“ Health is like MONEY, we never have a true idea of its value until we LOSE IT”
All people practicing medicine or dentistry are NOT the doctors. Some of them are quacks, who is “an unqualified person who falsely claims to have medical knowledge”. As it is known, the ‘unconventional dentistry, ‘holistic dentistry’, or ‘biologic dentistry’, is the well prevalent stigma of quackery being followed in the dental sciences, not only in the rural areas of India but also among the urban population. The reason of the local folks being attracted towards these practices is the low cost treatment done by the quacks, without being aware of the fact that the lower cost of treatment as claimed by them, is at the cost of quality of the treatment provided by them.
Inarguably, oral and maxillofacial diseases are one of the most prevalent diseases in our community. Also, oral and maxillofacial diseases are one of the most neglected diseases by the general population. It has been reported many a times that high cost of dental treatments, illiteracy, lack of awareness, poor accessibility to dental clinics, and the repeated dental appointments draw the patients to these unregistered dental practitioners in large numbers. Though, quacks claim an immediate and painless treatment, but there is always a lack of appropriate sterilization protocols, indefinite procedural follow up in the light of incomplete scientific knowledge. You all must be aware that “Half a knowledge is worse than ignorance”. Many a times, we used to hear the consequences of these malpractices resulting in a much severe outcome for the patient, who had trusted the quack on their health. Recently, I had come across a poor victim of such a malpractice, whose condition I would like to share here.
A female patient had come up to me sometimes back with a severe pain in the lower right side of the jaw since 3-4 months. She had given me a history of swelling in the lower right region 4-5 months back for which she had gone to one of the local practitioner. She had undergone a traumatic extraction (painful removal) of the teeth on lower right side. According to her, the procedure was not carried out on a dental chair, instead she was made to sit on a chair and the tooth was extracted forcefully. Although anaesthesia was given, but extraction of the tooth was very painful for her. She was also give some medications for which she is unknown. No specific post-extraction instructions were given to her. Even the diagnostic instruments used by us were new to the patient, which means no proper instrumentations or procedure was followed by the local practitioner. All this history given by her made us to draw the conclusion that the procedure was carried out by a quack instead of a registered dental practitioner, the fact for which she was unknown. The persistent pain is present since then in the same region. When the patient had come up to us, she seems to very weak and friable. A bandage was placed on the right side of the chin about 3-4 cm away. On complete examination, it was found a through and through breach in the mucosa with atrophy and proliferative changes seen on the lesion extraorally (fig 1). The mandibular (lower jaw) bone was visible through the proliferative mass. In terms of lymph nodes, both the right submandibular and upper deep cervical lymph nodes were found to be 2-3 in number, firm to hard in consistency, tender and mobile on palpation. When the same site was examined intraorally, indurated lesion was palpated in the right side of the lower jaw (45, 46, 47 region as is called in the medical terminology). Also severe resorption of the bone was seen in the same region (fig 2). The right lateral border of the tongue shows an erythematous zone extending from anterior to the posterior site with atrophy of the mucosa seen at some sites (fig3). The dorsal surface of the tongue was coated with plaque (coated tongue in medical terms) with generalized elongated and erythematous papillae (site responsible for taste sensation). Apart from this, there was a generalized calculus deposits with severe recession of the gingiva was seen. To further elaborate the diagnosis, we had asked the patient to take a full mouth scan (Orthopantomograph or OPG, as is called). The findings in the OPG reveal a severe scooped out bone erosion seen on the right side of the lower jaw. The alveolar bone around the first premolar (45) was resorbed giving the tooth an appearance of floating in the jaw bone (floating tooth, as is called). No periosteal bony reaction could be appreciated in the region (fig 4). All the above mentioned features, including the history given by the patient, clinical and radiographic features lead us to make a diagnosis of carcinoma of that region. The patient was non-reactive of HIV and HCV tests. Haemoglobin levels and random blood sugar levels were also in the normal range. The neutrophil and RBC count was found to be little raised whereas lymphocytes and monocyte count had a lower than normal values. We had shifted the patient to a cancer institute for an emergency assistance.
From this case, it was clearly distinguished how an untrained, uneducated, non-degree holder, unregistered practitioner can ruin one’s life with his mere knowledge of medicine and dental sciences. A case of swelling or space infection secondary to tooth decay that can be treated by pharmacological (by medicines) and surgical procedures safely without any complications turned out be a cancerous lesion in the absence of proper awareness of both the patient and the practitioner. The Chapter V, Section 49 of the Dentist’s Act 1948 holds each and every dental practitioner, dental mechanic or hygienist to get registered in the Dental Council in India. The quacks can be penalized under the Dentist Act leading to imprisonment and penalty for the same, but strict rules have to be implemented and followed by the Government of India and State to ensure a safeguarded dental treatment to all its countrymen.
The practice of quackery feeds degeneration in professional ethics and sense of lack of confidence of the general population in science, medicine and dentistry. One of the published reports says that in India 2500-3000 quacks practice in Delhi alone. This report gives an insight to the danger held by the quacks to the mankind. But here, the question arises what are the factors that help these quacks to flourish and practice without any fear of laws. The answer seems to be no complicated.
The literature proves a lack of qualified dental practitioners in different regions of India. According to one of the reports, there is only 1 dentist per 10,000 people in urban areas and for about 2.5 lakh people residing in rural areas of India. The primary and community health centres (PHCs and CHCs) are devoid of dental practitioners which is major missing link for the unfortunate situation in a country like India. Even the areas where primary health care centres are established have infrastructure with very limited resources and the services limited mainly to the extraction (removal) of the teeth. Other preventive, promotive or restorative services are given no value in the lack of proper instrumentation and materials used for these procedures. Till date, no National Health Service or National Health program has been launched by our government which includes the services for oral and maxillofacial diseases. This results in lack of knowledge regarding importance of oral health among the masses especially in rural areas, though urban areas are no exception to this.
Also, India has neither oral health care policy nor oral health care plan. No oral health insurances are available in India for the people of India. The oral health policy which was drafted by Dental Council of India, a way back in 1985 is not included in National Health Policy of India till date. The policy demands the appointments of dental practitioners in different PHCs and CHCs of India. This policy has never been accepted or implemented under any National Health Policy, and hence, the appointments of dentists are out of question. After listing out all this, the question that arises in my mind is that Do we really think that oral health plays a least important role in maintaining the overall standards of a person’s health?????????? In this context, I could only say that our mouth is a mirror of our general health. To know more about this, you can go back and read my older articles.
Through an era of development, dentistry has come up too far where nano-dentistry, computer-aided design-computer aided diagnosis and treatment, lasers, rotary endodontics, zygomatic implants have been stepped up, there are people who still jumps up to an unqualified, unskilled practitioners for their ailments. Quackery is a derogatory term where fraudulent misdiagnosis of the disease and unskilled treatments are represented.
When we talk about India as a nation which intends to touch the skies of development in each and every field of engineering, aeronautics, space ships, economics, general health, then how can we neglect the oral health of our folks which is an integral part and system of our body. Though, the Government of India, different States of the Nation, Dental Council of India are held responsible for such an ignorance among the people of country and it is their duty to bring different policies and laws to raise the standards of oro-dental treatment, we as dental practitioners should also help in making the people aware of different oral and maxillofacial diseases and their treatment. At local levels, dentists can help in bringing a revolution in dental sciences by organizing role plays and general awareness programs in different localities. We cannot allow these social termites in the form of quacks to infect our society and hindering the health of our people.
Dentistry has progressed a lot in the recent years and is also one of the most respected professions. It is incumbent upon dentists everywhere, to protect that hard-earned reputation by weeding out quacks along with the help of Government and Dental Council.