Downturn erases routine dental check-ups, puts patients in savings mode

KLAIPEDA - If you want to find out more about a person’s status, ask them to open their mouth. Don’t be stunned to find a toothless cavity or bony debris in there, as many crisis-stricken people cannot afford any dental care. In order to find out prevailing trends in Lithuanian odontology, a team from Manoodontologai.lt, a project aimed to reveal the status-quo, recently conducted a survey, questioning over 50 odontologists. Fifty-six percent of those surveyed represent dental clinics, 30 percent were from dentist’s offices, while 13 percent of the interviewees were comprised of private dental care specialists. The majority of the surveyees - 60 percent - were dentists with over 10 years of work experience. The respondents came mainly from Lithuania’s three largest cities – Vilnius (56 percent), Kaunas (16 percent) and Klaipeda (16 percent), with the rest residing in the provinces.

The survey has revealed that the downturn has severely affected Lithuanian odontologists. Thus, 70 percent maintained that in 2009, their dental offices experienced a 10-50 percent fall in patient visits, compared to the pre-crisis years. Fifty-six percent of the questioned dentists claimed that the remaining patients’ visits became 20-30 percent less frequent. Some specialists complained that the year-on-year visit frequency has shrunk four-fold.

“The general estimation of the slump is 30-40 percent. Many people stricken with economic hardships have abandoned their dental care, as they come to see a dentist only when experiencing excruciating pain. Upon such cases, many patients, given an alternative to heal the painful tooth applying root canal treatment, refuse it as too costly and prefer extraction, putting off more intensive dental care for better times,” Anastazija Tutkuviene, Lithuania’s Odontology Chamber (LOC) chairwoman, maintained to The Baltic Times.

According to the survey, before 2009 patients would spend as much as 289 litas (83.70 euros) for every dentist visit. That amount went down to 191 litas in 2009. The survey’s spearheaders draw the conclusion that dental care seekers started choosing less expensive dental services, often sticking with those unavoidable procedures.

Dentist L.S. Slakaitiene of Taurage, in the southwest, supports this notion, acknowledging a 30 percent decrease in turnover. “Before the crisis, people would come in for routine dental check-ups. Parents would bring their children for prophylactic check-ups. It is sad to state that now I am dealing mostly with only so-called pain-patients – those who suffer from severe toothaches. In these kinds of cases, as a rule, it is impossible to save the tooth, as decay is spread in the tooth’s root canal. The only thing that could be applied in most such cases is tooth extraction. Surprisingly, nowadays, many patients gladly agree to have it done and are satisfied with the quick and comparably inexpensive solution. They do not give a thought to how much it will cost them to restore the missing tooth in the future. Asked why they delayed the visit so long, until the irreparable damage had been done, they excuse themselves bluntly, saying ‘I am unemployed and live only on a little social allowance...’ There are many cases like that. They make me sad. Particularly, I am sad about the situation regarding children’s dental care. It is absolutely deplorable,” Slakaitiene said.

She notes that there are too many dentists in this town of 25,000 habitants - she counts approximately 50. Though the competition is high, she has not decreased her dental service costs, maintaining, “No one has [reduced rates] in town, as our service mark-ups are minimal. Dentists in bigger cities cash in considerably more. How can one here slash service rates if value added tax has gone up, from 5 to 21 percent. Also, the costs of dental materials are constantly rising.” The dentist charges, depending on the kinds of material, 50-80 litas for a tooth filling and 80-100 litas for root canal treatment. This is considerably cheaper than in most dental clinics in the largest cities.

“There is no room to decrease the current dental service rates,” echoes Tutkuviene. According to her, due to the increased VAT, dental material and equipment prices have risen 5-7 percent during the crisis year. The organization’s representative remarks that in terms of dental service rates, there is an array of dental clinics and dentist offices, with price ranges that differ quite considerably from each other.

“As most odontologists provide dental services for similar prices, some do try to single out themselves with vociferous advertising campaigns, boasting of the lowest prices in the business. It may work for a while, as price remains the most important thing for many patients. However, upon such cases, I always cast doubt on the quality of such ‘cheap’ services, as it remains unclear what kind of dental material the dentists use. I dare to say dentistry is not something you can save on. Like picking a car, a more expensive one is safer and will run longer; the same applies to teeth – fixed with low-quality material, they will not serve you well for long,” Tutkuviene asserted.

She is convinced that Lithuanian odontologists in no way lag behind their foreign counterparts. However, differently from them, Lithuanian dentists have to respond to their crisis-stricken patients’ lesser purchasing power. “As a dentist, before leaning on a patient’s mouth, I scrupulously tell him or her how an application of a certain dental material or procedure differs in terms of quality and, yes, price. Before the crisis, 90 percent of people would choose a more expensive, but, quality-wise, better material. Nowadays, income-strapped people stick with less expensive services. Thus, instead of having tooth implants, they choose a less expensive dental bridge. Instead of having a metal ceramic prosthesis, many prefer a plastic one. Instead of having any prosthesis, some ask just for a filling. Instead of having a ceramic filling, a good deal of patients stick with a less expensive one. Dental cosmetic dentistry has completely lost its charm during the crisis,” Vida Kraujaliene, a dentist in Klaipeda, revealed.

She claims that, in particular, dental clinics focusing on providing dental implant services have endured a staggering fall in patient numbers. “It has reached the level where clinics often engage in foul competition, concealing the real costs of such dental services. Usually, these clinics add the costs upon the patient’s every visit. Thus, it goes from the ad price tag of 2,500 litas up to a whopping 7,000 litas. As the dental specialists explain the necessity of extra pricey services, the patient has no other choice but to open his wallet again and again,” Kraujaliene suggested.

Tutkuviene asserts that 80 percent of all dental clinics and offices are privately run, while 20 percent are budgetary. According to her, there are over 3,000 odontologists in the country. “Obviously, supply of dental care providers surpasses demand by a lot. Statistically, in Lithuania, every 10,000 inhabitants are served by 10.5 odontologists, while the ratio in Western Europe is considerably less - 6.5-7 dentists per 10,000 people. We have too many dentists, especially in the largest cities, while there is a shortage in the rural provincial towns and settlements. However, few odontologists decide to leave Vilnius and go to live and work in the provinces. Despite the abundance, only few dental offices have gone bankrupt,” Tutkuviene claimed.

Remigijus Kajackas, head of odontology clinic Dantis, maintains that small dental offices manage to survive only because they keep working off-the books. “Officially, they pay their dentists only the minimal salary, which is 800 litas. However, no dentist will work for this kind of money. It is hard for big clinics to compete with small dental offices, as they tend to provide cheaper dental services. However, their quality raises some doubts, as they have to use cheaper dental material in order to maintain the price level,” he noted.

Elderly dental patients have been particularly hard hit by the crisis, as previously unlimited state financing for pensioners’ dental prosthesis was cut to 1,200 litas per patient. “When it comes to the prosthesis, what can you do for that amount? Very little, maybe you can put in a dental plate, and that is it. Our patient numbers have fallen by 30 percent. However, lately, we have been seeing an increase of a specific segment of patients - emigrants. As dental services remain more expensive abroad, they do come back home and do not skimp on fixing their teeth here,” Kavaliauskiene, a prosthesist in Taurage, acknowledged to The Baltic Times.

Prosthesis service costs are considerably less in provincial towns than in a larger city. “For a metal ceramic crown, I charge 500 litas, while most prosthesists in Vilnius, Kaunas and Klaipeda rip off [patients for] 600-700 litas for it. Besides, I provide all extra services for free. Thus, let us say, a five crown metal ceramic dental bridge in my office costs 3,000 litas, while elsewhere it may cost double that. I am well aware that people do not have money nowadays, so I have to adjust to the situation,” Kavaliauskiene suggested.