 All essential services as envisaged in the CHC should be made available, which includes
routine and emergency care in Surgery, Medicine, Obstetrics and Gynaecology, Paediatrics,
Dental and AYUSH in addition to all the National Health Programmes.
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77.  Standards of services under existing programmes were updated and standards added for newly
developed non communicable disease programmes based on the inputs from various
programme divisions.
 Standards for Newborn stabilization unit, MTP facilities for second trimester
pregnancy(desirable), The Integrated Counselling and Testing Centre (ICTC), Blood storage
and link Anti Retroviral Therapy centre have been added.
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78. 5/4/2015 78

79. 5/4/2015 79
Basic Dental health Care Services are delivered at the CHC level

80. 5/4/2015 80

81. C O M M U N I T Y H E A LT H C E N T E R
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82. L I S T O F E Q U I P M E N T S ( D I S T R I C T H O S P I TA L ) [ 2 2 ]
5/4/2015 82
S. No Item
1. Electrically Operated Fully
Programmable Dental Chair
2. Autoclave
3. Storage Cabinet
4. Dental X-ray Unit with Day-light
Manual Developer
5. Panoramic with Cephalomatric
X-ray unit
6. Electro Cautery Unit
7. Digital Pulp Tester
8. Digital Apex Locator
9. Surgical Micromotor

83. S U B - D I S T R I C T H O S P I TA L / C H C
S.No. Item
1. Electrically Operated Fully
Programmable Dental Chair
2. Autoclave
3. Storage Cabinet
4. Dental X-ray Unit with Day-light
Manual Developer
5. Electro Cautery Unit
6. Surgical Micromotor
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84. P H C ( if dental surgeon is appointed at phc as per recommendation)
S.No. Item
1. Electrically Operated Fully
Programmable Dental Chair
2. Autoclave
3. Storage Cabinet
4. Dental X-ray Unit with Day-light
Manual Developer
5. Electro Cautery Unit
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85. S M I L E T R A I N [ 2 5 ]
• Every year 35,000 children in India are born with clefts. Without corrective surgery, these
children are condemned to a lifetime of isolation and suffering.
• The tragedy is that a cleft can be completely corrected with a simple surgical procedure that
could take as little as 45 minutes and is TOTALLY FREE!
• Since 2000 Smile Train has sponsored over 450,000 surgeries across India. But there are still
an estimated 10 lakh untreated cases of clefts in India.
• The goal of Smile Train is to continue providing cleft surgeries across India until we have
completely eradicated the problem of clefts.
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86. 5/4/2015 86
• provided free cleft surgery for more than 1,000,000 children in thirteen years.
• provide free surgery for more than 300 children every day.
• provided free education and training for more than 20,000 medical professionals.
Smile Train offers the following funding opportunities:
• Treatment Partnerships
• Treatment Grants
• Education & Training Grants

87. F U N D I N G P R I N C I P L E S
Smile Train funds hundreds of programs throughout the world dedicated to helping poor children
with cleft lip and palate and improving the safety and quality of cleft care.
General guidelines for funding:
• Smile Train funds programs and projects that focus exclusively on helping children with cleft
lip and palate.
• funds treatment for poor children in developing countries through partnerships with local
medical professionals, hospitals and organizations.
• Smile Train does not fund treatment missions unless there is no other source of treatment
within the country.
• Smile Train funds programs that help the maximum number of children for the minimum
amount of money.
• Smile train don’t fund large capital expenses such as construction or maintenance of facilities
or major equipment expenditures.
• Smile Train funds should not replace any other existing funding source.
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88. PA RT N E R S H I P P R O G R A M S
Treatment Partnerships:
• Smile Train has provided free cleft surgery and related treatment for more than 1,000,000
children around the world. All of these surgeries are performed by local doctors that Smile
Train has empowered through various partnerships and grants.
• Treatment Partnerships involve an on-going relationship with Smile Train and require a long-
term commitment providing free surgical treatment for children with cleft who would not
otherwise be helped. Treatment Partnerships significantly increase the number of cleft
surgeries performed at a qualified hospital/center. The Treatment Partner must meet and adhere
to The Smile Train Safety and Quality Improvement Protocol.
• Treatment Partners are reimbursed based on the number of patients treated. All Treatment
Partners are required to participate in Smile Train Express, an online patient record-keeping
database.
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89. Treatment Grants:
• Treatment Grants are one-time grants for medical professionals, hospitals, and organizations
that provide treatment for poor children with clefts in developing countries, but who may not
meet the requirements to become a treatment partner. These grants are designed to supplement
care for children who would not otherwise receive help through free treatment (i.e. surgery,
orthodontia, speech therapy), improving the quality of treatment or providing for related
expenses such as equipment, outreach programs, and patient travel. The grants may also be
designated for a specific project or need that help poor children with cleft lip and palate.
Education and Training Grants:
• Smile Train programs come in all shapes and sizes, but the objective of every one is the same:
to help the local medical community become self-sufficient. With the proper education and
training, surgeons and nurses in developing countries are empowered to deliver excellent
treatment and care. They are our best hope of helping the millions of children who need it.
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90. • Smile Train provides Education and Training Grants for doctors, hospitals and medical schools
to develop and deliver advanced in-country cleft lip and palate teaching and education
programs. These programs are made available to doctors, nurses, and medical professionals
who could not otherwise afford them.
• Education and Training Grants are designed to improve the safety and quality of cleft care
performed by existing cleft care professionals. They are designed to support in-country
training and education, not U.S. based training. Education and Training sponsored by Smile
Train should lead to improved treatment for poor children. The grants are not intended for
funding individual travel needs to conferences and symposiums. Training grant applicants are
chosen in accordance with their medical education, experience and ability.
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91. C O N C L U S I O N
 It seems it is important to act now to strengthen dental health policy and planning. Up-to-date
oral health data are rarely available at national level. A national oral health policy developed as
a result of the processes will be both new and innovative, with the best chance of making real,
sustainable improvements in the oral health of the population. A national dental health policy
must ensure there is an effective monitoring system in place so you can recognize problems as
they occur and find solutions for them. To provide adequate, respectable, and attractive
Employment opportunities to the workforce while maintaining a balanced geographical
distribution is the main challenge and the root of all the issues facing the dental profession in
India. To cope with number of dentists graduating each year will require a massive
infrastructure, a factor that requires the very urgent attention. This vicious cycle has to be
stopped to get at the root of the problem and begin providing sufficient employment
opportunities in an equitable manner. Effects of dental health burden induce health inequality
on health of a society are profound. In a large, overpopulated country like India with its
complex social structure and economic extremes, the effect of inequity on health system is
multifold.
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92.  Unequal distribution of resources is a reflection of this inequality and adversely affects the
health of underprivileged population. The socially underprivileged population groups are
unable to access the oral healthcare due to geographical, social, economic or gender related
distances.
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93. B I B L I O G R A P H Y
1. Oxford English dictionary;2010; 3rd edition; Oxford University Press.
2. Michael Rundell, Macmillan English dictionary;2007; 2nd Edition; Macmillan education
Publishers.
3. Stephanie Meyer; Collins English dictionary; 2009; Special edition; Collins Publisher.
4. Thomas H. Patten, Jr. Manpower planning and the development of human resources.
1971 Wiley-Interscience
5. Edwin B. Flippo. Principles of personnel management. 1976; 4 edition; McGraw-Hill.
6. Cynthia pine and Rebecca Harris, Community oral health- 2nd edition, Quintessence
publishing co. ltd, 2007
7. Soben Peter. Essentials of preventive and community dentistry; fourth edition; 2011:412-
420.
8. Indrajit Hazarika. Health workforce in India: assessment of availability, production and
distribution. WHO South-East Asia Journal of Public Health.2013;2(2):106-12
9. World Health Organization. The world health report 2006 – Working together for health.
Geneva, World Health Organization. 2006.
10. Mythri Halappa, NaveenB H et al; SWOT Analysis of Dental Health Workforce in India:
A Dental alarm. Journal of Clinical and Diagnostic Research. 2014;8(11):3-5
11. Dental Council of India. Available from: http://www.dciindia.org/
12. Anand S, Bärnighausen T. Human resources and health outcomes: cross country
econometric study. Lancet. 2004;364:1603-09.
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94. 13. Shobha T. Challenges to the Oral Health Workforce in India. J Dent Edu. 2004;68(7):28-
33.
14. Ashish Bose. Health for the millions, Population Scan, First results of census of India,
2001, March-April 2001.
15. Bulletin on Rural Health Statistics in India March-2003. Issued by infrastructure
division, Deptt. of FamilyWelfare, MOH&FW Nirman Bhavan New Delhi.
16. National Oral Health Policy: Prepared by core committee, appointed by the Ministry of
Health and Family Welfare, 1995.
17. Fourth conference of Central Council of Health and Family Welfare - Proceedings and
resolutions. October 11-13,1995 New Delhi. Bureau of planning, Directorate General of
Health Services, Ministry of Health and Family Welfare, Govt. of India, New Delhi.
18. Ramandeep SG, Prabhleen B,et al. Utilization of dental care: An Indian outlook. J Nat
Sci Biol Med. 2013;4(2):292–97.
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5/4/2015 95

96. 5/4/2015 96
Sometimes people just need to sleep!!
..Thanks anyways!