Total expenditure as a percentage of GDP in India is as low as 1.26%. It has been reported that India has one of the lowest public healthcare budgets in the world; countries like the United Kingdom, the Netherlands, New Zealand, Finland, and Australia spend over 9% of their total GDP on public healthcare, Japan, Canada, France, Germany, and Switzerland spend about 10%, and the United States 16%. In India, only 25% of the population has access to sanitation, and the use of diagnostic testing is almost in India. Though there has been a considerable increase in the Union Budget allocated to the healthcare sector from Rs 62,659.12 in 2019–20 to Rs 69,000 crore in 2020–21, there still seems to be scope for betterment (11). Out-of-pocket payments account for 70% of healthcare costs in India, whereas in the US these account for around 10%–12%.

In India, 63% of deaths are due to non-communicable diseases (NCDs) and 11% due to injuries. And yet the government spends less than 0.5% of its GDP on NCDs and so the states with high poverty levels have a low per capita expenditure on NCDs (12). When applied to the dental sector, this is especially true in cases of dental caries. According to a systematic review conducted by Shah et al., 49.6% of the children (approximately 100 million children) below the age of five years in India live with untreated dental caries. This substantially increases the burden of disease in the population and highlights the need for effective implementation of preventive strategies with early interventions such as fluoride application, pit and fissure sealants, etc., in the National Oral Health Policy (13).

While the Indian healthcare sector is divided into public and private, the private healthcare segment in India is mainly focused on urban centers, leading to the unequal distribution of services, with 75% of the healthcare infrastructure concentrated in urban areas where only 27% of the total Indian population resides. Only 11% of sub-centers, 13% of Primary Health Centers (PHCs), and 16% of Community Health Centers (CHCs) in rural India meet the Indian Public Health Standards (IPHS). Only one allopathic doctor is available for every 10,000 people and one state-run hospital is available for every 90,000 people. As per the 2017–18 budget announcement, 1,50,000 Health Sub Centers and Primary Health Centers are to be transformed into Health and Wellness Centers (AB-HWCs) by December 2022 to provide Comprehensive Primary Health Care (CPHC) to ensure healthcare for all (14). The PHCs in India are the primary point of contact for services regarding non-communicable diseases. Therefore, oral health promotion, check-ups, and appropriate referral as well as screening for chronic non-healing ulcers is an essential function of the PHCs (15).

The Union Health and Well-Being Budget 2021 was announced for the first time as a holistic presentation of healthcare needs, assimilating and amalgamating traditional and modern healthcare delivery systems and needs. Whilst allocating significant funds toward the AYUSH (Ayurveda, Yoga, Unnani, Siddha and Homeopathy) framework, a disappointing zero percent of the GDP has been allocated towards oral and dental care needs. No distinct consideration was given to oral health care under the Union Budget 2021–22 despite the schema of the Common Risk Factor Approach proving a strong relationship between the departure from oral health and its myriad links with systemic illness.

Oral health is an integral component of general health yet oral diseases still remain a burden for developing countries like India, especially among the rural population (16). Amongst emerging countries, China enjoys a relatively favorable dental health status and, amongst high-income countries, South Korea exhibits the best dental health status (17). In India, poor oral health status maybe primarily attributed to ignorance among the masses. According to one study (Mathur 2021), 95% of adults in India suffer from gum disease, 50% of citizens do not use a toothbrush or toothpaste, and 70% of children under the age of 15 have dental caries (18), which proves that the burden of oral diseases is on the rise, with oral health being an issue of “international neglect” by policymakers (19). The capacity of the existing health system to overcome these challenges is uncertain; as shown in Figure 2, the budget allocation to oral health care seems negligible compared to other policies. There is no specific allotment for the oral healthcare of the pediatric population as the majority of oral diseases can be controlled if intercepted at this growing age. To improve the system and bring about a policy change, a systematic analysis of the existing oral health system is necessary.

The NOHP is a stint of hope at acknowledging the gravity of oral health care. Praiseworthy initiatives like establishing 85 Muskaan clinics providing free dentures to anyone above the age of 65 years is a part of the Danta Bhagya Yojane, the national oral health policy which was drafted in February 2021 as a part of this initiative. The policy has appreciated the importance of equity, integration, community participation, gender, prevention and promotion, and research which would help in addressing the oral disease burden in India. The Rashtriya Bal Swasthya Karyakram which is a milestone so set that appraising the overall quality of life of children which involves screening of children from birth to 18 years for defects at birth, diseases, deficiencies, and developmental delays. The National Cancer and Tobacco Control Program, National Rural Health Missions, and School Health Program are other budding prospects for efficient delivery of oral health to the population.

Centers for oral health care like the PGI Chandigarh launching the E-RCTC- a joint initiative of PGIMER Chandigarh and the Union to strengthen the National Control Tobacco Programme (NTCP) has been launched. The Maulana Azad Institute of Dental Science (MAIDS) which has fabricated the Mobile Dental Clinic Project and Antitobacco cell, Centre for Dental Education and Research (CDER) is a part of Cochrane Oral Health's Global Alliance and is the National Centre of Excellence for Implementation of the National Oral Health Programme and the World Health Organization (WHO) Collaborating Centre for Oral Health Promotion have also been devised. These schemes have the primary objective of narrowing the rural-urban gap in oral healthcare with a definite budget allocation for the same, thereby increasing the utilization of public oral health facilities and community-based awareness by at least 50% per district by 2030, establishing baseline data for the oral disease burden of the country by 2025, and reducing morbidity and mortality from them by 15% by 2030. To ensure a district-level electronic database of information on health system components by 2025 while integrating oral health information architecture and exchanges between district and primary health centers by 2030. The aims of these initiatives is to eventually strengthen the oral health care system. As no specific care or onus is given to children between 6 or 12 years of age, it becomes essential to gauge how to cease the sustained degradation of oral health care in places where access and resources are inadequate through a common risk factor approach.

The essence of this communication lies in the fact that there has been considerable progress in the Government’s budget allocators and policymakers' consideration towards oral health and health, in general. Although an integral part of national upliftment, the oral health system of India is deficient in many aspects. The reorientation of oral health services is required to counteract the problems faced due to various oral diseases. Encouraging the system to bring about a change and help in providing attention to a systematic analysis of the oral health care system is necessary for the eradication of existing oral diseases.

About 50% of children in India under the age of six years live with untreated dental caries. This study throws light upon the need for the allocation of funds and the imposing of policies for the betterment of pediatric oral health and general oral health, and highlights the existence of numerous national health schemes devoted towards pediatric oral health such as Danta Bharat Yojna and Rasthriya Bal Swasthya Karyakram. The Union Health Budget allocates an average of 2.3% towards the pediatric health sector. However, the intricacies of this budget towards pediatric oral health is unknown. It is indeed high time to give due diligence to the importance of oral healthcare in India. The criticality and exigency of the deteriorating oral health status of children should not be undermined, as preventive care and pediatric oral care should be given as equal status as curative and restorative care.

The authors declare that this review is an independent opinion and that the authors do not support any particular government or political party or organization.