Back to Bite You!

Unauthorised dental services offered by fake dentists – or those who feel that watching a couple of YouTube videos makes them an expert at dental work – have caused much heartache (and toothaches) to those who have sought their treatment. Prof Seow Liang Lin, Dean, School of Dentistry, International Medical University, talks to us about bogus dentists

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Izmir, Turkey, 18, 09, 2021: In Guzelyali neighborhood of Izmir, Male dentist examines female patient's bracket system before adjusting it. Consultation and control examination in the dental clinic

The issue of fake dentists has been around for many years. The Ministry of Health received a growing number of reports of fake dentists made by disgruntled customers – 54 in 2017 which increased to 130 in 2019.

According to Prof Seow, dental treatment performed by anyone who is not registered with the Malaysian Dental Council (MDC), and who does not hold a valid Annual Practicing Certificate (APC)/ Temporary Practicing Certificate (TPC) to practice dentistry in Malaysia, is considered illegal.

“The fake dentists tend to fall into a few different categories,” she said. “There are groups of fake dentists who set up stalls, usually at but not limited to the “pasar malam” (night markets) or morning markets. They offer dental treatments to market-goers, who are generally in the middle to older age groups.” These fake dentists usually offer treatments to replace missing teeth on the spot.

Another group would be the beauty parlours, offering aesthetic work such as bleaching and veneers. “From my observations, it is the younger age group who seek these types of dental treatment at beauty parlours,” said Prof Seow. While it may seem like a simple procedure, there is no reason to trust a beautician to perform dental procedures.

There are also groups that promote their services on social media that have makeshift clinics in hotel rooms and who sometimes even offer house-to-house services. Many of them ‘learn’ their skills from watching YouTube videos and performing treatments from fixing braces to veneers.

Biting the bait

Agreeing to get dental work done at the morning or night market sounds a little strange, but it is usually sold as a convenient and quick way to solve the problem of missing teeth. People see a ‘dentist’ who promises things such as immediate replacement of their missing teeth. What they get is a fake dentist who usually just connects denture teeth to natural teeth using wires or something similar. Customers feel satisfied because they don’t have to get dentures made. But they don’t realise that these teeth don’t actually work, and will cause damage to the adjacent natural teeth and gums. “It can cause natural teeth to decay or cause gum inflammation when food is impacted,” said Prof Seow.

When it comes to dental treatment at a beauty salon, it’s the comfort level that plays a big part. “The perception of going to a dentist and going to the beauty parlour is very different. When you go for a facial or to a spa, it is a pleasant and relaxing experience. But when people think of dentists, there is always an element of dread and fear,” adding that customers also have a certain rapport with their beauticians, and if they go regularly for facials, they may include bleaching and veneers as part of a beauty package.

However, the overarching reason that enables rogue dental services to continue to be offered is the lack of education and awareness of the long-term consequences. “People are attracted to before-and-after photos which promise easy and quick fixes. They get caught up in the persuasive sales pitch. But although it may look good in the short term, in the long term you end up suffering,” says Prof Seow.

The real deal

What are the actual processes involved in these dental treatments?

Bleaching is a procedure to whiten teeth using a cream or gel that contains chemicals such as hydrogen peroxide or carbamide peroxide. The gel is applied to the surfaces of the teeth after scaling and polishing and the whole process takes one to one and a half hours. It can be done chairside (at the clinic) or through prescription (home bleaching). With home bleaching, you will be assessed at the clinic and then be guided to use a tray loaded with gel at home for a few hours a day for 1 week to 3 weeks. The whole process will be monitored by a dentist.

At a beauty parlour, you risk substandard bleaching gels that can cause harm to both teeth and gums. There is also no proper assessment of teeth before the process to ensure that the teeth are suitable to be bleached. “You might be paying money for treatment that is not suitable and therefore will not have any results for you,” said Prof Seow.

Veneers are also a popular treatment offered at beauty parlours. According to Prof Seow, veneers are used in several circumstances. One is for discolouration of teeth that cannot be bleached, for example in tetracycline stains (which happens when mothers ingest the antibiotic tetracycline during pregnancy, nursing, or when children take it when their secondary and primary teeth are developing). “These are greyish-black stains that cannot be treated by bleaching as the stain is internal,” she says. Other circumstances when veneers might be suitable to use are when teeth are a little bit crooked and the patient doesn’t want braces, as well as in cases of very worn-down teeth.

The process includes shaving off a thin layer of tooth structure and then glueing on veneers. This is a process called indirect veneers.  There are also what is termed direct veneers, where a dentist will use tooth-coloured filling material to cover up discoloured teeth and modify the shape and size of teeth.

At a legitimate dentist, indirect veneers are custom-made and produced in dental labs, while direct veneers need a skilled hand as teeth need to be shaped and polished properly to ensure it looks good. Trusting a beautician to do the treatments often leads to ill-fitting veneers that cause swollen and diseased gums.

When it comes to dental bridges to replace missing teeth, this first involves a process of trimming the tooth or teeth next to the gap and making a mould of the trimmed tooth or teeth. This is then sent to a dental lab that will fabricate the bridge. Treatment by fake dentists however really just involves wiring fake tooth or teeth to adjacent teeth. “By getting a fake dentist to fix a one-size-fits-all tooth with a wire, you risk tooth decay, gum problems and other problems caused by the ill-fitting fake teeth,” says Prof Seow.

Another popular treatment that people seek out is braces. There are two types of braces. The conventional method uses metal brackets and wires. A newer method uses a clear aligner. Clear aligners hit the market about 20 years ago and it uses a set of 40 – 50 clear plastic aligners provided to the patient. Every seven to ten days, over a period of one and half years, the clear aligners are changed sequentially and by doing this they will slowly move the teeth.

“Braces to fix mild and simple malaligned cases can be managed by dentists who have upskilled themselves by attending short courses, but for complex cases, you will need to see an orthodontist,” says Prof Seow.

Danger signs

How can we be certain that the dentist we are seeing is legit? All dentists need to be registered with the Malaysian Dental Council. The Annual Practicing Certificate (APC) of a dentist should be displayed at the clinic. If there is no certificate or it has not been renewed, then you are not in the right place. “Each and every clinic that operates legally need to have their APC renewed annually and displayed,” said Prof Seow.

You should also look out for the location of the services offered. It should be a proper dental clinic, not by the roadside, not in a hotel room or even a beauty salon.

Also, be wary of cheap online products that offer fake veneers, braces and other teeth whitening products. “Whether there will be real harm or danger depends on the ingredients used, but in any case, many of these do not look like they will work,” said Prof Seow.

Don’t take the risk, she adds. Not going to a proper dentist to receive dental treatment can cause irreversible damage to the teeth and gums. “Bogus dentists and rogue treatments can damage the supporting structure of the teeth. There is also the question of hygiene and the lack of proper tools used in these situations.”

Remember, some things are just too good to be true. “It may seem like you are getting a good deal but these things have a way of coming back to bite you,” warns Prof Seow.