Prosthodontic Rehabilitation as Essential Care Within India's District Health System: A Narrative Review and Conceptual Framework.

Abstract

Background: Despite the National Oral Health Programme (NOHP) mandating the provision of removable partial and complete dentures (CDs) at the district level, prosthodontic services in public facilities remain largely inaccessible across most Indian states, even after more than a decade of policy implementation. With India's elderly population projected to reach 347 million by 2050 and complete edentulism affecting 12%-14% of older adults, the unmet need for prosthodontic care is substantial and continues to grow.

Aim: This narrative review synthesises available evidence on the burden and impact of edentulism, along with policy responses in India and comparable settings. It further proposes a conceptual framework for essential prosthodontic care within India's district health system (DHS), positioning prosthodontic rehabilitation as a core health service, comparable to cataract surgery and hearing rehabilitation.

Methods: A narrative review was conducted following scale for the assessment of narrative review articles (SANRA) guidelines, drawing on epidemiological data, policy documents, low- and middle-income country (LMIC) programme evaluations and health economics evidence.

Synthesis and proposed framework: Nine critical implementation gaps were identified from the literature. In response, the DHS Essential Prosthodontic Services Framework is proposed, comprising a five-tier service package with the district hospitals as nodal fabrication units; a hub-and-spoke laboratory model; eligibility and benefit structure aligned with PM-JAY; integration with National Programme for Health Care of the Elderly (NPHCE) and Ayushman Bharat; eight key performance indicators and a phased 10-year implementation roadmap.

Conclusion: Framing prosthodontic rehabilitation as essential care comparable to cataract surgery provides the most practical and sustainable basis for the administrative reforms required to translate existing policy intent into functional district-level service delivery.