Would you pay Rs 30K for a picture-perfect smile?

Even as most of the country rarely visits the dentist, young India is willing to spend astronomical amounts on their teeth. Abhishek Mande and Anisha Ralhan explore this dichotomy.

It must have been past midnight when Kejal Mehta* woke up her husband. From the scant light that filtered from their curtains her husband, a doctor by profession, sensed the acute pain she was in. The 31-year-old housewife was holding on to her right cheek and gritting her teeth. One of her molars had acted up.

Mehta knew she couldn't sleep through this pain and begged her husband to give her some painkillers. Not the one to dispense medicines unless he has to, he suggested a traditional cure -- wrap a piece of cotton around a camphor tablet and leave it in the mouth. She followed his instructions.

An hour later, she was waking him up again. He reluctantly opened his briefcase and gave her a strong dose of painkillers. Soon she was fast asleep.

The next morning Mehta went about her business. When asked if she was visiting a dentist that day, she casually brushed away the question mumbling something about how much work she has at home. Her husband shook his head silently and left for the day.

He knew the pain would return soon someday in the near future and that the tablet wouldn't work then.

At some level, Mehta's story is our story too. Not many of us take dental health very seriously. A lot of us don't even bother to brush our teeth twice daily!

In fact if a recent survey conducted across the four geographic zones in India by research firm IMRB is to be believed, 34 per cent of respondents believed that brushing just once a day was sufficient.

Only 28 per cent of people interviewed in the survey brushed their teeth twice a day and two out of every three respondents had never visited a dentist.

Unsurprisingly, the survey concluded that Indians in general have a low level of awareness about oral health and hygiene.

*Name changed to protect privacy.

Illustrations: Dominic Xavier

Dr Kaustubh Gandhalikar, a dentist in Mira Road, a satellite town on the outskirts of Mumbai concurs. "Only five to six per cent of Indians visit a dentist, " he says, quoting a survey conducted by the Indian Dental Association. "In India, a visit to the dentist is usually need-based and not for a hygiene check-up."

Gandhalikar also speaks with some amount of experience. The 29-year-old dentist has been practicing for the last six years and explains that most of his patients visit him only when things have gone totally out of their hands. There are times when a root canal is the only way out.

Despite this (and the dismal figures he quoted barely few minutes ago), Gandhalikar is an optimistic man. He insists that even though the general awareness about dental hygiene is low right now, it is slowly but surely on the increase.

"It (the trend) might be restricted to people who are educated and those living in urban and semi-urban parts of the country. But the fact remains that these people are taking care of their teeth."

He mentions that employers of some of his patients even cover their treatment. "Companies like TCS, Wipro and SBI cover dental treatment of their employees. But this is far from the concept of dental insurance that will make regular check-ups compulsory," he says, adding that till dental insurance isn't introduced in India, people will keep finding excuses not to visit their dentists.

One such person is Pune-based Samik Sinha*. He is an HR boss with an MNC and confesses that he hasn't visited his dentist in over a year. For a large part of his career, Sinha was based in Mumbai. He says he used to see his dentist 'as and when it was necessary'. His excuse was that he never had the time. When he shifted to Pune, the visits became even rarer. On one occasion, however, the 53-year-old found himself in an unenviable position.

"I was ignoring my toothache for a long time. Then one morning it got really bad." Sinha drove down to Mumbai, got out offhis luxury car and sat like an obedient child waiting for his turn on a hard wooden bench in his dentist's waiting room.

Delhi-based software engineer Sharda Bharadwaj has an altogether different reason why she avoids the dentist. She says, "I detest going to dentists unless it's absolutely necessary. They are scary people who take sadistic pleasure drilling inside your mouth, sometimes redundantly. For instance, I once visited a dentist to seek a cure for my toothache. Before diagnosing the problem he asked me to go for a dental polish. I knew my teeth were white and plaque-free. So I protested, but he was bent on it."

Bharadwaj finally got rid of a tiny cavity after undergoing multiple painful sessions of tooth-cleaning.

Significantly on the other end of the spectrum are people who will go to any lengths to ensure their pearly whites remain that way.

Sure, the fascination with white teeth is universal. Unless you are Ross from the Amercian sitcom Friends whose bleached teeth began glowing in the dark, whitened teeth help you make a great first impression.

Mumbai-based dentist Dr Chitrang Thaker says it is the most popular treatment amongst his patients. Besides whitening teeth, people visit him to fill in gaps, repair chipped teeth and correct their gum line. Others who can afford it go for a complete smile makeover that costs anywhere between Rs 30,000 to Rs 40,000.

Thaker says that the demand for cosmetic treatment has gone up considerably. A part of the reason for this, he points out, is the rise in disposable income and the somewhat obsessive need to look good.

Another reason is that they barely take time. "Because of new technology the processes are painless and fast," he points out.

Among the people who Thaker counts as his clients are youngsters in their early 20s who are months into their first jobs. Some of these are call centre employees working in the nearby BPO hub of Malad.

He points out that a makeover gives their self-confidence a boost. "It makes a lot of difference, he says, "when they undergo a smile makeover."

Then there are requests for 'celebrity smiles'. Thaker has got requests from clients who want a smile like Lara Dutta and Perizad Zorabian.

Dr Ashton Turner, who practices in the upmarket South Mumbai area says Julia Roberts is a favourite amongst his clients, adding that requests for tooth enamel are becoming popular too.

The reason, he says, has a lot to do with the idea of 'body beautiful' that's gaining ground. In some cases, like that of a young gym trainer who is one of Dr Turner's clients, it is becoming a must. "He wanted a smile makeover because he felt it would make a difference to his personality. He interacts with people who are beautiful and didn't want to be left unnoticed," Turner says "He couldn't afford paying up in one go so we offered him a discount and an option of paying through instalments."

"Vanity is quite popular," he chuckles, "And people are willing to shell out up to a lakh on their teeth."

Dr Neeraj Verma, Senior Consultant, Dental Surgery at Indraprastha Apollo Hospital in New Delhi quotes an instance when a family came to him to improve their daughter's misaligned teeth. "I recommended braces, but the parents insisted on extracting her entire set of teeth and replacing them with beautiful artificial dentures. They had to get her married in a month and were ready to spend a bomb on their 20-something daughter's teeth!"

Dr Shankar Swamy, who has been practicing in Chennai for 25 years, also admits that requests for all kinds of cosmetic treatments have been on the rise. Needless to say, whitening is the most popular of them all.

The veteran dentist is, however, equally aware of the paradox. He says just about 20 per cent of his patients engage in preventive steps. "Why can't people take care of their teeth, when they go to great lengths to take care of their hearts, which they cannot even see!" he exclaims with some amount of exasperation. "People these days lose their teeth when they're in their 40s and 50s. Your teeth ideally should have a life of 100 years!"

The treatments that youngsters visiting his clinic request include tooth jewellery, something he doesn't exactly approve of. "It damages your teeth enamel," he says, "It isn't recommended."

While most treatments like tooth enamelling or denture implants may be out of reach for college students, those with that little extra pocket money sometimes go for tooth jewellery.

A sparkling health-grade stud can cost you as little as Rs 2,000 and as high as Rs 4,000 at Dr Thaker's clinic in North Mumbai.

In Gurgaon, where Dr Sandeep Sharma practices at the Artemis Health Institute, it will cost you anywhere between Rs 3,000 and Rs 6,000.

Tooth jewellery, says the Delhi-based dentist, is a rage among youngsters. He says, "Placed on the right or left tooth of the main frontal teeth, a stud drastically enhances a person's smile. Indian youth is increasingly emulating the West when it comes to looking good."

Sanam Sood is a 22-year-old student who a tooth-stud two years ago from Dr Sharma.

"I was really impressed with a tooth jewellery poster in a magazine. I wanted it badly. The next thing I knew, I was being showered with compliments from everyone on how sparkling my smile had become! It took barely ten minutes to get a crystal stud on my tooth and it's never bothered me. I quite enjoy the attention when I speak. Makes me smile all the more," she says, flashing it.

In Kolkata, however, the tooth jewellery craze is yet to catch up. Dr Abhishek Laha, who practices in the upscale South Kolkata area says that the requests he gets for fixing tooth jewels are almost negligible.

"There isn't a lot of disposable income in Kolkata," he says.

Contrast this with the teenagers in New Delhi who visit Dr Verma at Indraprastha Apollo Hospital and are willing to spend a small fortune only to correct bug teeth and fix their gummy smiles.

The slightly older clients or the younger ones who can afford it go for teeth bleaching and correcting the shape and alignment of their teeth. Dental veneering, Verma says, is popular among people of all age groups and costs anywhere between Rs 9,000 and Rs 15,000.

If there is one thing that the Neeraj Verma is dead against, it is tooth jewellery. "I find it highly absurd," he tells us over the phone, "It is never in the interest of your dental health to get a stud on your tooth as it can damage the gums and lip surface."

He continues, "Indians hardly understand the concept of prevention. Eighty per cent of my patients come to me when things have gone beyond their control and need urgent medical attention."

Verma quotes a WHO health survey that states 90 per cent of people in India suffer from gingivitis, a result of improper brushing.

"But people seldom take notice of this inflammatory gum condition and live with it for years," he says, "70-80 per cent of Indians have dental decay at some point in their life and it's purely out of negligence."

Some of the worst cases Verma has seen are those of people who require total extraction at the age of 30 or 40 years. "It is shameful that people need dentures at such a young age," he says.

Dr Gandhalikar, speaking over the phone from his Mira Road clinic, however, seems like a man in touch with the grassroots and believes things are taking a turn for the better.

He insists yet again that awareness about dental hygiene is spreading, in the rural areas too. Albeit slowly. "Thanks to marketing initiatives of private companies, people in villages are becoming more aware of dental health and health care products," he says.

According to him, the key to truly spreading awareness lies in the hands of the government. Gandhalikar points out that most public health care centres do not have a dentist's post at all and says that unless the authorities sit up and take note, things won't move anywhere.