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 Table of Contents  
SYSTEMATIC REVIEW
Year : 2018  |  Volume : 3  |  Issue : 2  |  Page : 75-78

An evidence-based review on quackery in dentistry


1 Department of Orthodontics and Dentofacial Orthopaedics, Rishiraj College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
2 Department of Maxillofacial Prosthodontics and Implantology, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
3 Department of Conservative Dentistry and Endodontics, RKDF Dental College and Research Centre, Bhopal, Madhya Pradesh, India

Date of Submission15-May-2018
Date of Acceptance27-Aug-2018
Date of Web Publication26-Dec-2018

Correspondence Address:
Dr. Sunil Kumar Mishra
Department of Maxillofacial Prosthodontics and Implantology, Peoples College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_13_18

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  Abstract 


BACKGROUND: Uncustomary medicine has been known since ancient period and is very commonly practiced by many individuals. Due to traditions and religious beliefs, these different unconventional practices were followed in the form of quackery.
PURPOSE: This review is done to focus the quack practices done in dentistry affecting the oral health of the individuals and what measures to be taken to totally eradicate it from the society.
MATERIALS AND METHODS: In April 2018, an electronic data search was done to find the published literature in PubMed, Medline, and EBSCOhost database. The search was focused on reports on quack practices in dentistry, reason behind such practices and their effects on oral health of the individuals. The titles and abstracts obtained in relation to focused questions were screened. Handsearching of other printed articles was also performed. The articles published in only English language were considered for the study.
RESULTS: The initial search resulted in 102 papers. The abstracts of the articles related to the focus question were independently screened by the reviewers. Eighty-seven articles were excluded for not being related to topic or not in English or whose abstract is not available. Handsearching of literature resulted in one additional paper. A total of 16 articles were included in the review, of which five articles reported dental treatment of subjects poorly treated with quacks and one article is on patient's perception toward dental quacks.
CONCLUSION: Quackery in dental field is growing fast in cities and villages and it is going to be a major challenge to populations due to unsterilized instruments being used. This gives unethical practices, giving invitation to certain major health hazards in the form of AIDS and hepatitis to individuals. It is the major responsibility of the government organizations and dental councils to interfere in the current scenario, so that quack practices in dental field can be eliminated from its roots, and to provide good oral treatment and education to the population who are in real need of it.

Keywords: Dental ethics, dental quacks, street dentistry


How to cite this article:
Kumari S, Mishra SK, Mishra P. An evidence-based review on quackery in dentistry. BLDE Univ J Health Sci 2018;3:75-8

How to cite this URL:
Kumari S, Mishra SK, Mishra P. An evidence-based review on quackery in dentistry. BLDE Univ J Health Sci [serial online] 2018 [cited 2019 Jan 16];3:75-8. Available from: http://www.bldeujournalhs.in/text.asp?2018/3/2/75/248545



Although we are in the 21st century, still dental services are not very easily available to the individuals who are in need of it. In developing countries like India, although there are a lot of dental graduates, majority of their practices are limited to cities. This tendency and mindset leads to difficulty in getting dental treatment to majority of populations living in villages.[1] Lack of knowledge in the society and unconventional traditions and practices followed in the form of quackery creates a major challenge in the society.[2]

Rural population in India accounts for almost 70% of the entire population and majority of them are below poverty line. The dentist-to-population ratio in India is 1:200000 in rural areas and 1:10000 in urban areas. These are the main reasons that make an individual in rural areas to visit the quack dentist more frequently for their treatment needs.[3]

In India, there are approximately >1 million dental health-service providers, who are unqualified or quacks.[4] In today's scenario, the main concern is how to provide ethical and high-quality dental treatments to the mass leaving in villages. This review has been done to focus the quack practices done in dentistry affecting the oral health of the individuals and what measures can be taken to totally eradicate it from the society.


  Materials and Methods Top


Search strategies

A structured and systematic literature search was undertaken in April 2018 without any time restrictions in the PubMed, Medline, and EBSCOhost database. The following search terms were used in the search strategy, with the filter “article types” selected with the item “abstract:”

(Subject and adjective)

(Subject: [Ouack Dentist or Cases of Quackery] AND Adjective: [Dentistry])

The reference list of the reported cases of quackery and the relevant reviews on the topic were again screened to find out any additional cases of quackery in dentistry.

Inclusion and exclusion criteria

The articles related to quack practices in dentistry, reason behind such practices and their effects on oral health of the individuals, whether they are related to clinical trials, either randomized or not, and case series and case reports on quackery were included in this review. Articles not in English and articles not related to quackery in dentistry were excluded from the study.

Study selection

The titles and abstracts resulted from the electronic searches were read independently by three reviewers and any disagreement regarding the inclusion or exclusion of the selected articles was resolved by a discussion between reviewers.


  Results Top


The initial search resulted in 102 papers. Eighty-seven articles were excluded for not being related to topic or not in English or whose abstract is not available. Handsearching of literature resulted in one additional paper. A total of 16 articles were included in the review, of which five articles reported dental treatment of subjects poorly treated with quacks and one article is on patient's perception toward dental quacks [Figure 1].
Figure 1: Flowchart presents the screening of articles related to the reports on quack practices in dentistry, reason behind such practices, and their effects on oral health of the individuals

Click here to view



  Discussion Top


Quack dentist: A major concern

Quackery is mainly promotion of unethical practices using unscientific methods for the treatment of patients to make profit. Quacks do not have any dental degree or education and their aim is to make as much money they can. This type of practices adopted by the quack causes increased trouble and health issues to the individuals.[5],[6] In India, quackery is practiced very commonly in rural areas and often called as street dentistry. Today, the metro cities are also affected by it and quack dentist tries to run a parallel practice at very low cost to target mass populations.[7]

The fact is how quack practice dentistry is very horrible, surprising, and terrific. They have few instruments which are very unconventional in nature and mainly consist of pliers, screwdrivers, and self-cure acrylic resins. They usually do extraction by elevating the tooth with the help of screwdrivers and then remove it with pliers. Patients usually report to the dental clinic with acrylic resins filled in there carious tooth or cavity. Quacks fixed a mobile tooth with acrylic resin, taking the support of adjacent tooth without bothering about the periodontal ligament health of that tooth. Dentures were marketed as fixed denture by retaining them with suction disc or by fixing them with adjacent tooth with acrylic. They even use a single syringe in many patients.[7],[8]

This practice done by a quack is a major challenge to the society. They are not concerned about the sterilization procedures because they do not know about it. They do not know about the health hazards arising due to their irresponsible, unethical practices and thus force patients' life in danger due to many transmissible diseases.

Literature-based evidence to visit quacks for dental treatment

Pramod Krishna et al.[9] reported a case of orofacial space infection in an old diabetic patient resulted due to a faulty prosthesis given by a quack practicing as a dentist. Injury to mucosa leads to involvement of submandibular, sublingual, and pterygomandibular space. Arigbede and Adesuwa[10] reported a rare case of pulp necrosis of mandibular and maxillary central incisors, in an attempt to modify the teeth structures to create midline diastema by a quack. Chauhan et al.[11] reported the case of a male patient who got a fixed partial denture from a quack. On examination, it was found that the quack had adhered the denture with the adjacent nature tooth with the help of self-cure acrylic.

Chalakka et al.[12] in their article reported a case of children who had undergone dental treatment abuse by a quack. The healthy anterior tooth of the children was capped with metal crowns to treat the proclination of the maxillary permanent incisors. Chaudhary et al.[13] reported a patient with severe pain and abrasion of tooth. On history and examination, it was found that abrasion and pulp exposure was resulted due to 57% hydrogen peroxide given by a quack to remove stains on the tooth. Naidu et al.[14] in their study investigated reasons to visit dental quacks and treatment satisfaction from both qualified dentists and quacks. About 67% of the study participants reported that they visit a dental quack for treatment. Reasons found for visiting quacks were older people visited more to quack, lower socioeconomic conditions, and living in an area with less government-run dental clinics. Toothache (74%) and extractions (61%) were the most common reasons found for visiting a quack.

Reasons for quackery in dentistry

It is very important to find out the reasons behind the quackery in dentistry to safeguard the health of the individuals. The reasons which we find in this present review are as follows:[8],[14],[15],[16]

  1. Lower- and middle-class individuals, who are socioeconomically weak, find it very difficult and almost impossible to afford the dental treatment charges by a good dentist
  2. Dental treatment requires multiple visits and patients due to unbearable pain get their treatment done from quacks as they find difficult to afford charges
  3. Even affordable and educated patients visit quacks just to save some money
  4. Unbearable pain to poor individuals forces them to take the services of a quack to get rid of it at a very low and affordable cost
  5. Less number of qualified dentists are available in rural places and many dentists do not want to practice in villages
  6. The treatment charges of the qualified dentists are too high and difficult to afford by all, who are in need of oral health
  7. While working with a qualified dental surgeon, quacks learn many dental procedures without knowing the basic science and applications behind it and try to perform this on patients without proper instrumentation
  8. There is lack of government policies for dental treatment to provide quality treatment through qualified dental surgeons at a very affordable cost.


Measures to be taken to prevent quackery in dentistry

In an effort to promote dental treatment options in remote areas, the World Health Organization (WHO) has suggested to train dental auxiliaries in the form of dental licentiate, frontiers, and dental aid.[17] Dental students should be educated in a more scientific way, so that they can also detect quacks and educate their patients to avoid them.[11] The population living in villages should be made more aware and taught through oral health program and camps as how to avoid quacks. They should be acknowledged about the dental treatments and also about transmissible diseases which can occur if proper treatment protocols cannot be followed. There is a need for more and more satellite dental clinics in remote areas, and also dental council should make it compulsory for the dental colleges to adopt few villages and provide them free dental treatments. The dental graduates should made mandatory to have rural posting of at least a month during their internship tenure.[4] It is very important for the dental surgeons to have ethical practice and provide quality treatment to their patients at a very affordable rate and simultaneously maintaining the quality of the treatment.[8] The vacant jobs should be filled in rural as well as urban areas. There must be proper guidelines to regulate the development and the usage of new therapies in a more scientific way.[18]

Recommendations

  1. Oral health awareness through mass media and educating the population about the ill effects of quackery
  2. Strict laws to be made by government and dental council to eliminate unethical practice.
  3. Regular dental checkup camps in remote and rural areas
  4. Posting of dental surgeons at peripheral and community health-care centers for easy and accessible dental care to the poor and needy population
  5. Compulsory rural posting for dental graduates during their internship postings
  6. Dental colleges to open satellite dental clinics in rural areas
  7. Dental health insurance coverage to the population at a very affordable price
  8. Dental health also should be included in national health policy.



  Conclusion Top


Today, major health hazards in the form of AIDS and hepatitis to individuals treated with quack are very serious issues. It is the major responsibility of the government organizations, dental councils, and dental professionals to take it as a challenge to interfere in the current scenario and discourage quack practices. Quack practices in the dental field should be eliminated from its roots, to provide good oral treatment and education to the population who are in real need of it.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Tandon S. Challenges to the oral health workforce in India. J Dent Educ 2004;68:28-33.  Back to cited text no. 1
    
2.
Boloor VA, Hosadurga R, Rao A, Jenifer H, Pratap S. Unconventional dentistry in India – An insight into the traditional methods. J Tradit Complement Med 2014;4:153-8.  Back to cited text no. 2
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3.
Lal S, Paul D, Vashisht BM. National oral health care programme (NOHCP) implementation strategies. Indian J Community Med 2004;29:3-10.  Back to cited text no. 3
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4.
Sandesh N, Mohapatra AK. Street dentistry: Time to tackle quackery. Indian J Dent Res 2009;20:1-2.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Chambers DW. Quackery and fraud: understanding the ethical issues and responding. J Am Coll Dent 2004;71:4-5.  Back to cited text no. 5
    
6.
Eskinazi DP. Factors that shape alternative medicine. JAMA 1998;280:1621-3.  Back to cited text no. 6
    
7.
Webster′s Online Dictionary. Search Term “Quackery”. Available from: http://www.websters-online-dictionary.org/definition/Quackery. [Last accessed on 2018 Apr 23].  Back to cited text no. 7
    
8.
Hans MK, Hans R, Nagpal A. Quackery: A major loophole in dental practice in India. J Clin Diagn Res 2014;8:283.  Back to cited text no. 8
    
9.
Pramod Krishna B, Batra R, Chopra S, Sethi N. Orofacial space infection due to faulty prosthesis. J Maxillofac Oral Surg 2015;14:38-41.  Back to cited text no. 9
    
10.
Arigbede AO, Adesuwa AA. A case of quackery and obsession for diastema resulting in avoidable endodontic therapy. Afr Health Sci 2012;12:77-80.  Back to cited text no. 10
    
11.
Chauhan H, Potlia I, Purohit N, Mallick S. Is quackery still a parallel world of dentistry – A case report. Int J Oral Health Med Res 2016;3:59-63.  Back to cited text no. 11
    
12.
Chalakkal P, Ataide Ide N, Krishnan R, Pavaskar R. Dental treatment abuse. J Clin Diagn Res 2014;8:ZD01-2.  Back to cited text no. 12
    
13.
Chaudhary A, Ingle NA, Kaur N, Nagpal A, Dhanker K. Footpath quacks. Br Dent J 2013;214:429.  Back to cited text no. 13
    
14.
Naidu RS, Gobin I, Newton JT. Perceptions and use of dental quacks (unqualified dental practitioners) and self rated oral health in Trinidad. Int Dent J 2003;53:447-54.  Back to cited text no. 14
    
15.
Oberoi SS, Oberoi A. Growing quackery in dentistry: An Indian perspective. Indian J Public Health 2015;59:210-2.  Back to cited text no. 15
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16.
Ahuja NK, Parmar R. Demographics & current scenario with respect to dentists, dental institutions & dental practices in India. Indian J Dent Sci 2011;2:8-11.  Back to cited text no. 16
    
17.
Dunning JM. Principles of Dental Public Health. 4th ed. Cambridge MA: Harward University Press; 1986. p. 453-4.  Back to cited text no. 17
    
18.
Greene CS. Holistic dentistry. Where does the holistic end and the quackery begin? J Am Dent Assoc 1981;102:25-7.  Back to cited text no. 18
    


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