Debate: Empty dental clinics in the provinces are due to a lack of graduates – and not the location of the degree programmes
It is surprising to suddenly see the political will to finance a third dental degree programme, when the two existing programmes have at the same time undergone such drastic cutbacks, write the heads of department at the University of Copenhagen and Aarhus University.
With a dot on a map of Denmark, the government recently announced plans to establish a dentistry degree programme in Hjørring. This happened in connection with the education initiative 'A step closer – More study programmes and strong local communities’.
In a number of ways, this is a very bad idea that reveals a lack of understanding of the structure, content and financial framework of the two dentistry degree programmes that already exist.
The dental profession is demanding
Perhaps we have not been good enough to show and explain the contribution made by the country's 4000 dentists – and what it takes to train and educate them.
When you sit in the dentist’s chair for your routine examination, you may not notice that one of the first things the dentist does is examine you for cancer of the oral cavity and keep an eye out for signs of diseases elsewhere in the body, which can show themselves in the mouth's mucous membranes, salivary glands or jaw.
The dentist is trained to perform surgery, X-rays, treat chronic inflammatory conditions and has a great deal of health-related pedagogic knowledge. He or she can perform surgery in the mouth and jaw and use fine motor control with a high degree of precision to operate fast-rotating instruments. Your dentist can also anaesthetise you and recreate your oral function with implants, crowns, bridges or prostheses, and has training in pharmacology with the right to prescribe prescription drugs. He or she has in-depth knowledge of anatomy and physiology, cellular functions and systemic diseases.
Could it be that the idiomatic ‘School of Dentistry' leads many people to forget that the dentistry degree programme is a research-based university education, which gives a dentist authorisation to go directly from the final exam and perform complex patient treatment?
A vocational education and training programme can be established anywhere in the country. On the other hand, a dental student is trained at an oral hospital in a strong academic health science environment with specialised researchers and teaching staff and in close collaboration with, among others, the medical degree programme.
Research over the last few years has shown how diseases in the oral cavity are crucially important for diabetes, cardiovascular diseases and vice versa, and how important it is that dentists are equipped to use a holistic approach in diagnosis and treatment. A healthy mouth and a healthy body go hand in hand.
There are neither enough researchers nor teaching staff
Today, theoretical and clinical learning takes place at the universities' oral hospitals with approximately two hundred dental units ("dentist’s chairs") in both Copenhagen and Aarhus. It is expensive to establish and run, and the funding granted has not kept up with the times.
The Danish Finance Act includes a smaller amount as a "clinical grant to the dentistry degree programmes", but the subsidy has been continuously eroded despite the overall number of students increasing by 72 per cent between 1992-2018. The clinical grant is factually smaller now than it was in the 1990s.
The consequences are that both of the universities in Copenhagen and Aarhus have been forced to increasingly cover the millions of kroner in structural deficit on the dentistry degree programmes.
The long-standing structural deficit has eroded the number of academic staff and thus the level of expertise in several specialist areas. In Denmark, we have a total of approx. fifty academic staff remaining on the two dentistry degree programmes to cover all of the odontological disciplines.
The number of researchers is so low that it creates a self-reinforcing negative spiral for the research environments and their ability to attract external research funding. At both universities, we have several subject areas with only one tenured academic lecturer. This is a fragile set-up, and it is probably not something that would be acceptable in other specialist healthcare areas in Denmark.
It will be more than difficult for a third degree programme to recruit qualified researchers and teaching staff. There is simply nothing to share, no matter how much we would like to help.
We have made all the cutbacks we can, both in terms of research positions and operating the clinic, and it is therefore puzzling to see that there is suddenly a political initiative to finance a third dentistry degree programme costing many, many millions of taxpayers money, when there has not previously been the political will to ensure a sustainable economy and to cover the actual costs of running the clinical training in Aarhus and Copenhagen.
Dentists are happy to live in the provinces
We have the framework to educate the necessary number of dentists for the whole of Denmark. Geography is not an issue for dentists, who when they graduate settle down all over Denmark – also outside of the major cities. In fact, an overview of mobility among our graduates shows that they are more spread out around the country two years after they complete their education, than they were six months before they began studying.
Denmark is a small country, and two educational institutions, one in the capital and one in Jutland, are sufficient to cover its requirements for dentists. When there are empty clinics in sparsely populated areas, this is because we do not train enough people – and not because of the location of the degree programmes.
One final important point is that a dentistry degree programme requires large groups of patients who are willing to spend time on the students' clinical training. This is also a reason why a dentistry degree programme in Hjørring, a town of 64,000 inhabitants with just over fifty kilometres to Aalborg University, appears poorly thought through.
The University of Copenhagen and Aarhus University require a total of 50,000 and 35,000 patient visits a year respectively, so that they can run the clinical training of dental students with the necessary academic diversity in the type of treatment and learning progression in degree of difficulty from simple to complex treatment needs.
We should strengthen the two existing dentistry degree programmes and their funding before we establish a third, and we would be happy to accept more students, as long as the funding is also in place.
Giving the two current degree programmes – which already send dentists to all corners of Denmark – a boost and stabilising them financially would require relatively little taxpayers money.
At the two dentistry degree programmes at the University of Copenhagen and Aarhus University, we are pleased to see the government's interest in the dentistry degree programme and the desire to create more student places. We are ready and willing to collaborate on the best conditions for the degree programmes, the dentists of the future and thus the health of the population.
The text was published in Altinget 15. juni 2021. (In Danish):