A dentist treats a young boy in central Athens, Greece, October 27, 2015. Photo: Reuters/Alkis Konstantinidis
Across the globe, news reports have put in the spotlight the vulnerability of dental professionals to infections of coronavirus during the pandemic – foregrounding equal attention to be paid to the profession of dentistry.
Dentists are more prone to infections in an outbreak like this because they are exposed to aerosols and droplets coming out of the patient’s oral cavity. The use of drills during dental treatment carry fine water particles in the air which could carry the coronavirus for up to three hours.
A study reported that a large number of dentists, like other health workers, feared getting infected with the coronavirus by their patients or their staff and hence have been sceptical of providing treatment. The death of seven dental professionals and a senior dental nurse in Italy and the UK respectively from COVID-19 have substantiated these fears.
This scare of coronavirus has also unmasked the crevices in the integration of oral health professionals into the public health system of India. According to National Health Profile 2018, the number of dentists registered with the Dental Council of India (DCI) is over 2.7 lakhs, of which the government employs 7,239 dentists, amounting to a meagre 2.7% dentists working in the public health sector.
The roots of this incongruity of the oral health professionals with the government system in India are embedded in the larger structural discrepancies. Right from the inception of the medical sciences, mouth and body have always been treated as separate entities which have led to building of domains of medicine and dentistry and perceived as discrete professions. This differentiation among these two sub systems is seen across populations by their “separate training programs, professional identities, payment structure and delivery system.”
This has simultaneously translated into underrepresentation of dentists in the “bare bone” Public Health System of the country highlighting the negligence for the profession. For instance, less than 20% of the Primary Health Centres (PHCs) across India have a dentist and at the level of Community Health Centres (CHCs) having a public health dentist seems a distant dream.
However, during this pandemic, dentists have been a source of additional manpower to the famished public health system of the country. A telephonic interview with one of the dentists from Delhi working in tertiary care public hospital, revealed that regular dental OPD has been suspended and the dentists in public sector are offering administrative and logistic support to the general staff for corona related activities, catering to only emergency dental services.
At the same time, it is appalling to note that the additional guidelines issued by the Ministry of Health and Family Welfare have created an environment of doubt and confusion among dentists working in the public sector. Labelling the dental OPDs as moderate risk, advising the dentists to use N95 masks, latex gloves and goggles and recommending the use of face shield only if body fluid splash is expected during dental treatment, leaves many questions unanswered. This notification comes at a time when there are cases of asymptomatic patients of the coronavirus which makes it increasingly important to note the influence of this pandemic on dentistry.
Certainly, dentistry has an unsavoury reputation of being controlled largely by the private sector. Besides, India is home to 310 dental colleges out of which around only 40 are government-run. With each dental college having the capacity to absorb around 100 students, there will be a surplus of more than 1,00,000 dentists in India by 2020. This commercialisation of dental education has its subsequent influence on the profession of dentistry and the dentists consider private practice to be more fruitful due to their non-absorption in the public sector.
It is imperative to note that increased number of dentists in the private sector and public sector offering fewer vacancies raises the cost of dental treatment. Despite the availability of dentists, the utilisation of oral health services in India is low due to high costs involved in oral health care, widening the oral health gap between various socioeconomic classes.
A news report in Visakhapatnam has highlighted that besides the regular expenses of the dental clinic, dentists in private practice will need to buy PPE and disinfectants to protect patients, staff and themselves from the coronavirus, increasing cost of providing dental care. Moreover, India enjoys a worldwide market share of 14% in dental tourism, which might be affected due to travel restrictions and increased cost of care.
While few dentists are contemplating raising fees by 30% on elective dental procedures, the dentists in Karnataka have demanded that minimum wage support should be given to the dentists and their staff till the situation normalises, including subsidised supply of Personal Protective Equipment (PPE) and other infection control material. These scattered reports on worries of dentists in private practice point to the fact that the cost of getting a dental treatment in the private sector will see an additional increase after the crisis subsides, as the government sector is not well equipped to provide advanced dental treatment.
In this scenario, it becomes important to acknowledge that health is a state subject and states are already reeling under the financial burden for subsistence. Due to a non-responsive public health system and insubstantial absorption of the dentists in the public sector, a supply-demand imbalance has been created in the profession.
It should be recognised that when India is already reeling under the crunch of human resource in the public health sector, the registered dental graduates in India can prove to be an excellent resource during the spread of a pandemic like that of the coronavirus. All of them should be recruited and trained at an early stage so that they can also be used in crisis situations as has been done by the NHS in the UK.
It is also highly important to mention that oral health is directly related to the general health of the population and can be of extreme significance in preventing various chronic diseases. However, the susceptibility of dentistry to risks associated with the coronavirus needs timely recognition and redressal by the health system of the country, allowing dental care to be provided while mitigating the spread of this virus.
Ramila Bisht is a professor at the Centre for Social Medicine and Community Medicine, JNU in New Delhi. Shaveta Menon is an assistant professor at the Centre for Public Health and Health care administration, Eternal University in Himachal Pradesh.