|Year : 2017 | Volume
| Issue : 1 | Page : 84-88
Perceptions Regarding Treatment by Dental Quacks and Self-Rated Oral Health Among the Residents of Bhopal City, Central India
Kolli V.G Reddy1, Vaibhav Bansal2, Pavan Kumar Singh3, Ajay Bhambal4, Manoj Gupta5, Shrutikirti Gupta6
1 Department of Public Health Dentistry, Narsinghbhai Patel Dental College and Hospital, Visnagar, Gujrat, India
2 Department of Public Health Dentistry, Sri Aurobindo College of Dentistry and PG Institute, Indore, M.P., India
3 Department of Public Health Dentistry, Post Graduate Student Vyas Dental College and Hospital, Jodhpur, Rajasthan, India
4 Department of Public Health Dentistry, People’s College of Dental Sciences and Research Centre, Jabalpur, M.P., India
5 Hitkarini Dental College and Hospital, Jabalpur, M.P., India
6 RKDF Dental college and Research Centre, Bhopal, M.P., India
|Date of Web Publication||14-Mar-2017|
Aurbindo Campus, Indore, Madhya Pradesh 453555
Source of Support: None, Conflict of Interest: None
Introduction: Dental quackery has become one of the most unethical practices misleading majority of the Indian population. It has become prevalent to such a grass-roots level that curbing this menace is becoming very difficult. This mockery of dental practice imparts unethical dental care to the innocent people and results in complications, which sometimes lead to death of the individual. Objectives: To estimate the prevalence of visits to dental quacks, and to describe the factors influencing these visits. Materials and Methods: A cross-sectional study was conducted for a period of 3 months in Bhopal, Madhya Pradesh. Study participants were recruited from one of the satellite centres of a private dental institution. Information regarding visits to dental quacks, reasons for the visit and self-rated oral health was obtained from the participants using structured questionnaires and face-to-face interviews. The obtained data were analysed using chi-square test and logistic regression analysis. P < 0.05 was considered statistically significant. Results: Out of 314 people who visited the centre during the study period, 280 (92%) agreed to participate in the study. The prevalence of the visits to dental quacks was 42.1%. The participants who visited quacks were older and less educated. The reason for preferring a quack to a dentist was primarily because of the referrals provided by the family members and peers. The most common reason for visiting a quack was toothache (66.1%), and tooth extraction was the most common treatment received (33.8%). Conclusion: Age and level of education significantly influenced the visits to dental quacks and are the two major factors influencing such visits.
Keywords: Oral health, prevalence, quackery, questionnaire
|How to cite this article:|
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
| Introduction|| |
Dentistry in India is facing serious problems regarding accessibility of its services because of significant geographic imbalance in the availability of dental care. Oral health facility is almost non-existent in many rural areas and urban slums. As a result, it is becoming difficult for the urban poor and the rural population to get access to basic dental care. The major factors attributing to this inequality are the non-availability of qualified dentists and cost of the dental treatment. This imbalance with respect to the distribution of dental services and qualified dental manpower has resulted in cropping up of people who have availed this opportunity and enact as qualified dentists; thereby, quackery ensues.
‘Quack’ is the German word for mercury (quacksalber) literally meaning ‘hawker of salve’. It was first used in the 15th century. A quack is ‘an unqualified person who falsely claims to have medical knowledge’. The workplaces for these dental quacks range from footpaths to well-furnished set-ups. They do not hold any qualification to practice dentistry. A significant number of quacks claim to have learnt the art of dentistry either from their ancestors or after watching an expert work in the dental office as an assistant.
The procedures performed by the quacks are extremely undesirable, harmful and dangerous resulting in a number of complications including death of the patient because of the absence of substantial exploratory base and because they did not attend any educational module in schools of dentistry. Sterilisation, autoclaving or disposable injections are not used in these clinics. Thus, the potential for spread of diseases such as human immunodeficiency virus/acquired immune deficiency syndrome and hepatitis B and C is high among their patients. In addition, these quacks give false hopes to their patients, which lead to delay in seeking professional medical attention.
According to the Dental Council of India, an individual is designated as a dental quack according to the standards set in Section 49 (1) of the Dentist Act of India (1948). Reports suggest that there are around one million quacks in India. A report by Central Bureau of Health Intelligence, India in the year 2006 revealed that the rise in quackery is because of the lack of adequate infrastructure, health care delivery systems, qualified human resources, and coordination among various stakeholders, as well as poor monitoring.
The Indian government has pursued an unsuccessful war against quacks. In the state of Madhya Pradesh, quackery is becoming an increasingly big menace in rural ghettos and town slums. Madhya Pradesh does not have any stringent law to deal with quacks. The health department takes action against them under Section 24 of the Madhya Pradesh Act No. 11 of 1990. In the city of Bhopal, which is the administrative capital of Madhya Pradesh, it has been observed that majority of the patients visited dental quacks for various reasons, and many had experienced several complications.
The existing literature reveals a high prevalence of visits to dental quacks in developing nations. Studies conducted by Pervez et al. in Pakistan and Naidu et al. in Trinidad revealed a prevalence rate of 42 and 66%, respectively. The reported data are alarming, and stringent measures should be implemented to put an end to this mockery at the earliest. Unfortunately, there are no data available from India, even though this mockery is practiced in many rural and urban slums of the country, to recommend to the policy makers to frame a policy against such mockery and save the lives of the innocents.
Hence, this research was undertaken with an aim to assess the perceptions regarding treatment by of dental quacks and self-rated oral health among the residents of Bhopal city, central India. The objectives of the current study were as follows:
- To estimate the prevalence of visits to dental quacks,
- To describe the factors influencing the visits to dental quacks, and
- To investigate the relationship between the visits and self-rated oral health.
| Materials and Methods|| |
This cross-sectional study was conducted for a period of 3 months (January–March 2015) in Bhopal, Madhya Pradesh after obtaining prior approval from the Institutional Ethical Committee (Ref/PCDS/ACAD/8/2014/87). Study participants were recruited from one of the satellite centres of the Department of Public Health Dentistry of a private dental institution in Bhopal after obtaining informed written consent. The study participants were guaranteed confidentiality for the gathered data. This study was preceded by a pilot study to assess the feasibility and to gather information about dental quacks.
A convenient sample size of 280 study participants who visited the satellite centre during the study period and agreed to participate in the study constituted the final sample. The information on selected study variables such as demographic data, visit to dental quacks, reasons for visit, treatment received and self-rated oral health was obtained using self-administered, structured questionnaire having multiple choice questions and closed-ended questions. The questionnaire contained information related to quackery to familiarise the study participants to the concept of dental quackery. The questions were prepared both in English and the local language, which is Hindi. The questionnaire was pretested, and necessary modifications were made to improve the question clarity and appropriateness of response categories. For illiterate participants, information was collected through face-to-face interviews. Hints were provided when required to obtain information about their visits to quacks and other study variables.
Data were processed using Microsoft Excel version 7.0 software and analysed using the Statistical Package for the Social Sciences version 21.0 software (SPSS Inc, Chicago, IL, USA). Chi-square analysis was used to investigate the differences between groups with respect to visit to quacks. Binary logistic regression analysis was performed to determine the independent predictors of the dependent responses. A P < 0.05 was considered statistically significant.
| Results|| |
Out of 314 patients who attended the satellite dental clinic, 280 agreed to participate showing a response rate of 90%. There were 118 (42.1%) respondents who reported visiting a dental quack.
[Table 1] shows the demographic distribution of study participants with respect to their visit to the dental quacks. Chi-square analysis revealed significant differences with respect to age and level of education between both the groups (P < 0.05). Those who visited dental quacks were older and illiterate. [Table 2] shows logistic regression analysis that revealed level of education as a strong predictor for visiting dental quacks followed by age (P < 0.05).
|Table 1: Distribution of the study participants according to their visit to dental quacks|
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|Table 2: Logistic regression analysis of predictors of visits to dental quacks|
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Among those who visited the dental quacks, the main reason for the visit was toothache (66.1%) followed by gum problems (20%), denture requirement (9%), abscess or swelling (3%) and other reasons (2%) [Figure 1]. Extractions were by far the most commonly received treatment (33.8%) followed by dentures (18.6%), medications (16.1%), restorations (15.2%) and scaling (4.2%). Some patients (11.8%) received more than one treatment.
The most common reason for visiting dental quacks was referral by family members or peers (50%) followed by cost of the treatments levied by dentists (39.8%), lack of time (5.9%), distance (2.5%) and dissatisfaction with the dental services (1.7%). Among those who visited quacks, 57.7% of the respondents reported that they had a bad experience after receiving treatment from dental quacks. There were 20.3% respondents who were undecided about their experience, whereas 22% reported a good experience. When all respondents were asked to rate their overall oral health, those who had visited dental quacks previously were less likely to rate their oral health as ’Excellent’ in comparison to the respondents who never visited the quacks, and the difference was statistically significant (P < 0.05) [Table 3].
|Table 3: Self-rating of oral health by those who visited and did not visit dental quacks|
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The perceived differences between dental quacks and qualified dentists as felt by those patients who had visited the dental quacks previously are shown in [Table 4]. There were about 61.0% of respondents who felt that dental offices were more hygienic. Forty-two percent of the respondents perceived that dentists provided better, safer or less painful treatment. Approximately 40.7% of the respondents were of the opinion that dentists were more expensive than quacks, whereas 35.6% believed that quacks provided treatment in less time. Only 21.6% of the respondents thought that dentures provided by dental quacks were better than those made in dental clinics.
|Table 4: Perceived differences between dental quacks and qualified dentists as reported by those who visited quacks earlier|
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[Figure 2] reveals that 61.0% of the respondents were satisfied with the services rendered by the dentists, whereas only 9% were satisfied with the services of the quacks. Majority of the respondents (78%) were of the opinion that they would never visit dental quacks in the future.
|Figure 2: Perceptions of visitors after receiving treatment from the dental quacks and qualified dentists|
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| Discussion|| |
Dental quackery has become one of the most unethical practices misleading majority of the world population especially those residing in underdeveloped and developing nations. Even though efforts were made by different researchers in different countries to publicise this act to gain the attention of policy makers and to put a pause to such mockery, the available literature from the Indian perspective is meagre to understand the scenario and initiate stringent action against the culprits. The existing literature reveals that majority of the patients get attracted by dental quacks because of their publicity gimmicks claiming a faster, cheaper and sure cure. Because of lack of firm action against the culprits, this activity has become pronounced in recent years resulting in complications for the innocent people and acting as an obstacle in providing quality dental care. In this study, an attempt was made to assess the perceptions of patients regarding treatment by dental quacks in Bhopal city of central India.
This study reported the prevalence of visits to the dental quacks as 42.1%, which is in agreement with that reported by Pervez et al. but is much less than that by Naidu et al. The difference in the prevalence rates at various geographical regions can be attributed to the variations in the degree of awareness towards oral health among respondents. Our study found that the patients who visited quacks were either the elderly or were less educated than the non-visitors, and this is in line with the findings of Naidu et al. This may be probably because of their trust in traditional healers in whom their ancestors believed.
We found that the most frequent reason for attending the dental quacks was toothache, and the most common treatment received was tooth extraction. This finding is in line with that reported by Naidu et al. but differs from that reported by Ekanayaka and Samarasinghe who found prosthodontic treatment as the most preferred treatment by quacks.
In our study, it has been observed that the main reason for preferring quacks over dentists was referral by family members and peers who were influenced by their ancestral belief in quacks; this observation was in contradiction to previous studies.,, In addition, affordability for dental care was identified as a significant barrier to seek professional dental care amongst the masses, which was analogous to the findings of Naidu et al. and Baig et al., wherein 66% of the patients reported that they would like to visit quacks because of economic reasons.
Furthermore, in our study, more than half of the study respondents were unsatisfied with the treatments received from the quacks, whereas the rest had no opinion or were happy with the treatment. This can be substantiated by the fact that the respondents who received treatment from dental quacks before expressed their strong unwillingness to receive further treatment from quacks and referring their family members or peers to quacks as they could witness the difference in the treatment provided at both the settings. This finding is in agreement with that of Naidu et al.
The self-rating of oral health, as reported by those who visited quacks before, was ’Poor’ in comparison to their counterparts who rated their oral health as ‘Excellent’, and the difference was statistically significant. This fact reflects the difference in efficiency and quality of services between a quack and a dentist. Our finding is in agreement with that reported by Naidu et al.
Our study has witnessed a transition in patient preference from quacks towards dentists, which is in agreement with that of Naidu et al. but not with that of Baig et al. who reported in their study that quacks were preferred over dentists for receiving treatment.
We included only a convenient sample of study participants who visited our satellite centre, which may not be the true representatives of the general population and thus questions the generalisability of the results. Future studies are recommended in this direction using a larger sample to achieve more valid conclusions and in recommending to the policy makers to put a pause to this mockery.
| Recommendations|| |
The government should take steps to bring an end to quackery by raising awareness among the masses through plays and dramas. Employment opportunities for qualified dentists in the rural and urban areas would likely bring a decline in quackery. Dental colleges can be made to share the responsibility of providing free dental health education and quality dental care to the masses on a periodic basis. A task force or vigilance team should be constituted by the state government to identify, track and initiate appropriate action against those who practice quackery.
| Conclusion|| |
Quackery in India is cropping up at alarming rates because of unawareness and ignorance of the masses towards oral health. Age and education level are the two major factors influencing the visits to dental quacks. Toothache was the most widely recognised reason for visiting quacks, and extraction was the most frequently received treatment. Affordability and the belief in dental quacks in society were identified as the most common hindrances to receive care from qualified dentists.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4]