For Valparaiso dentist James Arnold, dentistry is a global issue.

Arnold returned Oct. 7 from what he called a "whirlwind tour" across India, a sequel to a similar trip he took last year to teach advanced techniques to dentists in other countries.

His travels started in May 2006 when Arnold met with colleagues Trent Smallwood and Les Presad at a convention for cosmetic dentistry in San Diego. They realized the concepts they had access to weren't available in other parts of the world.

"The United States has far and away the best dental care system in the world," Arnold said.

"And since Dr. Presad hailed from India, that made his country a logical destination."

Naming their group the World Institute for Dental Education, the three decided to bring the most current information and awareness about new techniques in dentistry to less developed nations.

India, Arnold said, is a country with a "huge army of dentists" and 400 million "exceptionally well-educated" people, but it still lags behind the United States in dental technology and practices.

"We were there to share as much as we could with them in a short amount of time," Arnold said.

In July 2006, Arnold and three colleagues lectured more than 1,500 people in four cities.

This year, they followed a similarly grueling but gratifying schedule.

As if a 20-hour flight weren't enough, India's size requires further flights within the country. On some days, Arnold's group spent up to 14 hours traveling.

The worst day, Arnold said, was when they left Pune at 4 a.m. for a three-hour flight to Bombay, then flew to New Delhi, had a layover there and flew on to Chandigarh. From there, they drove four hours to Sunam, where their hosts insisted on showing them the city.

Early the next morning, they gave a lecture and attended a ceremony. Then they drove six hours to New Delhi to do it all again.

Arnold said the quality of Indian dentistry varies greatly depending on the locale -- he estimates Indian dental practices may be anywhere between 10 and 200 years behind that of the United States. And in some places, dentistry is even practiced on sidewalks.

Arnold and his colleagues lectured at universities, state dental association meetings and private practices.

"Our hosts had hearts as big as the room and they would do anything for us," he said.

At each lecture, they were honored with a ceremony and gifts, and would share tea and snacks with their hosts. And as they were introduced each time, a "candle of knowledge" would be lit and prayers given. At times, it would be up to two hours before they were able to begin speaking at their training seminars.

Facing challenges, creating solutions

"The dental culture over there is totally different," Arnold said.

"American dentists come in, do their thing all day and then just go home. Indian dentists face strong competition from other dentists, so they put in long hours, up to 70 hours a week in their clinics, even if they don't have patients to see during all that time. They are afraid a patient may go to another dentist instead."

While U.S. dentists typically work in teams, in India, there are few dental hygienists and support staff, so dentists often do everything themselves, from answering the telephone to performing oral surgery. And since Indian dental practices have difficulty keeping employees, they generally do not focus on preventive care such as regular cleanings and checkups.

There are other challenges as well.

The Indian economy is much different from that of the United States.

India has many more people, which is a strength and a weakness. Local infrastructure has trouble keeping up with the booming population. Arnold described traffic as "the great equalizer," explaining that every person who uses the roads, no matter their place in society, must suffer with rush hours.

A discrepancy in exchange rates also means Indian dentists cannot afford some of the latest dental machines and technologies. American medical companies often don't even bother to market their products in India.

And the Indian dental system generally does not feature dental laboratory work, since they lack skilled technicians like ceramists to make specialized fillings, crowns and dentures.

Arnold and his group sought to overcome these obstacles, so they communicated a message of practices management to help the Indian dentists manage their time more effectively, while also instilling some of the more technical aspects of their trade.

As education continues to improve in India, Arnold said there will be greater demand for dentists and more profit in the profession in that country as the field becomes more "Westernized."

Some of the seminars Arnold and his colleagues are proudest of include a session where they reconstructed a full upper arch for one young woman as 25 Indian dentists looked on. The program had the dual purpose of aiding the woman and showcasing newer methods to the local doctors. In the United States, the case would have cost around $20,000, but Arnold's group did it for free.

During last month's trip, a dental ceramist who creates restorations remained in Bangalore to work with several Indian counterparts on creating the woman's upper arch while Arnold and the others continued on.

Program set to grow

"During our entire process, relationships between our countries were strengthened," Arnold said.

"Several of those dentists have plans to visit the U.S. soon for a similar 'over the shoulder' program."

Arnold and his colleagues have already received invitations to return to India.

They also were treated to an enormous party attended by around 500 dentists and students. The party, a surprise, was held in a 3-acre courtyard and featured traditional Indian attire, dances and food that Arnold said was "phenomenal."

"The Indians drew us in, welcomed us, exposed us to their culture," Arnold said.

"Every place we went to and every new person we met just kept us going."

Arnold's dental group has been invited to Brazil, Portugal, Dubai and Spain, which will pose a host of new challenges and opportunities.

"It's such an inspiring thing to do," Arnold said, noting he and his colleagues might plan a few more trips for 2008.

"This is something that will grow slowly," Arnold said.

"Other dentists are interested in participating, but we will invite a few at a time, seeking the top clinicians in their field. We just want to make sure we're taking the best of the best with us."