Shoddy plastic crowns tagged crisis as aesthetic dentistry marks recovery

KLAIPEDA - If you stumble across a cracked-   toothed, or toothless man in Eastern London, the borough of the largest accruement of Lithuanian expats, there is a large likelihood this person is Lithuanian. “If I want to find out more about a person’s status, I ask him or her to open their mouth. I am no longer stunned to find a toothless cavity or bony debris in it, as many cash-strapped people cannot afford dental care. It is sad. However, statistics purport that Lithuanian adults’ and children’s teeth are the most decayed in the entire Europe, and our teenagers brush their teeth with the littlest frequency in the old continent,” says Virginija Maldoniene, an odontologist.

It is highly unlikely this miserable plight will change any time soon, as the Lithuanian Complex Mouth Cavity Disease and Caries Prevention Program has not yet got off to a start, despite redundant harangues about the necessity of it.
The touted Lithuanian Health Program aimed at reducing the prevalence of the population’s tooth disease by 2010 by 10 percent, and tooth decay by a significant 15 percent, has failed. Its pursuit is in question, as dental specialists admit that it has been scrapped due to the serious austerity measures, which have translated into considerably less financing for disease prevention programs.

“We still score worst among the EU’s 27 countries when it comes to dental care. Thus, in the age group of 1-3-year-olds, 52 percent of Lithuanian boys and 48 percent of girls suffer from tooth decay. The older the children become, the more appalling their mouths get. Hence, at age 6, a whopping 94 percent of all pre-school children have caries-decayed teeth, and the number, in the age group of 12 and older, is even more stunning – nearly all children have caries,” says Anastazija Tutkuviene, Lithuania’s Odontology Chamber (LOC) chairwoman.

She points out that mouth disease prevention is a crucial thing in achieving better results, which now are rather disappointing. “Only teamwork, starting at the kindergarten level, and closer cooperation with parents both in kindergarten and school can ensure a turning-point and breakthrough in these grim statistics,” emphasizes Tutkuviene.
There looms a long, cumbersome path for Lithuania to tread along that some more developed countries, like Sweden and Germany, have gone on a long time ago, achieving excellent results in dental caries prevention.
In Scandinavia, for example, a staggering 63 percent of all 12-year-olds do not have any decayed teeth, while in Germany only a mere 38 percent of 3-year-olds are ill-affected by dental cavities. These splendid outcomes are the result of all-encompassing and effective mouth disease prevention campaigns.

Meanwhile, in Lithuania, odontologists say only single prevention and prophylactic programs are being carried out. They can neither reduce the spread of the caries, nor nurture appropriate skills of good hygiene.
“Sadly, and shamefully to wealthy parents, many of our children never brush their teeth, though it is mandatory to do that at least twice a day in order to avoid mouth diseases,” says Maldoniene.

According to research by Apolinaras Zaborskis, Kaunas Medicine University’s Prophylactic Medicine Department professor, only half of girls and one-third of boys are into the habit of brushing their teeth.
The researcher points to an even worse plight in countryside villages, where every tenth child never tends to his teeth, or does so very rarely. Lithuanian teenagers brush their teeth the least in Europe, Zaborskis infers.
Lithuanian adults also devote little attention to their mouth hygiene. Only 51 percent of all surveyed adults in the middle and senior age group brush their teeth twice a day, Jurate Zubiene, Lithuanian Health Science University’s Mouth Observation and Children Odontology Clinic lecturer, discovered upon completion of her research.
She notes that a majority of Lithuanians never go for regular dental check-ups.

“It is common that most Lithuanians seek dental assistance only in cases of a toothache. It is common to see toothache-wrenched people knocking at the door, and finding not only decayed teeth, but also other mouth disorders. People have to make a choice – regularly do dental checkups,  and if not, tend to decayed teeth later, paying a lot for the whole mouth work, as State Patients’ Funds cover very few dental procedures,” says Tutkuviene.

Taurage-based odontologist L. Slakaitiene, acknowledging a 30 percent decrease in patient turnover in 2009 and a slightly better situation last and this year, says: “Before the economic hardships, people would come into my office for routine dental check-ups, as many parents would bring their children for prophylactic check-ups. It is sad to acknowledge that now I deal, for the most part, with only patients dealing with pain – those who suffer from terrible toothaches. In most cases, as a rule, it is impossible to save the tooth, as decay is spread often deep, into the root canal. Extraction is the only thing I can suggest. Surprisingly, nowadays, many patients gladly agree to have it done and are satisfied with the quick and comparably inexpensive solution, which is hardly imaginable in non-post-Soviet countries. These kinds of patients do not give a thought to how much it will cost them to restore the missing tooth in the future. Some, it seems, do not care at all about a lost tooth, suggesting they still have some left. What a horrible way of thinking!” says the dentist.

She says she tries not to be judgmental, as 99 percent of the pain-patients, asked why they delayed the visit for so long, 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, but there is not much I can do about them, except extract the tooth. Children’s miserable dental care distresses me most,” Slakaitiene said.
She says that there are too many dentists in the town of 25,000 habitants, approximately 50. Though the competition is high, she has not decreased her dental service costs, maintaining that “No one has done so in town, as our dental service mark-ups are minimal. Dentists in bigger cities cash in considerably more. The costs of dental materials are constantly rising.”

The dentist charges, depending on the kinds of material, 50-100 litas for a tooth filling and 100-150 litas for root canal treatment. This is much cheaper than in most dental clinics in the largest cities.
“There is no room to decrease the current dental service rates, as most of them go up due to the price increase of dental materials” the LOC chairwoman concurs.

According to her, due to the 21 percent VAT, dental material and equipment prices have risen considerably during the last years. She 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. The disparity is particularly seen in comparison of provincial towns’ and large cities’ dental clinics.

“With the big competition here, most odontologists stick to similar prices. However, there always pops up somebody with a vociferous advertising campaign, boasting of the lowest prices in the business. The strategy may work for a while, as prices are the most important thing for many patients. However, upon seeing an advertisement of ‘cheap dental services,’ I always doubt the quality of the ‘cheap services.’ With dental material suppliers offering similar price-range goods, it remains unclear as to what kind of ‘cheap’ dental material some dentists use. Some smuggled, EU-unlicensed stuff?” Aldona Ivanauskiene, a dentist, wonders.

Lithuanian dentists are convinced they do not fall behind their foreign counterparts. However, unlike them, Lithuanian dentists have to respond to their often cash-strapped patients’ lesser purchasing power. “Before leaning on a patient’s mouth, I courteously tell my patient 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 cheaper 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. Cosmetic dentistry has completely lost its charm during the crisis,” Vida Kraujaliene, a dentist in Klaipeda, maintained.

Elderly dental patients have been particularly hard hit by the crisis, Laima Kavaliauskiene, an odontologist, claims. “Previously, unlimited state financing for pensioners’ dental prosthesis was cut to 1,200 litas per patient. What can you do for that amount? Very little, maybe you can insert a dental plate in the mouth, and that is it. Our patient numbers went down by 30 percent during 2008-2009, but the numbers are picking up. Luckily, before major holidays, like Christmas, I always see an increase of emigrants. As dental services remain more expensive abroad, they come back to their hometown to fix their cavities or have a dental bridge put in,” Kavaliauskiene, a prosthesis specialist in Taurage, acknowledged to The Baltic Times.

“For a metal ceramic crown, I charge 500 litas, while most prosthesis specialists in Vilnius, Kaunas and Klaipeda ask 700-800 litas for it. Besides, I provide all extra services for free. I am well aware that people do not have money nowadays, so I have to adjust to the situation,” Kavaliauskiene suggested.
Joint Stock Company Geva, making up a network of many small dental offices, provides an array of dental services, including medical inspection and consultation, cavity filling, root canal treatment, cosmetic dentistry, prosthetic appliances (crowns, porcelain veneers, onlays and inlays), teeth decoration and teeth whitening, and some other services.

Geva odontologists charge 80-120 litas for a helium tooth filling, 200-400 litas for an aesthetic tooth filling, 60 litas for an uncomplicated tooth extraction, 120 litas for professional mouth hygiene, 500 litas for a metal ceramic crown, 800 litas for a metal-free crown and 1,100 litas for a zirconium crown.

With dental services rebounding from the downturn, Geva head Ruta Slegeriene says aesthetic dentistry is getting trendier, as it is a particularly fast way of having an impeccably ideal smile. “However, I see increasing popularity of this kind of dentistry among younger people, though recently I have also seen clients in their 50s walk in. It is so rewarding to see some clients who, upon completion of aesthetic dentistry work, get up from the dentist chair crying from happiness,” Slegeriene noted to The Baltic Times.

She says that the costs of aesthetic teeth restoration in Lithuania vary considerably. However, with the pace of life increasing, she says people search for fast results, which aesthetic dentistry can provide.
Geva clinics have been running from 1993, however, the most challenging part of the operations, she says, is finding a good specialist. “This kind of work requires not only professional knowledge, but also the perception of beauty, and even a knack for high art,” the entrepreneur says.

Slegeriene maintains that a flexible discount system Geva clinics apply plays a major part in the extremely competitive dental service market. “For example, for people who come back from abroad, we provide extremely fast prosthetic services. Upon need, we work both on Saturdays and Sundays. Most importantly, we provide extremely flexible prices. If, for example, most dental clinics in Kaunas charge around 600 litas for an aesthetic filling, we never charge more than 400 litas, while using the highest quality materials,” Slegeriene says.

Speaking of the crisis, she says it has been not as painful to the business as for the patient. “During the crisis years we saw a lot of patients with catastrophic mouths. Many of them, savings-prone, with tears in their eyes, would ask to insert temporary plastic dental bridges, which dentists usually put in only during the period of prosthesis and which are very temporary, ugly and cheap,” the Geva head related.
She notes, however, that with the economy recovering, patients come back to replace the plastic temporary prosthesis with more durable and expensive ones.

“We also see more patients who want to effectively correct their smile, applying aesthetic dentistry, and those who take care of their oral hygiene,” the specialist observes.
The entrepreneur says dental service supply in Kaunas City exceeds demand for such services.
“However, there is a shortage of good specialists. Sometimes we see such ‘mauled mouths’ that first we have to find proper words to explain the irreparable damage that has been done by the previous odontologist. That is partly due to the fact that anyone can complete dentistry studies in Lithuania, even those who have neither the vocation for the subject, nor knowledge. The only reason for such phony dentists’ study preferences is their parents, who often are famous odontologists, or odontology lecturers,” Slegeriene pointed out to The Baltic Times.

Asked about the sector’s outlook, she says that the activity will be impacted only by the economic situation. “Since our patients are ordinary Lithuanians, such factors like the heating season, September 1 and major seasonal holidays, should be taken into consideration. Despite the large emigration, the large turnout of emigrants to our clinics makes us rejoice, as they prefer Lithuanian dental services. During the crisis neglected teeth are starting to be taken care of and, anticipating an increase in patients, we are eyeing opening one more dental clinic,” the Geva head admitted.

Egle Juozaponyte, the Gidenta administrator, says that, like in other market segments, dental service costs have increased due to the VAT hike. “Dental technicians have also increased the prices of prosthesis,” Juozaponyte notes.
Speaking of marketing tools, she says that word of mouth, along with the Gidenta Web site, which, she says, is of high quality and is one of the very best attended of this kind of site, are the crucial factors in keeping clientele.
She says, before the downturn, patients would need to wait a few months for a dentist visit. Nowadays the waiting window has shortened to two or three weeks.

Juozaponyte says the clinic offers only very high quality services and materials; therefore, the  Gidenta service prices are higher than in other, similar clinics.
“Since our patients opt for better quality dental services for a higher price, we do not feel a patient shortage, or competition. [We also have] another competitive factor – a strategically good location in the center of Vilnius. Generally speaking, the dental service supply matches demand in Vilnius,” the Gidenta administrator asserted.
She says the dental clinic is to expand its activity in 2012, employing more odontologists and will move to larger premises.

When it comes to state-covered dental services, only children and people under social care can partly count on them, as all others have to pay for the dental materials and disposable tools. Thus, to cure an aching tooth in a state polyclinic costs 35-45 litas, while a private dental clinic charges 100-200 litas for the same services.

Though the dental prosthesis is covered for pensioners, children and disabled persons in Lithuania, it is marred by long lines, as state compensation-eligible persons have to wait for the call - up to 5 years in the thousand-plus waiting list.
Tutkuviene is convinced that dental patient lines and a shortage of resources for dental assistance in state-owned dental clinics will plague everyone until the state starts investing into dental care prevention and nurturing mouth hygiene, especially among children. “We have completed surveying Lithuanian Public Health Offices, and it turned out that only some of them organize events to raise awareness of the importance of healthy mouths.

Odontolgist Chamber, along with doctors and scientists, prepared a complex mouth disease prophylactic program 10 years ago. With the health ministers here and out of the office, and with a shortage of funding, it has not been launched yet,” Tutkuviene said regretfully.

With state dental care plagued by little funding or attention, more and more dentists flee the state sector for private dental clinics. And that is another big issue.