DOCTORS: GODS OR SOMETHING ELSE?? (PART I)

There have been many reports about Eminent Doctors taking cuts / referral fees. There cannot be any justification. But if in a whole system based upon corruption, a whole society facing inflation, people expect only one of its components to be sane, it’s insane.

There is corruption in every aspect of every field including religion, law and judiciary, government, politics, police, press, military, film industry, and also medicine, as the doctor is a part of this very same society, not from any outside world. There indeed is corruption in many aspects of medical field, referring a patient, unnecessary lab tests, CT/MRI scans, surgeries, cross referrals, almost everything.

As in every field, there are few people who do it by choice. There are some who have to be a part of the system to survive in India, and some who refuse to be a part of it all, facing many other problems including a perpetually low income.

This is where some thought has to be put. Why would a person with highest of merit, hardest of hard work, and a tendency to help others want to become corrupt? Not by choice, at least. No one becomes a doctor for greed. Some people might attempt to do so, but these people drop out in the first six months or a year, as they are not dedicated to a hard life, and cannot endure medical education in India.

Every doctor wants to do good of his patient, and also live a decent life. After a life-long meritorious career, he is expected to toil in villages / rural areas without any rewards for it. Should he not want his kids to go to the best schools? Should he not want a decent lifestyle? Should one give up a lucrative career in the west and return to his homeland feeling patriotic, to just be told that in your own country you are doomed to a life of sacrifices just because the society expects so?

“Someone who wants money should not become a doctor” says an actor, who is seen doing all immoral things (from peeing openly in a garden for press in real life, to cruel crimes and revengeful murders in movies, all this while running a show to change India to an ideal country). Should not a doctor not want money for a decent life? Should he endure the humiliation of so many non-meritorious people from his class, living in luxury, because they chose not to be a doctor, while he chose the noble profession?

Listening day-in and day-out to patient’s problems, tears, cries, allegations, threats, and expectations, not ever having a peaceful sleep for a week at a stretch, not eating in time, not having enough time for family, a doctor also wants to earn well.

Doctors are fined hefty amounts for medical negligence. If a judge, policeman or a politician is wrong, and even when proven wrong, can get away with it easily. There is a general presumption that the negligent doctor’s intention was bad. Negligence is possible in all fields (bridges/ buildings/ food/ public transport), and can cost many lives. The doctor alone pays in crores for a life that he was attempting to save, while in all other cases the motive is profit, not saving a life.

Judges decide the amount of fine for the so-called negligence. Doctors save millions of lives, some through heroic and exceptional efforts, without thinking of rewards. If a young patient is saved, the doctor does not charge according to all the income the person can make all his remaining future. So this criterion for deciding fines is also not correct.

Highly specialized doctors in India are expected to be at par with their western counterparts. They often are, because half the world travels to India for medical advice.

But the Indian community is yet to awaken to the doctor’s fees. An average specialist in the developed world charges between an equivalent of 10,000 to 30,000 Indian rupees for the first consultation. Appointments are very difficult to get. They don’t work out of 8 am to 4 pm slots, except in emergencies (although there are some honorable exceptions). And yet they get so many benefits from the hospitals they work at, and also from the government. They see no free patients. Most doctors live in luxury in the western world.

Indian doctors, on an average, charge 200-1000 rupees for an OPD patient, and also see many free patients (almost 40-50%) everyday. They continuously have to be occupied with the patient’s health, relative’s expectations, their anger (they think that every patient must get well irrespective of his / her health status, with many holding the doctor responsible for their illness / failure to improve/ complications) and continuous suspicion (patients think doctors are out to loot, with every investigation with an intention to get more profit out of the patient). People want the best, but want to bargain, like buying vegetables. There is also a widespread belief that pharmaceutical companies are actually serving the doctors, and not the patients.

Google searchers think they know better medicine just because of what they recently read about a tiny drop in the ocean of medicine. They take up a lot of doctor’s time, but don’t want to pay for that additional time. The very relatives who shout at the doctor seldom know what medicines the patient is taking, as it is all supposed to be his responsibility. So many people come over and threaten, abuse and even manhandle the doctors, which is a routine nuisance in every casualty in India. There is no sensible director in Bollywood to have realized a doctor’s plight while working under threat in casualty. Everyone loves the populist “Doctor-threatening” hero.

The respect doctors get is divine, that respect and the satisfaction of doing something godly by saving lives, helping people live better lives alone keeps doctors from going on and not quitting the profession for better incomes. It is not that the doctors do not have the options of making more money, having used their talents elsewhere.

But that respect does not substitute for children’s fees, rents, electricity, travel, or any other expense. Almost all doctors and their family members end up paying almost full bills for themselves at the very hospitals that they work in. Everywhere a doctor goes, he pays the same money that any other citizen does. There isn’t a separate queue for a doctor anywhere in any office. There is no pension. There is no security. If a doctor is sick, his / her income is zero as long as he does not work: No one cares if he has treated hundreds for free. The respect does not substitute for the stress a doctor bears, of years of listening to and attending pain and tragedy, years of sleepless life, fasting days, lost precious time with dear ones.

THE SILENT KILLER: HEPATITIS B

Hepatitis is the inflammation of the liver caused by viruses A, B, C, D or E. Hepatitis B virus (HBV) represents one of the most neglected global pandemics. One-third of the world’s population is infected with the hepatitis B virus (HBV), and more than 350 million have chronic (long-term) liver infections. It is estimated that about 370 million people worldwide are chronically infected with hepatitis B, the major cause of liver cancer. Most of those infected have no access to affordable treatment. Many live in fear of discrimination because of public misconceptions. Still others remain unaware they are even infected. And hundreds of millions of young people may still be vulnerable because they have not been vaccinated. Liver cancer and liver disease cases caused by acute and chronic HBV exceed the combined death rate from tuberculosis, HIV/AIDS, and malaria. HBV is transmitted the same way as HIV but the hepatitis B virus is up to 100 times more infectious than HIV. Without access to appropriate medical care or treatment, one in four persons chronically infected with hepatitis B dies prematurely from liver cancer or liver failure caused by the virus.

Hepatitis B is of two types. In the case of acute hepatitis B, the person's immune system may get rid of it within a period of time. However, the patient is capable of transmitting it to other patients. 'Chronic' hepatitis-B may be a warrant to death if liver becomes cancerous and a liver transplant is not done.

HBV poses a serious “silent epidemic” challenge to India. Infected persons are unaware of their chronic carrier status, and continue to infect others for decades and eventually burden the society with loss of productive workforce, and the health care system with expenses of treating liver failures, chronic liver diseases, and cancers. HBV is estimated to have led to 500 million chronically infected persons and one million deaths annually.

The incubation period (the time of exposure to onset of symptoms) is 6 weeks to 6 months. HBV is found in highest concentrations in blood and in lower concentrations in other body fluids (e.g., semen, vaginal secretions, and wound exudates). HBV infections are commonly caused by exposure to infected blood and these body fluids. Infections may also occur as a result of iatrogenic exposures (transfusion/ transplantation/dialysis of infected blood/ blood products or organs/tissues), and use of contaminated injections/equipment. Epidemics due to unsafe injection practices have been well documented in India (hepatitis B carriage is 46%), such as among injecting drug users and healthcare workers caring for infected people. Transmission through unsafe sexual intercourse and transmission from mothers to infants is also well-established. At the community and individual level, certain harmful behavioral practices, such as reusing razor blades and injection syringes, practicing unsafe sex, tattooing and sharing needles by injecting drug users all substantially increase the risk of infections with hepatitis B and C virus.

Despite the magnitude of the problem, no regional or national campaign had been carried out till quite late to educate the public and those at risk about the prevention, transmission, and management of hepatitis B. Blood donors are not aware of the threat that HBV poses, and action by governments and decision makers to prevent and control the disease has been slow.

With the efforts of governments to enhance early detection and appropriate management of HBV, the quality of life of millions of people living with this disease can be improved. Within health facilities, screening of blood and blood products, safe injection practices and clean dental work can significantly reduce the risk of infection from hepatitis B.

Prevention and control can be achieved through safe and effective HBV vaccines. World Health Organization (WHO) recommends routine infant vaccination along with catch-up immunization for adolescents and high risk populations. India introduced universal immunization against hepatitis B in 10 states in the year 2002, and in 2011, scaled up this operation countrywide. Screening and immunization of high-risk groups, such as those with history of exposure, risky practices, and occupational risk, such as health care professionals; specific measures for prevention of mother-to-child transmission and promoting safe blood supply, safe injections and safe sex are other recommended preventive measures.

DENTISTRY IN RURAL INDIA: THE “NEGLECTED CHILD”

Dental diseases are a significant public health burden in India, with tooth decay affecting 60 to 65 percent and gum diseases affecting an estimated 50 to 90 percent of the general population, with higher rates of dental diseases in rural areas. The consequences of widespread poor oral health can be seen on the personal, population, and health systems level, as dental diseases deteriorate individual health and wellbeing, decrease economic productivity, and act as significant risk factors for other systemic health ailments.


Dental diseases in rural India are primarily due to socio-cultural factors, such as lack of knowledge about oral health and hygiene, and systemic infrastructure deficiencies that prevent proper screening and dental care of oral diseases.

Nearly every human experiences poor oral health at least once in his lifetime. Tooth decay is the most common non-communicable disease in the world. Tooth decay can cause reduced quality of life and diminished function as a result of the pain and suffering associated with oral conditions. The need to address these oral health concerns is especially evident in India, because tooth decay and gum diseases affect a large number of the general population.

While there is a deficiency in dental care for all of India, it can be posited that oral health in rural villages is in more dire conditions than urban areas because rural areas in India are more susceptible to dental problems, in part because these areas have lower access to dental care.

A common global trend in oral health is a link between the prevalence of dental diseases and economic improvement in developing countries. Increased rates of dental diseases traditionally follow rising economic development because, as economies expand in developing countries, the populations within these countries have access to a wider variety of food as a result of increased income and trade. Thus, as countries become wealthier, there is more exposure to, and an increased preference for, a “westernized” diet that is high in carbohydrates and refined sugars. This change in dietary patterns influences oral health because chronic dental diseases are strongly related to diets rich in saturated fatty acids and non-milk extrinsic sugars. India has demonstrated a marked increase in sugar consumption in recent years, as per capita consumption was 13.8 kilograms in 1991, 16.5 kilograms in 2000, and 21.4 kilograms in 2013. This shows that an increasing consumption low nutritional value foods, or “junk” foods, and refined sugars in the form of chocolates and other sticky sugar-rich foods, especially in younger generations, may be contributing to an increase in dental diseases.

Effective oral hygiene practices have been well established in developed countries. However, oral hygiene practices in India indicate that there is still a lack of knowledge about proper oral hygiene. This is demonstrated by a 57% usage rate of toothbrushes and only 40% use of fluoridated toothpaste, with higher rates of usage reported in urban areas. This implies that toothbrush and fluoridated toothpaste usage in rural India is considerably lower than this mark. It has been observed to be common practice in rural areas to only brush once a day, rather than the widely-recommended twice a day brushing patterns utilized in developed countries. Additionally, there seem to be personal opinions on best practices for oral hygiene, with some people in villages using tobacco to clean their teeth. There is also a lack of oral health education in primary and secondary schools in villages, and a general lack of oral health knowledge within the community.

There also seems to be a general lack of awareness about oral health in general among Indians. The majority of people are aware of neither factors that could cause oral health problems nor any preventative measures that could be taken to prevent oral health issues. Of the residents that reported being aware of causative factors, most identify eating sweets and not brushing regularly as the two most important factors.

In rural India, the dentist to population ratio can be as high as one dentist for every 2,50,000 residents, while the ratio is estimated at one dentist to every 10,000 in urban areas. There has been an increase in the number of dental colleges in India over the last 50 years to over 150 dental colleges which graduated over 26,000 dentists in 2002. However, there is a geographic imbalance in the location of schools with 50 dental colleges located in only one state, and of those, about 15 located in one city. Additionally, only 2% of dental specialists are trained in community dentistry, the specialization that would typically practice in rural areas. The low number of dentists in rural areas, a distribution perpetuated by the current landscape of professional oral health training, is a significant barrier to access for rural village residents. In the 2012 fiscal year, India’s health care expenditures totaled just 4.9% of the country’s GDP, with the majority of spending coming from private parties. No government funds are specifically designated for oral health care. This lack of financing is reflected in the oral health infrastructure of government health centers. The most accessible and principal healthcare provision facilities for rural India, Primary Health Centers, do not provide dental services, and only 20-25% of Community Health Centers, the point of secondary healthcare for rural areas within the Indian healthcare system, provide dental care. In many rural areas of Punjab and Haryana, many people report having to travel more than a half an hour to reach a dentist.

On a personal level, dental diseases have a significant negative influence on the quality of life in both children and adults due to deteriorations in an individual’s general health and development. At the youngest ages, the discomfort and difficulties in ingesting food due to untreated dental caries can result in a failure to gain weight and impair cognitive development. By crippling the functionality of the oral cavity, dental diseases, combined with limited food variety and accessibility in rural villages, also causes malnutrition in adults, as severe pain due to untreated dental diseases incapacitates an adult’s ability to chew food. Beyond the human suffering and nutritional deficiencies created by the pain associated with untreated dental diseases, their damaging effects can also spread outside of the oral cavity to the rest of the body, including the kidneys, heart, lungs, and brain.

The widespread nature of dental diseases in rural India means that the detrimental effects of dental diseases within the individual will also have a negative impact on the functioning of a population. Oral diseases are identified as one of the priority health conditions because, in late stages, dental caries and periodontal diseases cause severe pain and are expensive to treat. This translates into a loss of man-hours which has a significant negative impact on economic productivity.

There is insufficient infrastructure for providing dental care in rural India. In developing countries such as India, there has been very little investment in oral healthcare and resources are primarily allocated only to emergency care and pain relief. When left untreated, the chronic inflammation and inflammatory mediators associated with dental diseases are a significant risk factor for several systemic diseases. These include the birth of pre-term low-birth weight babies, coronary artery diseases, and diabetes mellitus. The impact of untreated dental diseases on maternal and child health is especially disconcerting, as pregnant women suffering from gum disease are seven times more likely to give birth to a pre-term low-weight baby, even when controlling for other factors.

There are significant barriers to accessing dental services in rural India, including the high cost for services, long travel to reach a dentist, and extremely low dentist to population ratio. Because of these barriers, screening programs alone are not comprehensive enough to have any significant impact on the prevalence of oral health in India. Identifying cases of poor oral health without providing any follow-up care, or providing a referral for a treatment that is both far away and expensive, simply raises the prevalence of disease. In order to minimize these barriers, there needs to be a plan for the government partnering with nearby practicing dentists to visit regularly and hold dental clinic days. Bringing in visiting dentists will provide access to dental care. More dental partnerships can be formed in order to decrease the number of visits each dentist has to make.

In order for any dental care to occur at the primary health care centers, it is necessary to procure and install dental equipment in each of them, as a lack of dental equipment acts as a barrier for dentists to practice there. Therefore, even for the visiting dentists, it is necessary to have dental equipment. Until this activity is performed, it will not be possible to offer dental care at the village level.

Schools and teachers should also provide a broad spectrum health education program, including a component addressing oral health hygiene, as most children do not receive any type of education on oral health and hygiene in schools. Government can also begin to offer bi-weekly or monthly oral health education sessions for the general public.

Having established an implementation strategy and an evaluation protocol for this intervention plan, hopes can be made that this will begin to meet the goal of improving oral health in rural India.

WISDOM TOOTH: HOW WISE IT IS

A wisdom tooth or third molar is one of the three molars per quadrant of the human dentition. It is the most posterior (most distal) of the three. Wisdom teeth generally appear between the ages of 17 and 25. These are known as wisdom teeth because they appear so late- much later than the other teeth, at an age where people are presumably "wiser" than as a child, when the other teeth erupt.

Wisdom teeth are vestigial teeth that used to help human ancestors in grinding down plant tissue. The common postulation is that the skulls of human ancestors had larger jaws with more teeth, which were possibly used to help chew down foliage to compensate for a lack of ability to efficiently digest the cellulose that makes up a plant cell wall. As human diets changed, smaller jaws gradually evolved, yet the third molars, or "wisdom teeth", still commonly develop in human mouths.

Wisdom teeth have long been identified as a source of problems and continue to be the most commonly impacted teeth in the human mouth. Many times, wisdom teeth don't have room to grow properly and can cause problems. Erupting wisdom teeth can grow at various angles in the jaw, sometimes even horizontally. Sometimes wisdom teeth only partially emerge through the gums. Other times, they remain completely hidden. Wisdom teeth that aren't able to emerge normally become impacted, or trapped, within your jaw.

If the wisdom teeth emerge partially through the gums, a passageway is created, which can cause problems. And because this area is hard to see and clean, it can become a magnet for bacteria that cause gum disease and oral infection. They often need to be extracted when this occurs. A lack of room to allow the teeth to erupt, results in a risk of gum disease and caries that increases with age.

Some dentists recommend removing wisdom teeth if they don't fully emerge or if they grow near the nerve of the lower jaw. Many dentists believe it's better to remove wisdom teeth before the roots are fully formed, when someone is younger and more likely to recover faster from surgery. This is why some young adults have their wisdom teeth pulled before the teeth cause problems and become more firmly rooted in the jaw.

According to the author, wisdom teeth removal may be necessary if you experience changes in the area of those teeth, such as pain, repeated infection of soft tissue behind the lower last tooth, cysts (fluid-filled sacs), tumors, damage to nearby teeth, gum disease or extensive tooth decay.

The decision to remove wisdom teeth is not always clear. Talk to your dentist or an oral surgeon about the position and health of your wisdom teeth and what's best for your situation.

RISK OF HIV: HOW SAFE IS YOUR DENTIST??

HIV (human immunodeficiency virus) is the virus that causes AIDS. This virus is passed from one person to another through blood-to-blood contact (blood transfusions, HIV-infected needles) and sexual contact. In addition, an infected pregnant woman can pass HIV to her baby during pregnancy or delivery, as well as through breast-feeding.

AIDS (acquired immunodeficiency syndrome) occurs when the HIV infection has weakened one's immune system to the point that it has difficulty fighting off certain illnesses and infections. "Opportunistic" infections also occur, taking the opportunity a weakened immune system gives to cause illness.

A positive HIV test result does not mean that you have AIDS. AIDS is a medical diagnosis made by a doctor based on specific criteria. You also cannot rely on symptoms to know whether or not you are infected with HIV. Many people who are infected with HIV do not have any symptoms at all for many years.

The warning signs of infection with HIV are rapid weight loss, dry cough, recurring fever or profuse night sweats, profound and unexplained fatigue, swollen lymph glands in the armpits, groin or neck, diarrhea that lasts for more than a week, white spots or unusual blemishes on the tongue, in the mouth or in the throat, pneumonia, red, brown, pink or purplish blotches on or under the skin or inside the mouth, nose or eyelids, memory loss, depression and other neurological disorders.

Dental problems such as sore bleeding gums, herpes sores in the mouth, and fungal and candida (yeast) infections may be among the first signs of AIDS. However, you should not assume you are infected if you have any of these symptoms as these occur in the general population as well. The only way to determine whether you are infected is to be tested for HIV infection.

Due to the nature of dental treatment, HIV may be transmitted during the course of dental treatment. Universal precautions have to be used between each and every patient to prevent the transmission of HIV and other infectious diseases.

These precautions require dentists, dental hygienists and dental assistants to wear gloves, facemasks and eye protection, and to sterilize all handpieces (drills) and other dental instruments for every patient, using specific sterilization procedures outlined by the CDC (Center for Disease Control). Items that cannot be sterilized are to be discarded in special containers. After each patient visit, gloves have to be discarded, hands are washed and a new pair of gloves used for the next patient.

Laboratory studies have found that when traces of blood become embedded in dental handpieces, germicidal chemicals cannot kill even the weakest human pathogens, such as HIV. Studies were conducted using trace quantities of whole blood (100 microliters) from HIV-infected patients. The AIDS virus remained infectious for at least two days, but less than one week, when trapped in dental handpieces, even when treated with the recommended 2 percent solution of glutaraldehyde (one of the more powerful chemical germicides).

A study was published by the American Society for Microbiology in 1992 which stated that dental handpieces could potentially transmit HIV and other infectious agents. It recommended the adoption of a heat sterilization standard (autoclaving, chemclaving or dry heat) to kill viruses lodged in dental handpieces.

The dental patients simply “tell their dentists `goodbye` and walk out the door” after their treatment. If they later become sick with hepatitis, pneumonia, or even AIDS, there is no way to document whether or not the disease originated with a dental device, because no such records are kept. Also, the long incubation period of HIV makes tracking especially problematic, and legal barriers prevent disclosure of patient identities.

Use of high-speed dental handpieces provide two potential routes of infection, which occur primarily when patients are exposed to the air/water spray expelled by dental handpieces as the devices are operated inside the mouth: waterborne pathogens and bloodborne pathogens.

With waterborne pathogens, patient blood and saliva retracted into water lines inside handpieces can travel all the way back into the flexible lines that feed water into the handpieces. Therefore, before re-attaching water lines to handpieces after the handpieces have been removed and sterilized, it is recommended that dentists flush them for a couple of minutes. This washes out patient materials that may have been retracted into the lines, leaving behind only those organisms (mostly bacteria) that can cling to the inside walls of lines. These microorganisms multiply in “biofilms” or layers that can shed microbes back out during operation of the equipment, presenting the risk of pneumonia and other diseases, especially high to immunocompromised patients.

With bloodborne pathogens, traces of blood withdrawn into airways of handpieces remain largely undiluted with water and become embedded inside the handpiece or in air lines that exhaust away from the patient. This potentially infectious material, mixed with lubricants inside the devices, is impervious to germicides and presents a potential risk of infections such as HIV and hepatitis. Heat sterilization after each patient use can virtually eliminate the risk of transmitting bloodborne infections patient-to-patient, a risk shared by all dental patients if handpieces are merely treated with chemical germicides.

Almost any type of infectious disease, from the common cold to the AIDS virus, could potentially be transmitted by contaminated lubricants expelled by dental and medical devices. Patients at highest risk are those with damaged immune systems, such as the elderly, individuals undergoing chemotherapy, organ transplant recipients, and AIDS patients. However, of more concern in this country are the more easily transmitted diseases carried by a large portion of the population such as influenza, cytomegalovirus and infectious hepatitis. HIV is probably rarely transmitted by contaminated dental handpieces. So far, dental HIV transmission through this route is rare. However, in areas of the world where a high proportion of the population is HIV-infected and where old and worn dental devices are commonly used without heat-sterilizing them, patient-to-patient HIV transmission in dentistry may occur more frequently.

Recently updated guidelines recommend heat sterilization, or autoclaving, of dental devices. However, only 40 to 80 percent of dentists actually autoclave their instruments as they should. CDC published upgraded guidelines for dentistry in 1993, recommending the exclusive use of heat sterilization processes “for all reused devices entering the oral cavity.”

Some dentists consider wiping handpieces with chemical solutions to be a form of sterilization. Others just are not completely truthful with patients about their infection control practices. Patients should look for gloves being changed after every patient and sterilized instruments opened after the patient is seated. They should also ensure that the dentists as well as the staff members are wearing protective gear such as masks, gloves and eye protection. They should feel free to ask questions about sterilization procedures being observed in the dental clinic. One’s safety, after all, is in one’s own hands.

DENTAL SURGERY IN INDIA: THE BITTER TRUTH

Harshika (name changed) had fond dreams of becoming a dentist when she enrolled herself in a private dental college in Punjab. But, she was unable to either set up her own clinic or find a suitable job as dentist despite the BDS (Bachelor of Dental Surgery) degree she holds. Reluctantly, she has taken up a job in a private pharmacovigilance company in the city.

Shiksha (name changed) too had been nursing an ambition to become a dentist. But, due to absence of opportunities, she was unable to realize her dream and was forced to join a multinational drug research company, which not only offered her a job, but also a decent pay package.

These two are among the hundreds of BDS graduates in different parts of Punjab who have deviated from their chosen profession to join the workforce in various multinational firms besides call centres and medical transcription companies.

The high costs involved in establishing dental clinics in urban areas that are already concentrated with dentists appear to be forcing the BDS graduates to look outside their vocation for a rewarding career.

“I need at least Rs. 5 lakh to establish a clinic with the necessary dental equipment and minimal interiors. Besides, dentists are found in every nook and corner of the city and it takes a long time for any dental clinic to become established and begin drawing patients. Till then, how will I be able to pay the rent for the clinic and the EMIs for the loan?,” said another BDS graduate, who has dropped the idea of setting up his own clinic and is hunting for a stable job.

 “There are far too many dentists concentrated in urban areas such as Chandigarh. It is a problem of plenty. Even if the BDS graduates arrange for the funds and start a clinic, the returns will not commensurate with the investment at least for the first few years,” said a professor at a private dental college of Punjab.

Concurring with this, a dentist with a clinic near Mansa Devi Complex said he has to keep his consultation fee less than Rs. 50 to attract patients. “There are many dentists who offer free consultation, hoping to make up in the treatment they would be able to offer subsequently. But, most dentists do not charge more than Rs. 50 for consultation. “I barely make Rs. 15,000 per month after two years of practice. Out of this, I need to pay the rent for the shop and maintain the clinic by purchasing the necessary dental care items,” he said. Hence, most of them scout for teaching opportunities in dental colleges.

Though there is a provision for recruiting BDS graduates as tutors in dental colleges, the openings are difficult to come by and the remuneration is a measly Rs. 6,000 to Rs. 9,000. The Dental Council of India (DCI) has prescribed a minimum qualification of MDS (Master of Dental Surgery) for appointment as lecturer in dental colleges.

A professor at a private dental college said the curriculum for BDS courses is tailor-made for practicing dentistry. “It does not equip the graduates with teaching skills,” he opined.

A BDS graduate can enter the teaching profession only if he or she takes up MDS. But, MDS seats are few in number and can accommodate barely 15 to 20 per cent of all BDS graduates. Only financially well-off students can fork out the exorbitant donation and fees.

DCI member S.M. Jaykar has said that a way out of the impasse for BDS graduates is paving the way for their employment as dentists in primary health centres (PHCs). The government is coming forward to employ dentists in PHCs situated in rural areas of the State. “BDS graduates do not go to rural areas and set up clinics. The poor awareness of oral health care in rural areas will make the venture financially unviable.”

Dental colleges are mushrooming, the number of under graduate seats in the existing colleges is being increased, the number of dental graduates is increasing in leaps and bounds, but there hardly seems to be any serious thinking regarding the future and profitable employability of a dental graduate. The pay packet of a lecturer in a private dental college in some metropolitan cities of our country is in fact less than that of a skilled labourer. Unless stringent steps are taken to regulate the number and quality of graduates being registered, the situation is going to worsen and BDS may be reduced to the status of a basic degree from that of a professional degree.