Say Aaaagh!

On the daily walk to his small dental clinic in Hindupur, a small, sleepy town about 100 km from Bangalore, Dr Bharath is often greeted by a swarm of people. They are all patients, from the town and the neighbouring villages. Being one of the few dentists available in the area, he’s had a hand in producing these warm, shining smiles.

Bharath is lucky. This wouldn’t have been the case a few years back, but dental care and treatment have become more of a priority in India’s small towns and villages now. Even so, studies by the Indian Dental Association (IDA) show that over half of India’s population has never visited a dentist while over 80 per cent suffer from some dental problem or the other. An overwhelming majority of these cases are from smaller towns and villages. But times are changing. Dental hygiene and care is gradually becoming a part of life in small-town India.

In a way, the spread of oral cancer and other acute dental problems have had a role in this boom. For dental professionals, there’s never been a better time, growing standards of living and more awareness opening up a completely unt­apped market. So is it any surprise that a number of dentists are now relocating from big urban centres like Delhi, Bangalore and even Chandigarh to smaller markets? There are also those like Dr Bharath who relocated because the clutter and corporate nature of urban centre practices were not to their liking. “Working in the big city seemed to me more like a commercial rut of treating and earning. I never experienced the joy of personal interaction with my patients, which I get here,” says Dr Bharath who shifted his practice from Bangalore to Hindupur a few years back.

It may also be that for dental professionals in the country, the urban markets are beginning to witness a glut of sorts. The World Health Organisation recommends an average of one dentist for every 7,500 people. Against this, India’s urban centres have an average of one dentist for less than 5,000 people. Rural India, though, is far, far behind, with just one dental professional for 2.5 lakh people. The urban market is also increasingly being monopolised by corporate chains which have started eating into the business of most independent practitioners. New entrants are finding it tough to run a successful dental practice in bigger towns. “People don’t und­er­stand the expenses incurred in starting a practice. Dentistry is one field where even the richest will haggle over the costs,” says Dr Vimal Jain, who reloca­ted from Bangalore to his hometown in Chikmagalur district in 2000.

Even for the dentistry startups, the small town is becoming more and more attractive. Dental chain Smile Merchants, started by Dr Rushi Trivedi, Dr Alpesh Chaudhiri and Dr C.M. Pandey in 2012, has foc­used on the same, hoping to create awareness as well as provide quality oral healthcare to patients who may not be able to afford urban centres. “The idea struck us when we were travelling across a village called Kharbao with a huge population but not a single dentist,” says Dr Trivedi. “This made us realise the huge shortage of dentists in most areas in rural India.”

Setting up clinics, though, is just the first step. Doctors often have to educate the local population about oral health benefits before they expect patients to show up. This is often a time-consuming and financially draining process and usually includes a series of campaigns on the importance of oral health and, quite often, free dental camps. The IDA has of late been proactive in this, conducting awareness drives and free camps in collaboration with bigger hospitals in and around rural areas. In order to have a greater impact, such camps are usually coupled with campaigns explaining the ill-effects of tobacco and alcohol use. “Dental check-up camps carried out by IDA during the oral health month stress on the importance of maintaining oral hygiene for better overall health,” says IDA’s Glen D’costa.

Lack of awareness, though, is only the first hurdle for a dentist. “While patients may understand that they require treatment, it often becomes difficult to convince them to get the necessary procedure done,” says Dr Trivedi. The costs involved is the biggest disincentive in this. So dentists end up being patient advocates too, often simply doing the most urgent procedures only, be it a simple filling or a root canal. Most dental procedures are still costly because of the instruments and techniques required and this often tends to bec­ome heavy on the patient’s pockets. While several ind­­ep­endent practitioners like Dr Bharath often do procedures for free, not many can afford such liberties.

Meanwhile, the growing demand has pushed organisations and even individuals to find alternative methods and cheaper techniques to treat oral health problems. Social organisations have now started training villagers in basic dental procedures like filling or even tooth-capping. The Barefoot College in Tilonia, Rajasthan, now runs a programme on dental health and training for locals who wish to practice basic dentistry. The Indian government too has played its part in creating awareness by creating infrastructure to treat patients in rural areas. Some hospitals have also opened satellite dental clinics in collaboration with the government to offer affordable oral health care services in the villages.

Alternate methods of dental care and consultation have also come into play in the dental market. Startups like My Dental Plan organise education and awareness campaigns at schools and villages along with providing low-cost consultancy for dental patients. Dr Krishna Anand, founder of My Dental Plan, says the rural market is an untapped reserve which is starving for better dental health facilities. In fact, even now dental professionals around the country are looking at devising cheaper procedures to serve a populace which may not be able to afford the fancy equipment often associated with the profession.

That said, even now most of rural India is outside the pale vis-a-vis any sort of dental care. There is no denying that awareness as well as reception to dentists in the country needs to improve, but the migration into smaller spaces will only help in the growth of both the profession as well as the pressing need for better dental hygiene in the country.