Ten years of economic crisis have left their mark on people’s spending power in Spain, and a lack of money has also had an effect on their dental health. Many of those who used to visit the dentist regularly, aiming for perfect, blindingly white teeth, have found themselves with no choice but to restrict their visits and only go when absolutely necessary.
“Spanish people have never looked after their mouths very well, but things nowadays are the same as they were 20 years ago: people have to worry more about what they can afford to eat, rather than what they are going to eat with,” says Óscar Castro, the president of the General Council of Dentists of Spain.
In the early years of the economic recession, research was carried out by Granada University, using a ‘Survey into Living Conditions’ which had been drawn up by the National Institute of Statistics (INE). It showed that people were not visiting the dentist as often as they used to, especially the more vulnerable groups (the unemployed and those with little money).
Now, José María Suárez, president of the College of Odontologists of La Coruña, says the situation has not improved: four out of every ten patients no longer go for regular checkups. “By 2007 and 2008 we had reached acceptable levels of dental health, but from then onwards things changed. We are seeing more dental problems which are exclusively related to the crisis. It has been like a kick in the teeth for Spanish people,” he says.
The patients themselves, according to the latest White Book of Dental Health, which was published by the Spanish Dental Association (Consejo General de Dentistas) in 2015, corroborate this: the first reason why people don’t visit the dentist is because they don’t have any dental problems; the second is because they can’t afford it.
The result? There has been a three per cent increase in dental caries in adults aged 35 to 44, and it has become a problem which currently affects 95 per cent of the population in this age group; a sharp rise in bruxism, a condition associated with stress - “because people who are tense and worried tend to clamp their teeth, wearing them down and causing dental fractures”; an increase in extractions that could have been avoided if the problem had been caught in time; and more periodontal illness, an infection which affects the gums and destroys the bone which supports the teeth. About 73 per cent of the population in Spain are affected by this.
Experts say that stress and smoking are two factors which have contributed to the problem.
“Periodontal illness needs constant treatment; if people stop going for checkups, those who suffered from it previously will get it again. In the end, they may have saved a bit of money by not going for regular checkups, but the problem gets worse and they then have to spend far more on long and costly treatments,” says Antonio Bujaldón, vice-president of the Spanish Periodontics Society.
All the specialists we consulted agreed that prevention is always the cheapest option in the long run. However, surveys show a different picture: although for 84 per cent of people in Spain it is “important” to visit the dentist at least once a year - according to the White Book - the reality is that only 50 per cent of them do so, placing Spain among the EU countries with fewest visits to the dentist, above only Romania, Hungary and Turkey.
The experts say that dental health has never been a priority for the Spanish, and even less so during times of crisis, partly because of a lack of education, partly because of a fear of the dentist and also because of the cost.
Dental health appears to be low down the list of priorities, not only for the people but also for the health service. Services covered by the Ministry of Health only include “the treatment of acute odontological processes”, such as infections, dental traumas and the removal of unhealthy teeth. Implants, the extraction of healthy teeth and orthodontics are expressly excluded, as are cosmetic dental treatments.
The Ministry of Health has no qualms in admitting on its website that children’s dental health in Spain “could be improved and, especially, is not equal to that of some other countries, so this could be described as inequality.”
Location is important
The president of Spanish odontologists, Óscar Castro, says that many dental illnesses are determined by the genetic code, but someone’s post code also has an influence: “Depending on where you are born, you will have a better or worse mouth,” he says. In his opinion, it is a shame that there are 17 different health systems in Spain, one in each autonomous region.
“Dental health should be covered by the public health service as a priority, because it is incredible that they will not pay for a filling but they will for a heart transplant,” he says. “It is the great paradox of our health system and it is short-sighted, because some illnesses begin or become worse as the result of bad dental health, such as diabetes, premature births and many cardiovascular problems. They all have to be treated”.
In the Basque Country and Navarra, there is a pioneering plan for children’s dental care (PADI), which has been in operation since 1991 and is a benchmark for the whole country. It is based on four factors: public financing, mixed services (public health and private dentists), specific clinical protocols to guarantee a focus on prevention, and a system of payment per treatment.
A similar scheme is also used in Andalucía, Aragón, Baleares, the Canary Islands, Extremadura and Murcia. In other regions children’s dental care is funded exclusively by the regional health system, except Castilla-La Mancha and Castilla y León, where there is a mixed system - basic dental care under the health service and more specialised services by the private sector, with payment per treatment.
At present there are about 35,000 dentists in Spain, nearly three times the number recommended by the World Health Organisation. This, and the system, has resulted in a proliferation of clinics, some of which are criticised for charging low prices to attract clients, but providing a low standard of care in return. As Óscar Castro describes it, in some cases the clinics work on “a system of low-costs and maximum profits”.
Treatments. The Observatory of Oral Health in Spain shows that in 2016 more people went to the dentist for simple treatments, but more complicated procedures such as cosmetic dentistry, whitening and dentures dropped by 27 per cent.
Professionals. There are 35,000 dentists in Spain, one for every 1,167 inhabitants, three times higher than WHO recommendations (one for every 3,500).
Faculties. Spain has more Odontology faculties than any other European country, 23 in total, including private ones.
Work. Only two per cent of patients say they have had difficulty doing their job because of dental problems.
Clinics. About 80 per cent of patients go to an independent private clinic; 11 per cent to one approved by their insurance company; and eight per cent to a franchise.