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Demographics & Current Scenario with Respect to Dentists, Dental Institutions & Dental Practices in India

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Same as title. An interesting article. For most of us, we may not be aware much of the Dental market. This report provides a brief understanding about the same. Hope you enjoy reading

Same as title. An interesting article. For most of us, we may not be aware much of the Dental market. This report provides a brief understanding about the same. Hope you enjoy reading

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  • 1. Indian Journal of Dental Sciences.June 2011 Issue:2, Vol.:3 www.ijds.in Original ArticleAll rights are reserved Indian Journal of Dental Sciences E ISSN NO. 2231-2293 P ISSN NO. 0976-4003 ¹ N. K AhujaDemographics & Current Scenario with ² Renu ParmarRespect to Dentists, Dental Institutions ¹ MDS,PGDHHM Professor and Director Post Graduate Studies,& Dental Practices in India Dept. of Orthodontics & Dentofacial Orthopaedics Subharti Dental College Swami Vivekanada Subharti University Meerut, Uttar Pradesh- IndiaAbstractIndia is the largest democracy and the second most populated country in the world. However, more than ² MDS Sr. Lecturer, Dept. of Orthodontics Subharti Dental College Swami Vivekanada Subharti University70% of the people of India are residing in the villages. As, far as dentists and their availability is Meerut, Uttar Pradesh- Indiaconcerned to this huge population, the demand and supply ratio is far inadequate and insufficient. Thedentists: population ratio of India, on date is 1: 10,000. However, the reality is that; in rural India 1 dentist Address For Correspondence:is serving over a population of 2,50,000. Thus, the real picture is not that simple as it seems. As, we areabout step into the next decade, there lies an urgent need to analyze the dental work force of the country Dr. N. K Ahuja MDS Professor and Director Post Graduate Studies,and to study the scope and future of dentistry in the coming years. There are still many underserved Dept. of Orthodontics & Dentofacial Orthopaedicsgroups that do not have any access to oral health care. To address the complex circumstances facing Swami Vivekanada Subharti University Meerut,our dental workforce, solutions will almost certainly involve a broad spectrum of interests that include Uttar Pradesh- Indiaoral health and public health care professionals, representatives from minority in¬terests, insurers andother payers such as businesses, consumers, and most importantly, central and state legislatures.Dental educators, including those in dental schools must work together to strengthen and buildpartnerships within these communities. It is only by working together with a common goal that dental Date of Submission : 14/05/2011education will have the means to meet the challenging diversity of oral health care needs facing ournation and to maintain a viable and strong academic dental education system. Date of Acceptance : 20/05/2011Key WordsDemography, Quackery, Dentist:population ratio, Dental council of IndiaDental diseases are one of the most common worlds most populous country by 2025,of non-communicable diseases. Though surpassing China.1 “A peep into the past : The history ofthey are rarely life threatening, they do dentistry in India”impact the quality of life. Dental problems India is a country of diverse ethnic groups;can cause severe pain, loss of man days & geographical character, culture, religion and The presiding deity of Bastar (Themorbidity. Thus, they are an important languages. It has 29 states and 6 union Goddess of tooth - Danteshwari) :public health concern. According to the territories. The sex ratio at birth is – 1.05 Danteshwari is a temple in the town BastarWorld Health Organization (WHO), the male(s) / female(s). The average life of Jharkhand. It is believed that the tooth ofprevalent oral diseases are dental caries, expectancy is– 62.5 years & the literacy rate Sati fell here where this temple is locatedperiodontal diseases & edentulousness. is – 65.38%. today (Fig1).3“Dental diseases are expensive to treat However, India has an astonishinghowever, simple to prevent.” demographic dividend; where more than 50% of its population is below the age of 25Demographics of India - and more than 65% below the age of 35. It isSituated majestically in the Asian expected that, in 2020, the average age of ansubcontinent; India is the largest democracy Indian will be 29 years, compared to 37 for& the 7th largest country in the world. It China and 48 for Japan. More than 70% ofoccupies 2.4% of the worlds land area & the people of India live in more thansupports over 17.4 % of the worlds 5,50,000 villages, and the remainder in morepopulation. The demographics of India are than 200 towns and cities.remarkably diverse. India is the second mostpopulous country in the world, with over The total population of India is nearly 1.1471.147 billion people (estimate for April, billion, with 637.38 million males & 509.62 Fig 1. – Lord Shiva performing tandava with2010), more than a sixth of the worlds million females.2 the dead body of Sati, during which the toothpopulation & only China has a larger of Sati had fallen at Bastarpopulation. India is projected to be the Demographics of Dentistry in India -© Indian Journal of Dental Sciences. All rights are reserved 8
  • 2. Dentistry as portrayed in the Epic of specialties of dentistry. (Dental Council of dentists in the country, the most basic oralMahabharata : Indis’s fig. - 2,881 / Year).5 health education & simple interventions areLord Krishna in Mahabharata wanted to test also not available to vast majority ofthe “danaveerata” of dying Karan in the When we compare the dentist: population population and that is the misery of thebattle field of Kurukshetra. Disguised as ratio of India to that of America, the whole scenario.Brahmin, Krishna asks for gold in donation population of America is nearly 33crores, && Karan proves his worth by donating his there were 108 dental colleges. However,gold filled tooth (Fig 2). This part of the epic considering the dentists: population ratio &indicates the existence of dentistry even to cut the no. of fresh dentists graduatingaround 2500 BC, wherein defective teeth every year, the no. of dental colleges inwere restored with gold America are now reduced to 58.6 Thus, Comparing to the ratio of dentists: population of America, India should have only 119 colleges against 289.Similarly when comparing to the Chinese Population which is the world’s highest at 1.6 billion, there are only 160 dental colleges in China. In that direction, if we consider the dentists: population ratio of India, India should have only 112 dental colleges.Fig. 2 – Lord Krishna disguised as Brahminand Karan donating his gold filled toothThe Factual period :Sushruta, the great surgeon of ancient India;taught dentistry scientifically at Kashi,about 600 B.C. During that period, dentistryflourished scientifically all over. However, Fig. 4,5 –Dental hygiene practices in ruralthereafter; for ages dentistry remained in india (Oral health is given low priority)darkness as the Brahmins of ancient India WHO recommends, dentist to population To elaborate, the other established reasonsabhorred to touch flesh, blood & pus. Even ratio of 1:7500. Dentists-to-population ratio are as follows:in the Mughal period, the thinking did not of India, which was 1:300,000 in the 1960’s, 1. Geographical variationschange much. However, scientific dentistry stands at 1:10,000 today. However, the 2. Uneven dentists: population ratiowas reintroduced in India in the 19th century dentists: population in the Indian Army is far 3. Poor specialist: Generalist ratioby the Britishers. In spite of this; for long better at 1: 5,000; due to the fact that it is 4. Poor dentist: auxiliary ratiodentistry predominantly remained in the mandatory to see every individual’s teeth 5. Low priority given to oral healthhands of unqualified & even today in some atleast once in a year in the Army. There is aparts of the country it still remains the same. total workforce of 1,18,000 dental practitioners in India at present, which is According to the WHO, the provision of oralIn 1924 – The 1st dental college of India was expected to swell to 2,25,000 shortly.7 health care services are very little in ruralestablished in Calcutta by Dr. R. Ahmed. parts of India, further complexity is lent byIn 1933 - The Nair dental college & Are really we short of dentists? the great variation that occurs across thisHospital, Bombay, came into existence. Considering the above facts and figures, the population on social parameters such asIn 1938 – The Govt. Dental college; question arises that are we really short of income and education.Bombay, was started and thereafter there dentists? To answer this query, one shouldwas no looking back. understand the distribution of dentists in Prevalence of dental caries is high &Today we have come a long way from the India. The problem lies at the level of provision for restorative treatment ishypothetical era to the age of scientific & distribution rather than the number of dental inadequate in most parts of the country.evidence-based dentistry. surgeons. About 80% of dentists work in DCI’s National survey is been conducted to major cities in India; compared to the determine the prevalence of dental diseasesDentists, Dental institutions and Dental population where more than 70% of the in different states of India. Prevalence ofpractitioners in India – Indians reside in the rural areas. Very little dental caries is 40%-80% (Very high inThere is a staggering of 289 dental schools oral health care services are provided in the Northern states 85%-90%), Periodontalin India (Table 2 & Fig 3), producing more rural areas, however; oral healthcare conditions usually increase with age and arethan 30,000 graduates every year. [Dental seeking behavior is also very low, especially found more in rural areas. Oral cancer andCouncil of Indis’s fig. - 30,570 / Year] (Table among the rural population (Fig. 5). A precancerous conditions are 3%-10%1).4 mismatch exists between oral health (Highest being in Orissa 7% (World’sMore than 2800 postgraduate students are professionals & the population they serve.8 highest). 9enrolled every year (Table 3) in various Even with a workforce of 1,18,000 qualified© Indian Journal of Dental Sciences. All rights are reserved 9
  • 3. Dental practices in India – Only 15 – 20% of people in India are able to Demand for quality healthcare at affordableBarring aside quackery (Fig. 6), we have get dental services through national costs is the natural outcome of thissingle unit dental setups to the most modern schemes. The annual per capita public developmentlavish multi-chaired exotic dental clinics, health expenditure in India is no more thanincluding dental spas having the most Rs.200.8 Thus, reach and quality of public 3. Increasing market size -modern equipment and gadgetries spread all health services have been below desirable The Indian Healthcare market is at about 60over in cities and metros. standards. 80-85% of people are spending billion US$. The industry is expected to money from their pocket. May be due to this grow to 150 billion US$ by 2017. The Indian fact - Oral health care seeking behavior is healthcare market is one of the largest very low in India, people rarely visit dentist services sectors, contributing 2% to the and that too only in the event of pain. countrys GDP.11 Although huge unmet treatment needs exists; striking inequality in delivery 4. High growth in domestic market – system, and absence of an adequate Government has invested large sums in community-oriented prevention system is healthcare. India is among the top 5 further aggravating the lack of reach of countries that offer health services to poor in dental facilities in rural parts of India. public sector. Subsidies are provided to the economically poor Financial assistance Surprisingly, only 1% of the total GDP is from nationalized banks is provided at 9% to allocated for public healthcare moreover, 10% interest to establish private practices in there is no specific separate allocation for rural areas. oral health-care. In the last financial year only 6% of the total GDP was allocated to 5. Present Dental Industry - health-related expenditures in India, Total market for the Dental equipments and whereas other smaller Southeast Asian materials is estimated to be around 50 countries with smaller population allocate million US$ annually. The potential size of nearly the same amount or more for health India’s dental market is estimated to be vast. related activities. Even Maldives is spending 7.1% of its GDP on health-related 6. High growth in import of dental products activities. – Another area that is experiencing steady The brighter side of the picture - growth is the import of dental products. However, the brighter side of the picture India’s market for dental products isFig. 6 – A quack sitting with a whole bunch is reflected in - extremely dynamic, with a current estimatedof readymade dentures and another, filing 1. Growth in dental tourism - growth rate of between 25 to 30%.the teeth of a patient in order to reduce the Quality of medical and dental treatment indental display metropolitan cities in India is as good as 7. Health Insurance - anywhere else in the world & is available at After liberalization of economic policy, aHealth of a population depends on - much cheaper rates when compared to the large number of private players have entered1. Health care delivery system western countries. The cost of comparable into the Indian market. Dental health2. Socio-demographic profile of the dental treatment is 1/8th to 1/5th of that in insurance also, has become a part ofpopulation western countries. The concept of dental comprehensive health insurance cover now.a). Socio-economic status tourism is gaining significance and nearb). Literacy rate future will see a further growth in dental 8. Reduced import duty structure -c). Health indicators eg. maternal and infant tourism. Medical, including dental tourism Government has liberalized the importmortality rate, life expectancy etc. is expected to become a 2.2 billion US$ policy and a uniform taxation system. industry by 2012. Tourism has increased Presently, the import duty is only 10.7% onPrinciple is “Health for all”, through more than 20-fold since 2000.10 90% of the dental equipments & on theprimary health care approach, which is the remaining 10 %, it is 26%. For Consumablefoundation of rural health care system. 2. Increased health care awareness – dental products the dental import duty is a Robust national economic growth, rising max. of 28%. The liberal polices of govt. has family incomes, better socio-economic boosted global trading and created The integrated network environment, rapid growth in private sector, opportunities for international dental Aanganwadis increasing penetration of health insurance manufacturers. (including dental) have all made healthcare Primary health centre a fast growing private sector and leading to 9. World bank aid to set up infrastructure - increased health awareness. Growing Even World bank is providing financial Community health centre awareness has brought, increasing demand assistance to develop and run hospitals & for better healthcare facilities. Many Indians diagnostic centers in rural areas; Govt. is District hospitals are purchasing health insurance. Healthcare also encouraging such initiatives to improve awareness among the urban people is health care facilities. Tertiary care centre considerably higher than the rural people.© Indian Journal of Dental Sciences. All rights are reserved 10
  • 4. 10. National Rural Health Mission - dentistry is likely to increase. Thus, the Table 1. Growth in number of graduatesThe government seeks to provide effective future of dentistry is bright. from Indian dental schoolshealthcare to rural population throughoutthe country. The Mission is an expression of References - Year Graduatesthe governments commitment to rise public 1. Demographics of India. From Wikipedia,spending from less than 1% to 2-3% of GDP. the free encyclopedia. www.google.com 1960 1,370It is billed as the single-most largest [Last accessed on 2010 July 20] 1970 8,000program in the world to improve primary 2. CIA World Factbook demographic 1980 13,930healthcare delivery in India. Govt. has also statistics. Demographics Available 1990 20,000made center for oral cancer detection. f r o m : h t t p s : / / 2010 30,570 www.cia.gov/library/publications/the-Conclusion world factbook / geos / in.html. [LastDentistry faces serious problems regarding accessed on 2009 Mar 18] Distribution of dental colleges in Indiaaccessibility of its services to all in India. 3. The Army Dental Corps- Trail and (Table 2)The major missing link is the absence of a Triumphs : 1941-2008. No. Recog- Appro-primary health care approach. At present, in 4. Shobha Tandon. Challenges to the Oral States of nized vedrural India one dentist is serving 2.5 lakhs of Health Workforce in India. Journal of colleges seats seatspeople whereas; the overall ratio of dentists Dental Education; Vol. 68, No. 7 Karnataka 45 2800 250to population in India is 1: 10,000.12 Due to Supplement, July 2004. Maharastra 35 2030 990significant geographic imbalance in the 5. P.N Awasthi; Secretary, The Dental Uttar Pradesh 31 1680 1200distribution of dental colleges, a great council of India, July 2010. Tamilnadu 30 1380 1340variation in the dentist to population ratio in 6. Monette McKinnon, Gina Luke, Jack Andhra Pradesh 21 1380 450the rural and the urban areas is seen. Reports Bresch, Myla Moss, Richard W. Kerala 16 360 460suggest that there are about more than one Valachovic. Emerging Allied Dental Madhya Pradesh 14 760 500 Punjab 14 800 330million unqualified dental health-care Workforce Models: Considerations for Gujratproviders, or quacks, in India.13 They have Academic Dental Institutions. Journal of Haryana 12 520 620long been blamed for misdiagnosing and Dental Education; Volume 71, No. 11, Bihar 10 660 200 07 80 290mistreating. Nov. 2007. Himanchal Pradesh 05 340 - 7. National Oral Health Policy: Prepared by West Bengal 05 170 280Recommendations - core committee, appointed by the Jharkhand 04 100 3001. Emphasis on prevention to reduce the Ministry of Health and Family Welfare, Uttarakhand 02 140 -quantum of treatment requirements by 1995.improving and increasing the public dental 8. Sivapathasundharam B. Dental educationhealthcare system which will include health in India. Indian J Dent Res 2007;18:93.education, counseling, and health 9. Shan N, Pandey R, Duggal R, Mathur U.P,promo¬tion. Prevention is always cheaper, Kumar R. Oral health survey in India: A The specialty-wise distribution (Table 3)less time consuming than treatment & does report of multicentric study, WHO – Oralnot require skilled labor. health survey 2004. 1. Prosthodontists 4352. Increase the employment of dentists in 10. Future of Dentistry lies in India. 2. Endodontists 421public sector. www.google.com [ Search dated July 3. Orthodontists 399 2010] 4. Periodontists 3853. There are only 11,000 sanctioned Govt. 5. Oral surgeons 379jobs in India. The irony is only 5,500 jobs are 11. Indian Dental Market 2010. Indian 6. Pedodontists 270filled on date and the remaining are lying Dental Market 2010 - New market report 7. Oral medicine 240vacant. To begin with, remaining vacancies and analysis released 8. Oral pathologist 239should be filled by the concerned 12. Lal S, Paul D, Pankaj, Vikas, Vashishtauthorities. BM. National Oral Health Care4. Increase public awareness by dental Programme (NOHCP) Implementationhealth camps and use of mass media. Strategies. Indian J Community Med5. Control the dentists: population ratio by - 2004;29:3-10. 13. Sandesh N, Mohapatra AK. Streeta) Reduction of no. of dental colleges on the dentistry: Time to tackle quackery. Indianlines of America and China; further all J Dent Res 2009;20:1-2.academic dental institutions must meetquality standards established by the Dentalcouncil of India.b). Encouraging dentists to establishpractice in rural areas.c). Govt. should further reduce import dutyto make dental treatment affordable by morenumber of individuals.The efficacy of future treatments aredifficult to predict, however the demand for© Indian Journal of Dental Sciences. All rights are reserved 11