Dental ‘expert’: Adnan, who works in his uncle’s unofficial dental clinic, demonstrates his knowledge using a wall chart. JP/Anissa S. Febrina
They might not be your regular dentists, but for those without much cash, they can offer a solution for cavities or missing teeth or even the desire for a more attractive smile.
Just look for their signs, they are all over the place. When you come across a picture of bright white teeth resting nicely on deep red gums, you've found one.
Unofficial "dentists" are further evidence of the city's messy health service, more proof of how "unofficialdom" rules and how some choose to - and probably can only afford to - seek instant and cheaper ways to obtain dental care.
Consider Salamah, a 25-year-old mother of one who walked into a room no bigger than 4 square meters, in an alley in South Jakarta's Pondok Labu. She was missing a tooth.
She sat in the large wooden chair in front of a mirror, creating a scene similar to that in barbers. Except that, rather than reaching for comb and scissors, the man at her service took a set of loose acrylic teeth and Salamah opened her mouth.
"Would you like a permanent or a removable one?" asked Soleh, the middle-aged unofficial dentist, or ahli gigi ("dental expert") as locals call them. He merely glanced at the spot that was missing a tooth.
Deciding on a removable one that would be attached to her neighboring teeth with a short wire, Salamah waited five minutes while Soleh finished carving the bottom side of the chosen tooth prosthesis to fit into the position.
Meanwhile, Adnan, his younger assistant, mixed pink alginate powder with a liquid substance until it turned pink and jelly-like - the artificial gum on which the prosthesis would sit.
"My neighbor suggested seeing him instead of going to the dentist. And my father, too. It's cheaper and doesn't hurt," the Jakarta native said while waiting for her new tooth. "I'm afraid of going to the dentist."
Within a mere half-hour, Salamah has a new molar that only cost her Rp 50,000 (around US$5). The procedure would take at least three times longer and be three times as expensive if she were to consult a real dentist.
And most probably the dentist would have to pull out the remaining root of her missing molar after sticking in some needles for anesthesia - a procedure that not only Salamah but most of us dread.
"I have lots of customers like Salamah. That's what we are here for," said Soleh, who has been in the business for 10 years.
He said he learned the art of making dental prostheses from his uncle, also an unofficial dentist with a practice in Jl. Fatmawati.
Both are from Madura island in East Java. So is Soleh's young assistant, Adnan, who has been in training for the past five years, watching his uncle making gypsum molds, mixing acrylic powder and skillfully placing ready-to-use tooth prostheses.
Adnan can now handle most of his uncle's customers, earning a share of the total monthly turnover of between Rp 4 to 5 million while he saves Rp 20 million to start his own business.
And that's how these "dental experts" learn their business.
This kind of dental service is actually a legacy of the Dutch era, when dentists were scarce and people went to the Tandmeester.
It was first mostly ethnic Chinese that learned the skill, but these days, most of the dental experts you bump into are either Maduranese or East Javanese - an ethnic cluster that could probably be explained by their old tradition of having golden teeth implanted as status symbol, thus making it easier for them to learn the skill of making prostheses.
Nevertheless, these businesses are actually legally recognized. Licenses for such practices can be obtained by applying to local health agencies as long as the application includes a statement that they will not attempt curative measures such as filling cavities. Their businesses are supposedly limited to making prostheses.
But as the market evolves, these "experts" venture into areas in which they have no expertise, such as filling cavities, placing braces and even extracting teeth.
JP/Anissa S. Febrina
"I have treated two patients who came with an infection after being sloppily treated by *dental experts'," said Nabila Firdaus, a 30-year-old dentist practicing in Depok's Pangkalan Jati. "They argued that they wanted cheaper service, but when it got ugly they had to pay more."
The first case she treated was a cavity filled using acrylic instead of the proper amalgam or composite.
"And the cavity had not been cleaned prior to applying the fillers," she said, adding that this omission led to infection.
In another case, she had to spend an hour drilling a prosthetic tooth loose from the acrylic that bonded it to neighboring teeth, denting the supposedly healthy teeth. This was the same measure that Soleh referred to earlier as a permanent prosthesis.
And as braces become sought after in the trend for straight teeth, these experts are also providing such services. Adnan himself proudly wears braces on his upper teeth, the work of his uncle.
Dentists actually have their own formally trained technicians to assist in making prostheses, graduates from the Dental Health Academy, like the one in Kebayoran Baru, South Jakarta. But the problem is that graduates from such schools are limited and demand is rising.
And probably the "dental experts" are merely filling this niche market and providing services that for most are still too expensive. Services provided by subdistrict level community health centers are more affordable, but are scarce. Thus, "unofficialdom" rules.
The low price of the services is their main attraction, especially for lower-middle income families, as prices could be half or even a third those for the same service from dentists. A prosthesis on either the top or bottom jaw costs a total of Rp 1.5 million, while at the dentist it will cost at least Rp 3 million. A set of permanent braces costs Rp 2.5 million while dentists charge at least Rp 5 million.
But there could be more to pay later for choosing instant and cheaper services.
Head of the Indonesian Orthodontia Association Eky Soeria Soemantri warned of the long-term damage to one's jaws and nerves if braces were placed inappropriately, not to mention the infections mentioned above.
Supervision and regulation are always a problem in Indonesia, and health authorities always blame this on the lack of human resources. The Jakarta health agency, for example, has this year started to place supervision on these dental experts.
What real action should be taken? Everyone holds their tongue.
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