|Year : 2015 | Volume
| Issue : 3 | Page : 210-212
Growing quackery in dentistry: An indian perspective
Sukhvinder Singh Oberoi1, Avneet Oberoi2
1 Reader, Department of Public Health Dentistry, Sudha College of Dental Sciences and Research, Faridabad, Haryana, India
2 Private Practitioner, Department of Dentistry, Oberoi Dental Clinic and Orthodontic Centre, New Delhi, India
|Date of Web Publication||7-Sep-2015|
Sukhvinder Singh Oberoi
Reader, Department of Public Health Dentistry, Sudha College of Dental Sciences and Research, Faridabad, Haryana, New Delhi
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Dental disease restricts activities in school, work, and home and often significantly diminishes the quality of life for many children and adults, especially those who have low income or are uninsured. Though the overall dentist population ratio in India is 1:10,000, at present in rural India, one dentist is serving 2.5 lakhs of people. Only 15-20% of people in India are able to get dental services through national schemes, and 80-85% are spending money from their pockets, providing an ideal breeding ground for quackery into dental practice in India. Dental quacks cater to the lower-middle and lower socioeconomic classes that cannot afford qualified dental practitioners. A large number of people visiting these quacks seek care only when in pain, have a restricted budget, and are not very quality conscious. Dentistry has come a long way in the last one and a half century; today it is ranked as one of the most respected professions. It is incumbent upon dentists everywhere to protect this hard-earned reputation by weeding out quacks from among them. The government should urge fresh graduates to practice in rural areas and provide more incentives to them. Public health dentists should take the initiative of adopting more community-oriented oral health programs to increase the awareness among rural populations.
Keywords: Dental disease, dental quacks, oral health, quackery
|How to cite this article:|
Oberoi SS, Oberoi A. Growing quackery in dentistry: An indian perspective. Indian J Public Health 2015;59:210-2
Quackery results when competent and trained practitioners are in short supply or when their charges appear prohibitive to a segment of the population. Then, untrained individuals step in as there is a genuine need. The basic tools used by quacks are incompetence and fraud. Half-educated people often become a gullible prey to the quacks and their number at times become indeed a majority. 
Quackery has been defined as "the fraudulent misrepresentation of one's ability and experience in the diagnosis and treatment of disease or of the effects to be achieved by the treatment offered." 
When dental professionals are disproportionately allocated to the private sector relative to the public sector that provides subsidized services, financial affordability also becomes a barrier in the care of the less well-off.  Poor people who cannot afford specialty treatment prefer to go to cheap unregistered dental practitioners. Street dentistry is a form of quackery that is in practice in the rural and remote areas of India. 
The high cost of dental treatment, illiteracy, lack of awareness, poor accessibility to dental clinics, and repeated dental appointments are the reasons for which most patients are drawn toward quacks. Also, quacks guarantee their patients painless and immediate treatment. Rural people go blindly for such treatments with immense faith in unqualified medical quacks. 
The practice of quackery is harmful, that diminishes public confidence in science, medicine, and dentistry perverting science and public health and feeding degeneration in professional ethics. There is a paucity of the literature regarding the number of quacks in India, though this problem is highlighted by some authors in the literature. As such, no data are available regarding the number of quacks but the unqualified dental practitioners by virtue of their profession since many years are registered in the part B of the Dental Council of India (DCI). According to one of the published reports, there are about 2,500-3,000 quacks practicing dentistry in Delhi alone. 
Dentistry faces serious problems regarding the accessibility of its services to all. The major missing link for this unfortunate situation in a country like India is the absence of a primary health care approach in dentistry.  Oral health care delivered through primary health care infrastructure is of limited resources and dental man power provides services limited to mostly extraction of teeth. There is very little focus on the restorative, preventive, and promotive services. 
Private fee for service is the only mechanism of payment for dental care in most of the developing countries including India. The major disadvantage of fee for service is that many patients are unable to receive any care.  Only 15-20% of people in India are able to get dental services through national schemes and 80-85% are spending money from their pockets, providing an ideal breeding ground for quackery to dental practice in India.  Dentistry is unaffordable for a majority of the mass as dentistry of these trained dentists is costlier. Thus, people have no option other than resorting to these quacks.
Dentistry is not a part of any national health policy or national health program. Due to this, there is a lack of knowledge regarding the importance of oral health, especially among the rural masses. This is the reason for the thriving of quackery in dentistry. Dental services are available to people mainly through private services. So, it becomes unaffordable for a large majority of the population. There are no organized data regarding oral health services but quacks are seen to be practicing at roadsides as well as clinics in the rural as well as urban parts of India. 
India has neither an oral health policy nor a planned oral health care delivery system. Oral health policy was drafted by the DCI way back in 1985, which is not included as a part of the National Health Policy. The draft of the National Oral Health Policy (1985) recommends dentists to be appointed at primary and community health centers. Neither has the policy has been accepted as a part of the National Health Policy nor has anything been done for the implementation of the policy and so, the appointment of the dentists is out of question. 
Many of the quacks in India claim to have learnt the art of dentistry from their ancestors; but there are some quacks who are practicing dentistry after seeing a professional work in dental clinic(s) or who have learnt some basic procedures while working as assistants in dental offices. The procedures carried out by these quacks are very undesirable, harmful, and sometimes dangerous for people. They remove tooth without any asepsis, fill tooth with self-curing acrylic, and charge the patient for fixed denture.
The unsuspecting patients hoping to get a quick and easy remedy for their dental problem often end up with botched procedures that are not only painful but also destructive. Often these untrained workers cause more harm than good and, in some cases, cause irreparable damage.
The common malpractice in India includes use of wires to stabilize the tooth or denture with the support of adjacent teeth, which just damage the remaining healthy teeth. This procedure may be very harmful to the patients as they can lead to bone loss and adjacent tooth loss. Another common malpractice is replacement of a missing tooth with artificial teeth with self-curing acrylic directly in the mouth. The cold cure acrylic used for this purpose does not completely cure and can cause damage to the underlying gums and leads to bone resorption on adjacent teeth, and it is also a known carcinogenic material with high monomer content.
One of the notable malpractices in dentistry is fixing a tooth in the edentulous area with the help of ring plating on the adjacent teeth. These ring plating destroys the adjacent tooth, along with the sore spots below the artificial teeth. Other common malpractices include use of suction discs for denture retention, usage of single anesthetic needle on multiple patients, and leaving remnants of the tooth roots after extraction.
Recently, an article by Chaudhary et al.  presented an unusual type of abrasion leading to excruciating pain. The patients used a liquid thrice daily for 2 months for removal of stains and whitening of teeth following which their teeth were free of staining but had exposed the pulps. Chemical analysis revealed that the liquid consisted of 57% hydrogen peroxide, a concentration not recommended for dental treatment. Hydrogen peroxide has the potential to affect dental enamel because of its acidic pH.
The history of dental quackery parallels that of medical quackery. , Dentistry involves physical procedures with inherent risks of complications. In light of this fact, quackery can be harmful physically, psychologically, emotionally, and financially because of the treatment itself or because of the failure to get the treatment that might be helpful, or because of the resultant confusion. 
From a public health stand point, quacks cater to the lower-middle and lower socioeconomic classes that cannot afford qualified dental practitioners. A large number of people visiting these quacks seek care only in pain; they have a restricted budget and are not very quality conscious. There is a lack of organized data about the number of dental quacks in India. Quackery in dental practice is prevalent in all parts of India due to a vast population and a high proportion of poor people who are unable to afford dentistry. The situation, if not adequately addressed, might play havoc, increasing the chances of transmission of many lethal diseases.
| Conclusion|| |
The future of quackery depends on how deep and strong is the symbiosis of quacks and qualified practitioners. The sooner that symbiosis is broken and the sooner rational care can be made universally available, the sooner quackery would recede.  The best defense against quackery is an understanding of how scientific knowledge is developed and verified.
The Government of India (GOI) and the DCI should put forward a strong policy to culminate this unethical practice of harming the population. The DCI should make it necessary for the dental institutions to take the responsibility of adopting population in the rural areas as well as schools, old-age homes, schools for children with special needs, orphanages, and homes for women in distress in the district and provide the essential oral health care to them.
Apart from dental check-up camps, dental treatment camps should also be conducted to provide treatment in health care settings. Awareness regarding oral health should also be increased by imparting health education to the population, especially in the rural areas.
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