Dentistry is dying. To be more precise, it's been murdered.
This may seem a strange statement to make,
but I’ll explain.
Twenty years ago, dentistry was the up and coming profession in India,
to the extent that the magazine Outlook
even published a puff piece on it in circa 1997 (titled Dentists: The New Buccaneers, if I recall correctly). The article was full of mistakes and idiotic statements,
such as the claim that a root canal treatment is “normally” completed in three
sessions (and if it isn’t, your dentist is a “mercenary molar mechanic”, a bit
of alliteration that must have warmed the cockles of some sub-editor’s heart).
But it did make the very important observation that dentistry, once a
profession held in contempt and filled with those who couldn’t make it as
physicians, was now an increasingly respected, lucrative, and sought after line
of work.
And that is exactly what killed it.
Until the late 1970s, there weren’t that
many dentists. Indians, back then, didn’t really give a damn about teeth. The
attitude was that as soon as your teeth started giving trouble, you’d get them all taken out and replaced with
dentures. Obviously this didn’t exactly require dentists with a lot of
expertise in the job. Not surprisingly, the average dentist then was a quack who
learnt his “skills” as an apprentice with another quack.
I recall being taken by my father to one of
these quacks, one “Dr” Prabhat Bhattacharya, while I was a schoolboy. This
Bhattacharya was very popular with the Middle Class of the day, which was
stingy to the bone, because he was much cheaper than the two qualified dentists
this city boasted at the time. He had an old wooden barber’s chair as a “dental
chair”, and used a hanging motor – which is actually used for laboratory work
like trimming and polishing dentures – to do his “fillings”.
This Bhattacharya looked lugubriously at my
teeth, shaking his head mournfully, and declared “The enamel is spoilt, nothing
can be done now”. This, I later found, was his standard response to anything
that might even need filling, and the way he escaped having to do the incredibly difficult job of removing
decayed tooth tissue and replacing it with filling material. Fortunately, my
father took me to one of the two real dentists, who filled it with a simple
filling, which is still in place to this day, over 30 years later.
Actually, Bhattacharya was absolutely
typical of the kind of quack which infested Indian dentistry at the time, and
examples of which can still sometimes be found here and there. They can be
fairly easily recognised from their signboards. For one thing, they’ll never
have a degree after their name (I’ll mention some qualified dentists these days
who add an additional “degree” after their
names in a moment). For another, their shingles will always proclaim proudly
that they’re “specialists” in something, usually dentures. And in a huge
majority of these cases, there’s going to be a large, pastel coloured denture
on top of the quack’s name – usually, one of the type prevalent seventy or more
years ago, with a suction cup on top holding it to the palate.
Since people, as I said, neither cared
about their teeth, nor wanted to spend money on them, there was nothing
stopping these mountebanks from making a good living.
Their equipment also followed the same
standards. The basic dental electric motor, invented in the late 19th
Century, only became available to Indian dentists in the early 1970s. Previous
to that they’d been using a kind of sewing machine contraption with a treadle.
I saw at least two of these still for sale in a dental showroom in the late
1990s and was assured by the dealer that “unqualified doctors” still bought
them. As late as the early 1990s, when I was a student, we read about the
light-cure unit, which is used to harden filling material after placing it in
teeth, in our textbooks – but never saw one, because our dental college did not have a single light cure unit.
This dental college was one of the top in
the country then, and even in 2016 is Number Six in the dental college list.
Think about that. One of the very topmost dental colleges in the nation didn’t
have a basic piece of equipment.
I first saw a light cure unit in 1996 with
a private practitioner, in Calcutta. Today, I have no less than two of my own,
and can’t imagine surviving without them.
Now, one of the side effects of the “economic
liberalisation” of the early 90s was that suddenly people became rather more
appearance-conscious, and willing to spend some money on this. Not health-conscious, just appearance-conscious, but as far as
dentistry goes, good appearance pretty much implies you have to have good
dental health as well. And this, of course, meant in turn that dentistry
suddenly began attracting more money than it used to do.
Suddenly, the dental showrooms turned from
dingy little holes in the back passages of decaying commercial buildings into
swank establishments with plate glass windows proudly exhibiting the latest
model dental chairs, rather like car dealerships. Suddenly, they began
sponsoring dental conferences, spending money on making themselves known, and,
for instance, dentists who’d never even seen a full range of scaling hand
instruments were being invited to buy the latest ultrasonic sets. And, like it
or not, they had to, because everyone else was doing it.
In fact, I’d call the Dental Revolution of
the late 1990s the equivalent of the modernisation of Japan in the Meiji period
of the latter half of the 19th Century. Overnight, the material and
equipment we’d had to study about in our textbooks, without ever expecting to
see or use them, were at our fingertips. Suddenly, the average person
discovered that there was much, much more to be done with their teeth than just
extract them if they began to hurt.
And, of course, the market for dentists
then exploded. From being a neglected sideline, it became a sought after
qualification. Instead of young people settling for dentistry as a consolation
prize if they didn’t get to study medicine, they went into dentistry as a first
choice. Dental colleges suddenly no longer found it necessary to disguise
themselves as annexes to older, more prestigious, medical colleges. And the
Dental Council of India (DCI), the governing body of the dental profession, saw
a golden opportunity.
I should take a moment to speak of the DCI
and its equivalent in the medicine line, the Medical Council of India (MCI).
Both organisations, at the top level, are rotten with corruption. A couple of
years ago, the MCI’s President was even arrested for massive corruption, but of
course nothing ever happened to him.
One of the ways this corruption worked is
this: remember the bonanza for the dental companies I mentioned? It’s an open
secret that the MCI and DCI take kickbacks from the dental and pharmaceutical
companies, and do all they can to ensure these companies become richer. And
with the sudden growth of dentistry in the late 90s, the DCI got into the
business of private colleges.
It was extremely simple – anyone with the
right connections would start a private dental college, and charge enormous
fees from students to attend it. Many of these “colleges” had hardly any
equipment, or patients, or even teachers. If a “surprise” inspection from the
DCI was ever scheduled, the college would be tipped off well in time, and the
owner would hire dentists to turn up and pose as “teachers” while random people
from the streets would be bribed to pose as patients. Everyone, including the
inspectors, knew what was going on, of course, but nobody cared as long as the
money kept flowing in.
You can well imagine the standard of the “graduates”
turned out of these colleges. Now, as I said, my college was primitive in terms
of equipment, and some of the teachers were, let’s say, not particularly
interested in teaching...but I’m willing to bet a fair amount that I, and any
of my colleagues, are highly competent professionals at least as good or better
than the best of the West. This is not a boast. It’s based on my observations
of the standard of work I, and my colleagues, are capable of...and what I’ve
seen of the handiwork of American and British dentists. But these private
college degree-shoppers are nothing like that.
I recall more than one of these worthies
turning up at my clinic begging rather pathetically for a job. Hardly any of
them had even performed a root canal on a molar tooth in their lives. Not one of them had ever extracted an
impacted wisdom tooth. And as for doing such surgeries as an apicoectomy, something
I did several times as an intern? They’d have a heart attack if anyone had even
suggested it.
Not that the DCI people were ignorant of
this. Now, to them, dentistry was a lucrative business, and they were intent on
pushing their children into it as well. Most of their children didn’t have the intellectual
power to get through the rather tough selection exams of the government dental
colleges, though...and the government dental colleges had the only real degrees
going.
So they found a solution. They’d pay for
their kids to enter a private college, and then transfer to a government
college. At the time when they first did this – 1992 – it was still totally
illegal. So their further solution was to go to the Supreme Court to get it
legalised. With money to pay top lawyers, and nobody opposing them, it was
easy.
I remember the first set of these transfers
who appeared in our college. In 1992, they entered the class immediately junior
to us – the “90 Batch”, which started its course in late 1990. Several of them
were teachers’ children, and others were the kids of sundry politicians and
other bigshots. By then, they’d all already completed a year or more in various
private colleges – but you never saw such an incompetent bunch in your life. I remember one, the daughter of a police chief if memory serves, who was asked to
adapt a baseplate (a sheet of hard wax) on a plaster cast of the jaw. A
beginner normally breaks several baseplates before first succeeding.
Not this young lady. She didn’t break the
baseplate. She broke the cast instead.
Now, there was a problem. These transfers,
as I said, joined in 1992, about halfway through the academic year as I recall.
In order to appear for the year ending examinations, the Second Professional as
it’s known (there are four, one at the end of each year), they needed a certain
minimum attendance. And of course they didn’t have it. They could not, legally,
appear for the exam.
This, of course was not a state of affairs
that could be tolerated. The teachers and bigshots hadn’t spent all the money
and effort getting their kids into the college to have them balked in this
fashion. They tried a trick as transparent as it was guaranteed to succeed.
What they did was claim that the attendance
records of most of the class had gone missing. Not all the class – that would
have raised questions – but most, something like 75%. So only 25% of the 90 Batch
could appear in the Second Professional Examinations unless...
...unless, of course, they were all allowed to appear. And so it was
done. And – you’ll be totally astonished to hear – the teachers’ kids all got
medals and certificates for their performances.
You’re astonished, right? I thought so.
This was the kind of thing that happened in
a government dental college, a good one. In the private colleges, of course,
even the minimal checks and balances were dispensed with, and incompetent
nincompoops began pouring out by the tens of thousands, with the exact same
degree we’d sweated blood to earn.
Can you imagine what this did to the dental
profession?
Suddenly, starting in the late 2010s,
dentistry was no longer a star-spangled profession. Suddenly, new dental
graduates could no longer get a job to save their lives. Suddenly, more than
half of them, with a dental degree – even a proper degree, from a government
college – found it so impossible to get a job that they ended up looking for
work as a call centre operator or a salesperson. And still the number of dental
colleges grew, and grew, and grew.
These days, it’s the qualified dentists
who, to pretend to be more qualified than they are, have started adding fake “degrees”
to their names. One standard one is to call themselves MIDA, which actually
stands for Member of the Indian Dental Association. It sounds like some
achievement like the British FRCS, but all you need to be an Indian Dental
Association member is a dental degree and a couple of thousand rupees annual
membership fee. I’m an IDA member myself. There’s nothing special about it. But
the shrinking market means qualified dentists now have to pretend to be what
they aren’t.
Obviously, nothing of this – nothing at all
– was unknown to us dentists. We saw the carnage with our own eyes. But
apparently the only ones who didn’t see it, who were wholly oblivious of it,
were our masters in the DCI.
Their “reasoning” seemed to go this way: “India
has 1300 million people, and x number of dentists. Therefore there are only y
dentists per 10000 people, while in other countries there are as many as z
dentists for just 1000. Therefore we need more dentists.”
Really? In the first place, and this is
something they’d know if they were actual dentists and not simply jacked-up
administrators with dental degrees, we need better dentists, not ham-handed
incompetents who occupy jobs without the slightest idea of how to do the work.
Secondly, almost all Indian dentists are in the cities and towns, and will
always remain in the cities and towns, where the market is already saturated.
The villages? Well, for one thing, they’re far too poor to afford dental care,
and with “economic liberalisation” they’re getting poorer still. Secondly, the
villagers of India don’t care about good dental care and never will. To them, a
twig is better than a toothbrush, and such newfangled notions as getting your
teeth cleaned by a dentist are anathema.
By 2015 the situation had deteriorated to
the extent that student composition in dental colleges had changed. Back when I
was a student, the law mandated that 50% of the places had to be reserved for
women, though the colleges always struggled to make up that number. The average
class usually had about 30% females to 70% males. Nowadays, as someone in a
position to know assured me, it’s about 80% female to 20% male.
But isn’t that a good thing? Aren’t more
women with professional degrees a sign of progress?
Not if you realise that the vast majority
of these ladies are never going to land a job in dentistry, and in fact have no
intention of landing a job in dentistry. Their only purpose is to add a “Doctor”
in front of their names, so as to increase their value in the marriage stakes.
That is all it is.
Early this year, one of my former
classmates, who’s a teacher in a private college, and is thoroughly
disillusioned, informed our alumni WhatsApp group that all private dental
colleges in her state have handed the staff a compulsory 40% pay cut. I assume
holidays in Hong Kong and Amerikastan are right out in future for her. Quelle
horreur.
It was only as late as April 2016 that the
DCI finally admitted that something was wrong, and began to take steps. What
steps did it take? Did it shut down the useless private degree shops? No. Of
course not. All it did was declare that no new dental colleges would be set up.
The golden goose is killed, and they’re still
hunting in its beak for teeth. Even though geese don’t have teeth.
But I doubt if private college “graduates”
know that anyway.
