Sir, in India, caries is predicted to increase significantly and oral cancer is a growing problem.1 Meanwhile, the oral health workforce is showing a dramatic rise: the number of dental schools has increased from 95 to 290 within the last 20 years and more than 25,000 dentists are graduating each year in India.2 Most schools are in urban regions and partly as consequence the dentist-population ratio is as high as 1:4,000 in urban India while in rural areas can be as low as 1:30,000.2 Challenges include the fact that the disease burden is highest amongst the disadvantaged; oral health is not considered integral to general health; the inaccessibility of oral health services to people in rural regions; and much of modern dental practice is highly interventionist.

Whilst the small business model of dental care will be with us for the foreseeable future, we submit that countries need to refocus their health workforce to tackle disease burden. Policies should strive to curb the dental-medical divide and to reduce social and service inequalities. The focus needs to be shifted from interventionist to preventive approaches. Preventive care should be customised for communities and carried out by teams drawn from the whole spectrum of health and social welfare professions. For such a paradigm shift, barriers from the entrenched profession will be a major challenge. Practical suggestions for a start on such reorientation would be to ban new dental schools in over-served countries and to train all members of putative oral healthcare teams together. 'The family that prays together stays together.'