Special Feature

doi:10.1038/nindia.2017.28 Published online 20 March 2017

Dental practice, education and research in India

[Nature India Special Issue: Oral Health Inequalities and Health Systems in Asia-Pacific]

Balaji Subramoniam Muthiah1, 2 & Vijay P Mathur3


Policy recommendations

• Need to create national model for oral healthcare delivery at par with global standards considering cultural ethos and economic viability.

• Healthcare delivery at all preventive health centres through shared resources.

• Assessment of oral health needs through periodic National Oral Health Surveys along the lines of National Family Health Survey. 

• Identification of thrust areas and formulation of effective policies that can be implemented by an expert team.


Balaji Subramoniam Muthiah & Vijay P Mathur

Oral health, systemic health and well-being are highly connected1.Good oral health is not only necessary to avoid pain and maintain function but also for a better social and productive life. In order to achieve acceptable levels of oral health in populations, countries strive to improve healthcare systems. One of the major challenges is delivering optimum oral healthcare encompassing the entire population. Good oral health is not only necessary to avoid pain and maintain function, but for a better social and productive life. In order to achieve acceptable levels of oral health in populations, countries strive to improve healthcare systems. 

Oral healthcare delivery means comprehensive care of teeth, gums and other oral and peri-oral structures. Historically, the separation of the mouth from the body has been built into the domains of medicine and dentistry, and perceived as separate entities across populations/generations by separate training programmes, professional identities, payment structures, and deliv­ery systems2, 3.

Discussion on improvement of oral healthcare delivery system has been continuing for almost half a century in many countries and at a global level4. However, better outcomes are far from universal. Professor Bader, a noted re­searcher from North Carolina, USA termed method for improvement in oral care delivery as ‘ripe for development’ in his paper during a conference on Defining Quality in Oral Healthcare in 20095. There are five essential compo­nents to consider: strengthening dental school curricula to focus on patient care quality; engaging professional organisations to promote adoption and introduce diagnostic code usage; improving methods for changing practition­er behaviours; introducing and engaging purchasers of insurance plans; and conducting more outcome-driven research.

According to the last report of the Indian National Commission on Mac­roeconomics and health (about a decade back), the nation was estimated to suffer from a huge burden of oral diseases6. The report estimated that at least 623.1 million Indian would be suffering from dental decay and 362.48 million people would have moderate/severe gum diseases in 20156.

India, since its independence in 1947, has achieved much in terms of an oral healthcare system. Today, it has about 300 dental schools, increasing re­search output and penetration of oral health services at all levels of society7.  But, not all the benefits of the past 70 years have reached all Indians. The huge burden of oral diseases and patchy distribution of oral healthcare means that deficiencies in Indian dental education and research need addressing. This commentary considers some of the major challenges for Indian oral care de­livery and offers some solutions.

Dental practice

Figure 1: Distribution of dentists in Indian states. 
Source: National Health Profile for 2014, Central Bureau of Intelligence, Director-ate General of Health Services, Ministry of Health and Family Welfare, Government of India (2015)





The economic reality of running a dental practice and a lack of adequate in­frastructure and basic comforts in some parts of rural India has seen most dentists flock to urban areas. It is estimated that 85% of Indians, who reside in rural areas are served by 15% of all the country’s dentists. [Figure 1: Distribu­tion of dentists in India]  Conditions such as diabetics and hypertension, along with deleterious oral habits, have implications on oral health6 and lead to oral diseases, which are most often suffered by marginalized adults and children who already have poor nutrition, inadequate oral hygiene measures and a lack of access to oral healthcare.

Solution

A short-term approach to oral health and dental practice disparities would be to offer dental education and improve dental infrastructure in rural are­as. Programmes are needed to promote the use of available oral healthcare which should encompass preventive, diagnostic, treatment and rehabilita­tive services. A long-term solution would be to identify and eliminate bar­riers to oral healthcare, design better models of delivery where there are limited resources and develop preventive educational strategies to reduce risk. Offering oral healthcare delivery at all preventive health centres by sharing resources including dental personnel would also help disseminate oral healthcare delivery.

Dental education

The number of dental colleges in India has increased significantly since the 1990s, but their geographical distribution is not homogenous and there have been no concrete actions to address the issue7. Besides the geographical dis­tribution, the quality of dental education has been a cause of concern9, 10.

Solution

There is an urgent need for intervention in the Indian dental education system to introduce the latest concepts. The sector has shown positive signs with a significant number of dental colleges, both in government and non-govern­ment settings, adapting advanced curriculum and setting higher standards. Policy-makers need to ensure that this is accelerated and expanded to all In­dian dental education settings. Advanced information technology can be used to expand the current system.

Dental research

The gap in quantity and quality of Indian dental research has been described in detail elsewhere11. There is a need to include more evidence-based research and research for clinical translation, along with increasing funding for such research. Further, recent reports point to an acute lacunae in proper ethical based research settings12.

Solution

Policy-makers must identify critical factors that impede structured oral health research in India. Investment is needed to identify priority areas, cost control methods, and measures for quality control. There must be a focus on develop­ing thrust areas, backed by evidence based requirements, to mitigate the oral disease burden.

India needs to formulate a model of oral healthcare delivery on par with global standards in line with a regional-socio-cultural ethos and considering economical viabilities.


1Secratary General, International Association for Dental Research – Indian Division; 2Director, Balaji Dental and Craniofacial Hospital, Chennai, India (smbalaji@gmail.com); 3Additional Professor, Centre for Dental Education and Research; All India Institute of Medical Sciences, New Delhi, India (Vijaymathur7@gmail.com).


References

1. Vundavalli, S. Dental manpower planning in India: current scenario and future projec­tions for the year 2020. Int. Dent. J. 64, 62-67 (2014)

2. Hummel, J. et al. Oral health: An essential component of primary care. Seattle, WA: Qualis Health, 9-12 (2015)

3. Collins, R. J. Planning an oral health future. Medscape (2013)

4. Davies, N. G. Primary oral care for developing countries. World Health Forum. 12, 168-174 (1991)

5. James, B. Using outcomes in oral health quality assessment. Conference Proceedings: Defining quality in oral healthcare, critical issues and innovative solutions to advance quality in dental care treatment and delivery. Institute for Oral Health Conference, San Jose, CA (2009)

6. Shah, N. Oral and dental diseases: causes, prevention and treatment strategies. Bur­den of Disease in India. National Commission on Macroeconomics and Health, 275-298 (2005)

7. Jaiswal, A. K. et al. Dental manpower in India: Changing trends since 1920. Int. Dent. J. 64, 213-218 (2014)

8. Mathur, M. R. et al. Addressing inequalities in oral health in India: need for skill mix in the dental workforce. J. Fam. Med. Primary Care 4, 200-202 (2015)

9. Elangovan, S. et al. Indian dental education in the new millennium: challenges and opportunities. J. Dent. Educ. 74, 1011-1016 (2010)

10. Samuel, S. R. Dental Education: Too many graduates in India. Brit. Dent. J. 220, 219 (2016)

11. Eaton, K. A. et al. Improving the quality of papers submitted to dental journals. J. Den­tistry 43, 855-864 (2015)

12. Janakiraman, C. et al. Profile of institutional ethics committees in dental teaching in­stitutions in Kerala, India. Accountability Res.23, 219-229 (2016)