We all had heard the quote “Water, water everywhere; not a drop to drink”. Never did it become more evident than in the recent floods; where drinking water has become scarce. What is the profession of dentistry thinking? Are we waiting for? The signs are written on the wall, yet, we keep a blind eye towards the fact that the profession has failed miserably to make an impact on the oral health scenario of the country.
Today, it can also be said: Dentist, Dentist everywhere; none where needed. There is practically a functional non-availability of the dental workforce in the form of University qualified Dentists in the country; yet, you find high unemployment rates among the dentists. As a reaction to which saw a recent decline in number of admission in the dental colleges across the country. What do we do? We bring down the merit? Why do we do that? TO SAVE THE PROFESSION. What a laugh.
Is it that the leaders of the profession of dentistry have gone blind or is it, that we, the academicians and the decision makers of the profession blindly follow the path the “Seths” (owners of dental colleges) tell us to follow? Only because we do not want to lose our cushy jobs. Can we not see the flood of “unemployed” dentists looking for work? Can we not see that the oral health indictors of the country have not improved despite the huge surge of new blood in the profession?
Demand for treatment places for untreated oral disease is there; however, the oral healthcare delivery system of the country has little or none to offer. Ninety percent of the dental workforce is focused on the 10% of the population that can afford them. There is a distinct urban bias with almost 74% of the total dental workforce in the country residing in the big cities. There are those belonging to Karachi (29%); Lahore (16%); Rawalpindi/Islamabad (14%); Peshawar (7%); and Hyderabad and Multan 4% each. This is out of the 33,035 odd dentists registered with the PMC/PMDC as of 15th May 2022. In all these cities, the dentist to population ratio is around 1:2000; no wonder there are no jobs for them in these cities. There are 354 cities/towns in Pakistan with a population of 10,000 or more. Pakistan has 8 cities with more than a million people, 61 cities with between 100,000 and 1 million people, and 285 cities with between 10,000 and 100,000 people.Yet, only 125 cities have a registered dentist residing in these areas; out of which 26 locations have single digit number of dentists and 61 cities have dentists in two digits.
Deficiency of dentists and their urban bias in distribution was deliberated as an important factor in unequitable oral healthcare. It was assumed that by increasing the dentist-to-population ratio, this issue may be addressed. This resulted in mushrooming of dental schools especially in developing countries and Pakistan has been no exception; however, this failed to produce the envisaged reduction in the burden of oral disease in most parts of the world and in our country as well. Recruitment and retention of dentist in rural areas is a major issue even in developed countries, where there is an oversupply of university-trained dentists has left many oral healthcare facilities without appropriate manpower.
The Situation Analysis of the Oral Health Sector of Pakistan (2004) highlighted that there were just over 200 dentists working in the rural areas of the country at that time; making it a dentist to population ratio of 1:500,000 in these areas. Oral health care delivery in the public healthcare system of Pakistan is available at the Rural Health Centers (RHC). There are 600 RHCs in Pakistan and the paper record shows that at least one dentist is appointed at each of this facility. However, the quantum of untreated oral disease is a clear indicator of the effectiveness of these services. More than 90% of all carious lesions untreated speak volumes for the services provided; which is no secret and best not spoken about. All indicators show that there is a functional non-availability of the dental workforce in the form of university qualified dentists in the framework of Primary Oral Health Care (POHC) in the country.
Along with the mushrooming of dental colleges, especially in the private sector, in the past three decades, there came a cultural change in the demography of the dental students. As we all know, unfortunately, dentistry has always been seen as a second option for majority of those wishing to pursue a career in health sciences in Pakistan. Over the years it became an easier option for those with lesser marks and higher affordability to seek admission in private dental colleges, hence, a new breed of students from middle/upper middle socioeconomic class started populating the dental colleges. This new breed, has traits similar to that of the YUPPIE breed of the 1980s. Yuppies, as they were slanged, were Young Urban Professionals often characterized by youth, affluence, and their obsession with financial success. They were often well-groomed and smart in appearance and showed off their success by high fashion clothing and driving high-end cars – does this sound familiar?
There is a clear disconnect between the present generation of dentists and the communities they are being trained to serve. The only contact with the community is the oral health visit or two to a school of deprived communities, where they deliver lecture on brushing and distribute toothpaste. How exiting. On the other hand, one finds fresh graduates spending loads of money to do courses in aesthetic dentistry and implants but none appear for a session on removable partial denture, even if it is for free. There is a clear indication that the focus of the present generation is on getting trained to treat the affluent.
Then, there is this changing scenario of trained oral health workforce. On one hand, there is an increased female enrollment in dental schools; and on the other hand, a very few of them continue to pursue this career. In social circles, the degree in dentistry is considered part of the dowry package; making these girls more marriageable. In the healthcare delivery sector, the social norms do not allow these girls to take up jobs or open practices in areas where they are needed the most.
To top it all, the profession lacks dedicated leadership which can take up the case of this discipline and to make it a part of mainstream healthcare initiatives of the country. Even where initiatives are available, like inclusion of dental fillings and extractions in the Essential Package for Health Services in the UHC strategy for the country, there is no one to take it up with the authorities to implement the initiative.
The profession, generally speaking has given an impression that we have been living under the shadow of the medical profession. We have self-downgraded ourselves as children of a lesser God. We want a separate dental council and because the President of Pakistan is a dentist, we want him to do it for us. Dentistry will remain under shadow of Medicine till the dentists find sincere leadership and have their own Dental Council, says Pulse International in its July 15, 2019 issue.
I am sorry, but let us get our facts straight. Historically, whether it is the PMDC or PMC; dentists have always been put in-charge of decision making for dentists, dental education or matters concerning dentistry. We cover our inefficiencies with an excuse that we are not heard. What have we done to be heard or to be acknowledged?
What we seriously need to do is to GROW UP.
