Dental education in India was established around a century ago, when the first dental college was started in Calcutta by Dr. Ahmed in 1920. Diseases such as tooth decay, gum problems, poor oral hygiene and oral cancers have always been major public health issues in India. The ugly truth about Indian Dentistry is deeper than it seems.
It is well known that poor Socio-economic Status (SES) provides negative impact on favourable dental health awareness, attitude and oral hygiene behaviour. Only in the last two decades dental industry has emerged as a field independent from general healthcare. Moreover, efforts of various organizations like World Health Organization (WHO), Indian Dental Association (IDA) and Dental Council of India (DCI) to increase awareness of oral hygiene have provided major contribution in establishing today’s developing dental industry.
The Indian healthcare industry is experiencing quick transformation owing to the increasing demand for quality healthcare. With the ever-increasing standard of living, people in India are becoming health conscious, shaping a new market which is giving increasing importance to healthy teeth and dental cosmetics. The potential size of India’s dental market is vast, and India is slated to become one of the largest single country markets for overseas dental products and materials, with a yearly growth rate of nearly 10%.
This huge market of dental industry in India has also made a remarkable impact on the dental education. The dental colleges providing bachelor’s degree in dentistry (BDS) have grown in number with consequent increase in the number of dental graduates. Currently, 296 DCI recognized Dental colleges exist with total intake capacity of around 24,000 students per year (as per the information provided on the official website of DCI).
Among these, only 40 colleges with total intake capacity of 1,500 students are government colleges, rest are in private sector. This scenario demonstrates the impact of commercialization on dental education.
Despite the role of private sector in the growth of Indian dental education, there are certain issues regarding quality of education provided by private dental colleges. Unfortunately, many of the colleges have less than adequate infrastructure. There is evidence that many dental colleges are short of staff. Faculty members in many dental colleges are engaged in private practice with comparatively less time to devote to teaching. This may well result in less than adequate practical training for students. Often, Student’s in private colleges lack the necessary clinical exposure, and hence are not properly trained.
From a student’s perspective, the demand for dental courses is going down with each passing year, while the interest in medical education remains unaffected. This situation shows the lack of interest particularly in dental education rather than overall healthcare system. In spite of such a great promise of growth in dental industry, quite a few dental seats have remained vacant in past few years, showing lack of interest of students in dental education.
The entrance examinations are common for all the medical, dental and paramedical education including nursing, physical therapy, pharmacy, and occupational therapy. Typically, the order of preference for students is medical followed closely by dental and paramedical courses. One can say that, students select the dental education by force and not by interest, as they are not getting admission in medical course. The distribution pattern of the dental colleges across various states of India is also very uneven, leading to unequal distribution of dentists across the states affecting their dentist-population ratio.
An increased level of awareness among patients has raised their expectations from the dental practitioners. Awareness about the dental education among Indian population has also decreased the charm of BDS degree alone and more and more patients try to consult a specialist for their problems. This is the reason why the aim of dental graduate is to get the master’s degree (MDS). But the number of seats available for MDS is only around 3,000 compared to each year pass outs of 24,000 BDS students. This is a big bottleneck in career prospects of a dentist.
Dentistry is one of the highest paid professions in developed countries but the situation is not same in India. Opportunities for dental graduates are limited. Jobs in government sector are few. With each new hospital opening it creates only a handful of jobs for a dentist as compared to many jobs for medical graduates. The salaries in private hospitals are also less, with most Private hospitals and clinics offer a fresh dental graduate a meagre amount of less than Rs. 10,000 per month for a full time job.
Private practice in dentistry is more fruitful than being attached to dental hospitals or clinics. Working at dental hospitals provides fixed income with slower annual growth compared to private practice. Hence, private practice is the dream of every dental graduate. However, the investment for establishing a competent dental clinic is quite high due to expensive equipment’s.
Due to the above stated reasons many of young graduates after failure to get admission in MDS seats feel confused and try to search other alternatives for career growth. Some look for overseas where after an initial period of struggle, the opportunities and returns are better, with countries like USA, UK and Australia being popular destinations for dental graduates. Most of these countries will require clearing a licensing exam and few years of study.
Courses like Public Health, Healthcare Management, Clinical Research and Administrative services are also becoming popular with dental graduates where better opportunities await them in the corporate health care and pharmaceutical companies. Once absorbed, they need to compete with the people of various non-medical undergraduate streams and their dental education becomes unused.
The dentist-population ration in India is 1:15,000 against the 1:7,500 recommended by WHO. The ratio in urban areas is 1:10,000, and is close to 1:2,50,000 in rural areas. The major missing link causing this unfortunate situation in a country is the absence of a primary health care approach in dentistry. It is often difficult for the poor urban and the rural population to get access to emergency care. Community oriented oral health programs are seldom found, with no dentist found in Primary Health Centres (PHCs) and Community Health Centres (CHCs) in most of the states.
All the above mentioned factors cannot be taken care of immediately, but the government, both at the central and the state levels, should take some prompt steps to address the above mentioned problems.
First of all, the dental entrance exam should not be linked to the medical admission exam buts should be a separate exam by itself. Having a separate exam will definitely bring students to the dental college who are really interested in the dental profession. Also, the number of post-graduate seats should be increased so that there is enough motivation that students do not become averse to this profession.
More dental units in government hospitals should be established, along with posting dentists at all PHCs and CHCs across the country, along with creating more job opportunities by the government through state public service commissions, under National Rural Health Mission to serve in rural areas, under Rashtriya Bal Swasthya Karyakram (RBSK) for early child disease detection, anti-oral cancer and no-tobacco campaigns and school dental health programmes.
Dental graduates can also be used as a back-up choice in case of non-availability of medical graduates, having gone similar rigorous training. Currently the government is using AYUSH workers as second choice, who are not even allowed to prescribe medicines. Dental graduates and AYUSH workers working together could be of a greater aid in improving rural healthcare.
Also, as with Medical Officers (MO) and MO (AYUSH), the government should create posts of MO (Dentistry), along with making dentists eligible for Block Medical Officers (BM0s) and Chief Medical Officers (CMOs) to ensure that there is no disparity between medical and dental graduates, with separate directorates of dentistry should be made for every state so that proper policies can be framed.
Unless some drastic measures are taken, the situation may well go out of hand, and then it would be too late to put things back together.