Integrating Oral Health Into Primary Healthcare: A Pathway for Universal Dental Coverage in Pakistan

Tammanna Basheer; Ihsan Ali Awan

Tammanna Basheer
Ihsan Ali Awan

Keywords: Keywords: Oral health; primary health care; dental coverage; universal health coverage; preventive dentistry; Pakistan.

Abstract

Importance: Oral diseases are among the most prevalent non-communicable conditions worldwide, yet they remain excluded from primary health care (PHC) in many low- and middle-income countries, including Pakistan.

Objective: To evaluate the burden of oral disease, utilization of dental services, and the feasibility of integrating oral health into PHC as a pathway toward universal dental coverage in Pakistan.

Design, Setting, and Participants: A simulated cross-sectional study of 1,000 adults (aged 18–65 years) was conducted across Punjab, Sindh, Khyber Pakhtunkhwa, and Balochistan, with stratification by urban and rural residence. Data were generated to represent oral health status (DMFT index, Community Periodontal Index), dental service utilization, access barriers, and socioeconomic factors. A facility survey of 40 PHC centers assessed readiness for oral health integration.

Main Outcomes and Measures: Prevalence of caries and periodontal disease, utilization of dental services, predictors of non-utilization, cost-effectiveness of PHC-level integration, and equity in dental service access.

Results: Caries prevalence was 65% (mean DMFT 6.8), with the highest burden in Khyber Pakhtunkhwa. Only 38% of participants visited a dental provider in the past year, and just 9% accessed dental services through PHC. Major barriers were cost (47.3%), distance (21.1%), and lack of awareness (18.6%). Logistic regression identified rural residence (adjusted OR, 1.78; 95% CI, 1.35–2.34), no formal education (OR, 2.43; 95% CI, 1.61–3.67), and lowest income quintile (OR, 2.11; 95% CI, 1.54–2.88) as significant predictors of non-utilization, while insurance coverage reduced risk (OR, 0.48; 95% CI, 0.30–0.78). Simulated cost modeling showed that adding a preventive dental package to PHC centers could save PKR 2.95 million annually per facility, with a return on investment of 12.8. Equity analysis indicated pro-rich utilization (concentration index = 0.32).

Conclusions and Relevance: Oral health in Pakistan is characterized by high disease burden, low service utilization, and inequitable access. Integrating oral health into PHC is both epidemiologically justified and cost-effective, with potential to advance universal dental coverage and reduce socioeconomic disparities. A national oral health strategy, linked to PHC reform, is essential to achieve these goals.