Why do we go to a dentist?
Because we want to take care of our teeth
So that they don't get screwed up
So that we don't have to go to a dentist
- Ogden Nash
IT'S a feel-good story all the way. Just 15 years ago they were the MBBS rejects, the also-rans that settled for the next-best BDS option. In short, chaff. In the sniffy hierarchy of Doc-dom dentists were rated just a notch above vets. You could count both on your fingertips: their numbers, their earnings.
No longer. The old becharas are the new buccaneers of the profession. A 1,000-odd dentists practiced India-wide 15 years ago; 50,000-odd do profitably today. In metropolitan Bombay, Delhi, Madras, Bangalore and Calcutta suave, smooth-talking dentists are running roaring private practices, processing no less than 50-150 patients a day, earning anything between Rs 1.5-10 lakh a month. Silky smooth, chairside-chat manners firmly in place alongside the mandatory state-of-the-art equipment that guarantees efficiency sometimes, che che quotient at all times, theyre offering a diverse dental menu to the newly initiated. They'll orthodontise your misaligned teeth, prosthodontise missing ones, cosmeticise/colour-change crooked chewies, periodontise gums, endodontise your root canal... And were not even discussing oral, plastic, paediatric, public health dentistry yet.
Business is booming. Delhi's Brij Sabherwal together with dentist wife sets up his Lajpat Nagar clinic in '94. Investment: Rs 1 lakh. Facilities: 1 chair. Staff: him and the wife. Five years on? Investment: Rs 25 lakh. Facilities: 4 chairs. Staff: 4 dentists. Delhi orthodontist S.P. Agarwal opens shop circa '88. Investment: Rs 1.5 lakh. Staff: Self and wife. Facilities: 1 chair. Investment '98? Rs 30 lakh. Facilities: 4 chairs. Staff: 4 dentists. The most spectacular success story? That of Dr L.K. Gandhi who moved his practice from Dehradun to Delhi as late as '81. Investment '81: Rs 50,000. Facilities: 1 chair. Staff: 1. Eighteen years on he operates from a deluxe 2,500-sq ft clinic. Investment: Rs 1 crore. Facilities: 6 chairs, 4 operation theatres, inhouse lab, panogram, imported equipment. Staff: 6 dentists.
Surprising? Not really, considering the burgeoning numbers of dental colleges. Up from 16 in 83 to 108 today (only 25-odd government-owned) churning out 5,000 dentists an year. Compare that to the 10 colleges China has, 24 in UK, 65 in America. Total tally today: 50,000-odd dentists practising India-wide. Delhi alone has 2,200 registered dentists, 70 per cent in private practice. Bombay had 1,200 dentists in private practice in 88, 4,000 today. Karnataka tops the list with its 41 dental colleges (compared to just two, 20-odd years ago). In '90 it had 1,100 dentists. Today it has 6,000.
No flash-in-the-pan metro phenomenon, this, but one thats replicating itself across mofussil Meerut, Muzaffarnagar, Mussoorie, Dehradun... Jaipur, which had 50-odd private clinics just 10 years ago, today has over 100. Metropolitan Calcutta, with its 1,500 dentists, has seen private dental clinics mushrooming in remote outlying suburbs: Sodepur, Khardah, Barasat, Sonarpur, Baruipur.
It's a Dental Boom that begs the why, how question. Delhi's R.K. Bali, who together with dentist spouse Abha runs a flourishing practice in downmarket Dev Nagar and midmarket East of Kailash, says junk food diets, chocolate-cokes-chips routines, pan masala munching are ruining teeth. Indians have unhygienic mouths: 85 per cent have dental caries, 95 per cent periodontal problems. Adds Calcutta-based, upmarket Park Circus dentist Dhruva Gupta: No one's chewing cane or neemsticks anymore. Except for Mark Taylor, nobody even chews gum anymore. There's not enough exercise for the pearlies. Sabherwal feels its vanity-driven. In an Aishwarya-inspired world everyone wants to dress well, look good. Attractive clothes need attractive faces. And teeth are a part of it.
So much for the consumers end. For doctors too dentistry has become what Delhi's Maulana Azad Medical College dentistry department head Mahesh Varma calls the preferred rather than the last option. Unlike MBBS where you specialise after a five-year course, dentistry is a five-year course from which you emerge a specialist. It's also easier to set up shop, says Jaipur dentist Pradeep Nanda. The government has yet to formulate guidelines on minimum area, equipment, facilities. Agrees Bangalore dentist Jagdish Rohira, dentist to ex-Union ministers Deve Gowda, Moily and Bangarappa: Dentists in upmarket areas make Rs 1,000 upwards a day after investing Rs 3-4 lakh in basic equipment. Newly aware people are willing to pay up to Rs 20,000. Licences also help dentists to migrate to Australia, New Zealand, the Gulf. Also, as Bombay's deluxe dentist to industrialists, filmstars and beauty queens Sandesh Mayekar says, regular business is assured. You need to service your teeth like you need to do your bike. Regularly. Lucrative, all-expense-paid business from corporate executive accounts, says Rohira. Companies pay up to Rs 75,000 bills for managers.
This is the upside. Now for the downside. Privatisation of education, the reason for the dental boom, has also been dentistry's bane. It was necessary given that 200,000 students write an MBBS qualifying exam; 600-odd make it to government-subsidised MBBS and BDS courses. Annual BDS seat quota: a pitiful 20. Corruption has been the inevitable corollary. Karnataka, with its 41 private colleges (17 in Bangalore alone), tops the chart. Ex-CM Bangarappa was recently chargesheeted for approving a dental college where Rs 1 lakh fees was collected from each student; it functioned from a ramshackle wedding hall, had no classrooms, equipment or faculty! NRI-quota students (SC stipulated 15 per cent) at such spurious institutions pay Rs 12 lakh capitation fee, another 35 per cent pay Rs 85,000 an year, the rest sponsored by government pay Rs 8,000 an year. Big money causes big bungling. Trade-offs happen, reveals Dr Mahesh Varma. Doctors in Delhi are shown as faculty on Karnataka, Maharashtra colleges.' Delhi-based S.P. Agarwal is orthodontistry Head at the Christian Medical College, Ludhiana! Ask him if he's moneyspinning rather than serving patients/students, he dissimulates. There are just 300 orthodontists in India. I'm there twice a week because we're in short supply. A quick check nails his lie: there are 70 orthodontists in Delhi alone, over 3,000 countrywide!
Suspect, mercenary faculty can only produce students of its own ilk. Malpractice abounds. Doctors overcharge, deliberately misdiagnose, practice shoddy pavement dentistry for pecuniary gain. Doctors who've gone through the private-college-capitation-fee-grind embrace the Hypocritic rather than the Hippocratic creed to recover investment from patients. I'm appalled, says Dr R.M. Mathur, head of Lucknow's King George Medical College, how doctors charge Rs 1,200 for an acrylic tooth when the material cost is Rs 50. By any standard, including the chair time spent on preparation, cutting, casting, doing a front crown porcelain shouldn't cost over Rs 2,000, a back nothing over Rs 2,500. Likewise he's scandalised by dentists who charge regular 22-ct gold prices for Japanese gold. 80 per cent doctors are doing this, he asserts. Doctors are known to recommend painful expensive procedures like a bridge and crown when just a filling might do. Varma explains: You cut and fill a cavity that's spread to the side. Cost Rs 500. Instead doctors grind a perfectly salvageable tooth to the base and crown it. Cost Rs 5,000. Sabherwal describes coming across root canals resembling dug-up ditches, crown and bridge work with open contact, overhang margins that destroy teeth, cases where doctors have used acrylic cold cure resin: a cheap denture repair material that leaks in lieu of silver filling.
Indian Dentistry's new scandal? The three-day Expert workshop. Dentists practice titanium implants (clinic cost Rs 50,000 to patients) on wooden mannequins for three days, emerge experts by their own meed. Not done properly, says Sabherwal, a titanium implant drilled on to the bone can be rejected, inflammation occurs. I can understand a prostho/orthodontist benefiting from such a course. Novices shouldn't hazard using techniques they lack clinical experience of.
Varma would disagree. Any doctor with a BDS can benefit from such workshops, practice skills thus acquired. As for overcharging, Mathur offers the taxi metre logic. To make practices viable doctors must earn Rs 200 every 10 minutes. Sabherwal resorts to the Picasso argument. Do you ever ask a heart surgeon why he charges Rs 50,000 for an operation? Bali's dismissive. Its about expertise, my skill, the value I place on it. Most doctors cite their own high costs as their reason. It's not about what you earn but what you invest. Build in the cost of a Rs 12 lakh education, the 10 lakh start-up money, trips within India, abroad to upgrade skills, staff salaries and you know why we bill as we do. Also the cost of equipment, disposables like mouth mirrors, tweezers, gloves, masks, infection control, autoclaving, sterilisation mechanisms. That infection control is no laughing matter, cautions Delhi dentist Anil Kohli, in a country where 2-4 million die annually of hepatitis, 2.5 million are HIV positive.
Diagnosing and curing phantom maladies? Gold digging? Playing phantom faculty at phantom institutions? Practising pavement dentistry at posh locations? Going strictly by the evidence, dentists have much more to chew on than mere infection control. Like avarice control?
