Issue dtd. August 2006

The 'T' Factor In Indian Dentistry Foreigners are eyeing India as a new destination for dentistry, but dental tourism still has to pick up pace, says Jayata Sharma Tourism and medicine have become synonymous in India. And the latest one to join the bandwagon is our line of talented dentists. Holidaying in India has become all the more relaxing as the tourists are set to get a perfect smile, new crowns and fresh implants, all at a much lower cost than other countries. The result is that tourists can spend the rest of their time relaxing in the wide range of mystic places in India. "Dentistry has an edge over other medical treatments as hospitalisation is not required and tourists can just roam about and have fun while getting treated," says Dr Sandesh Mayekar, Founder President, Indian Academy of Aesthetic & Cosmetic Dentistry, Mumbai. The maximum patients come from countries such as Germany, France, the UK, the US, Canada, Australia, New Zealand, Ethiopia, Middle East, the former Soviet Republics, South Africa, Spain, Singapore and Denmark. Though foreign patients are flocking to various parts of the country for dentistry, the four metros witness the maximum inflow. NRIs have been trooping to India for dentistry for as long as 30-40 years now. But experts hold that real dental tourism is when foreign patients come to India in large numbers solely for treatment purposes. "If a single patient visits a dentist once in a while, then this is not dental tourism. When we have large volumes of patients visiting many dentists all over India, we can say there is business," opines Dr Ajay Kakar, Periodontist, Mumbai. Experts say that dental tourism in India is still in its infancy and growing at the rate of around 20-25 per cent annually. On an average, every dentist in India has 25-30 foreign patients annually. Why Tourists Flock To India The Cost Factor: Dental treatment is generally not reimbursed by the health schemes of many countries. "Patients have to pay through their nose if they get treatment done privately," avers Delhi-based Orthodontist Dr Bela Jain. "Foreign tourists save almost 75 per cent on total treatment cost by coming to India," informs Dr Sandeep Singh, Cosmetic Dentist, Allahabad. And why is the treatment less expensive? With more than 15,000 dentists in the metros, India is well equipped with dentistry. Tourists receive quality treatment in India primarily due to low labour cost as compared to any other region in world, viz the Middle East, Western Europe, the US, or the UK. "Our overheads are less, because dental assistants are not that expensive here. Plus, in India, finding assistants is also easy," says Dr Mayekar. Thus, even if the cost of materials and equipment stays the same, the overall cost of the treatment plunges. Low cost does not mean compromise in treatment. "We strictly adhere to our quality control measures for equipment, materials, procedures and lab technicians," insists Dr Singh. Easy Appointment: In other countries, patients have to wait for months to get an appointment. "What makes India favourable for dental treatments is that online appointments are possible here," says Dr Balvinder Thakkar, Orthodontist, Jaipur. An additional factor is that dentists abroad do not spend much time with their patients. "One of the things international patients appreciate is the quality time we spend with them," says Dr Jain. Clubbing With Tourism: India has a great cultural history and Indian philosophy is internationally acclaimed. "The varied nature of the Indian population with respect to language, religion, practices, celebrations and geography is very interesting and enticing for foreign travellers," says Dr Prasanth Pillai, Oro-maxillofacial Surgeon, Kochi. Moreover, travel and accommodation in India are certainly cheaper than in Western countries. "We first consult the patient and look at his records online. This way, the treatment is decided before the tourist arrives in India. We keep everything ready; only the fixing has to be done. When the tourists arrive, they have to spend minimal time at the clinic and the rest can be utilised for tourism," avers Dr Thakkar. An Irish patient at Dr Singh's Allahabad centre, along with the treatment, immensely enjoyed her stay at Varanasi. An Australian patient who came to his Gurgaon centre had a memorable visit to the Taj Mahal at Agra. Apart from the patient directly getting in touch with doctors, liaison agencies are providing the bridge between the foreign patient and the Indian dentist. "Patients also come after browsing the Web where the dentists give attractive packages so as to club treatment with fun," says Chandigarh-based Dr Sanjay Kalra, Professor and Head, Department of Prosthetics at BRS Dental College, Panchkula. Categorising Patients NRIs: These people like to visit India more often as their roots are here. And it is easy for them to seek out dentists here, as they are aware of the setup in India. Such kinds are easy to attract. People Of Indian Origin: They are the second or third generation Indians born abroad and have nothing to do with India directly. These only have a vague idea of what India is all about. This category is difficult to break, but when they come to India they are potential patients as they are not on the look out for saving money. They might not visit Indian dentists until someone prods them. Purely Treatment-specific: These are the ones who come only for treatment purposes. When this category visits, then it can be termed as real dental tourism. They research well in advance and know what they are seeking. This category is visiting India, but only sporadically. Leisure Seeking: They are the ones that come for travel and tourism purposes, stay at places where they can enjoy their holidays along with their treatments. Business Oriented: They come mainly with business as their motive. These choose a dentist in the same city where they are visiting for business, as they do not want to stay for long. Benefits To Indian Dentists As far as benefits are concerned, various dentists have their own ideas. But two things are a sure extract from foreign patients: international exposure and monetary benefits. "I get lots of work and a good feeling that you are going global. Another important factor is that the turnaround time is fast," is what Dr Kakar thinks has benefited him. "Monetary benefits from a single foreign patient are far more than the combined benefits of our domestic patients," says Dr Thakkar. And for Dr Mayekar, "Aesthetic dentistry is a high-cost job, and as a result margins are higher." Comparison Of The Cost Of Few Treatment Procedures Between USA And India Dental procedure Cost in US ($)—Top End Dentist Cost in India ($)—Top End Dentist Dental Implants 4,000.00 1000 Porcelain-Metal Crown 1,200 150 Porcelain Metal Bridge(3 Unit) 3,000 450 Metal Free Crown 1,500 200 Metal Free Bridge (3 unit) 4,500 600 Veneers 1,500 200 Tooth whitening (At Home) 500 110 Tooth whitening (In-Office) Britesmile 1,000 350 Root canal Treatment 1,200 150 Smile designing (Ant 6 teeth) 8,000 1,500 Complete Dentures 3,000 500 Marketing Mantras Most dentists in India market individually and mainly through their websites. However, to tap dental tourism they are now exploring various options. For instance, Dr Kakar, who also runs his clinic called LeVisage, is exploring opening channels in the UK and the US. "All my foreign patients have come through word of mouth, but I have spoken to people in London and US for partnership," says Dr Mayekar. "In addition to running a website, I have my own travel agency. So, promoting our clinic becomes easier," says Dr Thakkar. Tie-ups with tourism websites work for others. "We have tie-ups with tourism websites like inosoftsystems.com, run by Incredible India, the official website of the Ministry of Tourism, Government of India. A big achievement is the good ranking that we have in all major search engines like Google, Yahoo and MSN," says Dr Singh. Hurdles In Dental Tourism India has given medical tourism quite a boost, but has conveniently neglected dentistry, rue dentists. A case in point is a business tourism development conference held in London in May this year, which was organised by the Department of Tourism, Government of India. All fields of medicine in India were projected extensively, except dentistry. "Dentistry is not yet marketed properly abroad. What we need is an official body of dentists which will promote Indian dentistry and set up criteria for diagnosis, treatment, and post-operative care," suggests Dr Mayekar. Many dentists are of the view that they should get support from the Indian Government and the tourism and hospitality industry. Language is another roadblock. "We are losing out on Japanese patients as we do not have enough language experts for communicating with them," adds Dr Mayekar. Lack of proper infrastructure and amenities also poses hurdles. "When the tourists alight at the airport, they start doubting our quality, and the worst part is when they have to pass through slums," says Dr Kakar. Several overseas patients are concerned about the sterilisation and disinfection methodology adopted by Indian doctors. "Accreditation norms for institutions should be in place and monitored by a neutral governing body," opines Dr Pillai. Patient follow-up of foreigners in their country is another stumbling block. "What worries them is, if something goes wrong, who will take care of it, as they cannot frequently visit India," states Dr Singh. The Road Ahead Indian dentists are now planning strategies on a large scale to promote India as the best destination for dental tourism. "I will have a strategy with no loopholes. Tourists will be picked up from the airport, taken to the hotel and from there directly to the clinic. I won't give them time to see the filth around and have second thoughts about our standards of healthcare," says Dr Mayekar. "I do not believe in marketing individually, we should have a consortium of dentists to market Indian dentistry globally. This whole concept is so huge that we ought to have a controlled network of dentists all over the country," avers Dr Kakar. While some dentists feel that the Government should authorise various clinics in the country, others counter that the Government should not meddle in this, as it will only delay procedures. "The Indian Dental Association (IDA) can identify dentists doing quality work and maybe put out an official listing," avers Dr Jain. There should be periodic evaluation of the treatment standards being provided by the institutions. This will ensure that the standard infection control protocol as well as treatment protocol is maintained, which in turn will improve patient satisfaction. Dentists stress the involvement of dentists in the promotion of Indian dentistry, as they think promotion should not be done by someone who does not understand dentistry. Having NHS-accredited dental clinics in India is another solution. Two years back, the British Government published a study stating that their country was short of dentists. And, of late, NHS is referring their patients to some dentists in India. NHS is also considering hiring dentists from India temporarily. For this, they will first screen dentists and then employ them at an appropriate remuneration and give them temporary work permits. What is perhaps more advisable is that NHS recognises various clinics and dentists in India and provides them with NHS accreditation. They already have this scheme running in the UK, and NHS pays dentists a staggering sum for their services. "We can have NHS Service Centres in India, whose technologies will be accredited by the NHS. An average rate of the cost in the UK (or any other country) and rate in India can be fixed and charged to the patients coming from abroad. This way, India and NHS both can benefit," observes Dr Kakar. Let us hope all the points of concern are sorted out, and the new face of Indian dentistry emerges soon.

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