The
modern, private-enterprise economy of Belgium has capitalized on its central
European geographic location, highly developed transport network, and
diversified industrial and commercial base. Industry is concentrated mainly in
the populous Flemish area in the north. With few natural resources, Belgium must
import substantial quantities of raw materials and export a large volume of
manufactures, making its economy unusually dependent on the state of world
markets. Roughly three-quarters of its trade is with other EU countries.
In
Belgium approximately 85 %
of the population is covered by national insurance for health treatment. Treatments available under national insurance and the levels
of reimbursement are reviewed every other year. Private dentists deliver most of
the care for both children and adults, since public dentistry services are only
available in university dental school clinics. The majority of dentists in
Belgium adhere to a fee scale for private treatments, which is agreed by a
commission in the Office of National Health Assurances. The dentists who choose
not to follow this scale set their own fees.
There are very few dental hygienists and therapists
operating in Belgium. The 1958 decree that allowed dental technicians to practice
as para-medics was repealed in 1972 on insistence of the dental profession. There has been formal training for denturists since 1973,
however they are still not permitted to work independently of dentists.
Recently, illegal denturists have requested to be legalized, and dental
technicians have called for paramedic status. Consumer bodies and the public
have in the past rallied behind this cause.
Under current EU law, the dentists' organization is not
mandated because they are not doctors and are only working in a partial area of
medicine. A Belgium judge have stated that the
monopoly position
dentists hold is no longer realistic in Europe and legally not
sustainable. The National Council of Medicine has confirmed they will support
Denturists in a political process to the goal of acknowledgement of the
profession.
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Canada
The second-largest country in the
world has enough natural beauty and sights to keep you going for several
lifetimes and it is said that rugged Canada will blow the dust off your heart
and soul. Its wild bounty of nature parks hold bald eagles, bears, lynxes,
wolves and thousand-year-old pines. Its cities are shaking off their staid
reputations and reveling in their cosmopolitan chic. A
land of vast distances and rich natural resources, Canada has developed
economically and technologically in parallel with the
US, its neighbor to the south. Canada faces the
political challenges of meeting public demands for quality improvements in
health care and education services, as well as responding to separatist concerns
in predominantly French-speaking Quebec. Canada also aims to develop its diverse
energy resources while maintaining its commitment to the environment.
The market for dentistry in Canada is almost entirely
private. Dentistry is a self-regulating profession. All dentists must be
registered with the Dental Regulatory Authority (DRA) for the province in which
they practice. The principal remit of each DRA is to protect the public;
however, they also set standards, discipline their members, administer a
complaints procedure and initiate quality assurance schemes. Individual
practitioners set their fee scales, which are in fact limited by the levels of
compensation that public and private insurance companies will pay out. Dentists
are obliged to transfer dental records at the request of the patient.
Throughout Canada
all 10 provinces and 2 territories have independently
on own merits achieved legal status where denturists generally provide a full scope of practice including all removable
prosthetic appliances, and (in some
states ) tooth whitening
of natural teeth. Of
the ±2000
denturists registered in Canada 1750 are active members of the Denturist
Association of Canada. Alberta was the first state in Northern
America to legally recognize denturism in 1933 and completed the puzzle with the
2004 Prince Edward Island initiative. Denturists may be trained directly without being a
dental technician first, but have to be taught for a third year to learn how to
set up teeth and manufacture dentures. The former animosity between
dentists and denturists have been largely replaced by mutual acceptance of all
members of the Oral Team as professionals in their own right with a particular
responsibility to serve the public in their own unique role. Between the 4
schools for denturism in Canada 75-100 students qualify every year. The
Denturist Association of Canada (DAC) have developed an electronic claims network for
denturists (DACnet) that will be ready to be launched with the two first
carriers in 2007. Canada
hosts the offices of the International Federation of
Denturists and is proud to have input into the profession worldwide.
Hygienists are on the whole self-regulating, although they still have to work under the
auspices of a dentist or to prescription and cannot charge the public directly.
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Cyprus
On
the Mediterranean island of Cyprus, all
oral Health Human Resources is foreign trained, mostly in the EU. Of
the 700 registered dentists in Cyprus, all being “active
”.
43% are female. Most dentists (94%) practice in private practice. There are
250 Dental Assistants in Cyprus. Those working for the public sector are
salaried. The others, in the private sector, are salaried or have an agreement
with the dentist to work on commission. There are only 7 Hygienists. They are
neither registered nor regulated in Cyprus, and are paid a set fee for every
patient who is seen.
Dental
Technicians are trained in Greece, the UK, other European countries, or the
USA. The minimum requirement, for a dental technician to be registered, is 3
years study, after the completion of the secondary school studies. They
normally work in separate dental laboratories and invoice the dentist for work
done.
There are 70 commercial
dental laboratories and 200 dental technicians, some of whom practice
Denturism. Cyprus is part of the European Union since 2004, but the official
position the Cypriot Dental Council has, is that Denturism is illegal. Several
attempts have been made to have a meeting with the Dental Council but have
failed. Being a member of the EU might facilitate an easier transition into
the profession but every country reserves the right into their own affairs.
The Minister of Health has been notified that, if discussions do not open with
the Dental Council in the near future, a denture clinic may be opened without
enabling legislation.
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Denmark
Once the seat of Viking raiders and
later a major north European power, Denmark has evolved into a modern,
prosperous nation that is participating in the general political and economic
integration of Europe. The Danish economy has in recent years undergone strong
expansion, fuelled primarily by private consumption growth, but also supported by
exports and investments; features a high-tech agriculture, up-to-date
small-scale and corporate industry, extensive government welfare measures,
comfortable living standards, and high dependence on foreign
trade. Unemployment is low and Government objectives include streamlining the
bureaucracy and further privatization of state assets. Danish living standards
are among the highest in the world. A major long-term issue will be the sharp
decline in the ratio of workers to retirees.
Dental care is free for all those under 18 years of age
and is provided by dentists in public school clinics. Approximately 30 % of
dentists are government salaried to work in these public clinics. Most adults
receive private dental care, of which a percentage is reimbursed, depending on
the age of the patient and the nature of the treatment. Some one million Danes
have private health insurance to cover the cost of treatments not included under
the public system. The private system is funded by social and private insurance,
as well as funds from general taxation, and by direct payment. There is a
general system for complaints regarding healthcare, and patients are able to
request valuations of any treatment they are unsatisfied with.
Hygienists have a screening role in some of these
public dental clinics and are authorized to work independently of a dentist in
the private sector. If they are self-employed, they remain responsible for the
patient’s well-being and can charge them directly; if this is not the case
then the dentist is accountable.
Dental laboratory technicians are not permitted to work independently.
Denturists are allowed to provide all types of dentures to the public and receive payment, as long as the patient has no
pathological lesions; which must be referred to a dentist. There is specific rules that oblige dentists and
denturists to cooperate when caring for patients. All
Denturists and dentists must
enter agreements with municipal
governments, thus
providing subsidized treatments for people with low income and for elderly
living in nursing homes, who pay 85 % of the costs. Mentally and physically
handicapped people are also covered by these agreements. According to the Vice
President of the International Federation of Denturists, these are very
effective.
Denturism
have been recognized legally in Denmark since 1843. Dentists have tried many times to fight the
profession, without success. There are approximately 250 Denturists in Denmark.
A recent needs survey indicates that there will be a requirement for additional
Denturists in the future. A 1999 survey revealed that denturists were making and fitting 75-80
% of all removable dentures in the country.
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Estonia
After
centuries of Danish, Swedish, German, and Russian rule, Estonia attained
independence in 1918. Forcibly incorporated into the USSR in 1940 it regained its freedom in 1991, with the
collapse of the Soviet Union. Since the last Russian troops left in 1994,
Estonia has been free to promote economic and political ties with Western
Europe. It joined both NATO and the EU during 2004.
About
95% of Estonian population is a member of a Sick Fund. The remaining 5% are unemployed. For employed people, the employer pays 33% from the salary to
the Fund. Estonian health insurance is solidarity insurance, so for all
retired persons their health care is covered by a sick fund. About 90% of oral
healthcare in Estonia is provided through general (private
) practice. Dental
care services for adult patients (over 19) are paid by patients and reimbursed
by the sick fund although emergency care (traumas,
infections ) is paid by the
sick fund. Patients who do not have insurance can only get first aid.
The
(active ) dentist to population ratio was 1:418 (2003). There is no reported
unemployment amongst dentists in Estonia. Access to
oral healthcare may be difficult for patients who live in some urban areas, as
well as all those in rural areas, as salaries there are generally too low for
private care, with the low reimbursements. Indeed, there may be difficulties
for patients, all over Estonia, obtaining prosthetic treatment under the
scheme.
The
title Dental Technicians is legally protected and there is a registered
qualification which dental technicians must obtain before they can practice.
They train in the country’s special technicians’ school, for a period of
3.5 years. The register is held by the Healthcare Board. Their duties are to
prepare dental prosthetic and orthodontic appliances to the prescription of a
dentist and they may not work independently, except for the provision of
repairs to prostheses. Individual technicians are normally salaried and work
in commercial laboratories which bill the dentist for work done. In 2002 it
was reported that there were 232 dental technicians. Despite established
direct supply of dentures, not one formal complaints about this illegal
practice have been reported to the authorities. Denturists working illegally have contacted the IFD
in 2006, to assist with getting
recognition.
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Finland
Finland
is situated in northern Europe, bordering the Baltic Sea, between Sweden and
Russia. In the past half century, the Finns made a remarkable transformation
from a farm/forest economy to a diversified modern industrial economy; per
capita income is now on par with Western Europe. Finland has a highly
industrialized, largely free-market economy. Its key economic sector is
manufacturing. Forestry, an important export earner,
provides a secondary occupation for the rural population. High unemployment
remains a persistent problem.
Oral healthcare is provided equally between the public
and private sectors. Most adult dental care is provided privately and those born
after 1956 receive subsidized treatment in private practices. The
Finnish healthcare system is investigating means to change towards co-operation
of communal and private care funding and concerned with the treatment of
increasing numbers of old people in hospitals and care homes. Denturists are
needed but they currently only work on private healthcare.
In Finland denturists are legally recognized and they receive specialist training.
However, denturists can only work independently of a dentist in certain
circumstances. They can fit full
dentures if the
patient is edentulous, but partial
dentures have to
be made by the order of a dentist. There are about 400 active denturists
practicing in Finland. The Union of Denturists have
recently
suggested to the
Finnish Parliament for changes to the denturist-law. They wish to make removable
partials directly to the patients. Private dental
services is mainly provided by dentists and denturists. Both dentists and denturists must be
registered with the Office of Healthcare Legal Protection and are obliged to
take out comprehensive patient insurance. Any complaints are dealt with by
either the county healthcare official or by the consumer authorities. A recent
report about the professional relationship of dentists and denturists, concluded
that healthy cooperation between dentists and denturists was common. Oral healthcare
professionals who referred their patients to the other profession also benefited
by receiving more patients on referral from them.
Dental technicians can take money directly from the
patient, although the dentist remains legally responsible for their work. As in
Sweden Oral Hygienists are also authorized to work independently of dentists in
the private sector. They may charge the patient directly.
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France
France
today is one of the most modern countries in the world and is a leader among
European nations. In recent years, its reconciliation and cooperation with
Germany have proved central to the economic integration of Europe, including
the introduction of a common exchange currency, the Euro. France is in the
midst of transition from a well-to-do modern economy that has featured
extensive government ownership and intervention to one that relies more on
market mechanisms. France's leaders remain committed to a capitalism in
which they maintain social equity by means of laws, tax policies, and social
spending that reduce income disparity and the impact of free markets on
public health and welfare. With at least 75 million foreign tourists per
year, France is the most visited country in the world and maintains the
third largest income in the world from tourism.
Standards
of health care in France is rated as amongst the highest globally, but France
is also renowned for being ultra-conservative about human resource development in
the Oral Health sphere. Very rigid control and enforced authoritarian regulation of all
aspects of practice in the health professions is reported. There
were 42 000 dental surgeons on the register in 2002, of whom almost 70% were men.
There are 1 800 dental surgeons specializing in orthodontics (the only
dental specialist category recognized). In France no auxiliaries are allowed
to work in the mouth. The only recognized auxiliary personnel are dental
assistants, receptionists and dental technicians.
Most
dental surgeons use independent dental laboratories and there are 5 500
industrial laboratories employing about 14 000 salaried workers. About
5 illegal denturists/clinical dental technicians are prosecuted every year.
In France, because of the nature of its severe prohibition, the denturist
movement has been entirely underground and is fearful of the power of the
dentists and the legal system.
The
biennial meeting of the IFD were scheduled to take place in the Palais
de Congres in Cannes
in 1989. The French Dental Association manipulated the Mayor of Cannes to
cancel the booking on very short notice and the meeting were held in
Mandelieu instead. Vast sums of money was made available by the Dental
Association to resist any infringement on the monopoly of it's members.
Legal counsel for a previous French
Association was threatened with disbarment should she continue to work for
Denturists. A school for Denturism has recently opened in France, but on insistence
of the Dental Association, the Minister of Justice has threatened to have it
closed. The French Denturist Association has recently renewed its
contact with the IFD and is looking to IFD for support in bringing
education, examination and finally recognition to French Denturists.
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Germany
As
Europe's largest economy and second most populous nation, Germany is a key
member of the continent's economic, political, and defense organizations.
European power struggles immersed Germany in two devastating World Wars in
the first half of the 20th century and left the country occupied by the
victorious Allied Powers in 1949: divided into the the western Federal Republic of Germany
and the eastern German Democratic Republic. The decline of the USSR and the
end of the Cold War allowed for German unification in 1990. Since then,
Germany has expended considerable funds to bring Eastern productivity and
wages up to Western standards.
Among
the most important reasons for Germany's high unemployment during the past
decade were macroeconomic stagnation, flat domestic consumption, structural
rigidities in the labor market, lack of competition in the service sector,
and high interest rates. The modernization and integration of the eastern
German economy continues to be a costly long-term process, with annual
transfers from west to east amounting to roughly $80 billion.
There is a long established
insurance-based healthcare system of "sick
funds
", which are not-for-profit organizations. Almost 90% of the population
belongs to one of the 350 funds. There is also wide use of private
insurance. Dental fees, both inside and outside sick funds and insurance
based care, are regulated. There are over 64 000 dentists, all of whom must
be members of the local Dental Chamber (x17) and the local self-governing
regional dental authority (x22), and
regulated by the National Federation of Dental Chambers. About
30% of all dentists belong to the Liberal Association of German Dentists. Four
dental specialties are recognized and continuing education for dentists is
mandatory.
There
are 3 grades of specializations of Dental Chairside Assistants, of whom
there were about 140 000 in 2002. Germany also has 250 Hygienists and a
total of 65 000 Dental Technicians, who don’t have to register. In order
to operate a commercial dental laboratory the dental technician owner must
be registered by the Master Dental Technician’s Guild. Since the licensing
of graduates from dental colleges was abolished in 1952, no new denturists
have been trained and dentists have ever since had a
monopoly on the public supply of dentures.
The
founder members of the IFD in 1956 was a German dental technician from
Gelsenkirchen, Stephen Grabert, together with Hannes Stiebler (Vienna,
Austria ) and Rolf Pfenninger
(Zurich,
Switzerland ). The movement was
originally called the "Internationale
Arbeitsgemeinschaft der Zahnprotetiker
"
(IAZ)
In
a unified Germany with a total population of 82 million, the freedom of movement
of workers as members of the EU, will likely result in the reintroduction of
denturism that is currently operating underground.
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Greece
Geographically, Greece is a very rural and mountainous
country, but the population of 10.7 million is urbanizing rapidly, with over
4 million people (nearly
half the population ) living in the capital, Athens.
Greece
has a capitalist economy. Tourism provides 15% of GDP. Immigrants make up nearly one-fifth of the work
force, mainly in agricultural and unskilled jobs. Greece is a major
beneficiary of EU aid. The Greek economy grew by nearly 4.0% per year
between 2003 and 2006, due partly to infrastructure spending related to the
2004 Athens Olympic Games, and in part to an increased availability of
credit, which has sustained record levels of consumer spending. The Greek Government continues to grapple with cutting government
spending, reducing the size of the public sector, and reforming the labor
and pension systems, in the face of often vocal opposition from the
country's powerful labor unions and the general public.
General healthcare in Greece is provided by a complex
mixture of private practitioners, social security organizations and, since
1983, of a basic state-funded national health services. Oral healthcare,
besides preventive services offered free by NHS clinics to all children, is
almost entirely provided by private practitioners, with patients paying the
total cost of care. Indeed, one third of total private healthcare
expenditure is on oral health, and about 80% of dentists are in private
practice. In 2003 there were 12,800 dentists registered in Greece, of whom
46% were female. There are only two recognized specialties (Orthodontics and
Oral and Maxillofacial Surgery) but there are many other specialists in
private practice.
The only auxiliaries are dental technicians and a
limited number of chairside assistants. There are currently 160 dental
assistants - the majority of dentists work without assistants. There are no
hygienists or therapists in Greece. All dentists must belong to the Hellenic
Dental Association (HDA). Continuing education is not mandatory, and is
organized by the HDA and the dental societies in various fields and
specializations.
In 2003 there were approximately 5,000 dental
technicians. They are allowed to work independently by establishing a
private laboratory - working under the strict prescription of the dentist,
and they are not mandated or trained to do intra-oral work. However, and in
spite of the strict restrictions on this, there are many Dental Technicians
that respond to the public needs to supply dentures directly. These Illegal
denturists are small in numbers
and it is not known whether there is a movement towards obtaining clinical
training or recognized status.
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Hungary
Hungary
was part of the Austro-Hungarian Empire, which collapsed during
World War I. The country fell under Communist rule following World War II.
In 1956, a revolt and an announced withdrawal from the Warsaw Pact were met
with a massive military intervention by Moscow. In 1968, Hungary began
liberalizing its economy, introducing so-called "Goulash
Communism." Hungary held its first multiparty elections in 1990 and
initiated a free market economy. Hungary has made the transition from a
centrally planned to a market economy, and continues to demonstrate strong
economic growth and acceded to the EU in May 2004. The private sector
accounts for over 80% of GDP. Inflation has declined from 14% in 1998 to
3.7% in 2006. Unemployment has persisted above 6%.
Out
of the 10 million population of Hungary, only 140 000 people have a private
health insurance, so they have little significance in the dental health care
system. About 30% of dentists work wholly privately, outside the State
system. Patients pay their dentist directly, under an item of treatment
system. There is no regulation of private fees. The quantity of work done
may come under the scrutiny of the Internal Revenue Service. Of the 70% who
work in the State system, some will also work privately, part-time. For
dentists who are contracted to work with the NHI the only private items that
can be provided are those that are not covered by the insurance scheme. For
those dentists who are in private practice, their patients are personally
responsible for the fees charged.
Hungary
has 5 000 dentists in active practice. There are no unemployed dentists. The
most popular of 4 specialties is Pediatric Dentistry. There are 4 000
salaried dental assistants and 525 Hygienists who are usually paid a set fee
for every patient they treat.
Hungary
has an estimated 2 200 Dental Technicians. Laboratories
are registered. Only technicians who have passed a “masters ” examination are registered. They normally work in commercial laboratories. They
construct prostheses for insertion by dentists and they invoice the dentist
for the work that is done. Many
dental technicians do clinical work and have better experience than dentists
in prosthetics.
Training in Denturism ceased in Hungary after 1956 but
Denturists in Hungary have 30-35 years practical experience. It is those
avant-garde
Denturists who can re-introduce the profession to Hungary again.
The Society of Hungarian Denturists has a dedicated number of members who
meet regularly. Their main concern is accreditation of the clinical
examination and finding a way to get recognition for the diploma in Hungary.
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Ireland (Eire)
Irish
governments have sought the peaceful unification of Ireland and have cooperated
with Britain against terrorist groups. A peace settlement for Northern Ireland
is being implemented with some difficulties. Ireland
is a small, modern, trade-dependent economy with growth averaging 6% over the
last decade. Agriculture, once the most important sector, is now dwarfed by
industry and services. Over the past decade, the Irish
Government has implemented a series of national economic programs designed to
curb price and wage inflation, reduce government spending, increase labor force
skills, and promote foreign investment.
The
majority of dentists and hygienists practice
privately. All PCDs must be supervised by a dentist, and the situation
regarding dental technicians has not changed despite an enquiry by Restrictive
Practices Commission (now the Irish Competition
Authority ). The Commission
recommended that the relevant section of the Irish Dentists Act be amended so as
to provide that the general prohibition on the carrying on of dentistry by a
non-dentist does not apply to the provision to a person of eighteen years of age
or over provided it does not involve work being done on living tissue. The
Commission also emphasized that the practice of denturism should not continue to
be prohibited by law. These recommendations were never implemented, apparently
due to resistance from the Irish Dental Council.
The lack of official status for those working in this
area of dentistry has been debated extensively since the 1970s. The Restrictive
Practices Commission, a predecessor of the Competition Authority, held an
official public enquiry into the issue in 1982 and published a Report
highlighting the negative implications for consumers. Over twenty years have passed since the publication of the Restrictive
Practices Commissions’ Report, yet dental technicians still operate in an
uncertain legal environment. There is still no official recognition for
auxiliary dental professionals who would be qualified to sell dentures directly
to the public (i.e. clinical dental
technicians ), to do so legally .
Despite the Dental Council’s reservations about the necessity for a Clinical
Dental Technician grade, it has submitted a proposal for the establishment of
such a grade, following a request from the Minister . Under the proposed Scheme, clinical dental technicians would be permitted
to supply and fit dentures to members of the public. This scheme were rejected
by the Minister primarily because it did not include a mechanism (or
"grandfather clause" ) for recognizing the experience of dental technicians who currently work
in the industry and who, in many cases, already sell dentures directly to the
public (illegally).
However, the Irish Association for Denture Prosthesis
continue to petition the Competition Authority, Dental Council and Department of
Health for the legalization of denturism. In 2005 the Irish Competition Authority Report into the
professional services of Dentists did in depth investigations into the
results of restrictive practices in dental services. The Report concluded
by making explicit direct recommendations for the immediate implementation of a
class of Clinical Dental Technician to provide this service in competition to
dentists, as it will inevitably increase the competence of the service and
decrease the price to the dental consumer.
It is
not understood how the Irish Dental Council have managed to resist the direct
prompting from the Minister of Health to implement Denturism for so long! It is
reported that Ireland will soon have similar legislation to the UK.
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Italy
Italy
has a diversified industrial economy with roughly the same total and per
capita output as France and the UK. This capitalistic economy remains divided
into a developed industrial north, dominated by private companies, and a
less-developed, welfare-dependent, agricultural south, with 20% unemployment.
Most raw materials needed by industry and more than 75% of energy requirements
are imported. The current government has enacted numerous short-term reforms
aimed at improving competitiveness and long-term growth. Italy has moved
slowly, however, on implementing needed structural reforms, such as lightening
the high tax burden and overhauling Italy's rigid labor market and
over-generous pension system, because of opposition from labor unions. Unemployment remains at a high level.
There
are thought to be up to 44 000 dentists who work in private practice, but this
includes many medical physicians and general practitioners who have some
dental equipment in their office. They are self-employed and charge fees
almost exclusively as ‘items of service’, the levels of which are
controlled by market forces.
Italy
has 2 000 Hygienists, 60 000 Chairside Assistants and about 7 000 Dental
technicians. Hygienists can only work under the prescription of a dentist who
must be present in the same practice at all times. Their duties (defined by
Decree in 1999 ) include oral hygiene instruction, scaling and dietary advice.
Hygienists are unable to administer local anesthesia.
Dental
Technicians
are not legally authorized to work at the chairside, or treat patients, and
are only legally allowed to manufacture prostheses from a dentist’s
prescription. There is also a considerable amount of illegal practice in
Italy, some of which is condoned by medical practitioners, who cover for the
technicians concerned. Many Denturists
practice under the supervision of dentists. Their movement towards legislated
Denturism is limited.
/CDI4181.gif)
Kenya
Kenya is located on the east
coast of Sub-Saharan Africa on the Equator and
incorporates an area of some 13, 000 square kilometers of lakes including Lake
Victoria, it hosts the
magnificent snow-topped Mount Kenya (Africa's second highest peak),
the Rift Valley and part of the Serengeti Plain. The Kenyan Highlands
comprise one of the most successful agricultural production regions in Africa; a
unique physical geography supports abundant and varied wildlife of scientific
and economic value. Kenya's climate
varies from tropical along the coast to arid in the interior and has
been hampered by recurring drought and flooding during the rainy seasons.
The
regional hub for trade and finance in East Africa, makes Kenya
powerful in the region but is poor by world standards. The
country has suffered from faltering economic performance over the past decade.
The population of Kenya is 33.5 million with a growth rate of 2.5% one of
the fastest in the developing world. 50% of the population is younger than 15
years old.
In December 2002 the National
Rainbow Party Coalition came to power in peaceful elections. While Kenya
is regarded as politically stable, most of it's neighbors are currently or
have until recently been - fighting civil or external wars. This has led
to an influx of arms and refugees to Kenya, particularly from Somalia and
Sudan. Since the elections, the new government has made some progress,
including the introduction of primary education and the enactment of
anti-corruption legislation. However, there is still a critical need to invest
in the country’s health and economy.
The Kenyan Government’s
Ministry of Health is the biggest provider of health care services. Fifty
percent of hospitals are government funded as are 80% of community health
centres and 61% of dispensaries. Non-government organizations are a vital
part of the Kenyan health system, providing funding for some hospitals,
dispensaries and community health centres. Although there are subsidies to state hospitals and
clinics, individuals are personally responsible for payment
for all dental services. The large majority of inadequate numbers of dentists in
Kenya are working in larger affluent urban areas such as Nairobi and Mombasa,
with very few deployed in the rural areas. There are no chairside assistants,
but dental health officers (therapist/hygienist
category ) are employed by the state to provide basic services
including simple fillings, extractions and oral hygiene education, etc.
Kenya has 180 Dental Technologists, who are
"officially " not qualified to do intra-oral work. About 100 are in private practice,
making dentures and some crown & bridgework, on contract for dentists in
the urban areas. Another ±80 are salaried to work for the State in hospitals and clinics,
especially in the rural areas. These rural clinics are often operated without
dentists. Even when dentists are available, much of their time is engaged with
administration work in state hospitals. Their clinical efforts are focused almost
exclusively on oral health procedures, i.e. fillings, root canal treatments, extractions and surgical
procedures and they do not have the time (or
the specialized skills ) for the clinical procedures of supplying removable appliances. These
dentists do very little denture work and direct such denture needs to dental
technologists working in the clinics, who are better equipped to provide the service directly.
The Kenyan Dental Technology Association is interested
in the recognition of these "denturists
", and is seeking an avenue to attain
accredited clinical training for dental technologists doing this work. Dental
technicians with practical experience in this field working in Nigeria and
some other North-African countries are also reported to be interested in upgrading
their qualifications to become approved Denturists.
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Malta
Malta lies
at the heart of the Mediterranean, situated south of Sicily and north of North
Africa. The country comprises an archipelago, with only the three largest islands
being inhabited; numerous bays provide good harbors. Malta has narrow meandering streets, towns and villages that are crowded
with Renaissance cathedrals and Baroque palaces and the oldest known human
structures in the world. With superbly sunny weather, expansive beaches, a
thriving nightlife and intriguing history, there is a great deal to see and
do. The economy is
dependent on foreign trade, manufacturing (especially electronics and
pharmaceuticals), and tourism. Malta and Tunisia are
discussing the commercial exploitation of the continental shelf between their
countries, particularly for oil exploration.
This
Mediterranean Island has a population of 400 000. Private
practice provides the bulk of all dental treatment and patients pay directly
for most of the dental treatment. Private medical insurance only covers
certain procedures, such as surgical procedures. Private fees are fully "free
market "
by nature and they are determined by agreements between dentists and their
patients. Continuing
education for the 140 dentists of Malta is not mandatory.
16
Dental hygienists work under the prescribed instructions of a dentist,
in a clinic or private practice. Their work includes scaling and normal dental
hygiene, and oral health instruction.
In
the late 19th
century,
tradesman from Sicily arrived in Malta to practice as Dentists or Denturists
to make teeth. When dental education was introduced, some of these trade’s
people became trained in dentistry and became dentists. Others continued their
practice of fabricating dentures and became known as Dental Mechanics. Without
formal education, Dental Mechanics became dependent on the monopoly of
dentists. Eventually, realizing the hard work in providing dentures, dentists
gave the practice over to Dental Mechanics to do the laboratory work. Some Dental
Mechanics continued to provide dentures direct to the public and a rivalry
between the two professions began. Dentists referred to them as "quack dentists
" making dentures that
"caused cancer
". Independent Dental Mechanics
or Denturists were blacklisted by dentistry and only those who remained under
dentistry’s control were given contract laboratory work.
However,
Denturists continued to practice their profession and in fact there were no prosecutions, because
although Denturism is not recognized specifically
by law in
Malta, it is not regarded as illegal. The
MDTA have developed a Code of Ethics, which was officially launched on the website
of the Department of Health, together with those of all the other paramedical
professions, and a Mission Statement. Denturists
provide full and partial dentures. They also provide
immediate dentures
with
the cooperation of a small group of dentists. In 1985, a school of Dental
Technology was established and in 1986 registration began for Dental
Technicians who became recognized as a paramedical profession and subsequently
became known as Dental Technologists. All 20 dental technicians of Malta are
members of The Malta Dental Technician Association
(MDTA), of which 5 are officially known as Denturists.
The Association is looking to develop the 4-year diploma course in dental
technology into a degree level. In collaboration with the European Dental
Laboratory Owners (FEPPD), the Malta Association has established an
educational sub–committee to help in the standardization of education and
training for both the laboratory Dental Technician and the Denturist. In
this matter of standardization of Education and Training in the EU, Denturism
is well ahead as there seems to be better understanding of the development and
evolution of this specialization. The
MDTA is hopeful that with the advent of legislation in the UK in 2006, the
Maltese government will be more willing to have more intense and fruitful
discussion on the formal legislation of Denturists in Malta.
The 2008 AGM of the International Federation of Denturists will be held at the
Fortina Hotel in Sliema on the
Mediterranean island of Malta. Sliema
is a fashionable resort with modern amenities and a rocky beach. The peninsula
stretches out into the Mediterranean looking out to Valletta and has a
promenade, which is ideal for early morning jogs or early evening walks.
/mauritius.gif)
Mauritius
Situated
just South of the Equator in the crystal clear waters of the Indian Ocean,
Mauritius was officially discovered in 1505 by the Portuguese and has since
gone on to attract a variety of occupants, including British, French and
Dutch natives along with the introduction of African, Arab and Chinese
influences over the decades. Summarized in simple terms
as a ‘Tropical Oasis
’, Mauritius is at first sight a sanctuary of peace
and tranquility, combining lush forests with inspiring greenery and dazzling
beaches. However deep at the heart of this divine island, lies a vibrant and
exciting multi-cultural community. Its enviable mix of culture is what adds
to the intrigue of the island, and visitors are welcomed with sincere warmth
and hospitality.
Since
independence in 1968, Mauritius has developed from a low-income,
agriculturally based economy to a middle-income diversified economy with
growing industrial, financial, and tourist sectors. For most of the period,
annual growth has been in the order of 5% to 6%. This remarkable achievement
has been reflected in more equitable income distribution, increased life
expectancy, lowered infant mortality, and a much-improved infrastructure.
Sugarcane is grown on about 90% of the cultivated land area and accounts for
25% of export earnings. A stable democracy with regular free elections and a
positive human rights record, the country has attracted considerable foreign
investment and has earned one of Africa's highest per capita incomes. Recent
poor weather and declining sugar prices have slowed economic growth, leading
to some protests over standards of living in the Creole community
The relative paucity of dentists provides services to
only a small group of wealthy upper class. The Dental Act recognizes Certified
Dental Mechanics, who are legally permitted to provide full
& partial dentures
directly to the public[7]. There are no
further data available about the details of numbers in practice or whether
health insurance is a factor in the distribution of health services on
Mauritius.
/230134565700_1.gif)
Netherlands
A modern,
industrialized nation, the Netherlands is also a large exporter of agricultural
products. The country was a founding member of NATO and the EEC (now the EU).
The Netherlands has a prosperous and open economy, which depends heavily on
foreign trade. The economy is noted for stable industrial relations, moderate
unemployment and inflation, a sizable current account surplus, and an important
role as a European transportation hub. The country
continues to be one of the leading European nations for attracting foreign
direct investment.
Health
care is provided by a government-regulated system of health insurance. There are
schemes which an individual may belong to, public schemes (sick funds), or
private for higher earners. The public scheme is compulsory for those under 65
on low incomes. In 2003 there were 7,623 active registered dentists under 65
years of age of whom 23% were female. Whilst the use of specialists is
limited to orthodontics and maxillo-facial surgery, there is a broad use of
dental auxiliaries. Continuing education is not mandatory. All dentists practice privately, however, 90 % of
dentists are also contracted to a public dental scheme. The national healthcare
scheme is financed by both employers and employees, and is for those in the
low-income bracket. Approximately 63 % of the populations are insured under
this, while those who can afford it subscribe to private health insurance to
supplement the cost of treatment. In the Netherlands maximum fees for private
dentistry are set nationally, and regulated by the government. The Health Care Professions Act introduced in 1997
impacted upon dentistry in that it made registration compulsory, revised the
disciplinary code and introduced formal quality assurance procedures.
Hygienists are permitted to work independently of
dentists and charge their patients, although the majority still work within the
dentists’ practices and charge the patient via the dentist (since all work
they carry out must be referred by them. ) They are, therefore, accountable for
the work they carry out. There is a case study on the liberalization of
hygienists in the Netherlands.
Since the passing of the 1989 Denturism Act by the Dutch Parliament in
The Hague, Denturists can fit full
dentures if the
patient is edentulous, but partial
dentures can only be
made in co-operation with a dentist. Dutch consumers have voiced their
irritation about the unrealistic restrictions on denturists' scope of practice.
Denturists are also authorized to take money
directly from the public.
In 2006, the Dutch health care
system has undergone the severest change in the last 60 years. All
Dutch citizens are now obligated to join in the collective health care
insurance. This system insures that
all dentures and dentures on implants are insured in this basic health care
policy. An internet application
helps the Denturist to screen patients on insurance.
This data is collected in a central database.
The Denturist is also able to send declarations digitally to the
insurance companies and payment is directly sent to the Denturist.
Good
partnership in so-called dental teams (dentist, dental hygienist,
Denturist )
is becoming common in the Netherlands.
/newzealand.gif)
New Zealand
Over the past 20 years the
government has transformed New Zealand from an economy dependent on
concessionary British market access to a more industrialized, free market
economy that can compete globally. This dynamic growth has boosted real incomes
(but left behind many at the bottom of the ladder), broadened and deepened the
technological capabilities of the industrial sector, and contained inflationary
pressures. Per capita income has risen for the past 8 consecutive years. The Labor Government promises that expenditures on health,
education, and pensions will increase proportionately to output.
Dentistry in New Zealand is almost entirely privately
funded. There is some limited state-funded dentistry for children up to the age
of 18 years, and through hospital dental departments. There is no set fee scale
in New Zealand, as the Commerce Act outlaws collusion or any similar behavior
that may restrict competition. The transfer of records at the patients’
request is commonplace.
The Office of the Health and Disability
Commissioner deals with complaints regarding dentists. If they feel it is necessary, the complaint can be passed to the
Director of Proceedings for prosecution, before the Complaints Review Tribunal
or the Dentist Disciplinary Tribunal. The former can fine dentists, while the
latter may strike them off the register, suspend or restrict their practicing.
The trade body, the New Zealand Dental Association, also has a complaints
officer in each regional branch.
The proposed Health Practitioners Competency Bill will mean that dental
therapists will not have to be overseen by a dentist. If it comes into force,
therapists will be registered and they will also be permitted to work in the
private sector. At present, hygienists are required to work under the direct
supervision of a dentist, who must be on the premises. Hygienists will be
registered under the Health Practitioners Competency Bill, and their trade body
is petitioning for them to be allowed to work under the supervision of a dentist
who is not on the premises.
Clinical dental technicians providing
full
& partial dentures
can work directly to the public since 1988. The first
CDTs were registered through a grandfather provision after proof of competence
was established for illegal practitioners. CDTs are now trained alongside dental
students and are tutored by both Prosthodontists and Clinical Dental Technicians in
Dunedin at New Zealand's National School of Dentistry at the University of Otago. CDTs may provide mobile services, which is popular amongst denture
wearers in retirement complexes, homecare and rural areas. The New Zealand
Institute of Dental Technologists (NZIDT) regulates
both dental technicians and CDTs. As in Australia and the Netherlands there is a
trend for Dentists, CDTs and Hygienists to combine their services in group
practices.
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Norway
In 1996 the dental fee system in Norway changed from
one where fees were determined largely through negotiation with the Ministry of
Social Affairs and Health, to an entirely private system with fees being
determined by market forces.
Dental care is still free for those under 18 years of
age, while 19 to 20 year olds pay 25 per cent of the charges. There are no
subsidies to reimburse the cost of private care. Under the Dental Price
Information Act, dentists are required to provide patients with comprehensive
price information and to advertise their range of treatments widely. Dentists
are expected to record the diagnosis and discussion of treatment options in the
patient’s records. If the cost of the treatment exceeds a given amount, then
the patient should be given a written estimate.
Hygienists have been allowed to practice independently
of a dentist and charge the public directly for their services since the
beginning of 2001. They are legally accountable for their work, unless a dentist
has delegated it. However, unlike the other Scandinavian countries of Sweden
and Finland, denturism remains illegal in Norway.
Most dentists practice in the public sector in Sweden.
The public dental service offers free care for children up to 19 years and only
care deemed appropriate and necessary to adults. The latter is financed by state
dental insurance, and by fees paid by patients. Charges are regulated by the
government, and are comparable in both the public and private sectors. The costs
of all types of treatments in the public dental service are reimbursed, as long
as they are necessary to patients’ oral health. Complex and costly courses of
treatment are refunded on the condition that an expert has approved them prior
to treatment.
/dental11.gif)
Poland
Poland
is an ancient nation that was conceived near the middle of the 10th century.
Its golden age occurred in the 16th century. In a
series of agreements between 1772 and 1795, Russia, Prussia, and Austria
partitioned Poland amongst themselves. Poland regained its independence in
1918 only to be overrun by Germany and the Soviet Union in World War II. It
became a Soviet satellite state following the war, but its government was
comparatively tolerant and progressive. A "shock therapy" program during the early 1990s enabled
the country to transform its economy into one of the most robust in Central
Europe, but Poland still faces the lingering challenges of high unemployment,
underdeveloped and dilapidated infrastructure, and a poor rural underclass.
The new
leaders of the Solidarity Trade Union pledged to reduce the Trade
Union's political role. With its transformation to a democratic,
market-oriented country largely completed, Poland is an increasingly active
member of Euro-Atlantic organizations.
Poland
has a system of healthcare financed by means of a common health insurance
within the National Health Fund. Availability of dental care is limited due to
the Fund’s insufficient financial means and very low budgetary expenditure
on dentistry. Private care is freely available, however. Private
fees are fully free market in nature. They are determined in agreements
between dentists and their patients. Attempts have been made at founding
private insurance systems.
24
100 of all dentists are actively working (72%
female ). 5 000 registered
dentists were over 65 years old. Specialists
are widely used, but the clinical auxiliaries are limited to hygienists.
Continuing education for dentists is mandatory, and is administered by the
Polish Chamber of Physicians and Regional Chambers, to which all dentists must
belong.
There
are 2 500 hygienists in Poland. Their duties include preparation,
registration, prophylactic care and promotion of health. They may not diagnose
or give local anesthesia and are not allowed to work without the presence of a
dentist. They may not accept fees from patients, except on behalf of the
dentist. There are 9 700 dental nurses. They are assistants, with training by
the dentist. There is no formal education available for dental nurses. Besides
assisting the dentist they are not permitted to undertake other duties.
Poland has about 7 000 dental technicians. The training
for Dental Technicians is conducted at Medical Schools and Universities (Technical
Colleges ), and lasts 2 years. Dental technician is a professional
title conferred upon the completion of the training, when a diploma is
granted. They register with their own association to conduct commercial
activity. Technicians normally work in commercial laboratories, only a few are
employees of dentists or of clinics. They may work in clinics on salaried
contract or by tender for fees. Dental Technicians do not have a strong association so there is a lack of
credible representation in dealing with government. This situation dates from
the communist era when dentists and dental technicians worked for the state
but could also work privately for themselves. It was a unique situation in all
communist countries. During the communist era they could not organize an
association. After the collapse of communist system, dental technicians worked
freely, establishing private dental laboratories.
A
proposition regarding implementation of Denturism has been presented to the
Ministry of Health. Rejection of the application would allow a push for favorable
legislation by means of self-education, assisted by the IFD. The Denturist
Association have renewed contacts with colleagues who are interested in
practicing Denturism legally.
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Portugal
Following
its heyday as a world power during the 15th and 16th centuries, Portugal lost
much of its wealth and status with the destruction of Lisbon in a 1755
earthquake, occupation during the Napoleonic Wars, and independence from Brazil as a
colony in
1822. A 1910 revolution deposed the monarchy; for most
of the next six decades, repressive governments ran the country. In 1974, a
left-wing military coup installed broad democratic reforms. The following
year, Portugal granted independence to all of its African colonies.
The Health
Service employs doctors, nurses and other supporting staff, but only a very
small number of stomatologists and until recently no dentists. The
publicly funded oral health care system in Portugal is complex and not very
comprehensive. Dentists may contract to one or more Sick Fund schemes. Each
scheme has its own list of eligible treatments and scale of fees and most
include emergency care. Few provide cover for advanced prosthodontics. In 2003
there were 4,500 dentists registered in Portugal. Specialists are new to
Portugal and there were only 41 (37 orthodontists and 4 oral surgeons).
Portugal
has 600 dental technicians who have various degrees from six universities.
There are another 2 000 bench-trained dental technicians who qualify through a
union sponsored exam. Although there is a Paramedical Act, there is no current legislation for Denturists, but
larger laboratories do denture work directly for patients. One university is interested in a Denturist
syllabus and is ready to propose this to the Ministries of Health and
Education. Portugal is also looking to the IFD for assistance in developing
this course.
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Romania
After decades of dictatorship, Romania began the transition from
Communism in 1989 with a largely obsolete industrial base and a pattern of
output unsuited to the country's needs.
There
is strong domestic activity in construction and agriculture, and a need for
creating a middle class and address Romania's widespread poverty, while
corruption and red tape continue to handicap the business environment. Romania
joined the European Union in 2007, and the IMF has praised the country's
recent reform efforts in preparation for EU.
Almost
90% of Romanian dentists are private; they have fiscal code and all kinds of
legal authorizations for free practice, with full responsibilities. 42% of
Romanian dentists are owners of their dental offices. 48% of dentists are not
owners, but work in old buildings offered temporarily, free of rent, by the
Government, which is the real owner. The dentists who work within social
health insurance are paid partially (40%) by the CSHIH (through banks) and
partially directly by the patients (60%). Patients pay the dentists, who work
in private sector, directly and completely. The financial position of the
patient also determines the choice of possibilities. It is estimated that
patients directly pay at least 90% of the costs of dental treatments.
In
Romania, there are 8 700 dentists (2002) – 66% being female. More then 40%
of dentists are older than 50 years. In some parts of Romania, it is reported
that some dentists use old types of dental treatment and prosthetic
restorations, due to the level of dental education of different generations of
dentists. Romania also has 5 000 General Stomatologists. There are officially
no clinical dental auxiliaries in Romania. There are approximately 7 200
Dental Assistants (Nurses) and additionally, 3 000 Dental Technicians. Both
categories have to be registered with the Order of Romanian Medical
Assistants.
Dental
assistants train in secondary medical schools, with 3 years of study and a
final examination and diploma. The duties of dental assistants are: assisting
dentists, maintaining records, sterilization, infection control, and office
work. Dental assistants are paid a salary.
Dental
technicians are trained in dental technician colleges, organized in frame of
the dental faculties. The training is for
3
years, with a final examination and a diploma. Dental technicians normally
work in separate dental laboratories and invoice the dentist (or directly the
patient) for completed prosthetic works. A small number of technicians are
employees of dental practices and they are paid with a percentage of the fees
for the prosthetics work.
In
the absence of clinical training for dental technicians, there is some illegal
supply of dentures practiced by technicians, without appropriate further
qualifications. This practice of
illegal denturism
is being suppressed and
prosecuted, but does not prevent the public denture wearers from seeking out
these direct providers.
/dental12.gif)
Slovakia
The
dissolution of the Austro-Hungarian Empire at the close of World War I allowed
the Slovaks to join the closely related Czechs to form Czechoslovakia. Following
the chaos of World War II, Czechoslovakia became a Communist nation within
Soviet-ruled Eastern Europe. Soviet influence collapsed in 1989 and
Czechoslovakia once more became free. The Slovaks and the Czechs agreed to
separate peacefully in 1993. Slovakia has mastered much of the difficult
transition from a centrally planned economy to a modern market economy and made
excellent progress in macroeconomic stabilization and structural
reform. Major privatizations are nearly complete, and the government has helped
facilitate a foreign investment boom with business friendly policies such as
labor market liberalization and a 19% flat tax. Unemployment remains the
economy's Achilles heel. Slovakia joined the EU in 2004.
61% of dentists in Slovakia are female.
About 73% of private
dentists have an agreement with an insurance company. These dentists work mostly
in former public institutions, where they rent the premises, and sometimes also
the dental equipment. They are paid from the health insurance according to their
output, paid fully or partly by the insurance company (depending upon the
patient’s co-payment).
The
Slovak Denturist Association meets every third Saturday to participate in
continuing education seminars. Membership is growing and a second group of
practitioners undertook the clinical exam in March 2004 after the initial 15 successful
candidates. Eight candidates successfully completed the Exam facilitated by an
IFD examination panel. Another 65 candidates are waiting to take the
examination.
The Slovak Denturist Bill
in an advanced stage during 2004, was held back by more pressing
priorities such as joining the EU. Having
hosted the IFD AGM in Bratislava in 2005 convinced the Slovak Minister of Health
of
the benefits of the Denturist profession for the public. Despite huge opposition
from dentists, The Minister introduced the Denturists Bill to the legislature. With only another 24 hours needed to pass
the Bill, the government collapsed and an early election was called. The
denturist political supporters are now in the opposition. In view of the general
popularity and the benefits of denturism to the public, the new government is
likely to introduce the profession soon.
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South
Africa
South
Africa is a middle-income, emerging market with an abundant supply of
natural resources; well-developed financial, legal, communications, energy,
and transport sectors; a stock exchange that ranks among the 10 largest in
the world; and a modern infrastructure supporting an efficient distribution
of goods to major urban centres throughout the region. However, growth has
not been strong enough to lower South Africa's high unemployment rate, and
daunting economic problems remain from the Dutch and British Colonial era
followed by the apartheid policy (separate development for different races) of the previous Government - especially
poverty and lack of economic empowerment among the disadvantaged groups.
South African economic policy is fiscally conservative but pragmatic
focusing on targeting inflation and liberalizing trade as means to increase
job growth and household income.
This
website is about introducing the category of denturist to the oral health
needs in South Africa. White women of South Africa, older than 65, who has
had access to the best dental services in the country, have an unacceptably
high level of edentulousness, almost twice as high as the males of the same
group, due to their dutiful regular visits to the dentist. The creation of
financial incentives in the private sector have detracted from the ultimate
goal of health for all, and instead have created freedom for practitioners
to abuse and mismanage the patient’s health and medical schemes. Access to
basic oral health services has been woefully inadequate and unaffordable to
the majority of the population. Unilateral decision-making and health care
planning by dentists and the Department of Health have previously deliberately excluded the denturism
lobby.
By law
only a dentist is allowed to measure, fit and sell dentures to members of
the public. There are dental technicians in South Africa who specialize in
the manufacture and repair of dentures, many of whom serve the public
directly, practicing
Denturism illegally "on
the side ".
However, despite having made provision for Clinical Dental Technology
through enabling legislation in 1997, they are unable to acquire appropriate
clinical training in South Africa or to register as clinical dental
technologists. The
poorer segment of the edentulous population, who are not able to afford
private dental fees are making use of illegal, untrained, unqualified
denture services by quacks,
and are subjected to unhygienic procedures and cross infection of
communicable diseases. The state does not provide a safe alternative route
of supply to the indigent population.
The
creation of a register of clinical dental technicians, who will be allowed
to sell dentures direct to the public, will provide competition to dentists
in the sale of dentures. Buyers of dentures will have more choice for at
least the same, or a better quality service then currently exists, provided
by qualified professionals and thereby displace the current illegal and
unsafe supply of dentures by
quacks.
The provision of dentures by denturists will free the hands of dentists to
use their time and specialized skills more effectively towards the
prevention and treatment of oral disease and the promotion of oral health.
With
this website at
<www.denturism.co.za>
The Society aim to become
more effective in sharing facts about denturism especially to the
public.
A debate involving the public is now possible without the
interference of a go-between! This Website intends to inform relevant
stakeholders of our motivations, professional services, products and up to
date information as it becomes available.
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Spain
Spain's
powerful world empire of the 16th and 17th centuries ultimately yielded
command of the seas to England. Spain remained neutral in both
World Wars, but suffered through a devastating civil war during the 1930’s.
A peaceful transition to democracy following the death of dictator Franco in
1975, and rapid economic modernization have given Spain one of the most
dynamic economies in Europe and made it a global champion of freedom.
Continuing challenges include Basque Fatherland and Liberty (ETA) terrorism
and relatively high unemployment.
Despite
the economy's relative solid footing significant downside risks remain
including Spain's continued loss of competitiveness, the potential for a
housing market collapse, the country's changing demographic profile, and a
decline in EU structural funds.
In
2002 there were 19,678 registered dentists in Spain (±14 000 actively
working ), of whom 41% were female. Approximately 98% of the profession work in
the private sector and are largely in single-handed practice. Most are
self-employed and earn their living through charging fees for treatments.
Generally such private practitioners accept only private fee-paying patients.
There is no prescribed fee scale and the laws controlling free competition
restrict the possibility of set fees, but regional dental associations provide
recommended fees for different treatments.
The Dental Act of 1986 recognizes
Hygienists and Dental Assistants but do not recognize Denturists. There are 9 000 Hygienists and 20
000 Dental Assistants. Hygienists are allowed to carry out prophylaxis and
oral health education, but only under the prescription of a dentist who must
be present in the building while they are working.
Spain has almost 10 000 dental technicians but dentists dominate the provision
of dentures. The IFD had contact from Spain to assist in the denturism
aspirations of dental technicians seeking to get legalized recognition.
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St Kitts
(St
Christopher ) and Nevis
Saint
Kitts and Nevis achieved independence from Britain in 1983. In 1998, a vote in
Nevis on a referendum to separate from Saint Kitts fell short of the
two-thirds majority needed. With coastlines in the shape of a baseball bat and
ball, the two volcanic islands are separated by a three-km-wide channel called
The Narrows; on the southern tip of long, baseball bat-shaped Saint Kitts lies
the Great Salt Pond; Nevis Peak sits in the centre of its almost circular
namesake island and its ball shape complements that of its sister island.
Sugar
was the traditional mainstay of the Saint Kitts economy until the 1970s. The
government closed the sugar industry following the 2005 harvest after decades
of losses at the state-run sugar company. To compensate, the government has
embarked on a program to diversify the agricultural sector and to stimulate
other sectors of the economy. Activities such as tourism, export-oriented
manufacturing, and offshore banking have assumed larger roles in the economy.
Tourism revenues are now the chief source of the islands' foreign exchange;
Additional tourist facilities, including a second cruise ship pier, hotels,
and golf courses are under construction.
The
Caribbean Islands had been represented in the past at the IFD, when Jamaica
were members for an extended period, and have hosted the biennial Congress of
the Federation on this Caribbean Island during the early 1990's. The vast area of scattered islands,
is not only famous for calypso & reggae music and for being a popular
tourist destination, but also hosts denturism ambitions. Two individual
members from St Kitts and Nevis have recently joined the IFD, and hopes to
advance their cause for legal status as direct denture providers.
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Switzerland
Switzerland's
sovereignty and neutrality have long been honoured by the major European powers,
and the country was not involved in either of the two World Wars. The political
and economic integration of Europe over the past half-century, as well as
Switzerland's role in many UN and international organizations, has strengthened
Switzerland's ties with its neighbors. Switzerland remains active in many UN and
international organizations but retains a strong commitment to neutrality. Switzerland
is a peaceful, prosperous, and stable modern market economy with low
unemployment, and a highly skilled labor force. The Swiss in recent years have
brought their economic practices largely into conformity with the EU's to
enhance their international competitiveness. Switzerland remains a safe haven
for investors, because it has maintained a degree of bank secrecy and has kept
up the franc's long-term external value. Unemployment has remained at less than
half the EU average.
In Switzerland, apart from a
small number of dentists employed by hospitals or the school dental service,
most oral healthcare is provided by independent private practitioners and paid
for directly by individual patients. About 10% of the population are members of
private insurance schemes, which cover some dental care costs, especially
orthodontics. 89% of dentists are in private practice of which 50% is
in single-dentist practices. Numerous
dentists do not like to work in the field of full and partial prosthetics.
This is due to a lack of experience and due to
Universities offering only superficial training in the field of
prosthetics.
Some dental technicians work illegally; but they would be willing to
accept training to become a Denturist if such training was available.
Since 1961 Denturists are permitted to work
in private practice, but only in the cantons of Zurich, Nidwalden, Schwyz
and
Appenzell-Innerrhoden. They are allowed to provide all
removable prostheses independently.
Their services are not covered by the health insurance. They train under
postgraduate modules for dental technicians offered only to residents (of >5
years) of Zurich and this requires an additional
training period of 1 500 hours. Denturists have to register with the cantonal
health department. The Swiss Society have very recently rejoined membership to
the IFD and plans to restructure their training system in terms of international
trends, and are aiming to have the whole of Switzerland legally accessible to
Denturists.
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United
Kingdom of Great Britain /FImage5.gif)
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The
jurisdiction of the UK includes England, Scotland, Wales, Northern
Ireland as well as the Channel Islands of Guernsey & Jersey and the Isle
of Man. The UK National Health Service (NHS) is largely funded
through general taxation and providing healthcare to all. Approximately 80%
of NHS funds are from general taxation, with the balance coming from charges
to patients for prescriptions, dental and optical care. About 40% of all primary
dental care is paid from the state system and the balance is through
patients’ co-payments and fully private practice. Specialists are
widely used and the use of clinical auxiliaries is well developed.
Participation in continuing education is mandatory for all registered
dentists, whether in clinical practice or not.
In 2003 a
Health Act was passed by Parliament, enabling changes to the system of
delivery of NHS healthcare at the “primary” level, from April 2005. The
Act will alter the relationship of primary care practitioners to more
locally negotiated contracts, and new payment systems. The majority of
details of these changes were not available for inclusion on this website.
There will also be changes to the system of co-payments by patients. Despite the fact that the
workforce is slowly growing, there is a severe shortage of dental workforce in
the UK. Apart from some 32 000 dentists in the UK, there are also 45 000
dental auxiliaries known as Professionals Complementary to Dentistry (PCDs),
classed as:
In the
UK, Dental Technicians admitted to the Dentists’
register under the 1921 Dentists Act proved to be successful dental
practitioners, particularly in dental prosthetics, by virtue of their training
as technicians .
The Nuffield Foundation concluded in 1980 that dental auxiliaries would play a
much bigger part in delivering future dental and oral health care. In 1993 the
Foundation did another in depth investigation into the education and training
of Dental Personnel and a demand and need for a class of denturist was
identified. The
2003 Office
of Fair Trading Report into private Dentistry in the UK
did an in-depth investigation
into the results of restrictive practices of denture provision. In
conclusion the valued contribution of Denturist practice were acknowledged by
the Report,
and specific recommendations made for the introduction of a category of
Clinical Dental Technician, in order to improve efficiency and cost to the
patient.
Legislation for
Clinical
dental technicians were passed in the UK in 2005, to provide all
removable dental appliances. They will
be referred to as registered Dental Care Professionals and will be allowed to sell dentures directly to the
public and work in their own practices independently of dentists and will be
allowed to employ any other member of the Oral Health Team. The General Dental
Council has established a new Register of Clinical Dental Technicians as well
as a Register of Dental Technicians. As yet there are no Clinical Dental
Technology training programs in the UK but the General Dental Council is
currently working with training providers to develop such courses. As an
interim measure, The George
Brown College in Toronto, Canada qualification is now being accredited by the
Royal College of Surgeons of England and has become a recognized diploma for
registration in the UK. Patients will not be required to visit a dentist in the first instance.
Clinical dental technicians will only need to refer patients to a dentist if
they themselves are not competent to carry out a particular procedure or if a
condition is present that is beyond their scope of practice.
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United States of America
The US has the largest and most
technologically powerful economy in the world. In this market-oriented economy,
private individuals and business firms make most of the decisions. US firms are at or near the forefront in technological
advances, especially in computers and in medical, aerospace, and military
equipment; their advantage has narrowed since the end of World War II. Long-term problems include inadequate
investment in economic infrastructure, rapidly rising medical and pension costs
of an aging population, sizable trade and budget deficits, and stagnation of
family income in the lower economic groups.
The dental market in the United States is mainly
private, with a small percentage of public funded dentistry. Prices for private
treatment are not set by a particular body, as this could constitute price
fixing, which is against state and federal law. Dental records are frequently
transferred between dentists at the request of a patient. Patients who are
unhappy with their treatment can complain to the complaints officer of the
dental or denturist regulatory board. In some states, dentists and PCDs are
registered and regulated by the same board, in other states they are separate.
Denturists receive extensive formal training, and work independently of
dentists and charge directly for their services
In
1980 the ADA advocated the development of inexpensive techniques (the
Triad-system) to reduce the cost of services as a method of reducing the impact
of Denturists in the provision of services at much lower cost. Dental clinics
were opened in
Oregon,
Maine
and Arizona
and operated by Dentists to provide a
low cost denture service in competition with privately practicing Denturists.
These clinics were financially supported and subsidized by the ADA, but this did
not, however, end the popularity of Denturists
and these clinics have since
closed and the counter-offensive failed.
In the States of Idaho
(1982),
Montana
(1984) and
Washington
(1994) the
profession of Denturism have since been legislated bringing the USA total to six
and in a number of other states of
California,
Colorado, Connecticut, Florida,
Georgia, Illinois, Indiana, Kentucky,
Louisiana,
Massachusetts, Michigan, Minnesota, Mississippi, New Jersey, Oklahoma, Pennsylvania,
Tennessee, Texas, Wyoming,
etc
major
battles have been going on for some time, some more intense than in others. This
appears to be a turf war determined by vast sums the ADA are prepared to spend
on lobbying/defending dentists rights, and the general public are the losers,
being denied from having any choice in getting dentures from alternative
providers.
Throughout
the US, many dentists are
discontinuing to offer denture services, dental schools have cut back their
curriculum hours in denture training for dental students by 90% over the past
thirty years and over the next ten years, one-third of all dentists who
currently provide denture care are expected to retire from practice, leaving the
US denture population in a vacuum[14]. With
denturism being legalized in all Canadian states up north, and with at least 25 State Associations active, it appears that denturism ambitions is
distributed fairly general throughout the USA. In most states the practice is
forced underground. Clientele is build solely by
word-of-mouth referral from previous customers to their friends and their
relatives. Sizable illicit practices have been built in this manner. Another
common practice is for denturists to guarantee their work to the satisfaction of
their customers, to provide as many adjustments as necessary for such
satisfaction without additional charge, and to make refunds where satisfaction
is not received. This practice is obviously good public relations which is
likely to be particularly important for businesses built on referrals from
previous customers. It is a competitive tool with respect to dentists who
virtually uniformly do not offer refunds to dissatisfied customers and are in
some states forbidden by law from guaranteeing their work[15].
The
US Federal Trade Commission
sent all state
governments a letter of recommended rule-making; encouraging them to institute
the profession of denturism in their state, after conducting a five year study.
In most legalized states denturists are not restricted in the services that they can
provide (i.e. full and
partial dentures) and are permitted
to own denturist and dental practices. As the President of the National
Denturist Federation USA stated: "Denturists
are trained stand-alone practitioners who are in direct competition with
dentistry for that market which is referred to as Removable Oral Prosthetics."
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