Whither Dentistry

Ayyaz Ali Khan

Quo Vadis simply means “Where are you going?”- in Latin. Simple as it may sound, it has a profound derivation. It has been used by hundreds of writers and speakers to ask a question that is both momentous and melodramatic. There is a mythical story that this was a question put to Jesus Christ by St Peter. “To be crucified again” Jesus is believed to have replied.

This seems to be the predicament of dentistry in Pakistan.

Some of my seniors and to some extent our generation has witnessed the 60 years of progress  in dentistry; from a foot peddle drill to Laser dentistry. These six decades years also saw the establishment of dentistry as a specialty of health sciences from being a mere semi skilled vocation. From barbaric tooth puller to a sophisticated healthcare specialist; Dentist today are recognized in the society as an important health professional.

Let me take you back in time; the number of dental colleges stagnated in the first 50 years of the twentieth century; and, this was a global phenomenon. There was just one college for the whole country in 1947 when Pakistan became independent; fifty years later till 1997 there were 5 dental colleges all in the public sector. This was a 5 fold increase in 5 decades. This was the golden period of dentistry as during this time dentistry went on to become a much sought after profession recognized by the medical fraternity and society. It reached its pinnacle about 25 years ago. At the height of its glory Dentistry became a competitive profession with entry only for the brightest.

Over the next 20 years the increase became more dramatic. The number of college rose sharply to 40 dental colleges today. This is an increase by 800% in 20 years. Today, dentistry is teeming with mediocrity. As a profession it is losing its appeal. Dental education has moved into the hands of the private sector where admissions are open to candidates with moderate scholastic ability.

Thousands are jobless. We are witnessing the first signs of dissipation and the dim side of the profession. The proliferation of dental colleges, cheap commercialism, redundancy, ethical misdemeanours and several tribulations has begun to move stealthily into the once respected profession. Dentistry is coming towards a full circle. A lot could have been done in these last 25 years; as Charles Dickens puts it in The Tale of Two Cities - “It was the best of Times. It was the worst of times‟.  

We chose to make it the worst of times. Compromises were made – times and again. First it was hidden or camouflaged – later the rules and regulations were blatantly abused. The irony was that everyone got away with it.

Although the World Health Organization website clearly says and I quote “The issue of oral health personnel - which categories of personnel need to be educated, their duties and the numbers of each - has for many years been of great concern. The importance of this matter really has become evident in a number of countries where the production of dentists appears irrelevant to the oral health needs and demands” (http://www.who.int/oral_health/action/services/en/). However, in majority of the meetings the WHO recommendation for a dentist to population ratio of 1:7500 is quoted and then 180 million is divided over 15000 odd dentists; and a ratio of 1:12000 is quoted. Please note that there is a major urban/rural divide and there are only 500 odd dentists serving the rural community of this country and the urban dentist to population ratio today stands at 1:4200. With the number of students in the dental schools today this number will further increase in the next four years and the ratio would stand at 1:3000 for urban areas.

“There are three kinds of lies: lies, damned lies, and statistics” this quotation is often attributed to Benjamin Disraeli, the 19th century British Prime Minister. We are doing all. Increasing the BDS course to a five year program is all of them. Yes, the academics have recommended it – but are we ready in terms of investing into a 25% increase in terms of the dental units and a similar increase in the number of faculty. It is a lie that this increase will put us at par with global standards; it is a damned lie that with this increase in the training our graduates will be exempted from ORE and National Boards. The draft syllabus is incomplete and I can assure you that it will be adopted as such because no one is bothered.

Why has Dentistry alone face this plunge?  Money! Money! Money! The Role of Money in Dental Education is huge. Total money required for starting up a Dental College- Rs 5 Crores, four Kanals of land and the name of ten postgraduate persons (only names required!). Returns on investment is better than Medicine or nursing- invites more and more rapacious private players in dentistry. There are at least three dental colleges up for sale for 20-25 crores each.

Unplanned Growth- dependence on faulty statistics, lack of response by the Government despite protests from relevant quarters, corrupt Regulators to name a few are other factors responsible for deteriorating dentistry.

I appeal to the top notches in dentistry; the academic decision makers; the principals; the professors; the subject specialists and the members of the regulating bodies. It is time we wake up to realities and stand up for what dentistry stands for. Please stop working on the agenda of the businessmen and destroying the profession. It is a  National Shame! Witnessing the collusion of managements (ministry) with regulators and other government agencies have caused embarrassment and shame to medical and dental education in the country. The regulators seem to be in a great hurry to provide benefits to their masters – destroying institutions and the professions in the process.

I hang my head in shame!

(I attribute the ideas in this commentary to a similar commentary on Dentistry in India)