Quackery in Dental Practice in Nepal

Predictors of apical periodontitis in root canal treated teeth from an adult Nepalese subpopulation: a cross-sectional study

BACKGROUND

Endodontic literature search revealed that no study has been conducted to evaluate the prevalence of apical periodontitis (AP) in root canal treated teeth from an adult Nepalese population of Madhesh Province. Consequently, little is known about the extent and risk factors associated with it. This study aimed to determine AP prevalence in root canal treated teeth from an adult Nepalese subpopulation and to analyze the related risk factors including age, sex, tooth type, type of coronal restoration and quality of root canal treatment and coronal restoration as predictors of AP.

METHODS

Digital panoramic radiographs were evaluated. Periapical status of 300 root canal-treated teeth was scored by using the periapical index. The quality of root canal treatment and coronal restorations were categorized as adequate or inadequate through radiographic and clinical evaluation. The data were analyzed using univariate and multivariate logistic regression models.

RESULTS

Prevalence of AP in the present study was 31.7%. In 45.7% of the treated teeth, quality of root canal treatment was adequate whereas 46% of the cases had adequate coronal restorations. Multivariate logistic regression analysis revealed statistically significant associations and remarkably increased risk for AP in teeth with inadequate root canal treatment (odds ratio [OR] = 7.92; 95% CI: 3.96-15.82; p < 0.001) whereas lower risk for AP was found in females (OR = 0.51; 95% CI: 0.28-0.90; p = 0.021) and in teeth restored with crown (OR = 0.22; 95% CI: 0.09-0.51; p < 0.001) and filling (OR = 0.18; 95% CI: 0.08-0.42; p < 0.001). Quality of coronal restoration, tooth type and age of the patient were not found to be the predictors of AP.

CONCLUSIONS

Within the limits of this study, a high prevalence of AP and poor overall quality of root canal treatment and coronal restoration was found in the subpopulation studied. Quality of root canal treatment, type of coronal restoration and sex of the patient are significant predictors of possible AP development in root canal treated teeth. Substantial efforts are needed to improve the endodontic treatment standards.

Quackery as a Cause of Maxillofacial Infections and Its Implications

BACKGROUND

In recent times, the prevalence of quackery in oral and maxillofacial practice has become rampant with complications, one of which is odontogenic infections. This study was aimed to identify how common quackery is among our patients with odontogenic infections and the outcome of the patients.

MATERIALS AND METHODS

The study was a descriptive cross-sectional study of all patients presenting with odontogenic infections seen at the accident and emergency unit and the oral and maxillofacial surgery clinics of a tertiary hospital in North Central Nigeria from January 2017 to December 2021. Information obtained included sociodemographic characteristics, presenting complaints, duration of illness, prehospital care, diagnosis, duration of hospital stay, where the patient was first managed, what is the "doctor/dentist" status, and outcome.

RESULTS

A total of 237 patients were recruited with a male to female ratio of 1:1.3. The commonest presenting complaints were toothache and jaw swelling with patients been ill for up to 2 weeks before presenting. About 41.8% of the patients have a co-existing health condition, and 46.4% of the patients had tooth extraction by a quack, with 82.7% taking antibiotics prescribed by a chemist before presentation. About 11.0% of the patients died; 96.2% of those that died had their tooth extracted by quacks. Patients with preexisting health conditions and preadmission tooth extraction were more likely to die with odds ratio (OR) = 2.230; 95% confidence interval (CI) = 1.06-4.71 and OR = 28.9; 95% CI = 3.97-209.6, respectively.

CONCLUSION

Quackery is very common in our society. The odds of death are increased in patients with odontogenic infection if the patient has a preexisting health condition and even more significant if they had their tooth extracted by quacks.