Pakistan’s transition to a five-year Bachelor of Dental Surgery (BDS) programme may have settled one long-running debate over the length of dental education, but a potentially bigger question is now emerging: are the country’s dental colleges actually ready to deliver the expanded degree at the standard expected of it?
Prof Dr Kashif Ikram, Pro Vice Chancellor of Baqai Medical University, has offered a blunt assessment.
Asked during the latest Dental News Podcast whether Pakistani institutions are currently equipped for the shift, he replied: “No, because we are not ready to make the change.”
His comments bring institutional capacity into sharper focus at a time when Pakistan Medical and Dental Council (PMDC) policy has already extended the BDS structure from four to five years. PMDC announced that the five-year structure would apply from the 2025–26 academic session. A one-year house job remains mandatory for eligibility for a full professional licence.
The implications, however, extend well beyond putting another year on the academic calendar.
According to Prof Ikram, institutions will need additional resources, appropriately prepared faculty, equipment, physical facilities and the ability to deliver a broader curriculum. There is also a financial question — both for institutions expected to expand capacity and for students spending longer in undergraduate education.
And perhaps the most consequential part of his argument is this: he does not believe the previous four-year BDS structure was itself the reason Pakistani graduates faced skills-related shortcomings.
Five-year BDS puts dental colleges under a new kind of pressure
PMDC described the extension of BDS as a move intended to strengthen dental education, with the regulator having formally shifted the programme from four to five years.
But implementation ultimately takes place inside universities and dental colleges — and that is where Ikram believes the real test begins.
“Certainly,” he said while discussing the transition, “it requires resources, faculty, equipment, premises, and all of these things take time.”
He said institutions had been given time to implement the changes and argued that those able to adapt would remain competitive, while institutions unable to meet the requirements could eventually be filtered out.
That makes the five-year BDS shift more than a curriculum revision.
For colleges, it potentially means reassessing faculty strength, clinical teaching capacity, laboratories, equipment, patient exposure, academic planning, assessment systems and physical infrastructure.
PMDC's current accreditation framework already evaluates dental institutions against prescribed standards, and the regulator maintains separate BDS inspection proformas according to approved student intake. The PMDC Act also requires universities and their affiliated or constituent colleges to maintain approved accreditation standards and deliver undergraduate programmes according to the curriculum and scope approved by the Council.
In other words, an additional year is only one part of the transition.
What institutions put into that year may ultimately determine whether the reform produces better-trained dentists or merely longer-trained dentists.
‘Four years was not the problem’
That distinction became particularly important near the end of the podcast.
When asked directly whether shortcomings in dental skills had resulted from BDS previously being a four-year degree, Ikram rejected the argument.
“No, that's incorrect. We are all products of the four-year program, aren't we?”
He went further, saying it was wrong to suggest that four years itself had caused the problem. His focus, he argued, was not on defending four years against five years but on identifying the parameters through which dental education could genuinely improve.
That position places him somewhere between two competing narratives in Pakistan's BDS debate.
He is not arguing against implementation of the five-year programme. Earlier in the discussion, he said that once a national regulatory decision has been made, institutions have to work constructively with the new reality and use the available opportunity for improvement.
But neither is he suggesting that an additional academic year automatically fixes deficiencies in dental education.
His argument instead shifts attention to a more difficult question:
What should a Pakistani dentist actually be capable of doing at graduation?
The fifth year will matter only if the curriculum changes with it
Prof Ikram identified a range of areas he believes need stronger representation in contemporary dental training, including communication skills, professionalism, research, geriatric dentistry, implant dentistry and forensic odontology, alongside an outcome-based approach to education.
The significance of this goes beyond simply adding new subjects.
Outcome-based education starts with what a graduate should be able to demonstrate at the end of training rather than measuring education primarily by time spent in classrooms and clinics.
For dentistry, that raises practical questions about whether graduates can:
- communicate effectively and obtain informed consent;
- assess patients beyond a single tooth or procedure;
- recognise when systemic disease changes dental management;
- undertake appropriate diagnostic and treatment planning;
- understand contemporary dental technologies and therapies;
- conduct and critically interpret research;
- demonstrate professionalism and ethical decision-making;
- manage older patients with increasingly complex medical histories; and
- enter clinical practice with a consistent minimum level of competence.
Some of those themes surfaced repeatedly during Ikram's podcast discussion.
He criticised an approach in which students learn medicine, pathology, pharmacology and other disciplines without being sufficiently taught how to connect that knowledge to the patient sitting in the dental chair.
That issue, rather than programme duration alone, appears central to his view of reform.
Communication and professionalism could become as important as technical dentistry
One of Ikram's recurring arguments was that dentistry cannot be reduced to performing procedures.
Earlier in the episode, he said dentists need to improve the way they interact with patients, take histories, explain treatment and present themselves as healthcare professionals rather than simply technical operators.
He said the evolving curriculum was incorporating areas including leadership, professionalism, research, patient approach and outcome-based education.
That could become one of the less visible but more important elements of the five-year transition.
A technically competent graduate who cannot properly communicate risk, recognise a medically compromised patient, document consent or know when to refer may still fall short of contemporary expectations of dental practice.
The extra academic time therefore creates an opportunity — but only if curriculum design, clinical exposure and assessment methods evolve with it.
Geriatric, implant and forensic dentistry enter the conversation
Prof Ikram particularly highlighted geriatric dentistry, describing it as important, while also referring to implant dentistry and forensic odontology among areas relevant to modern training.
The inclusion is noteworthy because the patient profile facing future dentists is changing.
Older patients may present with multiple chronic diseases, complex medication histories, prosthetic needs and altered treatment risks. Implant dentistry, meanwhile, has become a major component of contemporary restorative care, while forensic odontology represents a highly specialised but important intersection between dentistry, identification and medico-legal work.
The broader question for curriculum planners is therefore not simply how much more should students study?
It is, what should they study differently?
Can Pakistan bring every dental college to the same standard?
Perhaps the most challenging part of Ikram's assessment concerns variation between institutions.
He estimated that Pakistan has around 50 dental colleges but stressed that they are not all operating at the same level.
His preferred goal is to bring institutions toward a common national benchmark.
“The degree may not be equivalent, but the skills could be equivalent,” he said while discussing how Pakistani dentists could compete internationally, adding that institutions should work toward ensuring graduates are skilled “across the board.”
The exact number of recognised institutions can change as PMDC recognition and admission statuses change, and PMDC maintains separate current lists for public and private dental colleges.
But Prof Ikram's larger point is more important than the number itself.
If one BDS graduate receives extensive clinical exposure, modern equipment, structured mentoring and competency-based assessment while another completes the same national degree under significantly different conditions, simply increasing both programmes from four years to five will not by itself eliminate the difference.
That puts standardisation and accreditation at the centre of the reform debate.
The financial question cannot be ignored
There is another pressure point.
Prof Ikram acknowledged directly that implementing the changes would place a financial burden on institutional owners — and on students.
“It is a burden on the owners. It is a burden on the students financially,” he said.
For institutions, a meaningful fifth year can require more than an additional set of lectures.
Faculty salaries, clinical supervisors, additional teaching facilities, dental equipment, consumables, laboratories, technology, quality-assurance systems and patient-based clinical training all carry costs.
For students and families, a longer undergraduate pathway raises questions surrounding tuition, accommodation, transport, living costs and the additional time before entering paid professional work.
The financial dimension therefore deserves scrutiny alongside the educational benefits.
The policy's eventual success cannot be judged only by whether institutions technically complete five years of instruction. It will also depend on whether the added educational demands remain sustainable and whether students receive measurable value from the additional time and cost.
Five years versus four years may be the wrong debate
For years, the easiest way to frame the issue has been as a binary choice:
Should BDS be four years or five?
Prof Ikram's comments suggest that Pakistan may now need to move beyond that question.
PMDC has already made the structural decision.
The challenge now is determining whether the fifth year results in graduates who communicate better, diagnose more comprehensively, work more effectively with other healthcare professionals, understand research, demonstrate stronger professionalism and possess more consistent clinical skills.
That is why Ikram's rejection of the idea that the old four-year format was inherently responsible for the skills gap matters.
If the problem was not simply the number of years, adding one year without fixing the weaknesses inside those years would risk missing the point of reform altogether.
International relevance is part of the ambition
Prof Ikram also linked curriculum improvement with the ability of Pakistani dental graduates to adapt internationally.
He acknowledged that formal degree equivalence and skills equivalence are not necessarily the same thing, but argued that Pakistan should at least aim to produce dentists whose practical competencies can stand alongside those expected elsewhere.
That matters for a profession whose graduates increasingly pursue postgraduate education, licensing examinations and employment opportunities abroad.
A five-year structure may address one element of international comparability, but employers, universities and regulators ultimately assess much more than programme duration.
Clinical competence, communication, professionalism, evidence-based practice, patient safety and demonstrable skills all matter.
The strongest case for the fifth year, therefore, may not be that five is inherently better than four.
It may be that Pakistan now has an opportunity to use the structural change to rethink what its dental graduates should look like when they leave university.
The real test begins inside dental colleges
The PMDC decision has already changed the structure of dental education in Pakistan.
What remains unresolved is whether every institution can convert that change into genuine educational improvement.
Ikram's assessment is optimistic about reform but clear about the scale of the challenge.
Colleges need resources. They need faculty. They need equipment and premises. Students face additional financial pressures. Curriculum content needs updating. Clinical and professional competencies need to become more consistent. And institutions operating at different levels need to move toward a common national standard.
That is ultimately why the next phase of the five-year BDS debate could prove more important than the original decision itself.
The question is no longer simply whether Pakistan should have a five-year dental degree.
The question is whether the country can make the fifth year count.
CLICK HERE to watch the full Dental News Podcast.