|Year : 2014 | Volume
| Issue : 1 | Page : 13-17
Dental schools in the Republic of India: A geographic and population analysis of their distribution
Karandeep Sandhu, Estie Kruger, Marc Tennant
International Research Collaborative - Oral Health and Equity, Anatomy, Physiology and Human Biology, The University of Western Australia, Nedlands, 6009, Western Australia
|Date of Web Publication||18-Feb-2015|
International Research Collaborative - Oral Health and Equity, The University of Western Australia, Nedlands, 6009
Source of Support: None, Conflict of Interest: None
Purpose/Objectives : India is the seventh largest country (3 million square kilometers) and the second most populous (1.2 billion people) country of the world. Dental education in India has expanded greatly, now having the highest number of dental schools in the world (nearly 300). Graduate numbers have increased rapidly from 1300 in the early 1960s to 26,000 in the early 2000s. Against this background, the aim of this study was to undertake a detailed state-by-state analysis of dental school distribution and compare it with populations to enhance our understanding of dental education in India. Materials and Methods: The complete list of all the Indian dental schools was obtained as of June 2012. The addresses were cross-checked with the official websites of each dental school geocoded using Google maps and compared with the census population data. Results: A substantial range in population to school and population to annual graduate number was found between states from a high of just over 100 graduated per million people in Chandigarh down to zero in 10 states. In five states, 75% or more of the population lived further than 40 km from a dental school while at the other extreme in Chandigarh and Delhi, no one lived more than 20 km away. Conclusion: The immediate amelioration of supply issues (access for dental care) at a national level requires effective steps to "redirect workforce" toward areas of need to reduce the disparity in workforce distribution. This will require the collaborative efforts of many areas of government.
Keywords: Dental education, distribution, geography, India, workforce
|How to cite this article:|
Sandhu K, Kruger E, Tennant M. Dental schools in the Republic of India: A geographic and population analysis of their distribution. Int J Oral Health Sci 2014;4:13-7
|How to cite this URL:|
Sandhu K, Kruger E, Tennant M. Dental schools in the Republic of India: A geographic and population analysis of their distribution. Int J Oral Health Sci [serial online] 2014 [cited 2019 Nov 12];4:13-7. Available from: http://www.ijohsjournal.org/text.asp?2014/4/1/13/151614
| Introduction|| |
India is the seventh largest country (3 million square kilometers) and the second most populous (1.2 billion people) country of the world, and has a universal health care system run by the constituent states (n = 28) and territories (n = 7). Oral health has been a neglected issue for a long period of time in India, but recently it is being recognized as an important issue for the wellbeing of the society. In spite of the recent advancements and awareness in the Indian oral health care sector, oral diseases like dental caries, periodontitis and oral cancer are highly prevalent. Oral diseases are a significant public health burden in India, with 60-65% of the general population being affected by dental caries and 50-90% of the population being affected by periodontal diseases.  The frequency, incidence, severity and disparity of oral diseases requires India to have effective dental education strategies and oral health care delivery systems. , Workforce shortages and uneven geographic distribution of the oral health practitioners are associated with reduced access to dental care and oral health services.  In line with the recent focus on dental health, dental education has expanded greatly, now having the highest number of dental schools in the world (nearly 300). , Graduate numbers have increased rapidly from 1300 in the early 1960s to 26,000 in the early 2000s, with a dentist to population ratio of 1:10,000 in urban areas and 1:250,000 in rural areas.  In India's National Oral Health Plan (NOHP), the Indian Dental Association also voices its concern about workforce maldistribution and the severe shortages in some areas, as well as the overall capacity of the workforce to meet the anticipated demand for oral care as public understanding of its importance increases. The NOHP also emphasizes that incentives should be offered to students to return to rural areas, that the diversity of the oral health workforce should increase, that more training and recruitment efforts are needed and that "the lack of personnel with oral health expertise at all levels in public health programs remains a serious issue, as well as the projected unmet oral health faculty and researcher needs."  Against this background, the aim of this study was to undertake a detailed state-by-state analysis of dental school distribution and compare it with populations to enhance our understanding of dental education in India.
| Materials and Methods|| |
All data for this study were from open sources and, as such, there was no requirement for ethics approval.
All the dental schools are required to be recognized by the Dental Council of India. ,, The complete list of all the Indian dental schools was obtained from the official website of the Dental Council of India as of June 2012. The addresses were cross-checked with the official websites of each dental school.  Using the dental school's addresses, the longitude and latitude of each dental school was obtained using Google maps. 
All population data were obtained from the Indian census data of 2001. 
Geo-coded dental schools and population data were integrated using ArcGIS-version 9 (ESRI, Redlands, CA, USA). The geographic measures analysis was completed using the ArcGIS software. All subsequent data analyses were completed using Excel (Version: 2003, Microsoft, Redmont, WA, USA).
| Results|| |
The analysis included 289 Indian dental schools, 25 states, seven union territories and 1.04 billion people. Of the 289 dental schools, 39 dental schools were Government dental schools or public dental schools and the rest were private dental schools. The total number of dental schools geo-coded was 280, resulting in a 97% success rate [Figure 1].
|Figure 1: The distribution of dental schools across India, with population number for each district being shaded (the darker the shade the greater the population)|
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Distribution of Indian dental schools
There was a significant variation in the geographic distribution of dental schools across India, with some states having more than 20 dental schools and some states having no dental schools [Figure 2].
|Figure 2: The number of dental graduates (per annum) for each million people in the states of India|
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Number of dental students graduating each year per state
As the number of dental schools varies within each state, so does the number of dental students graduating each year, with the natural conclusion that those states having a high concentration of schools have more graduates in comparison with the states with a low concentration of dental schools. Karnataka, having the highest number of dental schools, is also found to have the highest number of dental graduates, i.e., 3260 dental graduates per annum. Andhra Pradesh, Uttar Pradesh, Kerala, Punjab, Tamil Nadu, Madhya Pradesh and Rajasthan are all states that have high numbers of dental graduates.
Population to dental schools
Andhra Pradesh has 22 (8% of all dental schools) dental schools that serve 8.2% of the population; on the other hand, Bihar has nine dental schools (3% of all dent schools) but 11% of the Indian population. Kerala (3% of population) and Karnataka (5% of population) are provided with 23 (8%) and 46 (16%) dental schools, respectively. On the other hand, some of the states like Tripura, Meghalaya, Arunachal Pradesh and Sikkim have no dental schools [Table 1]. The majority of the states with no dental schools are the north-eastern states of India: Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura. Other areas where no dental education is provided include the Union Territories of Dadra and Nagar Haveli, Daman and Diu and Lakshadweep. The proportion of the population in these states without dental schools (especially in the northeast) is high (approximately 11 million people) and includes Manipur, Meghalaya and Tripura, with 2.6 million, 2.5 million and 2.1 million people, respectively.
|Table 1: State-by-State breakdown of dental school numbers and population ordered by the ratio of the number of people (×100,000) per school |
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People within 20 km and 40 km of dental schools
[Table 2] shows the number of people living within a 20 km radius of a dental school in each Indian state. A large number of people are found to live outside the 20 km (and 40 km) radius of dental schools. Chandigarh and Delhi are the only two Union Territories having 100% of the population living within a 20 km or a 40 km radius of dental schools. On the other hand, Bihar is having a total population of 111 million but only 5.7 million people have been found to reside within 20 km of a dental school. In both Bihar and West Bengal, 17% and 37% of the total of population, respectively, is living within 40 km of the dental schools, while only 5% of the population of both states is living within 20 km. In Jammu and Kashmir, only 1.5 million people out of 10 million people live within 20 km of a dental school. A marked variation can be seen in the proportion of the population living within the 20 km and the 40 km radius of dental schools.
|Table 2: The number (and proportion) of people (×100,000) in each State of India living within 20 km and 40 km (as well as outside 40 km) from a dental school. Table is sorted by proportion of people living outside 40 km |
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| Discussion|| |
There is a substantial private market for dental education in India, which demonstrates the impact of commercialization on health care in emerging economies. In many cases, this has raised issues of quality of education provided by the private dental schools in India, with issues such as the shortage of teaching staff, inadequate infrastructure and lack of proper clinical training, affecting dental education.  Moreover, job opportunities for the new dental graduates are decreasing. Most of the dentists are investing in the establishment of their own private dental clinics and surgeries. And, most of the private practices are located in the main cities and towns. In other countries, it has been noted that graduates tend to work around their dental school of origin.  Comparatively, the cost of establishing a dental clinic in the rural sector is less, but the frequency of patient's visits is unexpectedly low in these areas due to lack of health education. The extent of employment by the government is limited and remuneration is less. All these problems are leading to the increased migration of the dentists to the other countries and adoption of alternate career pathways. 
Despite the high concentration of dental schools and dental graduates, India is facing continued poor outcomes in oral health, with maldistribution being a significant factor. These issues are not uncommon in countries where the number of graduates has increased to improve the overall ratio of dentist-to-population. The next clear issue faced is the development of methodologies that are socially and culturally adapted to the local conditions.  In Australia, for example, despite the population being about 20 million people in total, substantial maldistribution remains a real issue. 
The immediate amelioration of supply issues (for dental care) at a national level requires effective steps to "redirect workforce" toward areas of need. This will require the collaborative efforts of many areas of government.
This study clearly highlights the conundrum of free-market education and the mismatch of drivers in dental education that can lead to outcomes that are not necessarily the most efficient mechanism for driving improved community health. It also highlights the complex issues that face dental service and education globally in addressing maldistribution that exceeds the issues of pure numerical increase in graduate numbers. The complex interaction of variables to provide effective oral health care globally requires continued evolution of innovative models. The existing arrangements in economies as diverse as India, Australia, the USA and Europe are not yet effective in addressing the needs of all.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]