Streetside dentists
Entrepreneurs in Bangkok everywhere you look
By Jon Fernquest[Introduction|Vocabulary|Article]
[Reading Questions|Answers]
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Bangkok is a city full of entrepreneurs
Today's article looks at one type of streetside entrepreneur you are likely to find as you wander around the streets of Bangkok.
With a history going back at least 100 years, the artisan of dentures and false teeth fills a useful niche, albeit technically illegal, in the world of Bangkok teeth.
Thai professional dentistry has been around for decades. In Bangkok there is a surplus of professional dentists, actually too many per member of the population.
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Note that you can even buy false teeth for your dog.
Maybe a new export industry someday?
For further reading, read about a recent survey of Bangkok street vendors about the problems they face doing business.
Reading Questions
Here are some questions to guide your reading (See answers at end):1. What are some good points and bad points about dentures purchased from false teeth artisans rather than professional dentists? (Look for answers as you read)
2. What part of Bangkok can you find these streetside dentists?
(Look for answers as you read)
3. Do the false teeth artisans work on the side of streets?
4. Do false teeth artisans operate legally?
5. How expensive are the dentures made by artisans?
6. Can everyone afford the dentures made by artisans?
7. In what other countries can one find these denturists?
8. Whats up? Is there a shortage of dentists in Bangkok?
9. What other dental services besides false teeth and dentures do these artisans provide? Why don't they offer more services?
10. When did the first false teeth artisans start doing business?
11. What part of town did their business start to grow and proliferate in? When?
12. How and when did traditional teeth practitioners become illegal?
Bangkok Post Article June 21, 2007
Professional or artisan? The choice is yours
Some people still opt to visit a roadside stall rather than a modern dental surgeryPICHAYA SVASTI
On the crowded pavement beside Bangkok's Maha Rat Road are a few stalls displaying false teeth. There are signs saying "Making and Fixing Dentures" and contact numbers, too.
The purpose of the stalls is to attract customers to a row of shophouses in a nearby alley in front of Maha Rat pier, where over 20 makers of false teeth work.
"Brokers" from the stalls usually lead potential customers to this alley. In front of each shophouse are placards advertising the false teeth makers' work experience and fame, like "Original" or "As Seen on TV".
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Among these false teeth makers is 45-year-old Wanpen Phetnual, wearing a sleeveless T-shirt and leggings. Her workstation is an ordinary table with a tray containing samples of fibreglass dentures, a plastic box containing ready-to-use dentures, a drill, dental impression silicone, cyanoacrylate adhesive, some chemicals and tools.
In her shop in the alley, a middle-aged male customer ordered a set of six sets of dentures for 1,200 baht. Wanpen showed him samples, and let him choose the materials and colours he preferred.
She asked him to bite into dental impression silicone, removed it from his mouth, dipped it in the water and filled it with plaster to make a mould.
Wanpen said, "I make dentures, false canine teeth and fashionable crowns. I do not do extractions, fillings or scaling, because it is dangerous to do that without the proper equipment. Those with dental cavities or an infection will be rejected and are advised to see dentists first."
While working, she talked to customers and made them laugh. Producing each set of dentures usually takes her between one and four hours.
For her latest customer, it took four hours, because the dentures did not fit his mouth properly. Wanpen had to use the drill to reshape the false teeth until the man was satisfied with the fit.
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His dentures, obtained through a dentist, fell apart after he ate a sticky Thai dessert called kalamae. He went to hospital to get them fixed, but the queue was too long for him to wait.
Udom said, "I trust dentists, but one problem I have with them is that I have to wait so long. For dental crowns, people have to wait for up to two years. I have been waiting for six months at a public hospital for dental crowns which requires tooth drilling and bridge making."
According to Wanpen, customers mostly come to her shop, owned by her and her three siblings, for dentures, but prefer dentists for other tasks.
Wanpen, her younger brothers Paithoon and Veera, and her younger sister Mali, learned how to make false teeth from their late father, Dokdin Phetnual, who was a military doctor, and she claimed to be the first false teeth maker in this area.
According to the Phetnual family, stalls near Sanam Luang and Tha Phra Chan pier date back over 30 years, to around 1972-7. This family has been operating here since 1985.
Dokdin ran a false teeth stall on the roadside near Tha Phra Chan pier until 1995, when the city re-organised street trading. Dokdin relocated his business to the nearby Wat Maha That's compound and finally the top of a monk's quarters. He died six years ago and his children had to move to this shophouse about three years ago during the temple's renovation. According to Wanpen, her shop and tools are clean, and customers like chatting with her and appreciate her lifetime guarantees.
However, the business is not doing as well as it did in the past, due to the economic downturn. Currently, the four earn approximately 10,000 to 30,000 baht a month. Wanpen charges 200 baht for single false tooth, 800 baht for a false canine tooth, 2,000 baht for a fashionable dental crown and 2,500 to 7,500 baht for a full set of dentures.
She charges elderly customers only 100 or 200 baht for fixing dentures made from elsewhere. For poor customers she doesn't charge at all.
Other teeth makers charge 300 to 400 baht for a false tooth and 200 to 300 baht for repairs, she said.
So why do many Thais opt for these artisan traders, rather than dentists?
Wanpen replied, "We use similar techniques and materials. Dentists do good work, but it's slightly expensive and slow. Even rich but thrifty people come to us. Everyone wants good, cheap things."
Her customer Udom agreed and said, "It's a matter of price and decision-making power."
But, Somsri, a 69-year-old Si Sa Ket maid at a house in the Bang Kapi area, said convenience was the reason why she used a home delivery service by a false teeth maker recommended to her by a som tam vendor about three years ago.
"He came in a pick-up truck with clean tools and antiseptics. It was convenient and saved travel expenses and time. Instalment payment programmes were also available. But, there was no warranty," she added.
Several years ago, a similar question, "Why do people opt for denturists who are not recognised by the state?" popped into the mind of dentist Suphaluk Lertnanorut.
While working in the northeastern province of Loei, she had to treat several cases of infection caused by bad dentures. This prompted her to do research that later developed into her master's degree thesis at Mahidol University in 2005, entitled Street Denturists: The State, the Dental Profession and Illegalisation. Case Study of a Group of Denturists in Bangkok.
According to her findings, there are false teeth makers in Thailand and countries including China, India, Morocco and Tibet where dentures are available at stalls for customers to try on like shoes, and some false teeth makers also undertake oral surgery, including extractions.
In Thailand, many false teeth makers also offer dental crown and teeth whitening services, either openly or secretly. They may be unregistered, but there is no clear official policy to crack down on them.
In Bangkok, many false teeth makers work on the roadside areas, such as Maha Rat Road near Wat Maha That. Some operate from vans. However, the dentist, Suphaluk, believes that their popularity had nothing to do with accessibility to dentists.
"Because there are more dental clinics than 7-Elevens in Bangkok. Currently, the dentist per population ratio is 1:1,700 in Bangkok and 1:25,000 in the provinces," she noted.
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"Their work is on the same basis as dentists, yet in a simplified way. It excludes extractions or anything that can cause bleeding," Suphaluk said.
False teeth makers always ask customers with cavities or gingivitis to seek treatment from dentists before returning to them for dentures.
False teeth makers consider themselves craftsmen, not doctors, though they order dentures and materials from the same labs as dentists. But they can offer better prices by choosing lower-quality materials.
According to Suphaluk's thesis, the existence of false teeth makers in Thailand is believed to date back to the late Ayutthaya period, but they were first recorded in the reign of King Rama III over a century ago.
The book Mom Ped Sawan tells of a famous Chinese "tooth artist", named Jeen Yoo, who made dentures from wood and coconut shells for sale to Bangkokians.
Back in 1919, over 20 Chinese dental shops and two Japanese dental stops lined Charoen Krung Road. Sixteen of them were situated in front of Wat Mangkon Kamalawat, or Leng Nei Yi temple. Six or seven more were located near Hua Lamphong railway station and some more in Bang Lamphu and Bang Rak.
The business was booming because the Chinese liked gold crowns and opted for extractions, fillings and root canal work there.
So why, how and when did traditional teeth practitioners become illegal?
To find the answer, Suphaluk studied the legislative process in Thailand and the West. She found that the use of power to divide, control and monopolise medical roles went hand-in-hand with the creation of professional bodies.
In Europe, dental work changed hands from priests to barbers and then to dentists. In Thailand, the state played a major role in outlawing traditional healers, by changing concepts and laws on medicine and promoting professionalism.
The Medicine Act of 1923, the country's first such legislation, clearly separates modern and traditional practises, legalising only professionals. However, this law came before formal education for dentists existed in Thailand (the country's first faculty of dentistry was established in 1940).
Since the Medicine Act, practitioners who used herbs, smoke or holy water have been excluded from the traditional medicine category and become illegal.
Nonetheless, informally-trained Chinese dentists could choose to register with the state as second-class dentists, with some conditions like a ban on root canal work and treatment for impacted teeth. Very few of them remain in business, but some have children who are working as dentists or dental technicians.
Due to the legislation process, designed to secure public acceptance for trained dentists, most Thais turn to dentists for tooth extractions, fillings, scaling and polishing for reasons of safety.
Yet some people still opt for false teeth makers. They are believed by many dentists to have no access to state dental services or to be unhappy with the medical staff's communications skills.
But Suphaluk's surveys reflect that these people instead want to show their objections to dentists' power over them. Dentists decide prices, times and treatments, and regard them as patients, while false teeth makers consider them customers, with bargaining power. This implies some people's desire to protest against state power.
Suphaluk pointed out that false teeth makers survive in Thai society mainly because of support from people and social networks. Word of mouth recommendations build confidence among potential customers. Old customers usually show their smiles and ask for comments from waiting customers.
Praising this research, Dr Komart Chungsathiansup of the Foundation for Consumers commented that Thai dentists are not committed to helping the grass-root level because their profession was born in Thailand abruptly through a monopoly of power.
"The more false teeth makers try to catch up with dentists, the more they will lag behind the dentists who resort to more high-end technology. The gap will get wider, and more villagers will turn to false teeth makers," the Harvard University Medical School graduate predicted.
Dental Problems and Services
dentures - replacement teeth for missing teeth (See Wikipedia on dentures)
false teeth - replacement teeth, artificial teeth, fake teeth
cavities - holes in teeth (See Wikipedia on dental caries)
fillings - filling a cavity in a tooth, "a dental restorative material used to artificially restore the function, integrity and morphology of missing tooth structure" (See Wikipedia on dental restoration)
extractions - pulling out teeth (ouch!)
root canal - saving a tooth by removing an infected root of the tooth, before it gets worse (See Wikipedia on root canal)
dental crowns, gold crowns - (See Wikipedia on crowns)
a bridge - a partial denture that is not removable by the patient (See Wikipedia on bridges)
scaling - scraping away the hard bacterial plaque that collects on teeth (See Wikipedia on teeth scaling)
polishing teeth
teeth whitening - use chemicals to make teeth white again, to have a nice smile (See Wikipedia on teeth bleaching and cosmetic dentistry)
oral surgery - surgery on the teeth, gums, and mouth (See Wikipedia on oral surgery)
impacted teeth - when the rearmost and last teeth you get start growing in th wrong direction, usually have to be removed (See Wikipedia on impacted wisdom teeth)
gingivitis - gum disease, inflammation of gums (See Wikipedia on gingivitis)
Locations in Bangkok, Links to Wikipedia
Can you find all the places mentioned in the article on this map of Bangkok?
Maha Rat pier
Maha Rat Road
Wat Maha That
Sanam Luang
Tha Phra Chan
Charoen Krung Road
Wat Mangkon Kamalawat
Leng Nei Yi temple
Bang Lamphu
Bang Rak
Vocabulary (in discussion above)
albeit - although, reduces force and qualifies what was just said
professional - a person's who works at a specialised job that requires special training and high standards (for example, doctors, lawyers, architects, are all considered professionals)
artisan - a person whose job requires skilled work with their hands
shophouses - building with a shop downstairs with home upstairs, typically found in Thai towns
alley - a soi, a small street running off of a large street
placards - a large notice displayed in public
an impression - a copy of something (like teeth) after being pressed into a material (like clay or mud)
dental impression silicone - clay-like material that dentists use to make a copy of your teeth
a mould, a mold - hollow container, pour hot metal into it, and you get a statue or some other solid object
hesitantly - not sure, going slowly, testing before doing fully
broke the ice - talked to and tried to make friends with someone they did't know
lifetime guarantees - will replace for free forever, without time limit
thrifty people - people who like to save money, who are very careful about spending money, try not to waste money
instalment payment programmes - buying first, then paying for it in small monthly payments
no warranty - if it breaks they won't replace it for free
crack down on - enforce a law
for hygienic reasons - for cleanliness reasons
Medicine Act of 1923 - the country's first legislation setting legal requirements for the practice of medicine and dentistry, not that this law came before formal education for dentists existed in Thailand, the country's first faculty of dentistry was established in 1940
Word of mouth recommendations - (See Wikipedia on word of mouth)
Foundation for Consumers (FFC) - works directly with consumers and consumer protection policy advocacy, the main leading consumer organization in Thailand (Read about at website)
grass-root level - at the level of ordinary people, not the rich or famous
Answer Key:
1. What are some good points and bad points about dentures purchased from false teeth artisans rather than professional dentists? (Look for answers to this question as you read)
a. Bad: No warranty
b. Bad: People sometimes get infections from defective dentures.
c. Bad: Not registered or licensed so it is difficult to know how skilled they are.
d. Good: Cheaper.
e. Good: Shorter waiting time.
f. Good: Treat you like a customer, rather than talk down to you like a patient.
d. Good: Instalment payment plans sometimes given.
e. Good: Can still use if you have no access to state dental services or to be
f. Good: Some are unhappy with the communications skills of professional dentists and their staff
("While working in the northeastern province of Loei, she had to treat several cases of infection caused by bad dentures.")
2. What part of Bangkok can you find these streetside dentists?
In the China town area down to Sanam Luang.
3. Do false teeth artisans work on sides of streets?
No, they work in shophouses down sois (alleys). The stalls on the sidewalk are just advertising to attract customers.
4. Do false teeth artisans operate legally?
No, they are not registered with the government, so they operate illegally.
5. How expensive are the dentures made by artisans?
Very cheap. Six dentures for 1200 baht means they could cost as little as 200 baht per denture set, but the average price seem a little bit more expensive than that:
("She charges elderly customers only 100 or 200 baht for fixing dentures made from elsewhere. For poor customers she doesn't charge at all. Other teeth makers charge 300 to 400 baht for a false tooth and 200 to 300 baht for repairs, she said.")
6. Can everyone afford the dentures made by artisans?
Yes, everyone can afford them. In the article even a 69-year old maid from provincial Si Saket working in Bangkok comes to buy some following the recommendation of a Somtam vendor.
Discounts for things like repairs are given to the elderly and the poor.
("But, Somsri, a 69-year-old Si Sa Ket maid at a house in the Bang Kapi area, said convenience was the reason why she used a home delivery service by a false teeth maker recommended to her by a som tam vendor about three years ago.")
7. In what other countries can one find these denturists?
China, India, Morocco and Tibet are listed in the article.
8. What's up? Is there a shortage of dentists in Bangkok?
Definitely not, there are "more dental clinics than 7-Elevens in Bangkok. Currently, the dentist per population ratio is 1:1,700 in Bangkok and 1:25,000 in the provinces."
9. What other dental services besides false teeth and dentures do these artisans provide? Why don't they offer more services?
a. Dental crowns.
b. Teeth whitening services.
More services aren't offered "for hygienic reasons." When there is blood involved as there is in tooth extraction or fillings, a special clean and sterile professional dentists office is necessary.
("'Their work is on the same basis as dentists, yet in a simplified way. It excludes extractions or anything that can cause bleeding,' Suphaluk said.")
10. When did the first false teeth artisans start doing business?
Probably the late Ayuttthaya period, but the first recorded artisans are during the reign of King Rama III.
11. What part of town did their business start to grow and proliferate in? When?
This business grew the most in the Chinatown area around 1919.
12. How and when did traditional teeth practitioners become illegal?
The Medicine Act of 1923 made only professionals registered with the state legal. Some Chinese artisans were registered but their numbers have dwindled.
("The Medicine Act of 1923, the country's first such legislation, clearly separates modern and traditional practises, legalising only professionals. However, this law came before formal education for dentists existed in Thailand (the country's first faculty of dentistry was established in 1940)..."
"Nonetheless, informally-trained Chinese dentists could choose to register with the state as second-class dentists, with some conditions like a ban on root canal work and treatment for impacted teeth. Very few of them remain in business, but some have children who are working as dentists or dental technicians.")
