Do we have enough dentists?

Next month, the Universiti Malaya (UM) Faculty of Dentistry will celebrate its golden anniversary.

Having produced 46 batches of dental practitioners since 1976, it continues to serve the nation by offering postgraduate training in many dental specialties.

The formation of the faculty was first mooted by second prime minister Tun Abdul Razak Hussein, with the aim of providing oral care to a population of slightly more than seven million in the 1970s.

Alleviating the burden of oral diseases especially among schoolchildren and the poor, and addressing the shortage of qualified dentists were prime factors.

At the time, less than 1,000 trained dentists were registered with the Malaysian Dental Council (MDC).

Alongside the faculty’s growth was the emergence of 12 other dental schools, five of which are in public universities, namely, Universiti Kebangsaan Malaysia, Universiti Sains Malaysia, Universiti Islam Antarabangsa Malaysia, Universiti Sains Islam Malaysia and Universiti Teknologi Mara.

The others were established by private institutions, namely, AIMST University, Mahsa University, International Medical University, SEGi University, Lincoln University College, Penang International Dental College and Melaka-Manipal College (now known as Manipal University College Malaysia).

The latter two began their offerings as twinning programmes with dental colleges in India. All these institutions are recognised by the Malaysian Qualifications Agency (MQA) – previously known as the National Accreditation Board (LAN) – through rigorous processes of accreditations and reaccreditations, which are important to enable their graduates to be registered with the MDC. The Health Ministry, too, performs checks and balances to ensure graduates from these institutions are clinically and socially competent to practise safe dentistry. To date, there are approximately 11,000 dentists in the country, with a dentist-population ratio of 1:5,000 in Peninsular Malaysia, and 1:11,000 in Sabah and Sarawak.

But students, parents, institutional agencies and public departments continue to ask recurring questions such as: Do we have enough dentists to serve the nation? Will we have excess dentists flooding the job market? Should we review the enrolment system?

The reality is that nine in 10 adults polled in numerous national surveys still experience caries and periodontal diseases, the two most common infectious oral diseases; eight to 10 teeth of young children aged five and below are cavitated or infected; 40% to 70% of primary and secondary schoolchildren have painful cavities; and 94% adults suffer from gum diseases.

In addition, recent studies have shown a link between missing teeth and colorectal cancer.

And there are issues such as increasing cases of oral cancer, jaw and facial bone fractures, as well as oral-mental health problems associated with modern living.

Can the number of dentists in the country thus meet the current demands?

Another factor to consider is the prevalence of smoking, which not only affects the lungs, but can also lead to oral cancer.

There are 4.7 million Malaysian male smokers and some of them are as young as six years old.

Given that poor oral health has an impact on chronic diseases, including diabetes, and heart and respiratory diseases, it has resulted in a change in the curriculum of dental education where dental students are required to learn internal medicine and holistic management of general diseases.

Interestingly, while the norm to calculate dentist-to-population ratio has been based on the total number of registered dentists and the total population of the year, a 2016 study using the Geographic Information System (GIS) chose to identify the existing number of dental clinics-to-population ratio in the geographic locations instead.

Using the 2016 census data, the researchers found that for every public dental clinic, at least 38,000 patients are catered for, while for private clinics, the ratio is 1:13,000.

Simplistically interpreted, the report indicated that while dental public clinics are more evenly distributed throughout Peninsular Malaysia, geographic constraints are barriers to accessibility in Sabah and Sarawak.

Coupled with that is the anxiety to seek dental care, an area needing positive social media support to quell the public’s fear of dental visits.

The notion that private clinics are more saturated in major cities with higher population densities may no more be relevant in the future when Malaysia acquires the developed nation status, where the accessibility and affordability gap is expected to shrink.Indeed, one must be cautious in claiming “there’s more than enough or sufficient dentists” to serve the ever-increasing diverse Malaysian population.

That the country will see an increase in the ageing population needing special services by 2030 calls for a review of the dental curriculum.

As the recent GIS study suggested, it is timely for relevant policy-making agencies to review holistically issues of professional maldistribution and mislocation, to increase facilities, manpower and accessibility, and to optimise services, among others.

There is also a need to look at motivating students to pursue dental education at both basic and specialty levels.

In short, it is time “to think out of the box” to prepare for more challenges and align with modern expectations.

PROF DR RAHIMAH ABDUL KADIR

Registered dental public health specialist Adjunct professor, Universiti Malaya