Quackery in Nigeria: A case for Strengthening Health Systems on Regulating Informal Dental Providers

Abstract

Background: Dental quackery, the provision of dental services by unqualified or unregistered individuals, poses substantial patient safety and governance challenges in low- and middle-income countries (LMICs). In Nigeria, anecdotal and clinical reports suggest widespread informal dental practice, yet systematic health policy analyses are limited. Emerging evidence links informal care to severe clinical outcomes, including markedly increased mortality. This study provides a system-level examination of dental quackery in Nigeria, situating clinical, regulatory, and comparative evidence within a health systems framework.

Methods: A mixed-methods case study design was employed, guided by the WHO Health Systems Building Blocks framework, with governance as the central lens. Three data sources were integrated: (i) clinical data from a Nigerian study documenting preadmission exposure to informal dental care and associated outcomes; (ii) regulatory and policy analysis of instruments including the Medical and Dental Practitioners Act, Code of Medical Ethics, National Oral Health Policy, and allied regulatory frameworks, assessing enforcement capacity, coordination, and accountability; and (iii) comparative evidence from a Selective Review from Nepal and India examining prevalence, utilization patterns, and regulatory gaps. Clinical data were analyzed descriptively and using logistic regression, with mortality as the primary outcome, while regulatory documents were thematically coded using the WHO framework. Comparative analysis employed structured cross-country synthesis to identify recurring drivers and contextual differences.

Findings: Dental quackery in Nigeria is both prevalent and clinically consequential. In the reviewed study, nearly half of patients (46.4%) had teeth extracted by informal providers before hospital presentation, and 82.7% received inappropriate antibiotics from chemists. Mortality was 11.0%, with 96.2% of deaths occurring among patients exposed to quack care; preadmission informal treatment increased odds of death by approximately 29-fold. Structural determinants, including severe workforce shortages (dentist-to-population ratios as low as 1:254,521), maldistribution, high out-of-pocket costs, limited-service integration into primary care, and fragmented regulatory enforcement, facilitate reliance on unregulated providers. Comparative evidence from Nepal and India reveals parallel patterns: low public awareness, affordability-driven demand, and persistent regulatory gaps, although clinical outcomes are less frequently quantified.

Conclusion: Dental quackery in Nigeria is a systemic failure of the health system rather than a series of isolated regulatory breaches. Effective mitigation requires integrated, multi-stakeholder interventions: strengthening workforce capacity and distribution, embedding oral health within primary care, expanding financial protection, improving public awareness of provider qualifications, and enhancing coordination and enforcement across regulatory bodies.