This month’s blog follows on from the recent Dental Tourism blog which got me thinking, how many dentists does the world need? When I started writing on one sunny day in Edinburgh, there were 8,218,809,245 people on the planet. Incidentally, the world’s population is growing by 70 million per year, more of this later. With 2,542,592 dentists in the world, this is on average 3.3 dentists per 10,000 population. However, the inequalities are dramatic with 68% of WHO Member States having less than 5 dentists per 10,000 population [1], and 37% of countries have less than 1 dentist per 10,000 population.
If you want to travel to the most populous country for dentists according to the WHO, Cuba is the place to go, with 18.42 dentists per 10,000 population, whilst Chile has 16.8 dental personnel per 10,000 population. It will come as no surprise that China has the greatest number of dentists in the world at 637,000. There is one country though with a solo dentist, Kelvin Suli Ratu in Tuvalu, who initially trained as a Dental Therapist, then went back to Fiji School of Medicine to become a dentist. Dr Ratu is the most remote dentist in the world as Tuvalu lies midway between Hawaii and Australia. Interesting fact time, as a Commonwealth country, Tuvalu is proud to have the RCSEd Patron, King Charles III as the King of Tuvalu.
Data geeks like me will be interested to know that most developed countries where the College is active have a similar ratio of dentists per 10,000 population as the UK (4.85), including both Malaysia (4.06) and China (4.51). There are however some interesting deviations, with a relatively low ratio in Egypt (1.87) and a surprisingly high figure in UAE (8.85). Interestingly, Romania (11.4) and Portugal (12.05) have more dentists than I would have expected. There are however countries with low ratios of dentists to population where the College is active, notably India (1.59) and Bahrain (0.8) suggesting there is much work to do to provide oral healthcare for these populations.
Whilst the global average is 3.3 dentists per 10,000 population, the situation becomes more complex when Dental Care Professionals (DCPs) are considered. Not all countries maintain records of DCPs and not all countries use the same categorical definitions for specific dental professional roles. It could be argued that the UK is perhaps the most complex with 7 roles (Dentist, Clinical Dental Technician, Dental Hygienist, Dental Nurses, Dental Technicians, Dental Therapists and Orthodontic Therapists). The Faculty of Dental Surgery and the Faculty of Dental Trainers provide something for all registrant groups of course, and I am proud that as a College we are the professional home for the whole dental team.
When it comes to dental technicians, the UK fairs well at 33,000 and this is broadly in line with most other developed nations. The significant outlier is Germany at 68,000, which is well-known for the precision production of dental devices as well as other areas of manufacturing. The WHO category of Dental Assistants and Therapists produces some interesting information as well. The UK has 32,000, and although the US has 542,000, for the population size, Germany has a vast number for the population at 226,000.
All these data are very interesting but how many dental professionals does each country require? The WHO stated in 2016 that the dentist population should be 1:7,500 for developing countries. Indeed, many developing countries are making gains toward this and there have been concerns in some countries that they will even overshoot this, leading to unemployment. With a globalised workforce and many countries requiring additional dental personnel, I doubt this is likely, in the short or medium term anyway. Fellows and Members with RCSEd qualifications will appreciate the portability and global recognition of our qualifications. Cuba and Chile seem to be coping with the highest proportions of dental personnel in the world in any case. Complicating the dynamic further is geographic dispersal of populations and variations in disease prevalence within countries, and ability to pay where there is no universal health coverage.
There is no metric for the ideal ratio of dentists and dental personnel for a given population, which is surprising as this would allow governments to plan dental school exports; but with a part-service industry, market forces are also at play. My view is the WHO should be bold enough to state the facts and indicate the ratio for developed nations. This would provide a metric to show which countries are likely to provide an adequate dental number of dental professionals for their population. Without this, it is all just numbers and politicians around the world will play with populations, before, during and after election campaigns. We are all used to pre-election healthcare promises that are either difficult to deliver or cannot be delivered when in power due to other budget ‘pressures’. Europe and the Americas have one dentist per 1500-2000 population, which is a good place to start, accepting that there are still significant health inequalities to be resolved in developed nations. This translates to 4,109,163 million dentists across the globe, and with only 2,542,592 at present, we are falling short of providing an adequate dental workforce for the world.
Where does this leave us as the profession? We are all familiar with other metrics of oral healthcare delivery, DMFT, percentage of children being caries-free, proportion of adults as dentate/partially edentate, numbers of children requiring general anaesthetic extractions and so on. Furthermore, the news all too often covers the perennial story that access to dental care is challenging in many countries, particularly in the UK. We know there is an inadequate provision of oral healthcare provision across the world. However, is it too much to ask for a simple statistic to allow us to calculate the gap between current provision and current need? How many dentists and dental health professionals each developed country needs would be a simple, yet powerful tool. It might also help Kelvin Suli Ratu in Tuvalu, who works with two Dental Assistants/Dental Therapists and three Dental Technicians determines how many colleagues are needed in Tuvalu.
Oh, and by the way, the world’s population has increased to 8,218,817,489 in the hour since I started writing this. That is another 8,244 people on the planet, so we will need to train more dentists and dental care professionals to look after the oral health of the increasing global throughout their life.
References
[1] 1:2000 means 4,109,404 (1:1500 = 5.479.206)