Commercial determinants of oral health in India: implications for research and policy- a perspective

Oral diseases remain a major global public health challenge, with a disproportionate burden in low- and middle-income countries (LMICs) such as India. However, research and policy in oral health continue to focus predominantly on individual behaviours and clinical care, with limited attention to upstream determinants. This perspective piece applies the framework of commercial determinants of health to examine oral health in India, demonstrating how commercial actors shape disease risk and access to care. We examine three domains: (i) commodities related to oral health, including both harmful products and beneficial goods and services; (ii) structural conditions, such as economic liberalization, governance gaps, and societal norms that enable commercial influence; and (iii) market, business, and political strategies used by commercial actors to expand and sustain markets. Through interconnected pathways across these domains, commercial determinants contribute to differential exposure and access, reinforcing oral health inequities. We argue that advancing oral health equity in India requires us to expand beyond biomedical approaches towards integrating political economy and social science perspectives in research and policy. We also outline key research directions and methodological approaches to strengthen the evidence base on commercial determinants of oral health and inform more effective and equitable policy responses.