Penn’s multitude of rapidly growing China connections can be viewed through a number of different prisms. Some focus on its manufacturing networks or banking system. Others see it in terms of civil engineering challenges or consumer purchasing trends. But Penn Professor Syngcuk Kim has a somewhat more intimate view. His daily vision is of China’s widely opened mouth and 1.3 billion sets of teeth not particularly well cared for.

For the last five years, Kim, Penn Dental Medicine’s associate dean of global affairs, has been regularly flying to China as part of a six-member team that has logged 25,000 in-China miles shuttling back and forth to a dozen cities. It has established major collaborative programs with the six university-level schools that constitute China’s “Ivy League” of dental education.

Gigantic dental hospitals

Chinese dentistry is different than in the U.S. For one thing, dental services are mostly delivered in government dental hospitals that are also dental schools. For another, those dental hospitals are gigantic—like U.S. academic medical centers. Many log a million patients a year and have full surgical and in-patient treatment facilities because in China, along with teeth, dentistry “owns” oral cancer.

As in all other areas of health care delivery, China’s dental system is struggling to upgrade itself to modern scientific standards as well as provide access to a vast population, particularly outside the largest cities.

“When we first went to the Shanghai Dental School,” says Kim, “we arrived at 8 a.m. and looked down the stairs to see large crowds below and asked, ‘Is there a fire or has something happened?’ We were told, ‘No, these are patients. They always start arriving at 5 a.m. to begin the daily wait.’ We also learned there are so many patients and so few dentists that patient visits are often limited to 30 minutes.”

Some dentist-to-population ratios help illustrate the situation: The U.S. has about 180,000 dentists for a population of 300 million, or a ratio of about 1 dentist per 1,670 people. China has about 200,000 dentists for a 1.3 billion population or a ratio of 1 dentist per 6,500 people.

Penn Dental Medicine Dean Denis Kinane says that lopsided China ratio is even more so because substantial numbers of the existing dentists are not trained up to contemporary standards. He also notes that China’s large challenges offer equally large opportunities for institutions such as Penn that have the knowledge and experience that China’s government and dental industry are seeking.

Day-long lines

The overall picture of patients routinely lining up to spend five to 10 hours each day waiting for a health care visit, a huge national shortage of clinical professionals, and many working clinicians who need training in the latest tools and techniques, is similar to what faculty members in the Perelman School of Medicine, the Wharton School, the Leonard Davis Institute of Health Economics (LDI), and the School of Nursing describe about their own experiences and observations as they become more involved in collaborative China activities.

All are part of the health care-focused sector of Penn’s expanding involvement with China that officially began in 2010 and established a new milestone in 2015 with the opening of the Penn Wharton China Center (PWCC) in Beijing.

“The PWCC evolved out of Wharton School thinking about offering Executive Education in China and then, still led by Wharton, it morphed into a whole Penn initiative,” explains Penn Vice Provost for Global Initiatives and LDI Senior Fellow Ezekiel Emanuel. “Health-related things are only one component of that and include the medical school and all of Penn’s other health science areas.”

Emanuel points out that Penn Dental has the most extensive China engagements to date. This isn’t all that surprising, given that the Dental School has been focusing its student recruitment efforts on countries across the arc of Asia from India to China. According to Kinane, 40 percent of the dental students now studying on the Penn campus are from Asian countries.

Trekking China

As the Penn team traveled across China over the last five years, its members have lectured in nine major dental schools, taught short courses in three, and collaboratively organized and conducted four major symposiums and three hands-on courses for dentists gathered in Penn’s new PWCC facilities.

They are currently organizing two more in-China symposiums later this year at which 1,000 attendees are expected, and are conducting increasing numbers of smaller, live-video presentations by faculty members speaking from Philadelphia to Chinese academics gathered at the PWCC.

The dental school team has also received a grant from Penn Global’s China Research and Engagement Fund to organize a large forum on “Dental Care in China” at the PWCC in the fall of 2017.

Great structural change

“There is great change going on in the structure of dentistry in China,” says Penn Dental Professor Songtao Shi, an international authority on dental stem cell research who earned his Doctor of Dental Surgery degree at Peking University before coming to the U.S. to earn his Ph.D.

“Private practice is relatively small but growing, and those offices need education to maintain their quality,” adds Shi, who is also chair of Penn Dental’s Department of Anatomy & Cell Biology. “At the same time, dental teaching hospitals that used to run with government money no longer get government money. So now they have to balance how much actual teaching they can do against the amount of service they must provide to their panel of patients. Those daily services are the new way they make their income.”

In virtually all their travels across China’s vast landscape, the Penn team has found far-flung communities of dental professionals hungry for information about the latest dental techniques and technologies.

“They inherited training practices from the Russians and are now learning from the Americans,” says Shi. “Their education system is not stable yet, but we think it will become stable over the next several years.”

“China now realizes that their dentists have to have much better clinical training,” says Kim. “That’s why we are so busy and are becoming more so. Whenever we hold a symposium there, thousands of people show up. It’s incredible. A PWCC hands-on course is totally booked within days of its announcement.”

Meanwhile, back on the Philadelphia campus, 24 assistant, associate, or full professors from collaborating Chinese dental schools have come to Philadelphia over the past five years to study clinical procedures for stints of three or six months. Separately, 20 additional Chinese exchange academics and researchers have completed up to three years of Ph.D.-level courses on the Philadelphia campus. These programs immerse both groups in the latest research techniques and technologies. Meanwhile, the cross-cultural interaction builds long-lasting personal bonds.

“Dr. Kim and Dr. Shi are actually educating the Chinese educators of the future and all of them will be Penn-trained,” says Kinane. “The whole thinking in a nutshell is that we have them in our labs doing research. That’s a win for us. The experience is also a big win for them. It’s also a big win on the clinical side for China to be able to send people to our clinics for education that opens their eyes to the Western way of delivering dental care.”

Penn Dental is also working to establish exchange programs that would enable its own U.S. students to study with top specialists in China.

“Shanghai Dental Hospital has the best oral cancer surgical team in the world,” Kim explains. “They do five cancer surgeries per day. We have signed a memorandum of understanding with them and are actively talking about sending our oral surgery residents there for a month or so.”

Growth of private practice

Penn Dental is focusing on the emerging market for private practice dental care. It’s estimated that private dentists make up about 10 percent of the overall market, but the public desire for such services is growing as the middle class population increases. During the last five years, the number of private dental offices has increased by 50 percent.

“Many patients don't want to wait in day-long lines and they have the money to take advantage of private practice,” says Kim. “The offices of these new businesses are beautiful—they look like American dentist offices—but their general dentists are not well-trained like ours. The businessmen who run these companies know the kind of training their clinicians need but don’t know where to get it. That’s where we come in.

“There is an offshoot of the Lenova computer company in China called Bybo that is talking to us about working with them to train their dentists,” Kim adds. “That’s just one company. We’re already working with Arrail Dental, a Beijing company whose CEO is Robert Zou, a Wharton alumnus. We also have plans to go into other areas such as the Guangzhou area near Hong Kong because there are lots of private dentists there.”

“All these educational efforts,” says Kinane, “are not so much about money as they are about brand-building right now. We are broadly involved in collaborations so that we can position ourselves as the ‘Coca-Cola’ brand of dentistry in China at the very beginning.”