In front of a mechanic’s workshop next to the mosque where he used to pray, Mahmoud, 70, saw a man pulling out a customer’s molar and fitting him with a replacement, having placed his extraction tools on the same table on which the mechanic puts his own kit. Mahmoud, who had lost a number of his teeth and had a molar hurting him to the point of keeping him from sleeping, was occupied by only one question: how much would the treatment cost?
When he asked the mechanic about the man’s price, he received an answer that dispelled his hesitation: “Much cheaper than dentists.” So he agreed with a man called “Emad”, who presents himself as an Indian dentist, to extract the molar and fit a denture for EGP 7,000 (about $145).
The procedure began in front of the workshop with the extraction of the molar, with “Emad” to return a few days later to fit the denture. But the second time he came to Mahmoud’s home, and the two sat on the floor, with no dental chair, no sterilisation unit and no measure of any kind to prevent the transmission of infection, a young Egyptian man assisting him by handing him the tools, and next to them a cup of water in which a piece of cotton was dampened and used to wipe the teeth more than once, without sterilising the tools or changing what touched the patient’s mouth.
The denture did not turn out as Mahmoud expected; it was closer to a white lump resembling plaster fixed onto his teeth, in a way he describes as unsatisfactory. He paid the full amount, and then the man left without leaving any medicine, treatment instructions or anything to guard against infection and complications.
When Zawia3 asked him why he accepted the procedure in this way, he did not speak of trust in the man nor of the quality of the denture, but of money alone; he cannot afford the cost of doctors, and what he paid was within his means. He says: “I have no choice; dentists’ prices are very high and I cannot afford to pay them, and illnesses strike us anyway, so what could possibly happen through the teeth?”
Mahmoud did not treat the matter as a medical gamble, but as the available option, without knowing who treated him, where he works, how his tools are sterilised or what might befall him after the “healer” left. His case opens the door onto a phenomenon that has not yet been documented in Egypt: people who impersonate dentists and carry out extractions and fittings in the streets, cafés and homes, some of whom present themselves as Indian or of other nationalities without any verification of their identity. It is an old practice rooted in India itself, where it has spread openly for decades, and international media have previously covered it, among them a report attributed to “Sky News” titled “Pulling a Molar for a Dollar”. In Egypt, the service provider passes by the customers of cafés and shops offering to extract teeth, trim them or fit a full denture at prices far lower than clinics that patients like Mahmoud cannot afford.
A Pharmacist Earns Less Than a Customer-Service Worker in Egypt
The Phenomenon Is Documented Globally, and There Is No Egyptian Study of It
There is as yet no documented Egyptian study measuring the scale of the impersonation of the dental profession in the streets, which makes this investigation, with its field testimonies, an attempt to document it locally. But the phenomenon itself is documented globally, especially in countries where the gap between the cost of specialised healthcare and the citizen’s ability to bear it is widening.
A recent report issued by the FDI World Dental Federation (FDI) warned that the illegal practice of dentistry has turned into a growing global health risk, and pointed out that more than half of the medical associations participating in its survey recorded cases of actual harm inflicted on patients as a result of these practices.
In India, where the phenomenon has been widespread for decades under the name “street dentistry”, a study published in the Indian Journal of Dental Research documented the methods of these practitioners: extracting teeth without sterilisation, using non-medical acrylic materials in fillings and fittings, and even reusing teeth extracted from a previous patient and fixing them for another with adhesive, in a pattern that intersects, in the absence of sterilisation, with what happened to Mahmoud. The medical literature indicates that these practices may lead to loss of the bone supporting the teeth, local infections and blood poisoning in advanced cases, and, in the worst scenarios, to death.
A clinical study conducted at a military hospital in Pakistan on 240 patients also found that exposure to unsterilised tools, at barbers or unqualified dental practitioners, represents one of the most important transmission routes for the hepatitis B and C viruses. Although conducted outside Egypt, these studies record a pattern that recurs wherever the same gap exists: a patient who cannot afford the cost of safe treatment, and an unlicensed practitioner who fills the gap with tools that do not meet the most basic safety standards.
Universal Health Insurance Amendments Raise Fears Over the Fate of Earmarked Funds
“EGP 600 for the Fitting”: A Call With One of the Service Providers
Mahmoud’s case was not an isolated one, and reaching the providers of these services seemed easier than one might imagine. To verify the nature of what they offer, the author of this investigation called a man who said he was from Syria, after obtaining his number from a woman who had previously dealt with him and said he was of Indian nationality. The contradiction between the two accounts of his nationality is not a marginal detail; the patient does not know who treated him in the first place: not his name, nor his nationality, nor his fixed place of residence, which makes reporting or tracing more complicated.
The call began with a question about dealing with an “inverted” wisdom tooth, then about a broken, decayed tooth and the possibility of extracting it and fitting a replacement. The man revealed an activity he actually practises; he said that the cost of fitting a molar is EGP 600 (about $12), the same price as fitting a “cap”. But he showed no enthusiasm for extraction, and said: “If there is a solution without extraction, then we won’t extract, God willing,” justifying his reluctance: “The patient might have diabetes or a heart condition, and I am worried for myself, not for you.” He repeated more than once that his work is concentrated on fittings, and when the author of the investigation asked him about fillings or cleaning, he answered that his work is limited to fittings only.
His work was not tied to a specific clinic; when asked where he would come, he said that he comes to the place the customer specifies, and he enquired about the place of residence; when the author of the investigation mentioned Shubra, he went on to ask about the details, and asked for pictures of the teeth to be sent via “WhatsApp” to determine what could be done. Thus a call that lasted only minutes revealed the mechanism for reaching these services: a phone number passed between people, direct contact with the customer, the setting of a price, and travel to the customer’s location instead of a known medical facility. During the conversation the man seemed flustered, repeatedly asking who had given her the number before revealing his work, and when the author of the investigation declined to reveal her source, he hurried to end the call, in what appeared to be apprehension that the caller might be from the police or the press.
After this low-cost service, a legal and medical question remains: who in Egypt has the right to extract teeth and fit dentures, and what guarantees does the patient have when these procedures are carried out outside a licensed clinic at the hands of a person of unknown qualifications?
Too Many Graduates: or Failed Planning? Egypt’s Medical Placement Cuts
Head of the Dental Syndicate: The Danger Lies in the Absence of Infection Control
Walid Hassan, head of the Dental Syndicate in Cairo, tells Zawia3 that what happened to Mahmoud and what the call revealed is not an exception, but an extension of a phenomenon he has known for years; practising dentistry away from clinics “is not new”, and it does not stop at extraction but sometimes extends to fittings in the street.
The head of the syndicate locates the source of the danger in the absence of the most basic rules of infection control; while clinics and hospitals spend large sums and great effort on sterilisation and patient safety, this cannot be provided “in any way whatsoever” in the street or at cafés. He explains that potential infection is not limited to a single disease, but includes types of bacteria and viruses transmitted through blood and saliva, asking: “If there is blood on the person’s hand, and he is, God forbid, infected with a contagious disease, what could happen? There are diseases and viruses transmitted through blood, and others through saliva, among them tuberculosis,” and he describes the scene that recurs in the streets: “He holds a cigarette and a cup of tea, his hand is not clean, and he deals with a patient whose state of health he does not even know.”
He recounts an incident he sees as summing up the problem: a citizen underwent a tooth extraction inside a hospital with sterilised tools, but after leaving he went to a café, and while the extraction site was still open he met a person wandering around with a bag offering to fit teeth, and he agreed; the next day his condition deteriorated and his face swelled, so he returned to the same hospital accusing it of being “the one that caused the problem”, even though the complications resulted from a later procedure outside it at the hands of a non-specialist. He comments: “You have just had your tooth extracted or a procedure done on your teeth, so why do you let another person interfere with your teeth again as you are walking out of the hospital?”
The head of the syndicate does not attribute the problem to poverty and the absence of alternatives alone, but to a mistaken belief he sees as widespread, that dealing with non-specialists “merely because they are of other nationalities” or outside the medical framework is safer, and he considers it the result of “misleading discourse”; the citizen himself “goes to the clinic and asks where are the gloves? Where is the sterilisation?”, then “allows a person to deal with his teeth while he is sitting at a café”. On the legal level, he explains that whoever practises the profession without specialisation is subject to accountability as “a pretender to the medical profession”, and that this is indeed a crime, but the dilemma lies in the reporting mechanism when the incident takes place in the street, far from any facility that can be traced, and for this reason he places partial responsibility on the citizen for filming, documenting and reporting.
He recalls his previous experience as head of the Central Administration of Dentistry at the Ministry of Health, when the ministry, according to him, led an awareness campaign that lasted about two and a half years and reached about 7.5 million citizens through seminars inside health units and hospitals, and he calls for repeating the experience nationally: “There must be awareness for citizens, and it must be a national campaign and an initiative that falls within the scope of the presidential initiatives, and it must include awareness in all the media.”
Ashraf Radwan: Where Is the Judicial Enforcement Power?
If Walid Hassan focuses on the health and awareness dimension, Ashraf Radwan, one of the former leaders in the healthcare system, goes straight to the question of who is responsible for controlling these practices on the ground. He tells Zawia3 that the phenomenon, which appeared in some countries before moving to Egypt, “exploits citizens’ needs and their poverty” and exposes them to grave health and legal risks, and he does not settle for awareness but asks about the absence of enforcement tools: “The syndicate must have a role, and the awareness role is important, but where is the role of discipline? Where are arrest and summons? Where is the judicial enforcement power? And does anyone in the syndicate have judicial enforcement powers over these people?” He proposes a specialised task force to accompany the security agencies to assess cases technically “so that it can determine whether this is a violation or not”.
He recalls an incident from his clinic resembling what happened to Mahmoud: a patient came to him after having had a dental fitting done by “a Syrian person who was passing by carrying a bag”, and he comments: “What is this? And where do we stand in this story?” He does not confine the phenomenon to a particular nationality, but asks: “Where is the role of the infection control department in what is happening in the street, from the Indians and others?”; what the practitioners of this activity have in common, despite their varied backgrounds, is the absence of licensing and supervision. He sums up the risks in one sentence: “What happens in the street is a source of infection, and this is self-evident,” reminding that the Ministry of Health has two departments for precisely this purpose, infection control and quality, questioning their absence, and warning that the danger is not limited to the “C” virus: “It is not virus C alone; there are many things that could happen, and diseases transmitted through tools we do not know what is in them. These are not clinics.”
He does not see low cost as justifying putting health at risk, but he does not settle for condemning those who resort to it; rather, he criticises the absence of alternatives, citing his experience when he was running a dental centre on El-Merghany Street in Heliopolis and concluded contracts with bodies such as the Journalists Syndicate and the union committee at Al-Ahram to provide treatment at reduced prices: “Whoever is financially unable to afford treatment can go to a decent, respectable clinic.” He calls on businessmen and civil society to participate in providing safe alternatives for people on limited incomes, citing the upgrading of the Abbasiya Child Care Centre with donations from banks and companies, and he links the phenomenon to a broader yardstick of the state’s progress: “If this happened in a developed country, would they allow it? Even in a country like the UAE or Saudi Arabia, would anyone dare to do this? Of course not.” He believes that confronting it requires integration between the government, the syndicates, businessmen, civil society and the media, not loading the full responsibility onto a single party.
The Ministry of Health had not issued a comment on the absence of the infection control and quality departments from confronting these practices and the mechanisms for controlling them as of the time this report was prepared.
All the threads lead back to the question with which Mahmoud began: how much will the treatment cost? When the price of a licensed clinic exceeds the means of a segment of Egyptians, the street, the café and the home become an alternative, and the person carrying a bag of tools becomes a “doctor” regardless of his nationality, his qualifications or his adherence to the most basic rules of sterilisation. As Walid Hassan and Ashraf Radwan see it, confronting this does not rest on a single pillar; awareness alone is not enough without actual enforcement and clear reporting mechanisms, and enforcement alone is of no use if people on limited incomes remain without a safe and accessible alternative.
As for Mahmoud, the denture for which he paid EGP 7,000 is still in his mouth, and his question remains hanging: “Illnesses strike us anyway, so what could possibly happen through the teeth?”, while the studies and testimonies above answer it with what did not occur to him when he first sat on the floor in front of a man carrying a bag of tools.
