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Table of Contents   
CASE REPORT  
Year : 2020  |  Volume : 31  |  Issue : 2  |  Page : 323-325
Havoc of dental quacks in a district in India: A case series


1 Department of Dentistry, Government Medical College and General Hospital, Dhule, Maharashtra, India
2 Department of Oral Pathology and Microbiology, Government Dental College and Hospital, Mumbai, Maharashtra, India

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Date of Submission04-May-2018
Date of Acceptance03-Sep-2018
Date of Web Publication19-May-2020
 

   Abstract 


A “quack” is defined as “a fraudulent or ignorant pretender to medical skill or a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess.” A number of dental quacks are practicing roadside, making money by doing unethical and unhygienic practice, eventually, hampering the patient's oral and general health. Common quackery practices carried out in India are filling of teeth with acrylic resin, fixing the removable partial denture as fixed partial denture using wires and self-curing acrylic resin, using suction disc on the palatal surface of complete denture to improve retention, etc., leading to a number of unfortunate consequences. In this study, we present a case series of mal-treatments performed by different quacks in Dhule district of Maharashtra (India).

Keywords: Dental quacks, oral health, unethical

How to cite this article:
Siwach P, Pawar VJ, Thakur A, Shaikh F. Havoc of dental quacks in a district in India: A case series. Indian J Dent Res 2020;31:323-5

How to cite this URL:
Siwach P, Pawar VJ, Thakur A, Shaikh F. Havoc of dental quacks in a district in India: A case series. Indian J Dent Res [serial online] 2020 [cited 2020 May 31];31:323-5. Available from: http://www.ijdr.in/text.asp?2020/31/2/323/284572



   Introduction Top


Random House Dictionary describes a “quack” as “a fraudulent or ignorant pretender to medical skill or a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess.”[1] Quacks are those who have observed and self-learned a few techniques of dentistry either by assisting dental surgeons or inherited it from their families and adopted it as a profession.[2]

The high price of dental treatment, repeated dental appointments, poor access to dental clinics, illiteracy, and lack of awareness are the reasons for blooming of quackery in dentistry. Many dental quacks are practicing roadside, making money by doing unethical and unhygienic practice and eventually, hampering the patient's oral health.[2]

In this study, we present a case series of mal-treatments performed by different quacks in Dhule district of Maharashtra (India).


   Case Report Top


Case 1

A 55-year-old male reported to the dental department of General hospital, Dhule, Maharashtra (India) with complaint of pain in upper right back teeth region since 10 days. On intraoral examination, a prosthesis was present in the upper right quadrant of jaw. Patient gave the history of the prosthesis being given by a roadside practitioner (quack) around 10 years back [Figure 1]a. The prosthesis was having sharp margins causing ulceration in upper right buccal vestibule. Food lodgment around the prosthesis led to calculus and plaque deposition resulting in mucositis and halitosis. Copper foil was used on the occlusal surface of upper teeth to achieve proper occlusion. An aluminium foil was used over occlusal surfaces of lower right and left teeth [Figure 1]b. Both upper and lower prosthesis had flat occlusal surfaces. As the margin of the upper prosthesis was causing ulcer, it was removed [Figure 1]c. After removal of the prosthesis, multiple root stumps were observed under it [Figure 1]d. The prosthesis was foul-smelling and showing putrefied food on the inner surface. Oral hygiene was very poor.
Figure 1: (a) Quack prosthesis in upper right arch. (b) Aluminum foil wrapped over lower teeth with flat occlusal plane. (c) Upper arch prosthesis after removal from mouth. (d) Upper right arch after removal of the prosthesis

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The patient was advised antibiotics and saline gargles. Further, root stumps were removed under local anesthesia. Patient was recalled after 15 days for follow-up. Healing was observed uneventful.

Case 2

A 35-years-old male patient reported with complaint of pain in upper left back teeth region since a week. Patient gave the history of restoration in the same teeth region performed by a quack, 10 days back. On intra-oral examination, class II restorations in 25 and 26 teeth were seen, which were performed using cold cure acrylic resin [Figure 2]. Patient was having sensitivity to cold that lasted for few seconds. There was no history of mid-night pain. Therefore, patient was advised for the removal of acrylic resin and restoring the teeth with Glass ionomer cement (GIC) or composite.
Figure 2: Acrylic restoration performed (by quack) in Class II cavities of Maxillary left second premolar and first molar

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Case 3

A 55-year-old female patient reported with complaint of pain in upper front teeth region since 10 days. On intra-oral examination, a quack prosthesis made up of cold cure acrylic replacing 11, 21, and 22 was seen [Figure 3]a. Labial frenum was not relieved, and sharp margins were impinging on labial vestibule. The prosthesis was fixed to the adjacent natural tooth using undercut, extending up to first premolars. In addition, the prosthesis covered the natural 22 as it could be seen on the palatal aspect [Figure 3]b. Therefore, the removal of the prosthesis was performed by cutting the acrylic using air-rotor. Patient was recalled after 1 week, which she failed to report.
Figure 3: (a) A quack prosthesis made up of cold cure acrylic replacing Maxillary right, left central incisors and left lateral incisor. (b) The prosthesis covering the natural Maxillary left lateral incisor on the palatal aspect

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   Discussion Top


Reasons for booming dental quackery are numerous which includes lack of adequate infrastructure, health care delivery systems, trained and competent practitioners, and lack of awareness and knowledge among the common man, poor patient: dentist ratio in the rural population, as well as poor monitoring.[3],[4],[5]

Despite having more than 300 dental colleges and dentist to population ratio of 1:10,000, there is massive shortage of trained dental professional especially in rural area owing to mismatch in the distribution of manpower. As against the dentist to population ratio of 1:10,000 in urban area, the ratio is 1:2.5 lac in rural area[4] that has led the dental quacks to have flourishing business especially in rural and semi-urban areas.[6]

Common quackery practices carried out in India are filling of teeth with acrylic resin, fixing the removable partial denture as fixed partial denture using wires and self-curing acrylic resin, using suction disc on the palatal surface of complete denture to improve retention, etc., leading to a number of poor consequences.[3],[7] Use of wires to stabilize the tooth or denture with the support of adjacent teeth can lead to bone loss and damage to the adjacent tooth. Another common malpractice is replacement of a missing tooth with artificial teeth using self-curing acrylic directly adapting to teeth and oral mucosa. The cold cure acrylic used for this purpose does not completely cure and can cause damage to the underlying mucosa and lead to bone resorption on adjacent teeth, and it is also a known carcinogenic material with high monomer content.[8] In case of suction device, constant irritation caused by negative pressure causes not only perforation of hard palate but may also lead to malignancy.[9] Sterilization, autoclaving, or disposable injections are not used in these places.[10] In addition, exothermic reaction while using cold cure acrylic as tooth restorative material will lead to pulpitis.

These irrelevant procedures can result in bone loss, adjacent tooth loss, infections, and septicemia. Other major complications are oral cancer, space infections, and even death due to widespread infections. Possible chances of transmission of blood borne infections such as Hepatitis B, C, and HIV/AIDS are there as there is no sterilization protocol followed.[7] In addition, these quacks give false hopes to their patients, which lead to delay in seeking professional medical attention.[11]

According to Chapter V, Section 49 of the Dentist Act of 1948 in India all dentists, dental mechanics, and dental hygienists need to be licensed. Therefore, these quacks can be penalized under this Act which may lead to imprisonment and penalty.[6] However, the best way to tackle this menace is to provide affordable and accessible treatment option to the rural population, in particular.[12],[13]

Sanctioning of funds in government hospitals for providing better infrastructure, recruiting qualified doctors to rural areas, constant surveillance, and strict anti-quackery laws can curb this menace.[14]

A number of role-plays can be organized in local languages for educating the rural people about the evil effects of quackery. Routine free dental camps should be organized in remote areas so that people can get the basic dental services at their door-step.[9]


   Conclusion Top


Being oral health care providers, it is our ethical duty to prevent general population from the menace of these quacks. We discussed few of the mal-treatments performed by these quacks in Dhule district of India. Such similar havocs must also be present in other parts of the country or the rest of world, so it is our moral obligation to make patients aware of its hazards. These practices provide only temporary relief and are unacceptable.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Search Term. Quackery. Available from: http://www.en.wikipedia. Org/wiki/Quackery. [Last accessed on 2017 Dec 21].  Back to cited text no. 1
    
2.
Khan AS, Syed A, Qureshi A, Ijaz S, Khan AA. Evaluation of problems related to malpractice and professionalism in Islamabad area – A study. Pak Oral Dent J 2004;24:74-6.  Back to cited text no. 2
    
3.
Ahuja NK, Parmar R. Demographics and current scenario with respect to dentists, dental institutions and dental practices in India. Indian J Dent Sci 2011;3:8-11.  Back to cited text no. 3
    
4.
Lal S, Paul D, Vashisht B. National oral health care programme (NOHCP) implementation strategies. Indian J Community Med 2004;29:3-10.  Back to cited text no. 4
  [Full text]  
5.
Reddy KV, Bansal V, Singh PK, Bhambal A, Gupta M, Gupta S. Perceptions regarding treatment by dental quacks and self-rated oral health among the residents of Bhopal city, central India. J Indian Assoc Public Health Dent 2017;15:84-8.  Back to cited text no. 5
  [Full text]  
6.
Bhushan P, Kumar K, Ali FM, Nandkeoliar T. Menance of quack in dentistry: A case report. IOSR JDMS 2016;15:115-8.  Back to cited text no. 6
    
7.
Puroshottam S, Patil S, Rao RS, Agarwal A. Quackery in dentistry–An uncurbed menace. Int J Contemp Dent 2013;4:6-8.  Back to cited text no. 7
    
8.
Oberoi SS, Oberoi A. Growing quackery in dentistry: An Indian perspective. Indian J Public Health 2015;59:210-2.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
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. 9
    
10.
Goyal S, Kansal G, Deepika XX. Quackery in dentistry: An overview. J Dent Peers 2013;1:150-7.  Back to cited text no. 10
    
11.
Sandesh N, Mohapatra AK. Street dentistry: Time to tackle quackery. Indian J Dent Res 2009;20:1-2.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Oumeish OY. The philosophical, cultural, and historical aspects of complementary, alternative, unconventional, and integrative medicine in the old world. Arch Dermatol 1998;134:1373-86.  Back to cited text no. 12
    
13.
Pauly NG, Warrier S, Kashyap RR, Rao PK, Kini R, Bhandarkar GP. The curse of quackery in dentistry: A double-edged sword. Arch Med Health Sci 2017;5:92-4.  Back to cited text no. 13
  [Full text]  
14.
Bennadi D, Konekeri V. Quackery in dentistry. Res J Pharm Biol Chem Sci 2015;6:504-9.  Back to cited text no. 14
    

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Correspondence Address:
Dr. Pooja Siwach
Department of Dentistry, Government Medical College and General Hospital, Dhule - 424 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_396_18

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    Abstract
   Introduction
   Case Report
   Discussion
   Conclusion
    References
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