Better access to Western technology and education has yielded tremendous improvements in Lithuanian dentistry since the fall of the Iron Curtain, dentists say.
"We import all our equipment and supplies from Germany and the USA, and they meet European standards of quality," said Dr. Andrius Karciauskas head of privately-operated Dentamed clinic in Vilnius. His practice is a joint venture with a clinic in UK, permitting his staff to receive training in the latest techniques from Western specialists. Karciauskas opened the clinic six years ago, the second private practice to open its doors in Lithuania. Today there are seven clinics on the same street. He drives an expensive car and looks as much a part of a successful young entrepreneur as he does a dentist.
Dr. Darius Pocebutas runs a clinic with his mother just off the teeming Savanoriu Prospektas in Kaunas. The state-of the art equipment looks like it was just uncrated and installed.
"Each chair cost me $20,000," he said. The X-rays are digitized and appear on a computer monitor, visible during treatment. A graduate of Kaunas Medical University, he has also trained extensively in Sweden.
An ounce of prevention
The technology, expertise and equipment are in place, but Lithuanians are not fighting to occupy dental chairs.
Dr. John Birgiolas, a Toronto–based dentist, toured several private clinics in Lithuania last year.
"They rival or surpass any we have in North America but seem devoid of patients," he said.
Lithuanians are just beginning to have access to some specialists. Orthodontic treatment is a relatively new concept in Lithuania.
"Just a few years ago, there were fewer than 10 orthodontists practicing in Vilnius. They either received their training abroad or were dentists who taught themselves the techniques. Kaunas Medical University just graduated eight full-fledged orthodontists. I have one who practices at my clinic," said Karciauskas.
Dr. Rimas Karka, an orthodontist in Toronto of Lithuanian heritage, lectured at the university in May of last year. He was impressed with the latest equipment and techniques but noted there is "a major disregard for periodontal problems and dental cavities prior to starting orthodontic treatment. In North America, the teeth are restored to full health before starting treatment, while in Lithuania, it's like putting good paint on rotting wood."
Despite the massive improvements in technology and training, a major stumbling block for dental health in the country is still the public's attitude toward preventive dental care.
"Very often, people only come when they start feeling pain which is usually too late" said Pocebutas.
"Over one hundred patients a week pass through my clinic. I have only two who come for a regular check-up, and it's because they're both highly educated. I charge them seven litas ($1.75) for this service and sometimes nothing at all. I am just happy they came. People here just do not brush and floss often enough. Parents bring me three year olds whose teeth are in an advanced state of decay. It's tragic. I see young adults whose front teeth are in such bad shape that they refuse to smile" said Karciauskas. In Lithuania "kids get too many candies. It's the most prevalent reward throughout the country," said Canadian dentist Karka.
The notion of preventive dental care is just beginning to take root in Lithuania. The Kaunas Medical University will be graduating its second class of oral hygienists this year.
"A professor visiting us from North America said that thirty years ago prevention in his country was a struggle, and attitudes changed thanks only to massive public education campaigns. That's where we are today," said Arturas Tamulevicius, a student in the program.
"I have one hygienist working for me. She cleans patients' teeth before I undertake a procedure, but almost no one comes here just to get build-up removed," said Karciauskas.
Karciauskas knows only one person who has never had a cavity. He puts it down to strong genes.
"In Lithuania, this is virtually unheard of. For me a miracle is when a patient over the age of thirty opens his mouth, and he or she still has all thirty-two original teeth. I don't even bother counting the fillings," he said.
Far cry from Soviet times
Ten years ago, before the break-up of the Soviet Union, dentistry in Lithuania was still in the stone age.
"Patients would receive boxes of fillings from their relatives abroad and bring them into the clinic," said Pocebutas, "There was only one colour of cement available here so there was no question of aesthetics."
"X-ray machines didn't exist, and the quality of the cement we used was not far removed from the cement used in building construction," said Karciauskas. Drills were of a similar nature. "Modern dental drills use compressed air and revolve 300,000 times a minute. The patient hardly feels any vibration. The old ones were bulky and operated like a carpenter's drill. The patient's head would vibrate wildly. Worse still was the fact that anesthetics were in short supply and of very poor quality."
They'd rather pay taxes
Indeed, a glance at any newspaper in Lithuania reveals numerous advertisements for private clinics usually including the words "Painless Treatment" in large letters.
"People in Lithuania, especially men, have severe phobias about receiving treatment due to memories of the Soviet days," said Karciauskas. I often see people in my waiting room who haven't slept, are pale and distressed. I've had to revive patients who have passed out in my chair on numerous occasions. Parents pass their fears on to their children. They see me enter the room in my white coat, and they're immediately seized with panic. In summer we open the windows a little. Sometimes their screaming is so terrible that passers-by stop and wonder what is going on in here.
"Teenagers are the only group, so far, to break out of this mind set," he said. "During Soviet times I received treatment myself, so I understand what the fear is about."
Another continuing problem is that the older generation of Lithuanians still want old-fashioned metal or gold crowns.
"The problem with the older type of crown is that bacteria still get trapped under the metal, so the tooth continues to decay. This can lead to severe damage. I have a diagram explaining this problem that is worn thin because of the number of times I've had to show it to a patient," said Pocebutas.
"In the past, gold teeth were a sign of prosperity and some people still want them. I absolutely refuse to work with these patients," said Dr. Karciauskas.
Not everyone can afford the new dentistry, and must use sponsored dental clinics which are struggling to keep up with the private ones.
"They're underfunded, dilapidated and use inferior supplies. Some procedures have waiting lists of up to two years. The only people who go there are those who can't afford private treatment. Essentially, my services are for the middle classes and up," said Dr. Karciauskas. Dentists working in government clinics were reluctant to be interviewed for this article for fear of possible repercussions. Greater government regulation of private clinics seems to have both advantages and disadvantages.
"When I started this clinic six years ago, getting a permit was a joke. They were virtually giving them away and barely even checking credentials. Now I have to renew my license every five years. Last year I had to hire a lawyer and spend two months processing the paperwork," said Dr. Karciauskas. "One positive aspect is that all the illegal clinics are either disappearing or getting permits. I'm talking about people working out of their homes and all the hacks. It was difficult to compete with them as they didn't have the overhead I do and people would go to them to save money."