1 Priti Gupta "Current scenario and crisis facing dental college graduates in India"“A physician buries his mistakes, a dentist pulls them out, but a teacher has to live with them”The World Health Organization defines Dentistry as "the science and art of preventing,diagnosing and treating diseases, injuries and malformations of the teeth, jaws and mouth".Dentist are not only specialized in Extraction of tooth but they are doctorate level medicalprofessional who primarily aim to prevent and treat oral disorder by Providing preventivetreatment such as scaling, cleaning and fluoride therapy, Repairing teeth damaged by decay ortrauma, rebuilding tooth structures for functional or aesthetic reasons and providing crowns andbridges. Dentist helps bytreating diseases of the roots, gums and soft tissues of the mouth andcarries out various surgical procedures, from routine extractions to far more complex operationson the jaws and soft tissues, Using X-rays to detect abnormalities and plan treatment, Managingmalformation and misalignment of teeth and jaws by providing appropriate treatment. They arealso specialized in Designing dentures and oral appliances by taking impressions, recording jawrelations, selecting teeth and correctly fitting dental appliances manufactured by dentaltechnicians to the dentists prescriptions.The scientific & evidence-based dentistry is the handwork of Dr. Rafiuddin Ahmed. In 1928, heestablished the first dental college in Asia, in the city of Calcutta (India). Initially, it offeredaone-year course which was subsequently restructured to four years in 1935, was a pioneeringeffort towards setting up a dental institution of merit along modern scientific lines. Since then,India has experienced an exponential growth of private dental colleges. There is a regulatorybodydeveloped to drive this growth in a direction that benefits students and the health of Indianpopulation.The Dental Council of India (DCI), a statutory body was established under an act ofparliament „The Dentists Act 1948‟ (XVI of 1948)which came into existence in March, 1949. Itsresponsibilities include the regulation of dental education, profession, and ethics and liaisingwith the government to obtain administrative approval for dental college and higher educationalcourses. In August 1992, an Amendment was introduced to restrict the mushroom growth ofdental college, increase intake of student and enable starting of higher level of courses withoutprior permission of the Central Government‟s Ministry of Health & Family Welfare.Dental schools in India fall into one of three major categories: a) government dental school as apart of a government university, b) private dental school affiliated with a government university,and c) private dental school as part of a private university. Currently, there are 294 dentalcolleges in India. [Dental Council of India‟s (Figure 1.1)]. They enroll close to 23,900 studentsannually. The duration of the dental school program is five years, of which four years aredevoted to didactic, and laboratory course work and one year to compulsory internship rotation.
2 Priti GuptaDental school graduates in India are awarded a bachelor of dental surgery degree (B.D.S.). Thereare staggering of 1078 post graduate institutions available, rolling out close to 3389 specialists invarious field of dentistry every year (DCI 2011). In India, Every dentist who wants to renew hislicense will have to complete 20 hours per year of continuing medical education.Dentistry involves a broad range of professionals, from doctorate level to administrative levelpeople.Majority of dentist prefer to work in private practice. A dentist may set up a practice orpurchase an existing practice. Other ways of working in private practice include becoming anassistant dentist, which means they receive a salary from the owner of the practice; an associatedentist, where two (or more) join together to share the certain expenses, such as rent, while otherexpenses are paid separately and fees are collected separately; or as a partner where two or morepractitioners share expenses and profits/losses according to an agreed proportion.There are a variety of employers who need dental professionals such as the military and othergovernment institutions, in addition to private dental practices.Dentists can likewise work forGovernment and private hospitals. A salaried government dentist treats patients eligible forpublicly funded dental treatment. According to WHO, there is a total workforce of 78,096 dentalpractitioners in India at present (WHO status 2000 – 2010). Each of the armed services maintainsdental units which provide treatment for members of the service and in some circumstances theirfamilies.Some dental graduate can also find short-term appointments as tutors or lecturers. Permanentappointments require post graduate experience and higher degrees. Excellent employmentopportunities are available for dentists in the research and advisory departments ofpharmaceuticals. Now days, clinical research organizations and pharmaceuticals companies hiredentist as investigators or experts for research related finding and activities. Sometimes ethicscommittees of hospital appoint dentist as a member of committee for particular study.In term of specialization, with an increasing awareness of oral health and the introduction of newfields have all enhanced the scope of the field. 1. A Dental-maxillofacial Radiologistdeals with diagnostic imaging procedures applicable to the hard and soft tissues of the oral and maxillofacial region and to other structures which are relevant for the proper assessment of oral conditions. 2. An Endodontistdeals with the morphology, physiology, and pathology of the human tooth and, in particular, the dental pulp, root and peri-radicular tissues. 3. An Oral and Maxillofacial Surgeon deals with the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects of the human jaws and associated structures. 4. An Oral Surgeon deals with the diagnosis, surgical and adjunctive treatment of diseases and injuries limited to the dento-alveolar complex. 5. An Oral Physician deals with the clinical diagnosis, assessment and principally non- surgical, pharmacological management of anatomical variants, pathological conditions, diseases and pain of the dental, oral and adjacent anatomical structures and the dental/oral
3 Priti Gupta manifestations and complications of systemic diseases, pathology and conditions and their treatment. 6. An Oral Pathologist deals with diseases of the teeth, jaws, oral soft tissues and associated structures, studies their causes, pathogenesis and effects, and by use of clinical, radiographic, microscopic and other laboratory procedures establishes differential diagnoses and provides forensic evaluations. 7. An Orthodontist deals with the study and supervision of the growth and development of the dentition and its related anatomical structures, including preventive and corrective procedures of dentofacial irregularities requiring the re-positioning of teeth, jaws, and/or soft tissues by functional or mechanical means. 8. A PaediatricDentist deals with the prevention and the treatment of dental diseases and abnormalities in children and their associated developmental and behavioural problems.. 9. A Periodontist deals with the prevention, recognition, diagnosis and treatment of the diseases and disorders of the investing and supporting tissues of natural teeth or their substitutes.. 10. A Prosthodontist deals with the restoration and maintenance of oral health, function and appearance by coronal alteration or reconstruction of natural teeth, or the replacement of missing teeth and contiguous oral and maxillofacial tissues with substitutes. 11. A Public Health Dentist deals with the community as the patient rather than the individual, being concerned with oral health education of the public, applied dental research and administration of dental care programmes including prevention and control of oral diseases on a community basis. 12. A Special Needs Dentist deals with patients where intellectual disability, medical, physical or psychiatric conditions require special methods or techniques to prevent or treat oral health problems, or where such conditions necessitate special dental treatment plansPayScale.com reports that most general dentists received a total pay between Rs 63,960 and Rs594,609 per year, as of October 2011. Salary of a dentist varies with the industry and companies(Figure 1.2). There has been a marked improvement in the dentist-to-population ratio in generalterms. Dentists-to-population ratio of India, which was 1:300,000 in the 1960‟s. Currently, ratioof dentistry per 10,000 populations is 0.7 (1:7500) in India (WHO 2011).Considering the facts and figures, the question arises that are we really short of dentists? Toanswer this query, one should understand the truth behind the journey of dentalgraduate.Dentistry is rewarding but challenging field, as are most healthcare field.One of the challenges a dental student experienced is at education level. A dentist requires ahuge amount of commitment of time and money. Higher education secures the betteropportunities but at the same time requires 7 to 11 years to establish their job. A hefty amount isstockpiled in education. Additionally, there is a great deal of competition to get into dentalschool.
4 Priti GuptaNext challenge a dental student encounters is at the startupof a practice as a dentist. Dentist willhave to put in a lot of hard work before they can establish their name in this industry. A dentalgraduate begin his career as an associate in the office of a dentist or dental partnership with anestablished practice. This is because of the high start-up costs of an independent practice and thelack of independent clinical experience. As an associate dentist, they dyed-in-the-wool certainnumber of years for practice. Some dentists haveto handle business responsibility, like managingthe financial and administrative aspects, including hiring and management of personnel, can betime-consuming and stressful, in addition to work as a dentist.Repetition of job, Relocation once established with physical presence and emotional supportdemand of patients and lack of benefitssometimes disappointing for some dentist. Additionally,patient volume can decline in tough economic times, as many people will put off preventative orroutine visits when cutting back financially. Office revenue (and the dentists income) candecrease when patient volume declines.Above all, the biggest challenge for a dentist is spreading awareness among Indian populationabout the oral healthcare. A survey conducted on 35 – 44 year olds advocated that 80% of adultshave tooth decay, 90% have gum disease and 5.4 per person on an average suffering from DMFT(decayed, missing, filled) teeth. In addition it, other shocking fact suggested that only 33% ofIndian population ever visited a dentist (government of Indian‟s survey 2002 – 2003). The publicspending on urban and rural healthcare is 23% and 30% respectively.This profession is a “standing profession”. Dentist would stand while treating their patients.Now, it is largely a sedentary one and dentists are prone to back and neck problems. They alsohave to deal with biological waste and radioactivity as X-Rays are taken within the clinic setupin most settings, thus exposing dentist to harmful elements and disease.Bearing in mind the fact, dentists aredeciding on alternative options of their career.Whilst aqualified dentist, they are sidetrackingtheir career to other profession. Dentists are trying theirhands on jobs like marketing and business development. These kinds of job profile requireextensive travelling, which is not possible while working in dentistry set up. Now a day,companies are hiring Doctors for such profile as they are well contented with medicalterminologies and disease progression in addition to knowledge of treatment available.Dentists are getting good prospects in call centers and Knowledge processes outsource (KPO)which are either work for Insurance companies or for hospitals. Telemedicine and teledentistryare two new emerging areas of healthcare services. Because of uneven distribution of populationand dentist, these services getting popularity these days. About 80% of dentists work in majorcities in India; compared to the population where more than 70% of the Indians reside in therural areas. Teledentistry uses dental health records, telecommunications technology, digitalimaging and the Internet to link dental health care providers in rural or remote communities withspecialists in larger communities to enhance communication, the exchange of health-related
5 Priti Guptainformation and access to dental care for underserved patients. Major Business processoutsourcing companies gaining momentum form healthcare and life science industry. The IndianHealthcare market is at about US$ 60 billion. The industry is expected to grow to US$79 billionby 2012. The Indian healthcare market is one of the largest services sectors contributing 2% tothe countrys GDP. A number of varied services are available for Dentist like insurance billing,disease coding, forms processing and claims adjudication.Medical writing is one of the forthcoming promising professions. Dentists are approaching thesefields because of financial securities and more tranquil life. Dentists are well through withmedical knowledge. They implement their knowledge through writing to reach patient.Eventually, we have concluded dentists are facing thoughtful challenges in terms of practicingdentistry. Policy maker needs to understand lack of adequate opportunities for graduateespecially girls. As our life style and technology getting advanced day by day, new opportunitiesare making their way.Now a dentist might not require a hospital or clinic setup, they can assisttheir patient through other ways. This ensures dentist monetary support as well as a peaceful life. 180 160 140 120 Ahmedabad Municipal 100 Corporation 80 Govt. 60 Private 40 20 0 Approved Recognised Figure: 1.1 total number of college approved and recognized Popular Salary Range Industries Family Rs 69,335 - Rs 660,308 Dentistry Hospital Rs 71,878 - Rs 600,347
6 Priti Gupta Health Clinic Rs 64,815 - Rs 466,595 Dental Rs 74,156 - Rs 668,185 Prosthetic Services Healthcare Rs 72,029 - Rs 678,259 Figure: 1.2 comparison of salary of a dentist with companies and industryReferences: 1) http://www.dciindia.org/search.aspx 2) http://healthcareers.about.com/od/healthcareerprofiles/p/How-To-Become-A-Dentist- Dentist-Career-Overview.htm 3) http://becomeadentist.org/why-to-not-choose-dentistry 4) http://www.payscale.com/research/IN/Job=Dentist/Salary 5) http://marketerskaleidoscope.com/2009/08/indias-dental-health-market/ 6) http://www.ada.org.au/dentalprofessionals/dentist.aspx 7) http://www.ijdr.in/article.asp?issn=0970- 9290;year=2011;volume=22;issue=2;spage=189;epage=189;aulast=Reddy 8) http://www.who.int/whosis/whostat/en/