Overcoming barriers to oral healthcare in India’s tribal regions: Insights and strategies

Dear Editor,

In your April 2024 issue, the original article titled “Community-based early detection of oral precancerous lesion, accessibility and utilization of oral healthcare services among Irular tribes residing at union territory of Pondicherry” provided valuable insights into the prevalence of oral precancerous lesions, oral healthcare-seeking behavior, and accessibility of tobacco cessation and oral healthcare facilities among the Irular tribes in Pondicherry. I would like to offer further information and suggestions on improving oral healthcare in hard-to-reach areas.

According to a year-end review by the Ministry of Tribal Affairs, Scheduled Tribes constitute about 8.6% of India’s population, totaling around 10.4 crores. India recognizes over 730 Scheduled Tribes under Article 342 of its Constitution. Many members of these tribes suffer from oral cavity premalignant conditions and lesions, which often remain largely unaddressed.[1]

Tobacco use is a significant health concern among various tribal groups in India, with studies highlighting the prevalence and associated risks of precancerous oral lesions. Deepa et al.[2] found that 85.1% of the Wayanad Tribes had used tobacco, identifying 93 cases of leukoplakia, 38 cases of oral submucous fibrosis (OSMF), two cases of oral squamous cell carcinoma, and 61 cases of Chewer’s mucosa, all linked to tobacco use. Similarly, Muthanandam et al.[3] observed a higher prevalence of precancerous lesions (48.3%) among South Indian tribes, with nearly 80% being smokeless tobacco users. Another study reported a high prevalence of precancerous oral lesions (42%) among the Paniya tribes, with oral leukoplakia (12.9%) and OSMF (13.2%) being particularly notable among betel quid chewers.[4]

Providing oral healthcare in India’s tribal areas faces significant challenges. Remote locations and poor infrastructure make access difficult, while poverty, unemployment, and economic dependency limit affordability. Healthcare facilities are limited, and there is a shortage of dental practitioners and trained staff. High dental service costs and the need to travel long distances further discourage seeking care. Low literacy rates and awareness, coupled with cultural beliefs and mistrust of modern practices, hinder health education. The chewing of betel leaves, tobacco, mishri, gutka, and tambaku, along with alcohol consumption, poor dietary habits, smoking, and poor oral hygiene, exacerbate oral health issues. Traditional healing practices, oral piercings, and irregular dental care supplies add to the problem. Inadequate policy implementation and language barriers between healthcare workers and tribals further complicate efforts. Addressing these barriers requires community engagement, targeted education, infrastructure development, policy support, and culturally sensitive healthcare delivery to improve oral health outcomes for tribal populations in India.

To comprehensively improve oral healthcare in India’s tribal areas, a multifaceted approach is crucial. Initiatives include training local tribal leaders on dental issues and placing posters about oral lesions in community gathering areas. Mobile clinics staffed by dedicated dentists or dental surgeons should be established, supported by improved infrastructure. Behavior change communication programs targeting diet improvement and reducing smoking, alcoholism, and harmful practices are essential. Subsidized dental services can enhance accessibility, with incentives for health workers to improve reporting and engagement. Training programs for nurses, Anganwadi workers, and Accredited Social Health Activists can integrate dental screenings into immunization services and house visits. Establishing dedicated labs and conducting health education campaigns, along with integrating oral health into school programs, are critical. Community participation, including initiatives such as community gardens, can promote healthier lifestyles. Effective policy management is needed to institutionalize tribal dental care, facilitated by multilingual staff and a robust feedback mechanism.

Designating specific days for specialists such as Ear, Nose, Throat and Oral and Maxillofacial surgeons at primary health centers in tribal areas enhances healthcare delivery. Given that your study revealed biopsies were not routinely conducted for diagnosis, mandating biopsies would be crucial for the early identification of these conditions.[5] This approach can help prevent the progression of these conditions to malignancy, enabling timely intervention and appropriate measures.

Improving oral healthcare for India’s tribal populations requires a multifaceted approach, including community engagement, infrastructure development, policy support, and culturally sensitive healthcare delivery, to address significant challenges and enhance health outcomes effectively.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.