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GUEST EDITORIAL
Year : 2017  |  Volume : 8  |  Issue : 1  |  Page : 9-10  

Peeling back the onion: An outsider's observations


Diplomate, American Board of Pediatric Dentistry Diplomate, National Board of Public Health Examiners Fellow, International College of Dentists Fellow, American College of Dentists Fellow, American Academy of Pediatric Dentistry Senior Associate Director, Extramural and Special Projects Department of Dental Medicine, NYU Lutheran, NYU Langone Health System, New York, United States of America

Date of Web Publication24-Apr-2017

Correspondence Address:
David M Okuji
Diplomate, American Board of Pediatric Dentistry Diplomate, National Board of Public Health Examiners Fellow, International College of Dentists Fellow, American College of Dentists Fellow, American Academy of Pediatric Dentistry Senior Associate Director, Extramural and Special Projects Department of Dental Medicine, NYU Lutheran, NYU Langone Health System, New York
United States of America
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ccd.ccd_226_17

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How to cite this article:
Okuji DM. Peeling back the onion: An outsider's observations. Contemp Clin Dent 2017;8:9-10

How to cite this URL:
Okuji DM. Peeling back the onion: An outsider's observations. Contemp Clin Dent [serial online] 2017 [cited 2017 Jun 26];8:9-10. Available from: http://www.contempclindent.org/text.asp?2017/8/1/9/205039



I recently had the honor and pleasure to participate as a speaker at a conference in Punjab state and met with the leaders and members of the Indian Dental Association (IDA), Amritsar branch, and the administrators, faculty members, and students of dental colleges from the Punjab Government Dental College and Hospital, Amritsar, Sri Guru Ram Das Institute of Dental Sciences and Research, Government Dental College, Patiala, Dashmesh Dental Institute, Faridkot, National Dental College, Dera Bassi, Christian Dental College, Ludhiana, BJS Dental College, Ludhiana, and Maharishi Markandeshwar University, Mullana. At this same conference, Professor S.G. Damle, our esteemed editor of this prestigious and internationally renowned online publication, was honored as the chief guest and gave a moving oration which inspired the dental students to become leaders for the betterment of society.

In alignment with Dr. Damle's call to action for bettering society, my participation as a speaker was part of a team of dentist-volunteers with the Global Dental Ambassadors group.[1] The dentist-volunteers share the mission to participate in academic and self-subsidize cultural exchanges among oral health professionals and institutions around the globe.

I told the audience that this was my first visit to India and shared my observation that India is “like an onion” because I only had knowledge of the outer skin of onion from the stories of India, as told by my U.S-based colleagues of Indian ancestry. From these stories, my understanding of the onion skin was that India is geographically large, culturally diverse, and hugely populated.

Of course, “onions are considered as a basic ingredient or the fundamental of Indian cooking,”[2] so it is fitting for me to continue with the “onion” metaphor. As I prepared for my trip to India, I peeled off the first layer beneath the “onion” skin and learned about the oral health infrastructure in India compared to the United States. With over 1.2 million people, India has a population which is four times greater than the U.S.[3] However, with approximately 120,000 dentists, India has fewer dentists to serve its large population, compared to the 195,000 dentists in the U.S., with the ratio of population per dentist much higher in India.[4],[5] India's 310 dental schools are graduating nearly 31,000 dentists annually, compared to the 5500 dentists graduating each year from the 66 U.S. dental schools.[6],[7],[8] Hence, the first layer of the onion taught me that there was an overall shortage of dentists in India to serve its burgeoning population.

As I peeled back more of the “onion,” I learned that the majority of new graduates from Indian dental schools prefer to practice in the cities and not the rural areas, with only 75% of dentists located in urban areas which contain 25% of the population.[6],[9] Similarly, this is a trend found in the U.S. as well.[10] As I delved deeper into the “onion,” I found that the caries prevalence for children under age 5 years old is 39.9% in India and 28.0% in the U.S.[11],[12] Again, we find that there are similarities for both India and the U.S. with the burden of disease for early childhood caries and the mal-distribution of dentists. The overwhelming conclusion is that neither India nor the U.S. will be able to drill their way out of the burden of early childhood caries.



Going deeper into the “onion,” I found that in 2012, Dr. Raman Bedi, our esteemed colleague at King's College, London, conducted a survey of nearly 1200 Indian dentists to learn how the Indian diaspora might better support India. The results of the survey highlighted three key concerns expressed by the respondents. The dentists overwhelmingly concurred that (1) there should be a “national and or state community program to provide dental care for the underserved and health education to improve dental health literacy,” (2) improvements are required “in dental education at both the undergraduate and postgraduate level,” and (3) in general, “the population does not value oral health.”[13] According to Gambhir et al., “most of the people in India do not have access to basic oral health care” and “patients are not covered under any type of insurance and generally pay out of their pockets to get treatment from both public and private dentists.”[14] Comparatively in the U.S., 90% of children are beneficiaries of government or commercial insurance, with 10% un-insured.[15]

Still not yet at the center of the “onion” and after speaking with many of the dental students who attended the conference, I learned that the students were very knowledgeable and well versed in the dental and medical literature. I also learned that they were very concerned about their future as dentists in India. They shared that they are worried about finding jobs and being able to care for those in need. They also asked about pathways to the U.S.

Deeper in the “onion,” I spoke with faculty members and IDA members who informed me that the practice of dentistry in India differs from that in the U.S. due to (1) the large number of dentists who are women and (2) the prevailing practice model that dentists tend to retain patients within their practices for specialty care by minimizing the referral of patients outside of the practice.

“The most enlightening finding was the overwhelming and unanimous response by all of the conference participants, when asked to raise their hands if they believed that it was important that oral health care be equitable for all people. The entire audience raised its hands proudly and vigorously and, thus validating to me that the group was strongly committed to make society better.

In closing, I wish to again thank Professor Damle for helping me understand the depths of the “onion” through the sharing of his inspired message for world betterment. I am confident that all of us, as global citizen-dentists, will continue to work together toward this goal.”



 
   References Top

1.
Unauthored. Global Dental Ambassadors. Available from: http://www.webcitation.org/6nDuItdAe. [Last accessed on 2017 Jan 02].  Back to cited text no. 1
    
2.
Tasty Indian Recipes. Available from: http://www.tasty-indian-recipes.com/indian-cooking-glossary/onions/. [Last accessed on 2016 Oct 22].  Back to cited text no. 2
    
3.
Population of the World. Available from: http://www.livepopulation.com/country/india.html. [Last accessed on 2016 Oct 30].  Back to cited text no. 3
    
4.
Vundavalli S. Dental manpower planning in India: Current scenario and future projections for the year 2020. Int Dent J 2014;64:62-7.  Back to cited text no. 4
    
5.
Munson B, Vujicic M. Number of Practicing Dentists Per Capita in the United States Will Grow Steadily. Available from: http://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0616_1.pdf. [Last accessed 2016 Oct 30].  Back to cited text no. 5
    
6.
Dagli N, Dagli R. Increasing unemployment among indian dental graduates – High time to control dental manpower. J Int Oral Health 2015;7:i-ii.  Back to cited text no. 6
    
7.
Applicants, Enrollees, Graduates. Total U.S. Dental School Graduates 1960-2014. Available from: http://www.adea.org/publications-and-data/data-analysis-and-research/applicants-enrollees-and-graduates.aspx. [Last accessed on 30 Oct 2016].  Back to cited text no. 7
    
8.
Search for Dental Programs. Predoctoral (DDS/DMD). Available from: http://www.ada.org/en/coda/find-a-program/search-dental-programs#t=us&sort=%40codastatecitysort%20ascending. [Last accessed on 2016 Oct 30].  Back to cited text no. 8
    
9.
Tandon S. Challenges to the oral health workforce in India. J Dent Educ 2004;68 7 Suppl: 28-33.  Back to cited text no. 9
    
10.
Dentist Supply, Dental Care Utilization, and Oral Health among Rural and Urban U.S. Residents. Rural Health Research and Policy Center. Available from: http://www.depts.washington.edu/uwrhrc/uploads/RHRC_FR135_Doescher.pdf. [Last accessed on 2016 Oct 30].  Back to cited text no. 10
    
11.
Shah A, Batra M, Aggarwal V, Dany SS, Rajput P, Bansal T. Prevalence of early childhood caries among preschool children of low socioeconomic status in district Srinagar, Jammu and Kashmir. Available from: http://www.iaimjournal.com/wp-content/uploads/2015/03/2-Prevalence-of-early-childhood-caries.pdf. [Last accessed on 2016 Oct 30].  Back to cited text no. 11
    
12.
Early Childhood Caries. American Academy of Pediatric Dentistry. Available from: http://www.mychildrensteeth.org/assets/2/7/ECCstats.pdf. [Last accessed on 2016 Oct 30].  Back to cited text no. 12
    
13.
Bedi. R. Call for Action: Improving Dental Services and Oral Health in India. Global Child Dental Fund. Available from: http://www.gcdfund.org/sites/default/files/users/Indian%20Oral%20Health%20Survey%20Report%20-%20final.pdf. [Last accessed on 2016 Oct 31].  Back to cited text no. 13
    
14.
Gambhir RS, Brar P, Singh G, Sofat A, Kakar H. Utilization of dental care: An Indian outlook. J Nat Sci Biol Med 2013;4:292-7.  Back to cited text no. 14
    
15.
Children's Health Coverage in the United States. Children's Defense Fund. Available from: http://www.childrensdefense.org/policy/health/. [Last accessed on 2016 Nov 01].  Back to cited text no. 15
    




 

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