Context

An ever-expanding need and demand for dental care, oral health and aesthetics worldwide has resulted in an exponential rise in the value of the dental market. This has led to a significant increase in individuals or companies who wish to exploit this market.^1,2,3,4,5 Some of these providers take a solely commercial approach with less emphasis on professional ethics and patients’ well-being. In many cases, activities are provided by individuals with minimal or no training in dentistry. They may argue that they are not providing a health service but a purely cosmetic service and therefore are not required to adhere to healthcare regulations. Provision of such treatments puts patients at risk of inappropriate treatment and irreversible damage to their oral and general health and may deny them the chance of appropriate redress.

Through professional self-regulation and government regulation where it exists, dentists and their teams subscribe to professional ethical codes and standards, which ensure the provision of quality and safe patient-centered care.  This assures patients seeking treatment that their care will be provided by trained, knowledgeable and skilled individuals who will provide a comprehensive examination, full diagnosis, treatment plan including options and details of treatment, taking into account all necessary clinical aspects and after obtaining informed consent. It also ensures that, where treatment is not successful, the patient has access to some form of complaint system or redress through the professional’s insurance arrangements or licensing authority. 

Scope

This Policy Statement defines the term ‘illegal practice of dentistry’, highlights patient protection issues and calls for national authorities to stop individuals and/or organizations from providing dental treatments if they are not authorized and appropriately registered to do so or licensed by a recognized body. It does not make specific suggestions about how this should be done as this will be dependent on national or local regulatory systems.

Definitions

Illegal practice of dentistry: Provision of any oral care by individuals or organizations not specifically trained, licensed, registered and regulated to do so as defined in the appropriate local or national legislation.

Dental regulation: A national or local legislative framework of mandatory registration or licensure of dentists to protect patients, which defines the educational, ethical and professional standards and considers the competence and fitness to practice of registered oral health professionals. 

Principles

• Safety of the public: Patients need to be confident that any dental care they seek is provided only by professionals who are appropriately trained, licensed and regulated.
• Professional ethics: Dentists and dental team members should follow professional standards. Standards for the purpose of regulation are set nationally or locally.
• Professional self-regulation: Dentists and dental team members should be well-trained, ethical, competent and appropriately indemnified to serve the public.

Policy

• Dentists are academically trained and qualified health professionals providing a full range of oral healthcare and dental services to their patients. Depending on national or local legislation, they may be supported by, or delegate certain tasks to, other appropriately trained members of the dental team.
• Patients receiving treatment from unregistered and unqualified providers are at significant risk when irreversible procedures are being performed. This risk might also include the use of unregulated or illegal materials that may be harmful. When providers operate outside the regulatory system, patients who have suffered detriment will not have access to remedies including reimbursement via insurance arrangements or sanctions from a licensure authority. Patients may be left with permanent damage to their oral health, general health and personal well-being.
• Patients may not be aware that they have been treated by untrained and unregulated individuals, which can lead to a decline of public trust in the dental profession.
• FDI calls on regulators in all jurisdictions to prioritize the issue of illegal dental practice to ensure the protection of populations, and to ensure the proper functioning of the existing regulatory system. 
• FDI calls on dentists and dental team members to consider very carefully recruitment to any organization that is outside the regulatory framework and that attempts to have dentists and dental team members amongst its staff to give credibility to its operational approach.
• FDI’s Dental Ethics Manual⁶ and its policy statement on FDI’s Role in Dental Ethics⁷ outlines important principles of dental professionalism in the wider international context.

Keywords

Education, legislation, illegal practice

Disclaimer

The information in this Policy Statement was based on the best scientific evidence available at the time. It may be interpreted to reflect prevailing cultural sensitivities and socio-economic constraints.

References

1. Ran H, Arjunaidy B, Roslan NA, Syuhada WN, Muhamad AW. A descriptive summary of unlicensed dental practice. Malaysian J of Public Health Med. 2020;20(2): 252-260. Available from: https://doi.org/10.37268/mjphm/vol.20/no.2/art.548.
2. The Star. Fake dentists are making a comeback - at the unlikeliest of places. Available from: https://www.thestar.com.my/news/nation/2021/01/13/fake-dentists-are-mak… [Accessed 26 July 2021].
3. The Jet, Fiji Community Newspaper. Consumers at risk with unlicensed practitioners. Available from: https://www.thejetnewspaper.com/consumers-at-risk-with-unlicensed-pract… [Accessed 26 July 2021].

4. RajaRajeswari Dental College and Hopsital blog. Quackery In Dentistry. Available from: https://www.rrdch.org/blog/quackery-in-dentistry/ [Accessed 26 July 2021].

5. American Dental Association. Direct-to-Consumer Dental Services. Available from: https://www.ada.org/en/about-the-ada/ada-positions-policies-and-stateme… [Accesed 26 July 2021].

6. Brands W, Naidoo S, Porter S, Sereny M, van Dijk W, Welie J. FDI Dental Ethics Manual 2. London: Quintessence Publishing; 2018. Available from: https://www.fdiworlddental.org/resources/manuals/dental-ethics-manual-2 [Accessed 26 July 2021].

7. FDI World Dental Federation. Role of FDI in Dental Ethics. Available from: https://www.fdiworlddental.org/role-fdi-dental-ethics [Accessed 26 July 2021]. 

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