A series on oral health in a medical journal has raised concern over the increase in number of dental schools in countries like India, Brazil, Chile, Colombia and the USA as many are private, for-profit institutions responding to demand for dental courses with no reflection on the needs of local population.
To be published in the Lancet journal on Friday, the series states that oral diseases affect 3.5 billion people worldwide. However, dentistry has so far been unable to tackle the problem, the authors have said.
“Dentistry is in a state of crisis,” Richard Watt, lead author of the series and honorary consultant at Dental Public Health at University College London (UCL) said. The Lancet series, led by the UCL researchers, brought together 13 academic and clinical experts from 10 countries to understand why oral diseases have persisted globally over the last three decades, despite scientific advancements in the field.
According to Watt, this shortcoming is not the fault of individual dental clinicians committed to caring for their patients. The overall philosophical approach, system, and model of dental care delivery are at fault. The dental profession and the practice of dentistry are still very much dominated by a treatment-focused, interventionist, and technical philosophy that reflects patterns and understandings of dental disease that were current over 80 years ago, and ultimately date back to the surgical origins of the profession, the researchers pointed out.
Oral diseases, including tooth decay, gum disease and oral cancers, affect almost half of the global population, with untreated dental decay the most common health condition worldwide.
In India, oral disorders are the most prevalent disease condition and have remained for the past 30 years. “However the rapid increase in the number of dental schools in the country has not resulted in reducing the burden of oral diseases or has made oral health services available and accessible by each and every section of the society,” Dr Manu Raj Mathur, additional professor at Public Health Foundation of India and one of the researchers, told The Indian Express.
The burden of oral diseases is on course to rise as risk factors like sugar consumption – the primary cause of tooth decay – is increasing rapidly across low-middle income countries.
Oral diseases (as a whole) are the most prevalent disease condition in India. Global health data from the Institute for Health Metrics and Evaluation (2017) has said that most prevalent oral conditions in India with their age distribution include caries (dental decay) of permanent teeth – 26.45 per cent (age 5-14 years). At least one in 4 child/adolescent is affected due to this dental decay.
The prevalence of caries of permanent teeth in the age group 15-49 years is 37.69 per cent while it is 36.72 per cent in the age group 50-69 years. Prevalence of disease of the gums (periodontal diseases) is 35.25 per cent in the age group 50-69 years.
Most of the oral diseases are preventable, or if detected early, can easily be treated by minimum intervention. What is required is an appropriate “skill mix” in the dental workforce.
“You need more of dental hygienists and other dental auxiliaries rather than only dental surgeons,” Dr Mathur said. For about nearly 313 dental colleges in India producing dental surgeons, only 54 dental colleges train dental hygienists; 90 dental colleges train dental mechanics; and 25 dental colleges training dental operating room assistants.
Various preventive dental services like atraumatic restorations, which involves filling of teeth affected by dental caries without the use of any special mechanised equipments; education on proper ways of tooth brushing to children and adults, which would help to prevent dental caries and other periodontal problems; and tobacco cessation counseling, which could help in preventing oral cancer; can easily be undertaken by dental auxiliaries, Dr Mathur said.
There has been no major improvement in the prevalence of oral diseases in India in the past three decades, highlighting the lack of importance given to oral health from a policy and service delivery standpoint, Dr Mathur said. While WHO has advised an ideal dentist-population ratio of 1:7,500, the Indian Journal of Public Health, states that this ratio in rural areas of the country is 1:2,50,000 and is 1:10,000 in urban areas.
In order for primary oral care being affordable, accessible and available for all, we need to train more dental auxiliaries rather than dental surgeons, Dr Mathur stressed.