Modern dentistry stresses prevention through regular checkups. (source: SME)
HUMANS have been getting their teeth drilled for several thousands of years and in spite of all the technological advances in dentistry the dental drill still remains one of the most important instruments available to dentists. The good news for Slovaks is that top-quality dental treatment – in terms of materials, technology and procedures – is available here: the question is only how much patients are willing to pay. Most of the latest dental techniques are not covered fully or at all by the public health insurance scheme. But for most people there is a cheaper alternative, which is also the main current trend in dentistry: prevention.
“Dental treatment in Slovakia, as elsewhere in the world and in other developed countries in Europe, focuses especially on prevention of diseases of the oral cavity and on raising the awareness of citizens about oral health,” Simona Dianišková of the Slovak Chamber of Dentists, told The Slovak Spectator. “Along with this we also focus more on prevention in the case of children and other vulnerable members of the population.”
Dentists, when asked about trends in their practice, also list efforts to minimise interventions, and say that the question of aesthetics is becoming more and more important. But they warn that dentistry cannot exist without the drill. Dentistry has not actually made any major breakthroughs in dental medicine with respect to tooth health in the last few years.
Tomáš Pánek, a dentist who runs a private practice in Bratislava with a branch in Malacky and who specialises in dental implants and dentures, recalled that the first evidence of cavities being treated by drilling have been found on bones that are 10,000 years old.
“Thus in all those years we have not improved on the dental drill, except to make it much more sophisticated,” Pánek told The Slovak Spectator.
But while drills are still with us, many improvements have been achieved, especially in new materials, technologies and procedures. Huge headway has been made in dental implants and dentures, with more stress laid on aesthetics – to make teeth not only healthy but also look good, according to Pánek.
Dentist Alexander Schill, who runs a private clinic in Bratislava, agrees that even though there are new technologies, for example laser and ultrasound instruments, no practice can do without a dental drill. When asked about the latest trends he reiterated that prevention is best, and also mentioned better diagnostics.
“Prevention and related measures should reduce and can possibly eliminate the occurrence of oral health diseases,” Schill told The Slovak Spectator, adding that when intervention is needed then also the aesthetic question is taken into consideration, for instance dental implants are used instead of dental bridges or dentures.
Pánek added that now the trend is to keep as many healthy teeth or as much original tissue in patients’ mouths as possible.
“Any substitute is only a substitute. We are only rarely able to create in the mouth something that is better than what nature can create in optimum circumstances,” Pánek said, adding that of course some people are unlucky enough to have a generic predisposition for teeth which are naturally ugly, bad or prone to cavities.
The level of dental care in Slovakia
With regards to dental care and trends in Slovakia, Pánek identified two viewpoints. One is what dental care is able to achieve and provide in individual practices, and the second is where the general level of dental care and oral health in Slovakia is. While he believes that some practices in Slovakia provide top-quality dental care, he believes that from a national point of view standards are only gradually approaching the general European level.
“In general I think that the level of dental health of Slovaks is bad and that the population of dentists is aged,” Pánek said, adding that this means that those who have not caught up with new trends continue to work according to old ones that cannot be regarded as up-to-date dentistry. “Thus I basically believe that practices in large cities, which due to their higher incomes [for upper-standard treatment] are able to provide quality dental care, are not lagging in any parameter compared to their peers elsewhere in Europe."
Dentists agree that patients’ willingness to pay for dental care defines the level of care that can be provided, as all the new materials, methods and procedures are not cheap. Moreover, in Slovakia only some dental care is covered by public health insurance and some practices do not even have contracts with health insurance companies. This means that their patients must cover the full cost of dental care from their own pockets. People’s willingness and/or ability to pay for treatment therefore significantly influences the level of care they receive. This particularly affects people in rural areas who tend to be much less interested in fine dentistry.
Pánek said his experience in Malacky proves this.
“Of course, there are people in Malacky who can afford top dental treatment but the majority of people only want to get rid of pain,” said Pánek, adding that the latter are generally not interested in any follow-up solutions. “There are many more such people than in Bratislava, even though Malacky can be regarded as almost the periphery of the capital.”
With regards to implementation of the latest trends, Schill points to the difference in payments which Slovak dentists receive for their work compared with those abroad.
“The price of dental treatments in Slovakia are somewhere around one- quarter to one-third of the prices in western Europe,” Schill said, explaining that all the costs of materials, technologies and procedures used in Slovakia are basically equal to those abroad, so the difference comes in the amount that the dentists and nurses are paid. This means that when a Slovak dentist wants to invest in more modern equipment, he has to work longer to get it. But even though Schill perceives this as a limiting factor, he believes that dentists here can now obtain modern equipment, albeit a few years after it is first launched, once prices decrease somewhat.
“For example, 10 years ago it was a luxury for a small dental clinic to have panoramic dental X-ray equipment, whereas nowadays it is not a problem for a clinic with four to five dental chairs to obtain a dental CT,” Schill said.
The better diagnoses which such equipment allows is another facet of new trends penetrating dental care, according to Schill. Now it is much easier than it was 10 years ago to make diagnoses of much higher quality and to plan implants or dental surgery. Updated methods to produce dental restorations also save patients’ time and shorten the whole processes to one patient visit.
More work in the future?
It seems that dentists in Slovakia need not worry about work in the future. Statistics showing that the dental health of Slovak children is poor indicates that dental treatment will be very much in demand for some time to come.
“The dental health of Slovak children is not good,” said Dianišková, citing surveys that the Slovak Chamber of Dentists regularly conducts at approximately five-year intervals. “Alas, we have to say that Slovakia has been placed in the lowest rankings over recent years in terms of the oral health of its children.”
In this respect Dianišková pointed to the breakdown of the old scheme of school dental practices. Even though this system had its flaws, its demise means care for children’s teeth now falls squarely on the shoulders of parents. But when parents neglect their own oral health, there is a high chance that they will also neglect the oral health of their children, even though the public health-care scheme pays for two check-ups a year for children.
Pánek said that, based on his experience, the amount of attention people pay to their teeth and oral health varies greatly between individuals and added that, despite what one might think, there is no direct link to social status or wealth.
“People and their attitude to their teeth and to their health on the whole is a very individual and intimate issue, which has actually nothing in common with their ranking in society or wealth,” said Pánek. “There are people who are enormously wealthy but have a total cemetery in their mouth, and by contrast there are people who have to count each euro before spending it but arrive regularly for preventive checks and when they need some more expensive treatment ask me to make a later appointment and save up for it.”
“I think that this is linked to how each person perceives the question of health and what importance he or she ascribes to it in one's ranking of values,” Pánek concluded.
