IJCRR

IJCRR - 14(18), September, 2022

Pages: 11-16

Date of Publication: 24-Sep-2022

Comparative Study of Dental Education between South Asian and Southeast Asian Countries - An Empirical Analysis

Author: Kajal Agarwal, Prashanthy M.R., Bharathwaj V.V., Sindhu R., Dinesh Dhamodhar, Prabu D, Rajmohan M., Suganya P.

Category: Healthcare

Abstract:Introduction: Dentistry is the field that brings back one's smile. It is this field that teaches about the importance of oral hygiene. Dental education varies in all Southeast Asian and South Asian countries. Aim: To compare dental education concerning fee structure, dentist population ratio, and year of graduation between South Asian and Southeast Asian countries. Methodology: This study was conducted to the comparison of dental education in South Asian and Southeast Asian countries. Southeast Asian countries were classified as Group A and South Asian countries were classified as Group B. Data was retrieved from manual and electronic databases using search engines (Pubmed, google scholar, Web of Science). In this study, the keywords were Dentistry, Southeast Asian, South Asian, Dental colleges, and Dentist population ratio used in the search. Result: This study determined the difference between dental education, dentist population ratio, and the dentist's average salary among Group A and B. The number of Dental colleges was the maximum in India (71%) among all other Group A and B. Conclusion: Nevertheless South Asia had a plethora of colleges, and high-paying dental jobs were possible only in Southeast Asian countries. Hence substantial numbers of dental colleges with proper apportionment and job contentment is obligatory for better treatment outcome of patients.

Keywords: Dentistry, Dentist, South East Asian, South Asian, Dentist population ratio, Dental colleges, Fees structure

Full Text:

INTRODUCTION:

Asia is divided into several peripheral coastal regions, namely East Asia, South Asia, Southeast Asia, and the Middle East. Southeast Asia is a vast region of Asia situated to the east of the Indian subcontinent and south of China. It consists of two distinct portions, mainland Southeast Asia and insular Southeast Asia. Southeast Asian countries were classified as Group A which included Singapore, Malaysia, Thailand, Vietnam, Philippines, Cambodia, Indonesia, Brunei, Laos, Myanmar and Timor Leste. Southeast Asia stretches 4,000 miles at its greatest extent from northwest to southeast and includes 5,000,000 square miles (13,000,000 square kilometers) of land and sea. Currently, Southeast Asia's population is approaching half-billion or one-twelfth of the world's total.¹

Dental education in Southeast Asian countries highlights the high-quality dental services for dental graduates and dental practitioners' free movement. The Southeast Asian Nations (ASEAN) Dental Councils had proposed the Common Major Competencies for ASEAN General Dental Practitioners to support undergraduate dental education.²

South Asia extends south from the central part of the continent to the Indian Ocean. The western boundary is the desert region where Pakistan shares a border with Iran. South Asian were classified as Group B which included Sri Lanka, India, Bangladesh, Bhutan, Nepal, Pakistan, and the Maldives.³

People in developing countries were burdened excessively by oral diseases, such as periodontal diseases, dental caries, etc. Such conditions were aggravated by poverty, poor living conditions, ignorance concerning health education, and lack of government funding and policy to provide sufficient oral health care workers. World Health Organization (WHO) and the FDI World Dental Federation had identified the problems and developed strategies. However, acceptable goals and standards of oral health have to be agreed upon.⁴ It contains human resource indicators that provide us with an overview of the availability of trained and specialized medical, dental, nursing, and paramedical workforces in the country. It also provides information regarding regional distribution and disparities.

The number of dental schools and the total number of dentists had increased in the past two decades, but the dentist/population ratio was decreased.⁵ However, to serve the need for this massive population's oral health care, India had organized many dental educational institutes. Also, the dental field and educational sector had grown up during the past decades.⁶

Dentistry is a health science department that involves analysis, prognosis, and prevention of surgical and non-surgical ailments of the oral cavity. ⁷ The majority of dental infections and therapies were carried out to stop or deal with the most typical oral conditions such as tooth decay, periodontal illness, etc. Dental education aims to prepare students to be competent enough to meet public oral health needs. In the region of South Asian and Southeast Asia, the population's living and health conditions reflect the unequal distribution of dental health determinants and the disparity in the means to compensate for this inequality. The present study aims to compare dental education concerning fee structure, dentist population ratio, and year of graduation between group A and group B.

Methodology 

This study was conducted to the comparison of dental education between South Asian and Southeast Asian countries. Southeast Asian countries were classified as Group A which included Singapore, Malaysia, Thailand, Vietnam, Philippines, Cambodia, Indonesia, and Myanmar. South Asia was classified as Group B which included Sri Lanka, India, Bangladesh, Bhutan, Nepal, Pakistan, and the Maldives. Data were retrieved from the manual and electronic databases using search engines (Pubmed, Google Scholar, Web of Science). The total number of institutes, years of education for both undergraduates and postgraduates, fee structure, and the total dentist population ratio for different countries were the main source of the data collected. The Southeast Asian, dental colleges, South Asian, postgraduates, undergraduates, and dentist population ratio were keywords used to retrieve the data. Articles related to dental education in group A and group B were only included other than native languages were excluded. Documents like Letters, Meeting abstracts were excluded.

RESULTS:

The present study aimed to analyze dental education's current situation in group A and group B. Information regarding the total number of colleges in each country, undergraduate and postgraduate in dental colleges and duration of the course, entire fee structure of different colleges in different countries, were obtained and tabulated to provide an insight about dentistry in group A and group B.

Table 1 depicts the average fee structure, duration of the course, and the total dentist population ratio in other countries. Cambodia had the lowest dentists population ratio to other Group A. The duration of the course was almost the same for every country.

Table 2 reported the average fee structure and the total dentist population ratio in other countries. The duration was the same for all the countries except the Maldives for undergraduates. The Post-graduation course duration was 3 years in all groups B, whereas in Srilanka, the course duration was one year.

Table 3 showed that the distribution and comparison of a dentist's average salary per month in group A and group B. In group A, the dentists were highly paid in Singapore. On the contrary, the least was spent in Myanmar. While in group B, the dentists were highly paid in Maldives and least paid in Bangladesh.

Figure 1 showed that the total dentist ratio population in Group A. Cambodia had the least dentist-population ratio, while Myanmar being the highest dentist-population ratio.

 Figure 2 showed that the total dentist population ratio in Group B. Pakistan had the least dentist population ratio, while India being the highest dentist population ratio.

Figure 3 showed that the distribution of the total number of dental colleges in Group A. According to the figure, Myanmar (2), Cambodia (2), and Singapore (3) had a low number of dental colleges. On the contrary, Indonesia (30) had a high number of dental colleges.

Figure 4 shows the distribution of the total number of dental colleges in Group B. According to the figure, Bangladesh (35), Bhutan, Sri Lanka, and the Maldives had two dental colleges, Afghanistan (3), Nepal (13), and Pakistan (43) had the number of dental colleges. In contrast, India (318) had the highest number of dental colleges all over the world.

DISCUSSION

The current study reported a comparison of dental education in Group A and Group B. All the nations are dissimilar in cultural, social, and ecological aspects and their caste, ideology, and religion, with differentiating community needs in rural and urban structures. The number of dentists available for people varied in different countries.

The present study stated that India had the highest number of dental colleges among all other countries. In Group A, Indonesia had 30 colleges, Thailand had 11, Malaysia and Philippines had 10, and Vietnam had 8, whereas Singapore, Cambodia, and Myanmar had the lowest with 3 and 2 dental colleges. In Group B, India had the highest with 318 dental colleges, Pakistan had 43, Nepal had 13, the Maldives, Bhutan, and Srilanka had 2, Afghanistan had 3, and Bangladesh had 35 dental colleges.

This study stated the average salary of a dentist per month. The dentist's pay was too less in Myanmar while in Singapore was highly paid. All the other countries had mediocre salaries paid to dentists. Data obtained for the duration of the course for both undergraduates and postgraduates were mostly five years for undergraduates and 3years for postgraduates, respectively, except the Maldives, Myanmar, and the Philippines had 6years courses for undergraduates. On the contrary, Cambodia had no post-graduation dental course.

This study reported that India (71%) had the highest percentage of dental colleges distribution among South-Asian countries (group B), followed by Pakistan (10%). Bhutan and Bangladesh had the lowest percentage of dental institutions (2%). Among Southeast Asian countries (group A), the highest percentage of dental colleges were in Indonesia (36%), and the lowest number was in Singapore (4%). According to each country's population, there was no proper distribution of dental colleges to meet people's dental demands, especially in group A. At present, India has the highest number of dental colleges in the world.⁷

The dentist population ratio was a widely accepted measure of workforce outcomes. 8 To analyze the dentist population ratio of Group A, the ratio was 1:119000 and 1:43000 in Cambodia and Vietnam, respectively. In descending order, the dentist population ratio in other Group A followed the Indonesia dentist population ratio was 1:25000, the Philippines had 1:20,000, Thailand had 1:7000, and Malaysia had 1:6,000. In Singapore, the ratio was 1:10000, and in Myanmar had 1:3695.

World Health Organization recommends a Dentist Population ratio of 1:7500.⁹ It should be noted that most of the countries did not meet the recommended ratio given by the World Health Organization (WHO). The reasons for such an excess supply of dentists were poor (or) no workforce planning, reliance on faulty statistics, mushrooming of dental colleges, and inefficient regulatory bodies. The problem lies behind the distribution of dental colleges than the number of dentists. The number of dental colleges varied for all countries.

Major drawbacks would be the unequal distribution of dentists in all the areas, lack of systemic planning and allocation, and booming of dental colleges in all the countries. In rural areas, the dentist population ratio was less compared to urban areas. Due to unemployment and low income, most dentists in Group A and Group B moved to western countries. The reasons for dentist migrations were complex and included the lure of better remuneration, professional development, career growth, better working and living conditions. Political and economic forces also influenced the decision to migrate. A high population-to-provider ratio does not explain levels of untreated disease, potential demand, or sufficient demand. Therefore, it reveals little information about the criticality of intervention or the character of intervention. Pakistan had produced more than ten thousand dentists, but most of them left the country for a better future.¹⁰

The students pursuing a Bachelor's degree fail to follow a Master's degree due to the excessive fee, which has created a scenario in which some dentists intend to seek alternate professions. 11,12 The predominant migration pattern in the region was the movement of dentists from middle- to high-income countries. Dentists from India, Malaysia, Sri Lanka, and Bangladesh were more likely to migrate to high-income countries in the region, and have a Commonwealth connection.¹³ Dental colleges also have decreased their investment in physical plant and faculty numbers. Most of the dentists in all the countries had migrated to western countries due to unemployment and low salary provided by the dentist in Group A and Group B.^14,17,18,20To achieve universal health coverage, improved oral health care delivery with a skilled and motivated dental health workforce was necessary. Human resource shortages hinder the scale-up of health services and limit the capacity to absorb additional financial resources. Kasbah etal. the study reported that the efficiency of dental education was better in Saudi Arabia due to implementing the newer method Mini clinical evaluation exercise.²¹ A clear understanding of the dental health-workforce situation is very critical to develop effective policies. Shobana et al. study reported that the implementation of some ethical values and principles motivates them to get an awareness of education.²² The government authorities should conduct an awareness campaign to bring awareness about dental hygiene among the public.

There was gross inadequacy in dentists' availability and significant inequalities in their distribution between the different countries. In terms of health outcomes, poorly performing countries had a more substantial shortfall in dentists' number. The respective countries' regulatory bodies should reinforce the dentist's employment opportunities with dignified salaries and better living standards to retain qualified dentists from migrating to other foreign countries. Dental graduates among group A and group B prefer to pursue higher education in western countries. Many dentists are also deviating from their profession and choosing different parts such as insurance companies, hospital administration-related jobs, and medical coding because of the less pay scale available for dentists.

The Dental Council must be taken into action for the proper and equal distribution of dental colleges all around the Asian region according to the oral health care needs of the people. The existing framework appealing would prompt catastrophic outcomes unless intruded with the crisis without laxity to spare the profession's veneration.

LIMITATION

The major limitation encountered during the study was obtaining information about various dental colleges; the dentist population ratio in three countries of Southeast Asia and South Asian countries was not retrieved. Details regarding the number of colleges, population, and average salary of a dentist were available while regarding dental seats accessible in different colleges was not existing on any platform.

CONCLUSION

In today's world, oral health has become a significant factor to be considered. Oral hygiene habits are equally as crucial as other habits. Every year, the number of dentists is increasing, but people are still not aware of the importance of oral health. Socially appropriate strategies must be developed to target oral health issues. Nevertheless, South Asia had a plethora of colleges, and high-paying dental jobs were possible only in Southeast Asian countries. Hence substantial numbers of dental colleges with proper apportionment and job contentment is obligatory for better treatment outcome of patients.

ACKNOWLEDGEMENT: Nil

CONFLICT OF INTEREST: Nil

FUNDING: Nil

Kajal Agarwal- concept and study design, data collection

Prashanth M.R- Concept and study design. Data collection, and manuscript write up

Bharathwaj V.V- formulated the write-up

Sindhu R- Performed the analysis and interpretation

Dinesh Dhamodhar- Data analysis and interpretation

Prabu D- Provided revised scientific content to the manuscript

Rajmohan M- Correction done

Suganya- Data collection

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