The Ethical Dilemma of Illegal Street Dentistry

By Genni Burkhart

From Rhode Island to California, Texas, New Mexico, and countless communities across the U.S., “street dentistry” or “basement dentistry” is capturing headlines.

These forms of illegal dentistry involve fraud, botched procedures, unlawful prescription and dispensing of medication, death, murder, and a whole scale of legal and ethical violations.

We’ve all seen the dreadful do-it-yourself dental trends on social media and the often regrettable results. However, illegal dentistry takes unlicensed dental care even further.

Illegitimate, Illegal, and Dangerous

According to the FDI World Dental Federation, “Only those with the specific education, training, and qualifications, recognized in each country, can be entrusted with the practice of dentistry.” (1) Therefore, practicing dentistry without fulfilling all of these requirements is illegal. No matter what country you live in, providing dental care without a license, training, or professional standard is unethical and unlawful.

Street dentistry, or basement dentistry, involves someone illegitimately operating “as” a dentist. Usually, this is because they failed to meet licensing requirements, lost their medical license, lack formal training and education, or found legitimate practice too prohibitive and, therefore, have taken their “services” underground.

Trusting an illegitimate dentist in a basement or the back of a convenience store is, for most of us, unthinkable. Unfortunately, due to the rising cost of dental care, lack of dental insurance, and access to legitimate oral healthcare, some individuals feel they have only one option - to seek care from illegal, unlicensed, unreputable, and dangerous sources.

Underlying Causes

Illegal dental care is a complex global issue that transcends U.S. laws and regulations. It leads to poor oral health, which increases patients' risks of severe health problems and becomes a public health crisis.

The countless unlicensed dentistry headlines are telling of the underlying problems with health care, including access to affordable dental care, health inequities, and governance issues.

Access to Care

Approximately 70 million Americans live in areas without enough dental providers. In 2022, the U.S. average patient-to-dentist ratio was 1,538:1. In parts of the Southern U.S., that ratio jumps to 20,000:1 or even zero.

This situation has created an access-to-care crisis in America, leaving people without dental care due to a shortage of dentists, especially in rural and marginalized urban communities. Furthermore, many dentists don't accept Medicaid, leaving many low-income individuals without access to legitimate (affordable) dental providers.

The Cost of Care

Under the Affordable Care Act (ACA) of 2010, dental care for adults isn't considered an "essential health benefit." Furthering the issue, most dental coverage in the U.S. is lacking, leaving the most vulnerable Americans without adequate dental coverage.

The Kaiser Family Foundation reports that the number of adults without dental coverage is three times that of adults without health insurance. They also state that 30 percent of children with private health insurance lack dental coverage.

CareQuest Institute released data on oral health inequities in the U.S. in June 2022. Their 2nd annual State of Oral Health Equity in America survey found that 77 million adults in the U.S. did not have dental insurance. (2)

As inadequate dental coverage increases, so does the cost of dental care.

The consumer price index data for August showed an increase in the price for dental services of 5.3% in the past year. As treatment becomes increasingly expensive, 92% of Americans reported they'd consider holding off on dental care due to cost, as reported in a new study by Synchrony Bank.

Governance Issues

The issue of illegal dentistry has become a prolific global issue. In 2021, the FDI updated its “Action Against Illegal Dental Practices” to highlight the growing exploitation of services in the dental market and demand action on an international level.

The American Dental Association (ADA) previously stated that it doesn’t track the number of illegal dentists but acknowledged the issue in a 2013 Yahoo News article on an “underground dentist.”

The Ethical Dilemma

The following ethical issue arises due to a lack of access to quality, affordable care: Is illegitimate care better than no care at all?

Taking up the inevitable ethical dilemma of this issue, the International Dental Journal (2010) 60, 399-406 published Benzian et al.: Illegal oral care: more than a legal issue. This paper asks the difficult ethical question: “If an illegal provider is the only one available or affordable in an emergency, should the patient be discouraged from seeking their help?”

To the medical practitioner, any treatment that involves avoidable and unreasonable risk is unacceptable. However, for a “suffering patient,” their reasoning cannot be discounted, as pain is a powerful motivator.

In Conclusion

The abundance of headlines such as “Dentist gets probation for practicing without a license,” “Dental clinic allegedly operated out of a basement,” or perhaps the most terrifying, “Illegal dentists shoots, kills patient concerned about mouth pain” all sound like works of horror fiction but are actual headlines pulled directly from very real news stories.

While we could focus on the sensational facts and situations these stories pose, perhaps it’s more important to focus on why patients are willing to seek dental care in the back of a van, in someone’s basement, or through the back door of a convenience store.

Until oral health is officially recognized as a vital part of systemic overall human health and dental coverage is then expanded to every man, woman, and child, illegal dentistry, as well as the viral dental trends on TikTok and the popularity of dental tourism, will continue to dominate headlines with cautionary tales.

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Author: With over 13 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the Editor in Chief of the Incisor at DOCS Education.

References:

1. FDI World Dental Federation. Action against illegal dental practice. FDI Policy Statement, Vienna 2002
2. CareQuest Institute for Oral Health, State of Oral Health Equity in America 2022. https://www.carequest.org/SOHEA2022