PROVISION OF DENTAL CARE

; ORAL HEALTH CARE IN

EUROPE
‫گلناز عبدالمحمدزاده‬
‫دکتر انتظارمهدی‬
 INTRODUCTION

• ORAL HEALTH CARE IN EUROPE FINANCING, ACCESS AND PROVISION

• JULIANE WINKELMANN
• JESÚS GÓMEZ ROSSI
• EWOUT VAN GINNEKEN
• HEALTH SYSTEMS IN TRANSITION
• VOL. 24 NO. 2 2022
• CHAPTER 7
 SUMMERY

• ƒ ALTHOUGH ORAL DISEASES ARE ALMOST ENTIRELY PREVENTABLE, PREVENTIVE

STRATEGIES IN DENTISTRY ARE STILL UNDERUTILIZED ACROSS THE EU.
• ƒ IN NEARLY ALL EUROPEAN COUNTRIES DENTAL CARE AND HEALTH CARE
PROFESSIONALS OPERATE IN SEPARATE DOMAINS WITH DIFFERENT EDUCATION,
POLICIES, CULTURE AND TRADITIONS.
• ƒ THIS LACK OF INTEGRATION OR FOCUS ON PREVENTION MAY HAMPER THE
EFFECTIVE COMBATING OF RISK FACTORS FOR ORAL DISEASES SUCH AS DIET,
SMOKING AND USE OF ALCOHOL, WHICH ARE SHARED WITH OTHER
NONCOMMUNICABLE DISEASES (NCDS).
• ƒ FLUORIDATION OF DRINKING WATER HAS BEEN ABANDONED BY MOST
EUROPEAN COUNTRIES, BUT SALT AND TOOTHPASTE FLUORIDATION ARE
IMPORTANT STRATEGIES TO PREVENT CARIES IN THE WHOLE POPULATION. ƒ
• THERE IS LARGE VARIATION IN THE NUMBER OF DENTIST CONSULTATIONS
WHICH IS PARTLY EXPLAINED BY DATA COLLECTION METHODS. THE FREQUENCY
OF DENTAL EXAMINATIONS REFLECTS THE DESIGN OF COVERAGE OF DENTAL
SERVICES BUT IS ALSO DETERMINED BY THE DENSITY OF DENTISTS AND THE
NUMBER OF PUBLICLY FUNDED DENTISTS, AS WELL AS BY PATIENTS’ ATTITUDES
TOWARDS ORAL HEALTH.
• ƒDENTAL CARE, WHETHER IT IS COVERED BY INSURANCE OR NOT, IS MOSTLY
PROVIDED IN PRIVATE DENTAL PRACTICES IN EUROPE. ON AVERAGE, ABOUT
FOUR OUT OF FIVE DENTISTS WORK IN PRIVATE PRACTICES. THERE IS AN
IMPORTANT TREND OF FURTHER PRIVATIZATION OF DENTAL CARE DRIVEN BY
CORPORATE DENTISTRY.
• ƒ WITH DENTAL CARE COSTS VARYING WIDELY BETWEEN EUROPEAN
COUNTRIES, IT INCREASINGLY GIVES RISE TO CROSS-BORDER DENTAL CARE,
MAINLY BETWEEN WESTERN AND CENTRAL EUROPE AND AMONGST
BORDERING COUNTRIES.
• IN RECENT YEARS THE COMPOSITION OF THE ORAL HEALTH WORKFORCE HAS
ALSO CHANGED, AND THE FOCUS HAS CHANGED TOWARDS STRENGTHENING
THE INTEGRATION OF ORAL CARE INTO OTHER CARE AREAS.
 DENTAL PUBLIC HEALTH

• ORAL HEALTH IS OFTEN A NEGLECTED FIELD BOTH IN HEALTH SERVICES

RESEARCH AND IN HEALTH POLICY
• COMMON UNDERSTANDING OF THE TERM “DENTAL PUBLIC HEALTH” : “THE
SCIENCE AND ART OF PREVENTING AND CONTROLLING DENTAL DISEASES AND
PROMOTING DENTAL HEALTH THROUGH ORGANIZED COMMUNITY EFFORTS
 THE RISING AWARENESS OF ORAL HEALTH
AND THE ROLE OF PREVENTION
AND INTEGRATION
• LANCET SERIES ON ORAL HEALTH AND THE MANIFESTO “WHY ORAL HEALTH
MATTERS”
• ORAL HEALTH RESOLUTION ADOPTED BY THE WHO IN MAY 2021
• PREVENTIVE STRATEGIES IN EUROPE
• IN NEARLY ALL EUROPEAN COUNTRIES, DENTAL CARE SERVICES ARE PROVIDED
MOSTLY OUTSIDE THE HEALTH CARE SYSTEMS
 COMMUNITY ORAL HEALTH PROGRAMMES

• “IMPROVING THE KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING ORAL

HEALTH”
• PREVENTION PROGRAMMES IN SCHOOLS FOR ALL CHILDREN HAVE BECOME
COMMON ACROSS EUROPE
• EDUCATIONAL INTERVENTIONS HAVE NOT BEEN LIMITED TO SCHOOLS.
 PADI PROGRAMME

• • FREE ACCESS TO PERIODIC COMPULSORY CHECK-UPS, FISSURE SEALANTS, FILLINGS, ENDODONTICS AND ALL
OTHER TREATMENT NECESSARY FOR TEETH MAINTENANCE.
• • PAYMENT FOR CHILD DENTAL CARE IS MADE VIA ANNUAL CAPITATION VOUCHERS AND NO USER FEES APPLY.
• • EACH INDIVIDUAL CHILD SEES A PERSONAL DENTIST, AND THERE IS A FREE CHOICE OF PROVIDER FROM
DENTISTS EMPLOYED BY THE BASQUE NHS OR PRIVATE DENTISTS WITH COMMUNITY DENTAL SERVICE
ACCREDITATION.
• • CERTAIN PROCEDURES, PREDOMINANTLY THOSE IN RESPONSE TO INCISORS FRACTURE, ARE PROVIDED ON A
FEE-FOR-SERVICE BASIS AND SUBJECT TO AUTHORIZATION.
• • THE PACKAGE EXCLUDES TREATMENT OF ORTHODONTICS AND TEMPORARY DENTITION.
• • A SCHOOL DENTAL SURVEY EVALUATES THE PROGRAMME EVERY 10 YEARS.
 FLUORIDATION PLAYS AN IMPORTANT ROLE
IN DENTAL CARIES PREVENTION
• FLUORIDATED TOOTHPASTE
• COMMUNITY WATER FLUORIDATION (CWF)
• FLUORIDATION OF SALT AND MILK FLUORIDATION SCHEMES ARE VALID
ALTERNATIVES
 UTILIZATION OF ORAL HEALTH SERVICES

• PATIENTS VISITED A DENTIST FOR PREVENTIVE AND/OR CURATIVE SERVICES

• LESS OR MORE THAN 2 TIMES
• AGE EFFECT
 PUBLIC AND PRIVATE PROVISION

• PRIVATE OFFICES
• PUBLICLY FUNDED ORAL HEALTH CARE (PREVENTIVE AND EMERGENCY CARES)
• PUBLIC PROVISION IS THE MOST PRONOUNCED IN SWEDEN AND FINLAND
• NORWAY STATUTORY DENTAL CARE IS PROVIDED BY SALARIED DENTISTS IN
DENTAL CARE
• BEFORE 1990
• AFTER 2004
• IN 2021 PUBLICLY FUNDED ORAL HEALTH CLINICS
 CORPORATE DENTISTRY

• THEY ENSURE FINANCIAL STABILITY

• OFFER ADVANTAGES OF INVESTMENT IN TECHNOLOGY
• ALLOW FOR INCREASING SPECIALIZATIONS
• INCREASING INTEREST IN EUROPE
• IN MOST EUROPEAN COUNTRIES THE SHARE OF CORPORATE DENTISTRY IS STILL
RELATIVELY SMALL BUT GROWING
 CROSS-BORDER DENTAL CARE

• “DENTAL TOURISM”
• WESTERN AND CENTRAL EUROPE AND AMONGST BORDERING COUNTRIES SUCH AS AUSTRIA
AND HUNGARY
• BUDAPEST CONSIDERED EUROPE’S DENTAL TOURISM CAPITAL
• ROMANIA AND CROATIA, CURRENTLY ENVISION DENTAL TOURISM AS A PROMISING
INDUSTRY
• IN SWITZERLAND PEOPLE GO TO OTHER COUNTRIES
• FRANCE AND GERMANY, WHERE A WIDE RANGE OF SERVICES ARE COVERED IN THE BENEFITS
BASKET AT A FIXED MAXIMUM REIMBURSEMENT
• PROSTHETIC REHABILITATIONS TO INDIVIDUALS LIVING IN NEIGHBOURING
COUNTRIES OR COUNTRIES WITH HIGHER PRICES
• PROSTHETIC REHABILITATIONS TO INDIVIDUALS LIVING IN NEIGHBOURING
COUNTRIES OR COUNTRIES WITH HIGHER PRICES
• IN SWEDEN THE EMERGENCE OF LOW-COST DENTAL PRACTICES STAFFED WITH
DENTISTS MAINLY FROM EASTERN EUROPEAN COUNTRIES HAS BEEN A TREND
SINCE 2005.(THREE MONTHS AND MAY FACE LOWER QUALITY OF THE ORAL CARE
PROVIDED )
• DO NOT BENEFIT ALL EU CITIZENS
 TRENDS IN DENTAL CARE PROVISION

• LARGER GROUP PRACTICES TO MEET THE HIGHER INVESTMENT COSTS FOR EXPENSIVE EQUIPMENT
BUT ALSO TO SHARE RESPONSIBILITIES AND CONCENTRATE ON DIFFERENT TYPES OF CARE
• INDIVIDUAL PRACTICES (RUN BY ONE SINGLE DENTIST) VIRTUALLY DO NOT EXIST ANY MORE IN
THE UK
• IN THE NETHERLANDS THE SIZE OF PRACTICES HAS INCREASED BETWEEN 1995 AND 2018, WHILE
THE NUMBER OF INDIVIDUAL PRACTICES DECREASED
• COMPOSITION OF THE ORAL HEALTH WORKFORCE HAS ALSO CHANGED (ROLE AND NUMBER OF
DENTAL HYGIENISTS AND PREVENTION ASSISTANTS )
• TEAM APPROACH (RISING NUMBERS OF OLDER PEOPLE)
THANK U ALL 