A case of quackery and obsession for diastema resulting in avoidable endodontic therapy

Perception of midline diastema differs among individuals and cultures. To some, it is a feature of beauty, while to others it is aesthetically appalling. From a scientific point of view, midline diastema is a deviation from normal adult dentition. It is not uncommon among some African natives to find individuals demanding for artificially created midline diastema from dental practitioners.

To present a rare case of pulpal necrosis involving maxillary and mandibular central incisors as a result of poorly executed teeth modification in a bid to create upper and lower midline diastemata.

A 23-year old lady presented with history of spontaneous, sharp, persistent pain associated with palatal swelling and discharging sinus of two weeks duration in relation to maxillary central incisors (11, 21). The complaint was preceded by a history of recurrent pain in relation to 11, 21, 31 and 41 which started soon after obtaining artificially created maxillary and mandibular midline diastemata from a dental quack. Periapical x-ray revealed periapical radiolucency in relation to 21 and 41. Vitality test confirmed necrotic pulp in the lower central incisors. The affected teeth were scheduled for root canal therapy (RCT) and porcelain fused to metal crown. The RCT of 11 and 21 had been completed but further treatment stalled due to financial constraint.

This is a case of obsession for midline diastema, poor dental health education, and illegal dental practice.