Public health dentistry as a profession is still at its infancy in India. When we examine the origin of dental public health as profession, it was due to history of dental fluorosis [10], which in turn led to advent of the use of fluoride in dentistry. The wider prevalence of dental caries and the socioeconomic burden of disease are the factors that led to the need and growth of the dental public health.

In India there is accelerated growth of dentistry in last decade enormously to an extent, it houses large number of the dental schools and with highest dental graduates output in world [11]. In parallel, dental public health also grew in terms of teaching to dental graduate schools and specialists. The oral health care system is unable to meet the increasing dental graduate and even the dental specialist output in terms of employment [11]. Also, there is lack of public dental health programs where the unemployed professionals can be employed. Only option is that all dental public health specialists are employed in Indian dental school as faculty, teaching the graduates. There are nearly 1100 DPH specialists in India [9].

Ideally DPH specialists promote oral health by: assessing the oral health needs of the community; developing and implementing oral health policy and providing programs and services that address oral health issues [12]. However, many DPH specialists are working as faculty which is not their main ideal characteristic of the profession. DPH specialists in India at present are threatened over issue of lack of opportunities, stagnation of growth due to increased output of DPH specialists and lack of opportunities other than teaching profession [13]. It has become more of a teaching profession rather than public health practice. Teaching needs latest inputs from the public health practice. In view of current scenario, we examined career satisfaction among DPH specialists working in dental schools all over India. This is probably the first study to report the satisfaction among professionals in this speciality and the study findings provide insights to amendments that may be required in the profession.

Though five attempts were made to contact all 580 registered DPH specialists through online electronic mail, we could achieve a response rate of only 30.8%. However, with a reported average response rate of 24.8% for email surveys [14], we achieved a better response. Despite having active email accounts, online surveys are not acceptable to many. Lack of prior experience in completing online survey forms could be another reason for the low response rate.

Majority of the respondents chose DPH as career since they are interested and fascinated towards public health job. This is similar to findings from other studies conducted in India [5,6]. Efforts have been noted among public health dentists to acquire new skills and knowledge recently [15].

Career satisfaction also means to acquire required competencies of profession and accomplishment as professional. There is contrary view in the present study that even though respondents were having required competencies but could not accomplish as DPH specialists. This signifies that as DPH professionals are limited to teaching profession. There is lack of opportunities at dental school to use their full competencies to practice public health. Teaching needs latest inputs from the public health practice which is not happening.

Nearly 63% of participants have experienced lack of advancement in their DPH career. Career advancement is one of the most important elements for employee satisfaction and retention. This can be because the term professional advancement is perceived among persons in different perspectives. It could mean gaining experience in multiple professional fields and creating a unique and versatile role for oneself or attaining a senior position in a dental school.

Still other ideas of career advancement can be like starting an NGO, becoming dental public health consultant or acquire more complex technical expertise capabilities like doing PhD. The career advancement is unfortunately unexplored in the field of the DPH. Few universities [16] in India are offering PhDs in DPH, but unsure of the prospects. Many would aspire for additional responsibilities that lead to an evolution or a changing of their roles in teaching career in DPH. When career paths are dim or non-existent, individuals tend to be less motivated, less focused and more uncertain, which is seen among DPH specialists in India.

Nearly 72% of DPH specialists failed to get enough recognition as professional. Satisfaction is the rewards a person gets while doing their job. Rewards can take a monetary form (money) or be a more intangible reward, like the feeling a person might get when doing a job that helps others or making difference for others like doing some changes in oral health of the people or contribute a small change in oral health policy. These changes are not unfolding in DPH profession, so the specialists might have felt the lack of recognition. It can also be because of Westernized concepts acquired in DPH may be difficult to interpret and practice in the Indian settings. Also it can be attributed to lack of appreciation of importance of the dental public health concepts among the dental fraternity in India [11,13,17], which in turn reflects on the DPH specialists. In India, DPH professionals often, suffer from an identity crisis wherein their role is curtailed to that of a case finding or doing outreach programs for dental school to increase the patients for student clinics [13], which is contrary to their competencies which may attribute to lack of recognition.

Many respondents agreed that DPH career provided them with steady employment. An aspect of career satisfaction that is not really reward-related is job security. Some people obtain career satisfaction from knowing that they are stable. There are individuals who feel this as the most important aspect of a job. Having a stable job makes them feel secure, which helps to promote career satisfaction. When compared to other dental specialities, which are already saturated in teaching jobs, DPH provides a steady employment.

There were many respondents who thought of practicing the DPH rather than teaching profession. This view is sensible since DPH practice is the core function of DPH specialists. Practicing DPH is more challenging and satisfying than teaching. There are two basic views of satisfaction and performance. One is that satisfaction leads to performance, and other is performance leads to satisfaction. However, either view, performance to their core function is important for DPH specialists.

Many respondents were in the opinion that the DPH needs course and curriculum corrections. They felt that the skills in public health, community orientation and public health modules are important amendments required in DPH course. This can be attributed to the deficiencies in the current public health dentistry curriculum that revolves around case finding, needs assessment, data collection, and analysis [12,13].

There is a passion among DPH specialists to acquire new skills and knowledge and also few opting for modules and courses outside their postgraduate courses. This indicates poor design of our curriculum and also that the output product is short of necessary standards and competencies desired [15]. There is a need to broaden the subject spectrum from being merely assessment oriented. The policy making process entails collaboration, decision making skills, ability to make choice of goals and ability to resolve conflicts and negotiations. The assurance component involves implementation of legislative mandates, statutory responsibilities, implementation of programmes, evaluation of programs and provide quality assurance, inform and educate the public [18].

An amalgamation of these three core areas, namely assessment, advocacy and policy making to the curriculum on the lines followed in some of the developed nations can provide a strong foundation for DPH profession in India [15].