"I remember my first patient well," says 40-year-old Malkan Singh. "I pulled out the wrong tooth but didn't tell her. I was only 12 or 13."
The patient returned a few days later. Her tooth still ached, she complained. "I pulled out the right tooth and didn't even charge her for it."
Mr Singh, who operates on a pavement near Old Delhi's Red Fort, is one of a handful of surviving relics of a vanishing tribe. Twenty years ago, nearly 30 street dentists had patients lining up, says Mr Singh. Now, only four remain.
None of the quartet has formal training as dentists; they learnt by watching their fathers, and refer to their job as a "khaandani" (family) profession. They are unlicensed. Medical journals and pedigreed dentists refer to them as quacks; they provide dental care to some of the poorest people in the walled city.
Mr Singh wears his neatly oiled hair with a side parting. Three rings sporting astrological symbols embellish his stubby fingers. The nails of his little fingers have been grown out and painted a whimsical metallic pink. There is dirt under the fingernails he uses to examine the teeth of his patients.
Malkan Singh shows off a metal clasp and clamp used to hold false teeth
His 'clinic' is a stretch of pavement close to Jama Masjid metro station that throbs with ceaseless activity. Teeming crowds of tourists, coming to visit monuments nearby, spill out of the new glass-and-steel station and onto the pavements, eddying past the spot where Mr Singh has set up shop.
Mr Singh and his three peers are easy to miss in the milling crowds; I almost did even though I was looking for them. My attention was caught by the sight of a man with his ungloved hand deep inside another's mouth.
I stopped to watch as Balbir Singh plied needle and thread on his patient's gums. He paused mid-stitch to wipe beads of sweat off his forehead onto the sleeve of his dark grey polyester shirt, then resumed operations. His patient squatted on a square of folded newspaper that doubles up as the dentist's chair.
Balbir Singh's toolkit includes a pair of pliers, scissors and metal files of various sizes neatly packed in a steel tiffin-box - the kind you may carry your lunch to work in
Malkan and Balbir are migrants from villages in western Uttar Pradesh. Nearly twenty years ago, they travelled over 200 kilometers to the capital in the hope of boosting their earnings. Malkan Singh makes between 300 to 400 rupees a day, charging 50 to 80 rupees for a tooth replacement and up to Rs 2,000 for dentures. The rates, he said, are non-negotiable. Dentists in nearby clinics charge upwards of Rs 2,500 for a tooth replacement. "My patients come to me because they know I'll get the job done quick and cheap."
"I know how to do everything," Mr Singh claimed without going into specifics about the extent of his skills. "I don't extract teeth anymore. I can't take the risk." He then unwrapped a piece of paan and popped it in his mouth. "Paan is excellent for teeth," he mumbled. "It provides a nice massage for the gums."
His patient, a middle-aged man in skull cap and dusty slippers, flashed a wide grin that lit up his kohl-rimmed eyes, showing off two new front teeth. "I'm never scared when I come to Malkan saab. He's the best."
No anaesthesia is used. To stop them from writhing in pain, Mr Singh sometimes works by bending over his patients while using his knees to lock their body in place.
Balbir Singh's toolkit is laid out carefully on a folded square of newspaper. His patient waits unperturbed as he mixes together an adhesive
Mr Singh works from 9 am to 6 pm, every day except Sunday. His home is an hour away by motorbike, on the border of neighbouring Uttar Pradesh. "It's better to work where people know me," he says of the commute. "I've been here since 1997."
His battered black Bajaj Platina is parked in front of the patch of pavement that serves as his office. It is his transport; it is also an extension of his clinic. Its seat is Mr Singh's workbench, where he carefully lays out the unsterilized tools he will use on his patients. The bike also serves as a brace for his aching back; he leans against it, sipping a glass of masala nimbu pani (lemonade) or chai (tea) as he waits for his next patient.
Balbir Singh, like the other three street dentists, keeps multiple sets of acrylic teeth in his toolkit. Every five or six months, the men travel nearly 40 kilometers to Uttar Pradesh’s Ghaziabad to stock up on medical supplies. This often means missing a day of work
In the 12 hours I spent with the street dentists over two days, I saw a steady stream of patients. Many said they had been coming to the same spot in the shadow of the Red Fort for over two decades, to get rotten teeth extracted and broken ones replaced. Few had been to the licensed dentists in the area; they preferred entrusting their dental needs to the street practitioners who had kept their rates affordable over the years. Some were repeat customers; others were first timers, referred by neighbours and friends.
A balding man in a white safari suit and brown formal shoes with no socks waited in the scorching 40-degree heat. Balbir Singh reached inside his battered grey briefcase to pull out a pair of rusty pliers, with which he yanked out the row of acrylic teeth he had installed a few years ago. He used a large metal file, nearly black with age, to pare down the sharp edges of a new set of false teeth, and various chemicals and adhesives to fix the new dentures in his patient's mouth. He pulled out tools from a rusted tin box, washing them thoroughly with water but never disinfecting them.
Even as he worked, three people stopped by for consultations and quick fixes. As the older man waited for his new teeth to adhere, Mr Singh placed a shiny new tooth in a young mother's mouth. He dismissed another man, saying his teeth were far too rotten to be fixed, and then worked on a third while his first patient admired the new row of sparkling white teeth in a small pink-framed mirror. He rarely stopped to wash his hands between patients, simply wiping them on a dirty rag.
Balbir Singh installs a set of dentures for an elderly patient. Minutes earlier, he had used rusty pliers to extract the set he had put in a few years ago, and which lay discarded on the road beside the patient’s feet
The patients seemed to think nothing of a stranger's hand exploring their mouths while crowds milled around them. They took swigs of water from a shared plastic bottle, gargling and expelling the liquid onto the road beside them. "Where else will we go?" one veiled woman asked.
India has a patently inadequate dentist to patient ratio: 1:10,000 in urban areas and 1:250,000 in rural areas, according to World Health Statistics. The World Health Organization recommends a ratio of 1:7,500. "There is... a need to implement a long pending national oral health policy... making dental health more realistically accessible to the poor and needy rural population," urge dentists in the International Journal of Oral Health and Medical Research.
Balbir Singh examines a patient who dropped by for a consultation. Mr Singh says he has a university degree but never found a well-paying job. He learnt the trade from his father, who practiced it a village in Uttar Pradesh
Mornings and early evenings are the busiest times of day for the street dentists. This works out well for them, allowing for an hour or two inside a nearby park for lunch. Malkan Singh brings lunch from home, and eats in the company of Balbir Singh, at 50-plus the oldest of the quartet, and a younger, turbaned colleague who did not want to be named.
They share an easy camaraderie. The older men rolled their eyes as the conversation shifted towards politics. As the younger Sikh criticised the ruling BJP for enforcing a Supreme Court order banning unauthorised street hawkers, his older colleagues slapped his back and joked that he was the politician the country needed.
They share a less cordial relationship with Raj Kishore. The fourth dentist sits furthest away from them, speaks fluent English and claims to have worked as a dentist's assistant in a hospital nearby. "I have these skills, so why not earn money off them? Until the police shoo me off, I'll work (on the streets)."
"But don't you know (street dentistry) is illegal?" he asked.
Chapter V, Section 49 of the Dentists Act, 1948 requires all dental workers to be licensed. Unlicensed practitioners dentists can be fined anywhere between 500 to 1,000 rupees and face up to six months imprisonment. But the law appears to be rarely enforced. When driving the street dentists away, police officers hardly ever cite the illegality of the trade.
Malkan Singh holds an extracted tooth in his hands. Despite having worked across the street from Red Fort for over two decades, Mr Singh has never been inside. "What's there to see in old buildings?" he asks in disgust
Though they continue to make a living off their trade, all four are clear on one thing: they won't teach their children, or encourage them to get into this profession.
"It is not legal, so why would I tell my children to do this?" Malkan Singh says, talking over the cacophony of cars whizzing by, hooting their impatience. "I am illiterate, but I want all three of my children to study and get good jobs."
"There used to be 25 of us when I first moved to Delhi," he says, glancing around at his three busy colleagues.
"Everyone died. One day we will, too. Let this die with us."
Editor's Note: We wish to thank the National Geographic Society and the Out of Eden Walk, whose 2018 Journalism Workshop supported this project.
