Dental Liaison Committee in The EU

Dental Liaison Committee in the EU
MANUAL OF DENTAL PRACTICE
2004
*****
Authors:
Dr Anthony S Kravitz OBE

and
Professor Elizabeth T Treasure
Dental Public Health Unit in the University of Wales,

College of Medicine, Cardiff, United Kingdom
© The Liaison Committee of the Dental Associations of the

European Union
May 2004
EU Manual of Dental Practice 2004 ______
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Preface
The revised Manual of Dental Practice in the EU was commissioned by the Dental Liaison
Committee in the EU1 in November 2002. The work has been undertaken by the Dental Public
Health Unit in the University of Wales, College of Medicine, Cardiff, United Kingdom. Although
the unit had editorial control over the content, most of the changes were suggested and
validated by the member associations of the Committee.
About the authors2
Anthony Kravitz graduated from the University of Manchester, England, in 1966. Following a
short period working in a hospital he has worked in general dental practice in the Greater
Manchester area ever since. From 1988 to 1994 he chaired the British Dental Association’s
Dental Auxiliaries’ Committee and from 1997 until 2003, was the chief negotiator for the UK’s
NHS general practitioners, when head of the relevant BDA committee. From 1996 until 2003 he
was chairman of the Ethics and Quality Assurance Working Group of the EU Dental Liaison
Committee. He is an Honorary Research Fellow at the University of Wales3 College of Medicine,
in Cardiff and his research interests include healthcare systems and the use of dental
auxiliaries.
President of the BDA from May 2004 until May 2005, he was awarded an honour (OBE) by the
Queen at the end of 2002.
Elizabeth Treasure graduated from the University of Birmingham in 1979, following which
she completed a PhD. She then worked in the community dental service before emigrating to
New Zealand to become a full-time academic in 1990. She returned to Wales in 1995. She is
Professor and Honorary Consultant of Dental Public Health at the University of Wales 3 College
of Medicine, in Cardiff and is Vice Dean for research. She has been a scientific advisor to the
Department of Health in London.
Her research interests include clinical effectiveness, epidemiology and clinical trials. She has
been a member of the UK Medical Research Council group on fluoridation and on a European
Union Expert group reviewing the concentration of fluoride in paediatric toothpaste. She is one
of the authors of the 1998 UK Adult Dental Health Survey and has chaired a review of dental
workforce in Wales. She is the leader on the oral health specialist branch of the National
Electronic Library for Health.
Acknowledgements
The authors would like to express their thanks to the staff from all the dental associations of
the EU for their contribution. They would also like to acknowledge and thank:
The dental associations of 28 EU/EEA countries and Romania

The dental councils of several countries
The Secretariat of the EU DLC
Dr William Allen (Dent-Ed)
Rob Anderson
Ms Nadia Costacurta4
Dr Kenneth Eaton (CECDO)
Ann Yeomans
The Federation Dentaire Internationale (FDI)
The Chief Dental Officers of the EU (CECDO)
The European Union of Dentists (EUD)
The World Health Organisation (WHO)
The Union Bank of Switzerland (UBS)
The Organisation for Economic Cooperation and Development (OECD)
1
EU DLC Brussels Office, Avenue de la Renaissance 1, B - 1000 Brussels, Tel: +32 - 2 736 34 29, Fax: +32 -
2 732 54 07
2
The authors may be contacted at denhealth@cardiff.ac.uk
3
Will be known as the “University of Cardiff” from September 2004
4
Principal Administrator, Regulated Professions, Internal Market DG, European Commission, Brussels
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Dental Practice 2004
The CIA Worldfactbook
Disclaimer
The Manual was sent for publication on March 31st 2004, when many issues arising out of the
expansion of the EU on May 1st had still not been resolved.
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Contents
Preface....................................................................................................................................... 2
Introduction.............................................................................................................................. 20
Background..................................................................................................................... 20
The scope and presentation of the review....................................................................... 20
Information collection and validation............................................................................... 21
Additional explanatory notes........................................................................................... 22
Part 1: The European Union......................................................................................................23
The origins of the EU ........................................................................................23
Membership of the EU.......................................................................................23
Objectives of the EU..........................................................................................23
The Institutions..................................................................................................24
Proposed Changes from Enlargement of the EU................................................25
The institutions will all need to change as a result of the increase in the number
of countries of the EU. For an outline of these, see Annex 11, or for the full
description, click on ..........................................................................................25
Proposed New Constitution for the EU..............................................................25
The Economy of the EU....................................................................................26
Part 2: The Dental Directives, Acquired Rights & the Freedom of Movement............................29
The Dental Directives........................................................................................29
Freedom of movement and the (2004) Accession countries...............................31
The Mutual Recognition of third country diplomas and professional
qualifications......................................................................................................31
The General Directives on the mutual recognition of Higher Education
Diplomas............................................................................................................33
EC proposals (2004) for changes to the Directives............................................34
Part 3: Other Directives relevant to dentists.............................................................................36
Medicinal Products and Medical Devices..........................................................36
Medicinal products.......................................................................................................... 36
Medical devices............................................................................................................... 36
Data Protection..................................................................................................36
Consumer Liability............................................................................................36
Misleading and Comparative Advertising .........................................................37
Electronic Commerce.........................................................................................38
Unfair Commercial Practices.............................................................................38
Cosmetics Directive...........................................................................................38
Part 4: Healthcare and Oral Healthcare Across the EU/EEA.......................................................40
Expenditure on healthcare..................................................................................40
Population Ratios...............................................................................................40
Entitlement and access to care...........................................................................40
Financing of oral health care..............................................................................41
Part 5 – The Education and Training of Dentists........................................................................45
Undergraduate education and training ........................................................................... 45
Vocational Training...........................................................................................46
European Dental Education.............................................................................................47
The EU Directorate on Education and Culture has funded an innovative pan-European

project DentEd, www.dented.org to promote a common approach to dental education
across Europe. Over six years many dental schools in the EU and accession countries
have received advice and peer support from visiting teams of dental academics,
supported by several international conferences on trends and strands in dental curricula.
Work is continuing through the Association for Dental Education in Europe (ADEE) to
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develop a profile for a graduating dentist from a European dental school. Much of the
work undertaken by DentEd and ADEE will link to the need for dental education in Europe
to meet the requirements of the Bologna Declaration, which has a 2010 deadline. .......47
Part 6 – Qualification and Registration......................................................................................49
The use of academic titles..................................................................................49
Specific conditions relating to the right to practise............................................49
Part 7 – Dental Workforce......................................................................................................... 52
Dentists..............................................................................................................52
Specialists..........................................................................................................54
Dental Auxiliaries..............................................................................................55
Stomatologists/Odontologists............................................................................57
Part 8 – Dental Practice in the EU............................................................................................. 60
Liberal (General) Practice..................................................................................60
Public Dental Services.......................................................................................60
Public Clinics.....................................................................................................61
Hospital Dental Services....................................................................................63
Dentistry in the Universities..............................................................................63
Dentistry in the Armed Forces...........................................................................63
Financial Matters...............................................................................................64
Dentists’ Remuneration................................................................................................... 64
Part 9 – Professional Matters..................................................................................................... 66
Professional representation................................................................................66
Ethics.................................................................................................................66
Standards and Monitoring .................................................................................67
Advertising........................................................................................................67
Data Protection..................................................................................................67
Indemnity Insurance..........................................................................................68
Corporate Practice..............................................................................................68
European Dental Associations and Committees.................................................68
Part 10 – Individual Country Sections........................................................................................ 71
Austria.............................................................................................................................. 73
Government and healthcare in Austria...............................................................73
Oral healthcare...................................................................................................74
Education, Training and Registration.................................................................76
Workforce..........................................................................................................77
Practice in Austria..............................................................................................78
Professional Matters..........................................................................................80
Other Useful Information...................................................................................83
E-mail: ilse.quaritsch@uibk.ac.at...................................................................83
Belgium............................................................................................................................. 85
Government and healthcare in Belgium.............................................................85
Oral healthcare...................................................................................................86
Qualification and Vocational Training...............................................................87
All registered dentists in 2002 obtained the new title of General Dentist automatically.
Some of them can apply for specialisms in periodontics or orthodontics, if they match the
criteria for these.............................................................................................................. 88
Workforce..........................................................................................................88
Practice in Belgium............................................................................................89
Professional Matters..........................................................................................91
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Ethics.................................................................................................................91
Financial Matters...............................................................................................92
Retirement pensions and Healthcare..................................................................92
Taxes..................................................................................................................92
Other Useful Information...................................................................................93
Cyprus............................................................................................................................... 96
Government and healthcare in Cyprus...............................................................96
Oral healthcare...................................................................................................97
Qualification and Vocational Training...............................................................97
Workforce..........................................................................................................99
Practice in Cyprus............................................................................................100
Professional Matters.........................................................................................102
Ethics...............................................................................................................102
Financial Matters.............................................................................................103
Liberal or General Practice..............................................................................103
Not given........................................................................................................103
Public Health/Hospital.....................................................................................103
€13,200 per year..............................................................................................103
Retirement pensions and Healthcare................................................................103
Taxes................................................................................................................103
Other Useful Information.................................................................................104
The Czech Republic.......................................................................................................... 104
Government and healthcare in the Czech Republic..........................................104
Oral healthcare.................................................................................................106
Education, Training and Registration...............................................................108
Qualification and Vocational Training.............................................................108
Requirements for foreigners to practice dentistry in the Czech Republic (as at
April 2003)......................................................................................................109
Workforce........................................................................................................110
Dental Hygienists.......................................................................................................... 111
Dental Technicians........................................................................................................ 111
Dental Assistants (Nurses)............................................................................................. 111
Practice in the Czech Republic........................................................................111
Ethics...............................................................................................................114
Taxes................................................................................................................115
There is a national income tax (31 CZK - €1 at 1/4/03)..................................................115
City: Plzeň......................................................................................................117
City:Praha........................................................................................................117
Website: www.lf1.cuni.cz............................................................117
City:Hradec Králové........................................................................................117
City:Olomouc..................................................................................................117
Website: www.upol.cz................................................................117
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City: Brno........................................................................................................117
Website: www.muni.cz..................................................................117
Denmark.......................................................................................................................... 119
Government and healthcare in Denmark .........................................................119
Oral healthcare.................................................................................................121
Workforce........................................................................................................125
Practice in Denmark.........................................................................................126
Ethics...............................................................................................................129
Greenland and the Faroe Islands............................................................................................ 130
Taxes................................................................................................................131
Copenhagen.....................................................................................................131
Århus...............................................................................................................131
Estonia............................................................................................................................. 132
Government and healthcare in Estonia ............................................................132
Oral healthcare.................................................................................................134
Workforce........................................................................................................135
Practice in Estonia...........................................................................................137
Ethics...............................................................................................................139
Dentist 25 years old or 2 years after qualification............................................142
Dentist 45 years old or 20 years after qualification..........................................142
Liberal Practice................................................................................................142
Not given.........................................................................................................142
Not given.........................................................................................................142
Hospital............................................................................................................142
€6,000..............................................................................................................142
€12,000............................................................................................................142
Academic.........................................................................................................142
€6,144..............................................................................................................142
€8,400..............................................................................................................142
Taxes................................................................................................................142
Finland............................................................................................................................. 143
Government and healthcare in Finland ...........................................................143
Oral healthcare.................................................................................................144
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Workforce........................................................................................................146
Practice in Finland...........................................................................................150
There are generally no restrictions on these dentists seeing other patients outside
the hospital. The quality of dental care is assured through dentists working in
teams under the direction of experienced specialists. The complaints procedures
are the same as those for dentists working in other settings.............................152
The quality of clinical care, teaching and research in dental faculties is assured
through dentists working in teams under the direction of experienced teaching
and academic staff. The complaints procedures are the same as those for
dentists working in other settings. ...................................................................152
Ethics...............................................................................................................152
Ethical Code.................................................................................................................. 152
Liberal or General Practice..............................................................................155
Hospital............................................................................................................155
Public Health...................................................................................................155
Academic.........................................................................................................155
Taxes................................................................................................................155
Helsinki............................................................................................................156
Turku...............................................................................................................156
Oulu.................................................................................................................156
France.............................................................................................................................. 159
Government and healthcare in France..............................................................159
Oral healthcare .......................................................................................161
Practice in France.............................................................................................167
Ethics...............................................................................................................170
Taxes................................................................................................................172
VAT................................................................................................................................ 172
........................................................................................................................174
Paris.................................................................................................................175
Paris.................................................................................................................175
Bordeaux..........................................................................................................175
Brest.................................................................................................................175
Nantes..............................................................................................................175
Reims...............................................................................................................175
Germany.......................................................................................................................... 176
Government and healthcare in Germany..........................................................176
Oral healthcare.................................................................................................178
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Workforce........................................................................................................184
Movement of dentists across borders...............................................................184
Practice in the Germany...................................................................................186
........................................................................................................................186
Ethics...............................................................................................................191
Liberal or General Practice (2000)...................................................................193
€96,000............................................................................................................193
Public Health...................................................................................................193
Up to €50,000..................................................................................................193
Academic.........................................................................................................193
Up to €80,000..................................................................................................193
Taxes................................................................................................................193
Aachen.............................................................................................................195
Berlin...............................................................................................................195
Bonn...............................................................................................................195
Berlin...............................................................................................................195
Dresden............................................................................................................195
Dusseldorf........................................................................................................195
Number of students: 46 ...................................................................................195
Erlangen..........................................................................................................195
Frankfurt..........................................................................................................195
Freiburg...........................................................................................................196
Giessen.............................................................................................................196
Number of students: 40....................................................................................196
Greifswald..................................................................................................................... 196
Halle.............................................................................................................................. 196
Hamburg....................................................................................................................... 196
Number of students: 47................................................................................................. 196
Greece............................................................................................................................. 199
Government and healthcare in Greece ............................................................199
Oral healthcare.................................................................................................201
Workforce........................................................................................................205
Practice in Greece............................................................................................206
Ethics...............................................................................................................208
Retirement Pensions and Healthcare................................................................209
Taxes................................................................................................................210
VAT................................................................................................................................ 210
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Website: www.dent.auth.gr............................................................................212
Hungary........................................................................................................................... 213
Government and healthcare in Hungary...........................................................213
Oral healthcare.................................................................................................215
Workforce........................................................................................................219
Practice in Hungary.........................................................................................221
Ethics...............................................................................................................223
Taxes................................................................................................................225
Other Useful Information ................................................................................226
Budapest..........................................................................................................226
Debrecen..........................................................................................................226
Szeged..............................................................................................................226
Pécs..................................................................................................................226
Iceland............................................................................................................................. 227
Government and healthcare in Iceland.............................................................227
Oral healthcare.................................................................................................229
Continuing education arrangements are limited to one lecture series in the spring
semester about subjects related to dentistry and weekend courses on irregular schedule.
Teaching is in Icelandic................................................................................................. 232
Workforce........................................................................................................233
Practice in Iceland............................................................................................234
Ethics...............................................................................................................237
Taxes................................................................................................................239
Ireland............................................................................................................................. 242
Government and healthcare in Ireland.............................................................242
Oral healthcare.................................................................................................244
Workforce........................................................................................................248
* About 95 General Practitioners also work part-time in the Universities.......................248
Practice in Ireland............................................................................................250
Fitness to Practise............................................................................................252
Ethics...............................................................................................................253
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Dublin..............................................................................................................257
Cork.................................................................................................................257
Email: .............................................................................................................257
Italy................................................................................................................................ 258
Government and healthcare in Italy.................................................................258
Oral healthcare.................................................................................................260
From January 2003, the EU Directives were fully implemented by the Italian
Government, and only a university degree in Dentistry is acceptable for first
registration as a dentist in Italy........................................................................263
Workforce........................................................................................................264
Practice in Italy................................................................................................265
Ethics...............................................................................................................268
........................................................................................................................270
Dentist 25 years old or 2 years after qualification ...........................................270
Dentist 45 years old or 20 years after qualification .........................................270
Private or General Practice..............................................................................270
0 to 30,000.......................................................................................................270
30-100,000.......................................................................................................270
Public...............................................................................................................270
30,000..............................................................................................................270
40,000..............................................................................................................270
Hospital............................................................................................................270
30,000..............................................................................................................270
60,000..............................................................................................................270
Academic.........................................................................................................270
30,000..............................................................................................................270
70,000..............................................................................................................270
Taxes................................................................................................................270
Latvia.............................................................................................................................. 276
Government and healthcare in Latvia..............................................................276
Oral healthcare.................................................................................................277
Workforce........................................................................................................281
Practice in Latvia.............................................................................................283
Ethics...............................................................................................................286
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Taxes................................................................................................................287
Lithuania......................................................................................................................... 289
Government and healthcare in Lithuania ........................................................289
Oral healthcare.................................................................................................291
Workforce........................................................................................................295
Practice in Lithuania........................................................................................297
Ethics...............................................................................................................298
Taxes................................................................................................................300
Details of indemnity organisations:..................................................................301
Luxembourg..................................................................................................................... 302
Government and healthcare in Luxembourg ...................................................302
Oral healthcare.................................................................................................303
Workforce........................................................................................................305
Practice in Luxembourg...................................................................................305
No dentists serve full-time in the Armed Forces. ............................................307
Ethics..............................................................................................................307
Taxes................................................................................................................308
Malta............................................................................................................................... 310
Government and healthcare in Malta ..............................................................310
Oral healthcare.................................................................................................311
Specialist Training......................................................................................................... 312
Workforce........................................................................................................313
Practice in Malta..............................................................................................314
Taxes................................................................................................................319
The Netherlands............................................................................................................. 321
Government and healthcare in the Netherlands ...............................................321
Oral healthcare.................................................................................................323
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Workforce........................................................................................................327
Practice in the Netherlands..............................................................................329
Ethics...............................................................................................................331
Taxes................................................................................................................334
Norway........................................................................................................................... 336
Government and healthcare in Norway ...........................................................336
Oral healthcare.................................................................................................337
Workforce........................................................................................................341
Practice in Norway...........................................................................................343
Ethics...............................................................................................................345
Cases concerning breaks of the ethical code are discussed by a designated Board. The
consequence of a violation can be an action in the following forms: a formal notice of
disapproval, a decision that the dentist in question, for a period of two years, cannot be
elected as a representative within the NDA. They may also advise the NDA Board to fine
the member (to a maximum of 110,000 NOK - €14,100) or to exclude him/her from
membership of the NDA. The decision cannot be appealed, but the member has the right
to make a statement to the Board which handles the case. ........................................346
Patients’ claims are not handled. Liability is regarded as a separate question, and is not
part of the Board’s jurisdiction. .................................................................................. 346
Taxes ...............................................................................................................348
Main national association and Information Centre:.........................................349
Competent Authority:......................................................................................349
Oslo..................................................................................................................349
Bergen..............................................................................................................349
Poland............................................................................................................................. 350
Government and healthcare in Poland .............................................................350
Oral healthcare.................................................................................................352
Workforce........................................................................................................358
Practice in Poland............................................................................................360
Taxes................................................................................................................366
........................................................................................................................368
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Białystok .........................................................................................................369
Gdansk ............................................................................................................369
Website: www.amg.gda.pl .............................................................................369
Lublin..............................................................................................................369
Website: www.am.lublin.pl ............................................................................369
Łodz.................................................................................................................369
Zabrze / Katowice/...........................................................................................369
Warsaw............................................................................................................369
Szczecin...........................................................................................................369
Website: www.pam.szczecin.pl.......................................................................369
Wrocław...........................................................................................................369
Fax: +48 71 215 729........................................................................................369
Websites: www.am.wroc.pl and.......................................................................369
Poznań ............................................................................................................369
www.am.poznań.pl..........................................................................................369
Łodz.................................................................................................................369
Wojskowa Akademia Medyczna......................................................................369
www.wam.lodz.pl............................................................................................369
Portugal.......................................................................................................................... 372
Government and healthcare in Portugal ..........................................................372
Oral healthcare.................................................................................................374
Workforce........................................................................................................378
Numbers (2002)...............................................................................................378
Orthodontists....................................................................................................378
36.....................................................................................................................378
Oral Surgeons..................................................................................................378
4.......................................................................................................................378
Practice in Portugal..........................................................................................379
Ethics...............................................................................................................382
Taxes................................................................................................................384
Romania......................................................................................................................... 386
Government and healthcare in Romania..........................................................386
Oral healthcare.................................................................................................388
Education and Training....................................................................................390
Workforce........................................................................................................392
Specialists........................................................................................................393
Practice in Romania.........................................................................................393
Fee scales...................................................................................................................... 394
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Ethics...............................................................................................................396
Taxes................................................................................................................399
VAT................................................................................................................................ 399
...............................................................................................................399
Iaşi...................................................................................................................400
Timişoara.........................................................................................................400
Tîrgu- Mureş....................................................................................................400
Cluj-Napoca.....................................................................................................400
Constanţa.........................................................................................................400
Craiova............................................................................................................400
Bucureşti..........................................................................................................400
Sibiu.................................................................................................................400
Oradea..............................................................................................................400
PRIVATE FACULTY.....................................................................................400
Bucureşti..........................................................................................................400
PRIVATE FACULTY.....................................................................................400
Iaşi...................................................................................................................400
PRIVATE FACULTY.....................................................................................400
Arad.................................................................................................................400
Email: rectoratuvg@inext.ro ...........................................................................400
Slovakia.......................................................................................................................... 402
Government and healthcare in Slovakia ..........................................................402
Oral healthcare.................................................................................................404
Workforce........................................................................................................408
Practice in Slovakia.........................................................................................412
Ethics...............................................................................................................414
Taxes............................................................................................................................. 416
VAT................................................................................................................................ 416
Competent authority: ..............................................................................419
Main information centre:.................................................................................419
Medical Faculty with specialisation in dentistry..............................................420
Bratislava.........................................................................................................420
Medical Faculty with specialisation in dentistry..............................................420
Košice..............................................................................................................420
The medical faculty in this university does not have any specialisation in
dentistry...........................................................................................................420
Martin .............................................................................................................420
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Slovenia.......................................................................................................................... 421
Government and healthcare in Slovenia ..........................................................421
Oral healthcare.................................................................................................423
Workforce........................................................................................................425
Practice in Slovenia.........................................................................................426
Joining or establishing a practice................................................................................... 427
Ethics...............................................................................................................429
Taxes................................................................................................................430
VAT................................................................................................................................ 430
Ljubljana..........................................................................................................430
Website: http://animus.mf.uni-lj.si/~stoma/ ....................................................430
Spain.............................................................................................................................. 434
Government and healthcare in Spain ..............................................................434
Oral healthcare.................................................................................................436
Workforce........................................................................................................438
Practice in Spain..............................................................................................440
Ethics...............................................................................................................442
Taxes................................................................................................................444
VAT................................................................................................................................ 444
Universidad Alfonso X El Sabio...................................................................................... 445
Facultad Ciencias de la Salud........................................................................................ 445
Avda. de la Universidad, 1............................................................................................. 445
Tel: +34 91.810 92 00........................................................................................... 445
Universidad Europea de Madrid .................................................................................... 445
C/ Tajo s/n..................................................................................................................... 445
Tel: +34 91.616 82 56............................................................................................. 445
Universidad Internacional de Catalunya........................................................................ 445
Campus de Sant Cugat. ................................................................................................ 445
Hospital General de Catalunya...................................................................................... 445
Gomera s/n – ................................................................................................................ 445
08190 San Cugat del Vallés........................................................................................... 445
Tel: +34 935 042 000............................................................................................ 445
Universidad Cardenal Herrera CEU ............................................................................... 445
Facultad Ciencias Experimentales y de la Salud............................................................ 445
C/ Luis Vives, 2.............................................................................................................. 445
Tel: +34 961 369 000............................................................................................ 445
Fax: +34 961 395 270 ........................................................................................... 445
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Website: http://www.uch.ceu.es/principal/inicio.asp...................................................... 445
Madrid.............................................................................................................446
Barcelona.........................................................................................................446
Valencia........................................................................................................................ 446
Granada........................................................................................................................ 446
Vizcaya.......................................................................................................................... 446
Facultad de Vizcaya ...................................................................................................... 446
Universidad del País Vasco ........................................................................................... 446
Facultad de Medicina y Odontología ............................................................................. 446
Sarriena s/n................................................................................................................... 446
48940 Lejona (Vizcaya)................................................................................................. 446
Tel: +34 94 464 77 00............................................................................................. 446
Fax: .............................................................................................................................. 446
Santiago de Compostela................................................................................................ 446
Facultad de Medicina de Santiago de Compostela.........................................................446
Entrerios, s/n1............................................................................................................... 446
15705 Santiago de Compostela (La Coruña).................................................................. 446
Tel: +34 981 562 026............................................................................................ 446
Sevilla............................................................................................................................ 446
Facultad de Sevilla........................................................................................................ 446
Facutad de Odontología................................................................................................. 446
C/ Avicena s/n, .............................................................................................................. 446
41009 Sevilla ................................................................................................................ 446
Tel: +34 95 448.11.03............................................................................................ 446
Murcia........................................................................................................................... 446
Facultad de Medicina..................................................................................................... 446
Campus de Espinardo. .................................................................................................. 446
Hospital General Universitario Morales Meseguer..........................................................446
Avda. Marqués de los Vélez, s/n – ................................................................................. 446
30008 Murcia................................................................................................................ 446
Tel: +34 968 36 43 12............................................................................................ 446
Oviedo........................................................................................................................... 446
Facultad de Medicina..................................................................................................... 446
Clínica Universitaria de Odontología.............................................................................. 446
C/ Catedrático José Serrano, s/n , ................................................................................. 446
33006 Oviedo................................................................................................................ 446
Tel: +34 98 510 36 47 ............................................................................................. 446
Fax: +34 98.510.35.33.............................................................................................. 446
Madrid........................................................................................................................... 447
Universidad Rey Juan Carlos.......................................................................................... 447
C/ Tulipán s/n................................................................................................................ 447
28933 (Móstoles) Madrid............................................................................................... 447
Tel: +34 91.665.50.60............................................................................................. 447
Sweden........................................................................................................................... 447
Government and healthcare in Sweden ...........................................................447
Oral healthcare.................................................................................................449
Workforce........................................................................................................452
Practice in Sweden...........................................................................................455
Working in the Armed Forces .........................................................................456
Taxes................................................................................................................459
Dental Schools:.............................................................................................................. 461
Website www.sahlgrenska.gu.se .....................................................................461
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Website www.umu.se/odont ...........................................................................461

Switzerland..................................................................................................................... 463
Government and healthcare in Switzerland .....................................................463
Oral healthcare.................................................................................................465
Workforce........................................................................................................466
Dental Therapists.......................................................................................................... 468
Dental Chairside Assistants........................................................................................... 468
..................................................................................................................................... 468
Practice in Switzerland....................................................................................468
Ethics...............................................................................................................471
Ethical Code.................................................................................................................. 471
Standards and monitoring............................................................................................. 471
Advertising.................................................................................................................... 471
Indemnity Insurance...................................................................................................... 471
Corporate Dentistry....................................................................................................... 471
Health and Safety at Work............................................................................................. 471
Dental Associations (and competent authority)...............................................473
Switzerland......................................................................................................473
Liechtenstein....................................................................................................473
LIECHTENSTEIN...........................................................................................474
The United Kingdom............................................................................................................... 476
Government and healthcare in the UK ............................................................477
Oral healthcare.................................................................................................478
Workforce........................................................................................................482
Practice in the United Kingdom.......................................................................485
Ethics...............................................................................................................489
Taxes................................................................................................................491
THE BRITISH DEPENDENT ISLANDS.......................................................495
Annex 1 - Information collection and validation...................................................................... 500
Annex 2 – European Health Strategy...................................................................................... 503
OBJECTIVE....................................................................................................503
CONTENTS....................................................................................................503
Annex 3 – EU Institutions........................................................................................................ 507
Future size of the Commission ........................................................................507
The Council.....................................................................................................508
The European Parliament.................................................................................508
The Court of Justice.........................................................................................509
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18
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Number of members of the European Parliament 1999 to 2007 .....................510

The Economic and Social Committee..............................................................510
The Committee of the Regions........................................................................510
The Court of Auditors......................................................................................510
The European Investment Bank.......................................................................510
Types of Community Legislation.....................................................................511
Annex 4 – Diplomas and Qualifications................................................................................... 514
Annex 5 – Specialist Diplomas & Qualifications ...................................................................... 521
Annex 6 – Content of undergraduate training and education .................................................525
Annex 7 – Acquired Rights ..................................................................................................... 529
Annex 8 – Data Protection ...................................................................................................... 533
Annex 9 – Code of Conduct for Electronic Commerce............................................................. 536
Annex 10 – Tooth Whitening in the EU ................................................................................... 539
Annex 11 – A summary of the draft EU Constitution (as at June 2003)....................................543
__________________________________________________________________
19
________________________________
Introduction
Background with descriptions of how things work in
reality.
In common with many other professionals,
An introduction to the EU and dental
dentists are increasingly seeking
practitioners
opportunities to work and live in other
countries. Within the EU, the ability for
The opening chapters outline the origins of
dentists to move and work in any country
the EU and its attitude to health; how the
has never been greater and national dental
EU functions including descriptions of its
associations have experienced a
formal institutions (for example, the
considerable increase in the number of
Commission, the Council, the European
enquiries from members about practising
Parliament, the Court of Justice) and the
abroad. The problems and expense of
current membership of the EU. We have
answering these questions on an ad hoc
also described the EU Dental Directives
basis, and the need for associations to
which are directly relevant to dentists, and
conduct their national political negotiations
we have listed the titles and qualifications
in the context of international experience,
to which the directives relate.
resulted in the European Union Dental
Liaison Committee (EUDLC) commissioning
The comparative analysis
the Dental Public Health Unit of the
University of Wales Dental School in Cardiff
Further chapters provide a simple
(UK), in 1993, to produce a comprehensive
comparative analysis of the different
reference document describing the legal
systems for the delivery of oral healthcare
and ethical regulations, dental training
service, the nature of education, training
requirements, oral health systems and the
and the constitution of the dental
organisation of dental practice in 18
workforce, different practising
European (EU and EEA) countries.
arrangements, and other regulatory
frameworks and systems within which
Following publication of early drafts, the
dentists work. We have briefly covered
first full edition of this review was
dentists’ remuneration, ethical codes, the
published as a Manual of Dental Practice in
monitoring of standards, specialist and
the EU in 1997, and this was updated in
auxiliary personnel, and the relative
January 2000.
importance of oral health services provided
outside general or private practice.
The EUDLC again commissioned the
University of Wales, in November 2002, to
The country chapters
further update the Manual and extend it to
embrace the countries which were
The bulk of the Manual contains the
acceding to membership of the EU in May
detailed descriptions of the oral health
2004, and Romania (which accedes in
systems, and the ways in which dentists
2007).
practise in each of 29 countries. In addition
to the 25 countries of the EU, Norway,
The scope and presentation of the Switzerland and Iceland are included.
review Liechtenstein is mentioned within the
Switzerland chapter, and opportunities in
The Manual aims to provide comprehensive Greenland and the Faroe Islands are
and detailed information for dentists who described in the chapter for Denmark.
are considering working in another country. There are self-governing islands in the
The authors have endeavoured to construct British Isles and these have been included
a basic, minimum framework as an in the UK section. Romania has also been
introduction to the most relevant topics, included as this country is a candidate for
and a well-informed starting point for admission to the EU in 2007, and they
further questions which individuals may requested inclusion.
raise.
Each country chapter includes:
It has been written as a practical
“handbook” in which information is easy to • A brief description of the historical
find and to understand. The country background, political system and any
chapters also aim to balance information features of the country’s society,
about formal requirements including laws, economy or geography that are
codes of practice and other regulations
__________________________________________________________________
20
__ ____EU Manual of
significant for the organisation of health explanation of the framework for dental
services. practice in terms of professional
organisations, ethical codes and any
• The main features of the health system, other systems for monitoring standards
including: how it is funded, how health and handling complaints.
policy is decided, and how the provision
of health services is organised. • A “Financial” section, which briefly
introduces many financial
• A section on oral healthcare which considerations for practice.
provides a general overview of the
bodies responsible for its provision, the
population groups who have access,
• Finally there is an Other useful
information section which provides the
and the services that are available to
name, address, telephone and fax
them.
numbers of the main national dental
associations, together with some other
• A description of entry to and general data.
content of dental school
(undergraduate) education and
Information collection and validation
training, and the requirements for
registration - including the
The original information was collected in
requirements for legal practice, the
early 1996, in three stages using a
bodies which approve applications, the
questionnaire to the main dental
documents which need to be
associations in each of the then 18
submitted, and any other conditions
countries involved (the 15 EU countries,
which need to be met. Additionally, any
plus Norway, Switzerland and Iceland). For
postgraduate education and training
countries where there was no single main
(including specialist training) is
national association, more than one
described. The paragraphs on
questionnaire was sent to obtain the most
Specialists list the dental specialties
complete picture possible.
that are recognised, including the
formal training required for each, and
After the initial exercise, validation
its location and duration.
interviews were conducted between the
Spring and Autumn of 1996 to clarify and
• A section on what constitutes the extend the information provided by the
dental workforce in each country, questionnaires.
including numbers of dentists and
specialists. There are several The interview stage of the information
paragraphs on Dental Auxiliaries, which collection process was essential for
list the types of auxiliary that are identifying important differences between
recognised, what procedures they are countries, resolving potential ambiguities
allowed to carry out, where they work and exploring in detail those issues briefly
and the rules within which they may covered by the questionnaire, which were
legally practise. more important for dental practice in a
particular country.
• Paragraphs on Working in
General/Private /Independent practice, The first draft of each country chapter was
Working in the Public Dental Service written primarily on the basis of the
(where appropriate), Working in interview notes, supported by
Hospitals, and Working in Universities questionnaire answers, and any other
and Dental Faculties. For each of documents which the national dental
these, there is a brief description of the associations were able to supply. The draft
staff titles and functions, the minimum of each country chapter was then checked
formal qualifications required, and how for clarity, completeness and accuracy,
dentists are paid. For general or before publication.
private practice this usually involves
details of the administration of any fee- The process was repeated for the second
scales, whether remuneration is part of edition and the content was extended to
a contract, rules for prior approval, and include information about women in
some practical details of how to join or dentistry, specialisation and remuneration
establish a practice. trends where appropriate and available.
• A section on dentistry in each This third edition has been revised and
country which is described as updated using two methodologies: for the
“Professional Matters” and includes an “candidate” (new) countries of the EU new
__________________________________________________________________
21
________________________________
questionnaires were devised, based on an
analysis of the information supplied by the
existing countries in the first and second
editions. Interviews were then conducted
by the authors, with the representatives of
the relevant countries, at various
international meetings during 2003.
The data and information for the existing

EU countries were analysed and cross-
checked for common information and then
the individual country sections were
marked by the authors for clarification,
modification, expansion and revision,
before being sent to the 18 dental
associations in February 2003.
Following receipt by the authors of the

corrected country sections, clarification of
any ambiguous information was
undertaken, again at international
meetings and by Email. The data was then
validated with dental associations of the
countries, many chief dental officers, and
some dental councils and registration
bodies, before publication.
Documentary sources of information used

are listed in Annex 1.
Additional explanatory notes
It was not possible to obtain a single, valid

reference date for all data, across all
countries of Europe. The collection of data
took place during 2003, and so this should
be assumed to be the reference year for
the data, except where another date is
shown.
English language conventions have been

used for expressing numbers and figures,
so that:
• Decimals are expressed with a point,

eg 5.3
• Millions are expressed with a comma,
eg 1,000,000
• “Billion” refers to One Thousand Million
• The sign for a Euro is € and this is
placed before the number, eg €100
• The term “Accession Countries” refers
to the ten new EU countries at May
2004: Cyprus, the Czech Republic,
Estonia, Hungary, Latvia, Lithuania,
Malta, Poland, Slovakia and Slovenia –
and Romania, whose membership of
the EU will not be before 2007.
__________________________________________________________________
22
__ ____EU Manual of
Part 1: The European Union

The origins of the EU (EEA) to the countries of the European Free
Trade Area (EFTA). These remaining non-
The European Union (EU) was set up after EU EFTA countries are Iceland,
the 2nd World War. The process of Liechtenstein and Norway. One other EFTA
European integration was launched on 9 country, Switzerland, was included in the
May 1950 when France officially proposed initial agreement, but withdrew after a
to create “the first concrete foundation of a referendum in which its population rejected
European federation”. The Treaty of Paris the concept. This decision has also
which was signed on 18th April, 1951, delayed the involvement of Liechtenstein
created the European Coal and Steel because of its "customs union" with
Community (ECSC) in 1952. Six countries Switzerland.
(Belgium, the Federal Republic of Germany,
France, Italy, Luxembourg and the
Netherlands) joined from the very Objectives of the EU
beginning. The success of this limited
agreement persuaded the six signatories to
The European Union is said to be based on
extend their commitment.
the rule of law and democracy. It is neither
a new State replacing existing ones nor is it
To achieve this, on 25th March, 1957, they
comparable to other international
negotiated and agreed the two Treaties of
organisations. Its Member States delegate
Rome which created the European
sovereignty to common institutions
Economic Community (EEC) and the
representing the interests of the Union as a
European Atomic Energy Community
whole on questions of joint interest. All
(Euratom). These three collectively
decisions and procedures are derived from
became known first as the EEC, then as the
the basic treaties ratified by the Member
European Community (EC) and finally the
States.
European Union (EU).
It has been suggested that European
integration has delivered half a century of
Subsequently, there have been several stability, peace and economic prosperity. It
waves of accessions, so that by May 1st has helped to raise standards of living, built
2004 the EU comprised 25 member states. an internal market, launched the euro and
strengthened the Union's voice in the
Membership of the EU world.
Principal objectives of the Union are:

• Belgium, France, Germany, Italy,
Luxembourg and the
• Establish European citizenship
Netherlands (March 1957) – were
(Fundamental rights; Freedom of
the founding countries
movement; Civil and political rights);
• Denmark, Ireland and the United
Kingdom (January 1973) • Ensure freedom, security and justice
(Cooperation in the field of Justice and
• Greece (1981) Home Affairs);
• Spain and Portugal (January • Promote economic and social progress
1986) (Single market; Euro, the common
• Austria, Finland and Sweden currency; Job creation; Regional
(January 1995) development; Environmental
• Cyprus, the Czech Republic, protection);
Estonia, Hungary, Latvia, • Assert Europe's role in the world
Lithuania, Malta, Poland, (Common foreign and security; The
Slovakia and Slovenia (May European Union in the world).
2004)
• Bulgaria and Romania (2007) The EC treaty was amended on 1st July,
1987, by the Single European Act (SEA).
This restated the objectives of the EC by
On 1st January 1994, some of the privileges formalising the commitment to the
of the Community, for example "freedom of completion of the "Internal Market" by
movement" were extended through the 1992. The Act also extended the
Treaty on the European Economic Area competence of the Community to new
__________________________________________________________________
23
________________________________
areas such as environmental improvement • development of an integrated health
and the strengthening of social cohesion strategy: as a result of the Treaty
and modified the decision making process provision which stipulates that a high
by extending the use of majority voting in level of health protection must be
the Council of Ministers. ensured in the definition and
implementation of Community policies,
The 1993 Treaty which led to the creation health protection concerns all key
of the European Union further developed areas of Community activity. This new
these concepts and a "Green Paper" on strategy contains specific measures to
European Social Policy was introduced in address the obligation to incorporate
December of that year. Issues addressed health protection into all Community
included unemployment, social protection policies.
and social standards, the Single Market and
effective freedom of movement, equal
For further information about the strategy
opportunities for men and women and the
see Annex 2
transition to economic and monetary union.
Between March 1996 and June 1997 an The Institutions

Intergovernmental Conference (IGC) The EU is run by five institutions,
developed the consolidated Treaty of each playing a specific role:
Amsterdam revising the original Treaties on
which the European Union was founded.
The IGC is the formal mechanism for • European Parliament (elected by
revising the Treaties, which are the the peoples of the Member States);
constitutional texts of the European Union. • Council of the Union (composed
Any changes are agreed following of the governments of the Member
negotiations between governments of the States);
Member States which belong to the Union.
• European Commission (driving
force and executive body);
The extension of the EU to embrace the
new countries of Eastern Europe was • Court of Justice (compliance with
agreed at the IGC held in Nice in 1999. the law);
• Court of Auditors (sound and
In the context of the EU’s objectives, Article lawful management of the EU
152 (ex Article 129) requires the budget).
Community to “complement national
Five further bodies are part of the
policies” and to direct Community action
institutional system:
“towards improving public health,
preventing human illness and diseases, and • European Economic and Social
obviating sources of danger to human Committee (expresses the opinions of
health. Such action will cover the fight organised civil society on economic and
against the major health risks by promoting social issues);
research into their causes, their
• Committee of the Regions (expresses
transmission and their prevention, as well
the opinions of regional and local
as health information and education”.
authorities on regional policy, environment,
and education);
In 2000, a new EU Health Strategy was • European Ombudsman (deals with
devised. This was “to reflect the European complaints from citizens concerning
Community's new responsibilities and allow maladministration by an EU institution or
it to play its role to the full by helping to body);
raise the level of protection while at the
• European Investment Bank (contributes
same time supplementing Member States'
to EU objectives by financing public and
activities and responding to the main
private long-term investments);
challenges of public health”.
• European Central Bank (responsible for
monetary policy and foreign exchange
The strategy consists of two main operations).
elements: A number of agencies and bodies complete
the system. For further information about
• a public health framework, including an each institution go to Annex 3, or click this
action programme in the field of public Internet link:
health (2001-2006) and in public health
policy and legislation;
__________________________________________________________________
24
__ ____EU Manual of
Proposed Changes from Enlargement The Convention’s proceedings ultimately
of the EU led to the drawing up of a draft Treaty
establishing a Constitution for Europe, at
The institutions will all need to change as a the plenary session on 13 June 2003.
result of the increase in the number
of countries of the EU. For an outline However, at the Brussels summit of Heads
of these, see Annex 11, or for of State and Government (IGC) on 12-13
the full description, click on December 2003 they did not reach an
agreement on the final text of the
Constitution. Therefore, the discussions will
continue in 2004 under the Irish
Proposed New Constitution for the EU Presidency.
Noting that the European Union was
The final version, when adopted by the IGC,
coming to a turning point in its existence,
will have to be ratified by all current
the European Council which met in Laeken,
Member States of the European Union.
Belgium, on 14 and 15 December 2001
convened the European Convention on the
Future of Europe.
The Convention was asked to draw up

proposals on three subjects:
• how to bring citizens closer to the

European design and European
Institutions;
• how to organise politics and the
European political area in an enlarged
Union;
• how to develop the Union into a
stabilising factor and a model in the
new world order.
The Convention identified responses to the

questions put in the Laeken declaration:
• it proposed a better division of Union

and Member State competences;
• it recommended a merger of the
Treaties and the attribution of legal
personality to the Union;
• it established a simplification of the

Union’s instruments of action;
• it proposed measures to increase the
democracy, transparency and
efficiency of the European Union,
o by developing the contribution of
national Parliaments to the legitimacy of
the European design, by simplifying the
decision-making processes,
o by making the functioning of the
European Institutions more transparent and
comprehensible;
• it established the necessary measures

to improve the structure and enhance the
role of each of the Union’s three
institutions, taking account, in particular, of
the consequences of enlargement.
__________________________________________________________________
25
________________________________
To see the full text of the Constitution, click GDP per capita
this internet link: http://european- 2001
convention.eu.int/ .
Luxembourg
For a summary, see Annex 11

Switzerland
Norway
Denmark
Iceland
Ireland
Sweden
United Kingdom
Netherlands
The Economy of the EU

France
Finland
Austria
Belgium
Germany
Italy
Spain
The traditional way of measuring the Cyprus

Greece
Portugal
“wealth” of a nation is through its Gross Slovenia
Czech Republic
Malta
Domestic Product (GDP). The GDP Hungary

Poland
Slovakia
measures output generated through Estonia

Lithuania
Latvia
production by labour and property which is €0 € 10,000 € 20,000 € 30,000 € 40,000 € 50,000
physically located within the confines of a

country. It excludes such factors as income
earned by its citizens working overseas, but
does include factors such as the rental
value of owner-occupied housing.
Chart 1 – GDP per capita 2001: source
The measure of a country’s output of OECD
goods and services is calculated using
personal consumption, government However, this measure of wealth is
expenditures, private investment, absolute, not relative. Frequently used to
inventory growth and trade balance. GDP indicate the relative values between
is the broadest measure of the health of an countries, in the 21st century is Purchasing
economy. Power Parity (PPP).
The Gross National Product (GNP) is the PPP is a theory which states that exchange
total value of all final goods and services rates between currencies are in equilibrium
produced for consumption in society during when their purchasing power is the same in
a particular time period. Its rise or fall each of the two countries. This means that
measures economic activity based on the the exchange rate between two countries
labour and production output within a should equal the ratio of the two countries'
country. The figures used to assemble data price level of a fixed basket of goods and
include the manufacture of tangible goods services. When a country's domestic price
such as cars, furniture, and bread, and the level is increasing (ie. the country
provision of services used in daily living experiences inflation), that country's
such as education, health care, and auto exchange rate must be depreciated in
repair. Intermediate services used in the order to return to PPP.
production of the final product are not
separated since they are reflected in the
The basis for PPP is the "law of one price".
final price of the goods or service. The GNP
In the absence of transportation and other
does include allowances for depreciation
transaction costs, competitive markets will
and indirect business taxes such as those
equalize the price of an identical good in
on sales and property. The GNP is not
two countries when the prices are
usually used nowadays as it does not
expressed in the same currency.
facilitate international comparisons in an
accurate manner.
For example, a particular TV set that sells
for €750 in Calais should cost £500 in
The GDP of the 28 countries of the EU/EEA
Dover, when the exchange rate between
in 2001 (the latest full year available) can
the UK and France is €1.50 = £1. Clearly,
be illustrated thus:
PPP between different countries within the
Eurozone is easier to measure. So, looking
at relative wealth for the 28 EU/EEA
countries using PPP has slightly changed
the order of countries within the chart, but
still shows the apparent disparity between
the richer and poorer countries of Europe:
__________________________________________________________________
26
__ ____EU Manual of
P u r c h a s in g P o w e r P a r it y
2001
S w itz e r land
Lu x e mb ou rg
Ir e lan d
No r w ay
De n mar k
Ne th er la nds
G e r ma ny
B e lgium
UK
F in lan d
S w eden
A u s tr ia
S p ain
G r e ec e
F ra nc e
Ita ly
Po r tug al
Cz e c h Re p
S lo v e nia
Ro ma nia
Hu n gary
L atv ia
S lo v a kia
Lith ua nia
Po lan d
Es ton ia
0 .0 1 0 .0 2 0 .0 3 0 .0 4 0 .0 5 0 .0 6 0 .0 7 0 .0 8 0 .0 9 0 .0 1 0 0 .0
Chart 2 – PPP per capita 2001: source

OECD
These figures must be taken into account

when comparing incomes and fees
between individual countries.
So, GDP is a crude measure for oral

healthcare comparisons, and a better
measure is GDP per capita, based on
current purchasing power parities:
GDP per capita

2002
based on PPP
Luxembour g
Nor way
I r eland
Switzer land
Denmar k
Nether lands
A ustr i a
I celand
Uni ted
B el gi um
Sweden
Fr ance
Fi nland
Ger many
Ital y
Spai n
Gr eece
P or tugal
C zech
Hungar y
Sl ovakia
P ol and
$0 $10,000 $20,000 $30,000 $40,000 $50,000
Chart 3 – GDP per capita 2002, based

on PPP
Source OECD
NB: no official OECD data is available
for Cyprus, Estonia, Latvia, Malta,
Lithuania and Slovenia
__________________________________________________________________
27
________________________________
__________________________________________________________________
28
__ ____EU Manual of
Part 2: The Dental Directives, Acquired Rights & the

Freedom of Movement
A Directive is a piece of European • undergraduate training requirements,
legislation which is addressed to Member (see Part 5)
States. Once such legislation is passed at
the European level, each Member States • the duration and content of training
must ensure that it is effectively applied in (see Annex 6)
their legal system. The Directive prescribes
an end result. The form and methods of the • Acquired rights - Diplomas, and
application is a matter for each Member certificates which do not meet the criteria
State to decide for itself. In principle, a for free movement, as defined, but which
Directive takes effect through national were completed before the implementation
implementing measures (national of the Directives, may also be recognised,
legislation). However, it is possible that under an Acquired Rights provision. They
even where a Member State has not yet must be accompanied by a certificate
implemented a Directive some of its stating that the holders have effectively
provisions could have direct effect. This and lawfully been engaged in the dental
means that if a Directive confers direct practice for at least three consecutive
rights to individuals, then individuals could years during the five years prior to the date
rely on the directive before a judge without of issue of the certificate.(Annex 7)
having to wait for national legislation to • the use of academic titles
implement it. Furthermore, if the
individuals feel that losses have been • specific conditions relating to the right
incurred because national authorities failed to practise, (see Part 6)
to implement directive correctly, then they
• freedom of movement of dentists
may be able to sue for damages. Such
damages can only be obtained in national The principle of freedom of movement of
courts. personnel, which was established in 1969,
was intended to "abolish any discrimination
The Dental Directives based on nationality between workers of
the Member States in employment,
The EC Dental Directives (78/686 and remuneration and other conditions of work
78/687 EEC) provide that nationals of an EU and employment".
member state possessing an EU dental
qualification may practise in any other EU In essence, this means that every worker
member state. In addition, under the who is a citizen of a member state has the
European Economic Area agreement, right to:
freedom of movement also applies to
Norway, Iceland and Liechtenstein. The • accept offers of employment in any EU
mutual recognition of diplomas, certificates country
and any other evidence of the formal • move freely within the Community for
qualifications of dental practitioners are the purposes of employment
governed by the Directives which set out:
• be employed in a country in
accordance with the provisions governing
• The titles to which the Directives apply
the employment of nationals of that
(see Part 7 for the full list)
country.
• the diplomas, certificates and other • remain in the country after the
evidence of formal qualifications that are employment ceases
mutually recognised (see Annex 4 for the
full list) Limitations to this fundamental principle
will only be allowed if they can be justified
• the diplomas, certificates and other on grounds of public policy, public security
evidence of formal qualifications that are or public health.
mutually recognised for specialist practice.
(To be recognised as a speciality, a Since 1980, freedom of movement has
discipline must be recognised in two or applied to dentists from those member
more member states and accepted by the states whose dental education and training
Commission. In 2004, only two specialities met the requirements of the Dental
meet these criteria - Orthodontics and Oral Directives. Any dentist who is an EU
Surgery) - see Annex 5 for a list of national and has a primary dental degree
specialties.
__________________________________________________________________
29
________________________________
or diploma obtained in a member state is
able to practise in any country in the
Community.
Dentists wishing to practise in the EU must

register with the competent authority in the
country in which they wish to work. A list
of the competent authorities who are
responsible for certifying that diplomas,
certificates and other qualifications held by
a dental practitioner meet the
requirements are set out at the end of
every country section.
Each country also has an information

centre which may be the registration body
or national dental association which will
provide details of the registration
procedure and any special requirements
that there may be. The names and
addresses of these centres are at the end
of every country section.
In theory member states cannot put any

additional obstacles, particularly language
requirements to prevent an EU national
with an EU qualification from practising.
However, although the directives facilitate
free movement, they do not override all
internal requirements and a host country
may place the same restrictions on an
immigrant dentist as it does on its own
nationals.
Some dentists who wish to emigrate, make

use of the services offered by agents in a
country to help them with the registration
procedures. Such services can be very
expensive and are not normally necessary.
Their use is not recommended.
From the beginning of 1994, freedom of

movement has also applied to those EFTA
countries who are members of the EEA.
__________________________________________________________________
30
__ ____EU Manual of
Freedom of movement and the (2004) • Safeguards may be applied by Member

Accession countries States up to the end of the seventh
year.
The Accession countries have had to
ensure that, concerning the free movement The transition arrangement also includes a
of workers, there are no provisions in their number of other important aspects, such as
legislation which are contrary to a standstill clause, whereby current
Community rules and that all provisions, in Member State labour markets cannot be
particular those relating to criteria on more restricted than that prevailing at the
citizenship, residence or linguistic ability, time of the signature of the Accession
are in full conformity with the acquis (of Treaty. Also current Member States must
accession). give preference to acceding country
nationals over non-EU labour.
The key issue is that of free movement of
workers and it has been treated in a Austria and Germany have the right to
broadly similar way for all countries. The apply flanking national measures to
political and practical importance of this address serious disturbances or the threat
area of the acquis and the sensitivities and thereof, in specific sensitive service sectors
uncertainties surrounding mobility of on their labour markets, which could arise
workers has led to transitional measures. It in certain regions from cross-border
was expected that the predicted labour provision of services.
migration from the Accession countries
would be concentrated in certain member Under the transition arrangement the rights
states, resulting in disturbances of the of nationals from new Member States who
labour markets there. Concerns about the are already legally resident and employed
impact of the free movement of workers in a Member State are protected. The rights
are based on considerations such as of family members are also taken into
geographical proximity, income account consistent with the practice in the
differentials, unemployment and propensity case of previous accessions.
to migrate. The EU was also worried that
this issue threatened to alienate public This arrangement has been presented to
opinion and to affect overall public support the accession countries and they have
for enlargement. been able to accept it subject to some
minor adaptations. The solution reached is
The EU has not requested a transition identical - reciprocity vis-à-vis current
period in relation to Malta and Cyprus. Member States and the possibility to apply
However for all the other countries a safeguards against new Member States
common approach has been put forward. once at least one new Member State is
The essential components of the transition subject to national measures. Malta is
arrangement are as follows: concerned that its labour market could
come under pressure following accession
• A two year period during which national and so a safeguard clause has been
measures will be applied by current agreed, which will run for 7 years. A joint
Member States to new Member States. declaration is also to be attached to the Act
Depending on how liberal these of Accession allowing for recourse by
national measures are, they may result Malta to Community institutions, should
in full labour market access. Malta’s accession give rise to difficulties in
• Following this period, reviews will be relation to free movement of workers. With
held, one automatic review before the respect to Cyprus, no transitional
end of the second year and a further arrangements have been requested by
review at the request of the new either Cyprus or the EU.
Member State. The procedure includes
a report by the Commission, but The Mutual Recognition of third
essentially leaves the decision on country diplomas and
whether to apply the acquis up to the professional qualifications
Member States.
• The transition period should come to an Member States may recognise dental
end after five years, but it may be qualifications from non-EU/EEA countries
prolonged for a further two years in and allow the dentists who hold them to
those Member States where there are practise, provided they are satisfied that
serious disturbances of the labour the training received conforms to the EU
market or a threat of such disruption. Dental Directives. This does not confer the
right of freedom of movement. However,
see Acquired Rights (Annex 7).
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31
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In Spain and Portugal, there is a tradition of

reciprocal recognition of diplomas from
other countries, notably in Latin America,
but the legality of this has been challenged
by the Commission from time to time.
However, practical comparison of the
training received by the immigrant dentists
is difficult.
The issue of how to treat qualifications

obtained in third countries arises again for
come candidate countries. For example,
how should the EU treat qualifications
obtained in respect of citizens from the
Accession countries who completed their
education when individual candidate
countries were part of the Soviet Union (in
the case of the Baltics) or Yugoslavia in the
case of Slovenia?
The solution devised by the EU aims on the

one hand to guarantee the integrity of
professions in the EU and protects citizens
of the EU and also to give effect to these
rights in a way that is simple and clear to
all citizens of an enlarged Union, and which
does not result in an unnecessary
administrative burden for individuals or
administrations. The EU has retained the
notion of a declaration by the relevant
candidate country bodies of the
equivalence of the qualifications in
question to their diplomas (which, upon
accession, would be automatically
recognised in the EU), accompanied by an
attestation that the holders of the
qualification have been recently engaged in
the activities in question. This double
approach (declaration and attestation)
is said by the Commission to offer all
reasonable guarantees to EU citizens.
However it is difficult to ascertain with
certainty the standard of qualifications
dispensed in Accession countries and as a
result extremely tough monitoring
provisions, in particular for the sectoral
directives, are foreseen.
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32
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All the Accession countries have been 1-3 years, taken after qualifications, which
encouraged to step up their efforts to are necessary to enter University.
introduce the necessary administrative Vocational qualifications are included in
structures as well as education and training this definition. Where a migrant's training
programmes to guarantee the level of and education varies substantially from
competence of the qualified professionals that required by the regulatory body in the
required by the EU directives. country where they wish to work, they may
be required to undertake an "aptitude test"
For professional qualifications obtained on areas of the discipline which they have
before harmonisation, these countries are not covered or an "adaptation period" of
expected to take measures to ensure that assessed supervised training.
all their professionals can meet the
requirements laid down by the Directives Neither of the General System Directives
and can therefore benefit from professional applies to professions that are subject to
recognition throughout the EU from Sectoral Directives.
accession, in line with the procedures
applied in past accessions. At the time of
accession, dental training in Estonia,
Hungary, Latvia, Lithuania and Malta
complied with the requirements of the
Dental Directives. This training will comply
at a later date in the Czech Republic,
Poland, Romania and Slovakia (see the
individual country sections) and the
position in Slovenia was unclear at the time
of publication of the Manual. There is no
dental training in Cyprus.
The General Directives on the mutual

recognition of Higher Education
Diplomas
The first "Sectoral Directive" which covered

medical practitioners came into force in
1975, three years before its dental
equivalent. At that time, it was intended
that each profession should have its own
Directive in due course. This approach was
ultimately abandoned by the Commission
as impractical because of the time taken to
negotiate with some of the more complex
professions. As an alternative, "General
Directives" were introduced which could be
applied to hundreds of professions
providing they had received equivalent
levels of education and training and were
satisfactorily regulated.
The first "General Directive" deals with

those professions whose entry is regulated
by a qualification based on a minimum of
three years full time (or equivalent) higher
education or training leading to the award
of a diploma. It became law on 1st January,
1991, and allows freedom of movement of
the individual in the professions concerned.
The second "General Directive" includes

professional qualifications which do not
conform to the definition of a "three year
higher education diploma". It was
implemented in June, 1994, and extended
the general system to include qualifications
obtained after post secondary courses of
__________________________________________________________________
33
________________________________
EC proposals (2004) for changes to
the Directives
In 2002 the Commission published a draft

directive on the Mutual Recognition of
Professional Qualifications that would cover
all professions, including those which
currently have a sectoral directive. The
proposals caused much controversy with
the professions throughout Europe, as it
was thought that it could lower standards
of practice and weaken the competent
authorities’ ability to regulate the
professions, to ensure patient safety.
The main changes affecting the dental

profession are the proposals that migrants
could “provide services” for up to 16 weeks
a year without the need to register or notify
a host country’s regulatory body; and the
discontinuation of the arrangements for
automatic recognition of specialties. The
Directive will formally abolish training
advisory committees and thereby any
formal monitoring of education and training
at a European level. Because of this, at
the time of publication of the Manual, the
health professions were pressing for a
single dedicated committee to oversee the
application of the directive in the health
sphere.
Finally, it is not clear whether migrants

from new member states would have to
satisfy the basic educational standards
required of current migrants, or whether
each case would have to be looked at by
the regulatory bodies on its merits and
“compensation measures” arranged for
those who did not reach the standards.
These measures would be a period of
adaptation or an aptitude test.
The European Parliament, at its first

reading in early 2004, had made some
significant amendments to the text, to
which the Commission gave partial
agreement, but the Common Position had
not yet been published by March 2004.
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34
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35
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Part 3: Other Directives relevant to dentists

Medicinal Products and Medical
Devices To remove the obstacles to the free
movement of data, without diminishing the
Medicinal products protection of personal data, Directive
95/46/EC (the Data Protection Directive)
Medicinal products are only available for was enacted to harmonise national
dental treatment if they are licensed by the provisions in this field.
member state where they are used in
accordance with Directive 65/65 (and
amending directives). Further For further information, especially how this
harmonisation of the regulations governing relates to dentistry, see Annex 8
free movement of pharmaceuticals is
established with the establishment of the Consumer Liability
European Agency for the Evaluation of
Medicinal Products, in London The main features of the Directive on
(www.emea.eu.inti/home.htm). The Liability for Defective Products
Agency is responsible for co-ordinating the (85/374/EEC) include the principle of
evaluation and supervision of medicinal “liability without fault” - the Directive
products for human and veterinary use in establishes the principle of objective
the Community, in order to remove liability or liability without fault of the
remaining barriers to trade. EudraVigilance producer in cases of damage caused by a
is the European data-processing network defective product. If more than one person
and database management system for the is liable for the same damage, it is joint
exchange, processing and evaluation of liability. The word “Producer” has a wide
Individual Case Safety Reports (ICSRs) meaning including: any participant in the
related to medicinal products authorised in production process, the importer of the
the European Economic Area (EEA). defective product, any person putting their
name, trade mark or other distinguishing
Medical devices feature on the product, or any person
supplying a product whose producer cannot
The Medical Devices Directive (93/42/EEC), be identified.
which applies to all medical and dental
products which are non-pharmaceutical
The injured person must prove: the actual
and inactive, also has as its major purpose
damage, the defect in the product and the
the removal of the final barriers to trade
causal relationship between damage and
and sets requirements governing safety
defect. As the Directive provides for liability
and efficacy. The Directive requires all
without fault, it is not necessary to prove
manufacturers to register with the national
the negligence or fault of the producer or
competent authority and to observe certain
importer.
design and manufacture requirements,
clinical evaluation and conformity
assessment procedures and provide for Lack of the safety, which the general public
verification. The precise procedures and is entitled to expect, determines the
requirements vary according to the defectiveness of a product. Factors to be
classification of the product: as taken into account include: presentation of
custom-made, class I, Ia, IIb or III, the product, use to which it could
depending upon the nature of the device. reasonably be put and the time when the
product was put into circulation.
Data Protection
The producer is freed from all liability if he
Although national laws on data protection proves (in particular relation to dentistry)
aimed to guarantee the same rights, some that the state of scientific and technical
differences existed. The EC decided these knowledge at the time when the product
differences could create potential obstacles was put into circulation was not such as to
to the free flow of information and enable the defect to be discovered. The
additional burdens for economic operators producer's liability is not altered when the
and citizens. Additionally, some Member damage is caused both by a defect in the
States did not have laws on data product and by the act or omission of a
protection. third party. However, when the injured
person is at fault, the producer's liability
may be reduced.
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36
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For the purposes of the Directive,

“damage” means damage caused by death
or by personal injuries.
The Directive does not in any way restrict

compensation for non-material damage
under national legislation. The injured
person has three years within which to
seek compensation. This period runs from
the date on which the plaintiff became
aware of the damage, the defect and the
identity of the producer. The producer's
liability expires at the end of a period of ten
years from the date on which the producer
put the product into circulation. No
contractual clause may allow the producer
to limit his liability in relation to the injured
person.
National provisions governing contractual

or non-contractual liability are not affected
by the Directive. Injured persons may
therefore assert their rights accordingly.
The Directive allows each Member State to

set a limit for a producer's total liability for
damage resulting from death or personal
injury caused by identical items with the
same defect.
Misleading and Comparative

Advertising
Misleading advertising is defined as any

advertising which, in any way, either in its
wording or presentation deceives or is
likely to deceive the persons to whom it is
addressed or whom it reaches; by reason of
its deceptive nature, is likely
__________________________________________________________________
37
________________________________
to affect their economic behaviour; or for entertainment services (such as video on
those reasons, injures are likely to injure a demand), online direct marketing and
competitor. advertising and services providing access
to the Internet.
Comparative advertising is defined as any
advertising, that explicitly or by The chief aim of the Directive is to ensure
implication, identifies a competitor or that the Community reaps the full benefits
goods or services offered by a competitor. of e-commerce by boosting consumer
confidence and giving providers of
The Directives on Misleading and information society services legal certainty,
Comparative Advertising were introduced without excessive red tape.
to protect consumers, competitors and the
interest of the public in general, against For further information, especially how this
misleading advertising and its unfair relates to dentistry, including ethical
consequences. guidance to the use of the internet see
Annex 9
National rules may allow persons or
organisations with a legitimate interest in Unfair Commercial Practices
prohibiting misleading advertising, or
controlling comparative advertising, to take On 18 June 2003 the Commission adopted
legal action and/or go before an a proposal for a Directive on Unfair
administrative authority. Consumers have Commercial Practices. The aim of the
to check which system (judicial or Directive is to make consumers' rights
administrative) their national authorities clearer and cross-border trade simpler.
have chosen. Common rules and principles will give
consumers the same protection against
The national courts or administrative sharp business practices and rogue traders
authorities have enough power to order whether they buy from the shop on the
advertising to cease, either for a certain corner or from a website in another
period or definitively. They can also order country. Businesses will be able to
its prohibition if the advertising has not yet advertise and market to all 380 million
been published, but publication is consumers in the EU in the same way as to
imminent. A voluntary control by the their domestic customers. The existing
national self-regulatory bodies can also be multiple volumes of national rules and
carried out. court rulings on commercial practices will
be replaced with a single set of common
Advertisers should always be able to justify rules.
the validity of any claims they make.
Therefore advertisers (not consumers) The adoption of the proposal for a Directive
have to provide evidence of the accuracy of on Unfair Commercial Practices followed on
their claims. from the Commission's 2001 Green Paper
on EU Consumer Protection and the follow-
Electronic Commerce up that took place in 2002. This
consultation process concluded that a
The E-Commerce Directive was adopted on Directive harmonising EU Member State's
8 June 2000 and published in the Official rules on unfair commercial practices was
Journal of the European Communities on 17 the best policy option.
July 2000. The objective was to ensure that
information society services benefit from Cosmetics Directive
the internal-market principles of free
movement of services and freedom of In the early 1970’s, the Member States of
establishment, in particular through the the EU decided to harmonise their national
principle that their provision cross-border cosmetic regulations in order to enable the
throughout the European Community free circulation of cosmetic products within
cannot be restricted. the Community. As a result of numerous
discussions between experts from all
The Directive covers information society Member States, Council Directive
services and services allowing for online 76/768/EEC was adopted on 27 July 1976.
electronic transactions, such as interactive The principles laid down in the Cosmetics
online shopping. Examples of sectors and Directive were to take into account the
activities covered include online needs of the consumer, while encouraging
newspapers, online databases, online commercial exchange and eliminating
financial services, online professional barriers to trade. For example, if a product
services (such as lawyers, doctors, is to move freely within the EU, the same
accountants and estate agents), online labelling, packaging and safety regulations
__________________________________________________________________
38
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must apply. This was one of the main
objectives of the Cosmetics Directive: to
give clear guidance on what requirements
a safe cosmetic product should fulfil in
order to freely circulate within the EU,
without pre-market authorisation.
The 1976 Directive initiated the regulation

of cosmetic products, and within its
definition of “cosmetic product” included
“any substance or preparation intended to
be placed in contact with the various
external parts of the human body…or with
the teeth and the mucous membranes of
the oral cavity with a view exclusively or
mainly to cleaning them, perfuming them,
changing their appearance and/or
correcting body odours and/or protecting
them or keeping them in good condition.”
Article 4 of the Directive required Member

States to prohibit the marketing of certain
cosmetic products (mainly hair-care)
containing hydrogen peroxide – no control
of products for the teeth was made at this
stage. However, developments were made
during the 1980s and in 1992: “oral
hygiene products” were included within the
range of products for which a maximum
concentration of hydrogen peroxide was
directed. The substance hydrogen peroxide
(H202) was widened to include compounds
that release it, such as carbamide peroxide
and zinc peroxide. Directive 92/86/EEC, of
October 21st 1992 thereby prescribed that
“oral hygiene products” should include a
maximum concentration of 0.1% of H202
present or released. There is no definition
of “oral hygiene products”.
For further implications for oral healthcare,

see Annex 10
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39
Part 4: Healthcare and Oral Healthcare Across
the EU/EEA
Expenditure on healthcare The population of the areas covered by this
Manual (the EEU/EEA and Romania) was
about 489 million in 2003. The dental
The overall expenditure by countries on all associations reported that there were
forms of general healthcare (including about 314,000 active dentists (see Part 7,
dentistry) in the EU/EEA varies by a large Workforce), which leads to an (average)
amount, generally but not wholly according dentist to population ratio of 1:1,556.
to a country’s wealth as measured by However, there were wide variations from
GNP/GDP or PPP. However, there are major this figure:
exceptions to this rule – so whereas
Luxembourg and Denmark a have high
GNP/GDP/PPP, their spending on health is Dentist:Population Ratio - 2004
(EU average: red line)
much lower than average of 7.26%.
Conversely, healthcare spending in Malta
Spain
Slovenia was high, in comparison with their Romania

Portugal
Ireland
GNP/GDP/PPP. Nethlds
UK
Hungary
Austria
Slovakia
Switz'land
Poland
Percentage of GNP spent on health 2002 Luxemb'rg
Slovenia
France
Latvia
Czech Rep
Estonia
Ger many Belgium
Fr ance Germany
Nor way
Nethl ds Sweden
Sl oveni a Italy
Gr eece Lithuania
Bel gi um
Swi tz'l and Cyprus
Sweden Norway
Spai n
P or tugal Finland
I tal y Denmark
Austr i a Iceland
UK
I cel and Greece
Mal ta
C zech Rep
Fi nl and 0 500 1,000 1,500 2,000 2,500 3,000
Sl ovaki a
Hungar y
C ypr us
E stoni a
Luxemb'r g
Li thuani a
P ol and
Denmar k
Romani a
Latvi a
0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00%
Chart 5 – (Active) Dentist to Population

ratio (for figures see Table 4).
Chart 4: percentage of GNP spent on Who provides oral healthcare is discussed

health (2002) further in Part 8, Dental Practice
[nb: no data for Ireland was supplied]
An attempt was made to compare Entitlement and access to care

expenditure on overall healthcare in
countries, with reported spending on
dentistry, but this was not possible as the In all countries of the EU/EEA oral
interpretation of what constituted spending healthcare is available through private
on dentistry varied significantly. Some practice, using “liberal” or “general”
countries provided data for state spending practitioners. Although entitlement for all
only (as there was no data for spending by to receive state or insurance funded health
private patients) and some were able to care is a constitutional right in some
supply overall spending data. countries and a stated principle in others, it
is rarely guaranteed.
Population Ratios For the majority of the population in Europe

access to oral health care is determined by:
One measure of the provision of
dentistry/oral healthcare in countries is the • the geographical proximity of
dentist to population ratio. However, some ‘private’ dental practitioners;
caution should be employed when using • the level of fees charged to
this figure, as countries with large numbers patients for different treatments;
of dental auxiliaries (see Dental Auxiliaries) and
may require fewer dentists to service the
population. Indeed, dentists working alone, • access by particular population
without the use of a dental chairside groups (for example children) to
assistant, may provide oral healthcare to special services
fewer patients.
Where governments or other agencies offer that the content of the standard package
financial assistance, or directly provide has been reduced since 2000, with a
services, for particular population groups consequent increase in co-payments.
who would otherwise not receive care, this
is always a restricted “standard package” Financing of oral health care
of care. The standard package often only In every country examined, dental care is
consists of basic conservative treatments typically funded by direct patient payments
(examination, fillings), exodontia and some to a greater extent than other areas of
preventive care, but usually excludes all general health care. In most countries the
complex treatments (including, in many reliance on, and acceptance of, direct
countries, emergency care following an patient payments, especially for adults or
accident). There is some evidence from those with an income is exceeded only by
individual countries that of the cost of drugs or payments for
optometrists’ services.
While patient payments (or co-payments)

for state or insurance funded dental care
are widely accepted across Europe, every
country also has a system (or systems)
where individuals pay prospectively for
their dental care, through insurance or
taxation (or both). This system is usually a
The Four Models of Healthcare Provision
National Health Service type

• Public in nature
• Financed by taxes and patient co-payments
• Fully private (liberal) provision for remaining care
Categorical
the scheme may be limited to Cyprus, Denmark, Iceland
certain people, for example, Ireland, Malta,
children, the elderly, low- Norway and Spain
income families
Universal
Available to all citizens, but Finland, Greece, Italy
the treatment choices may Sweden and the UK
be limited and/or access, in
some geographical areas,
restricted due to low fees
Social Insurance type (“Sick Funds”)
• Compulsory public health insurance, maybe
supplemented with voluntary supplementary
insurance
• Patients make co-payments for claim reimbursements
from the sick funds
• Fully private (liberal) provision for remaining care
(prices may be regulated)
Income ceiling
There are income criteria for Germany
excluding some adults from The Netherlands
access to all or most of care
within the schemes.
So, there is mainly private

provision and finance, with a
government organised
residual health service for
specific groups (eg children)
or for those who are unable
to afford care from ‘private
practitioners’.
No Income ceiling
part of, or closely reflects the system of National Health Service type
funding for general health care. There is healthcare
no identified “model” system, except
Categorical
perhaps for general oral health care for the
adult population, where some form of In this group, the bulk of funding is from
“social insurance” system is the most national or local taxation, but the scheme
widely used. may be limited to certain people, for
example, children, the unemployed,
Almost all countries have a specific handicapped people, hospital inpatients or
alternative system which enables war veterans. Generally, treatment for the
individuals to collectively pay for some of under 18s will be free (except for some
the costs of oral health care. These orthodontic care in some countries), but
systems range from national social security there may be some co-payment necessary
systems or health services, state by adult patients, especially for
recognised or compulsory health insurance prosthodontic appliances.
(from “sick funds”), to voluntary insurance
from private companies. Additionally, in For patients outside the defined group
every country there is some form of other arrangements will apply.
financial assistance, subsidy or special Universal
services for population groups who cannot
afford to pay directly or collectively for In this group, funding is again from national
dental care, or have special oral health or local taxation, and in theory NHS
needs (such as children, the unemployed, treatment is available to all citizens. Where
handicapped people, hospital inpatients or NHS treatment is available, this is free to
war veterans). As children are not in a the under 18s and (often) to other groups
position to earn an income and pay for of adults - related to age, welfare status or
their own dental care, they most commonly medical conditions. However, in practice
have the best access to free or subsidised availability is limited – through a shortage
care. Indeed, in countries with a national of dentists who will provide the service in
health service or a state-organised social rural and socially deprived areas, or from
security system, the publicly funded dental low fees offered.
service is primarily for schoolchildren. In
the other countries children generally only In the countries where adult oral health
receive subsidised dental treatment if they care is subsidised as part of the national
are covered by a parent’s sick fund or social security system (or health service),
private insurance. for example in Denmark, Finland, Iceland,
Sweden and the UK these subsidies are
It is important to note that whatever the from a government body. However, often
actual route by which individuals indirectly local government or local social insurance
pay for their dental care, the administrative offices administer the subsidy system. In
mechanisms employed to keep dental care Iceland, although the subsidies are from
affordable (for instance, fixed fees), the government, they are limited to a few
appropriate (for example, prior approval) eligible patient groups.
and profitable to the private dentist
flexible, periodically negotiated fee-scales Oral health care through social
are common to many systems. In the insurance
countries where direct patient payments
are the dominant form of finance, there is The essential features of a social insurance-
typically a limited social security system. based oral health care system are:
For the patient, the cost of care is further • individuals have membership of an
complicated by the varying size of subsidy appropriate institution which is usually
offered for different treatments. At one funded by contributions deducted from their
extreme individual dentists may contract income;
with individual insurance schemes to • membership of an insurance institution may
provide certain care at certain prices. be compulsory for some sectors of the
However, in other countries there is a population;
nationally negotiated agreement between • employers also usually have to contribute;
representatives of the dental profession -
• insured members, and usually also their
the providers of care - and the purchasers dependants, can then access a defined
of care, whether they are a union of sick range of dental services;
funds, or the government.
• the cost of these services is usually partially
controlled by the insurance organisations;
There appear to be four models of provision
of healthcare into which the 29 countries • for a specified range of dental services the
insured individual receives a partial or full
examined fit:
subsidy, either by claiming from the
insurance institution or only part-paying the
dentist (who then in turn claims the include individual and population disease
remainder from the insurance organisation). levels, preventive strategies (including
water fluoridation), socio-economic and
Seventeen countries have health care cultural attitudes and external funding
organised through sick funds, but their arrangements.
exact constitution, membership and
funding rules vary considerably. We received estimates of patient normal
Government involvement typically extends re-attendance from most countries, with
only to the rules on compulsory only Spain being unable to provide data:
membership. As a result, membership of
compulsory sick funds generally covers Approximately The Czech Republic,
over 80% of these 17 countries’ 6 monthly Lithuania, Malta, Poland,
populations. Portugal and the UK
Sick funds are typically locally based or Approximately 9 Denmark, Estonia, France, the
centred on an employee’s occupation-type. monthly Netherlands, Slovenia and
Switzerland
They are independent, democratic and self-
organised to a large extent, but also Annual Austria, Belgium, Cyprus,
cooperate nationally in negotiations with Germany, Greece, Hungary,
the dental and medical professions. For Iceland, Italy, Ireland, Latvia,
example, in France, Belgium and Luxembourg, Norway and
Romania
Luxembourg the separate ‘caisses’ are
organised as a single scheme for the 18 months or Finland, Slovakia and Sweden
purposes of deciding some of the dentists’ more
fees (in the ‘convention’), and setting a
national budget. Table 1: Patient re-examination
periods
The split between employees’ and
employers’ average contributions also All countries made the point that patients
varies considerably, but is always with active disease may be seen more
calculated as a proportion of salary. In frequently than the normal time period
some countries this percentage is fixed and reported. In almost every European
does not vary between sick funds while in country, the overall levels of expenditure
others there is variation in the contribution and the amount of care provided is directly
level between funds. influenced by the regulations which govern
patients’ fees and private dentists’
Income Ceiling remuneration. Because of the dominance
of “private practitioners” in oral health care
Germany and The Netherlands allow access provision, regulations about patient
to the social insurance system for those payments, fixed remuneration fees, and
whose incomes are inside various norms, subsidy systems all affect the dentist’s
and more or less exclude adults whose incentive to treat and the patient’s
incomes are above certain thresholds. incentive to seek treatment.
Adult patients excluded from the state
system may arrange private insurance
care.
No Income Ceiling
Over half of the countries examined, who

provide care through sick funds, have other
criteria for access to subsidised care.
Usually there is a categorical access (as
above, in NHS schemes) for groups such as
children, the elderly, the unemployed,
handicapped people, medically
compromised, hospital inpatients or war
veterans. Limited care may be offered for
adults above a low level of earnings.
Frequency of attendance
The decision about the frequency of
attendance of patients to receive oral
health re-examinations is largely a decision
between dentists and their individual
patients. However, there are a number of
influences on these decisions, which may
Part 5 – The Education and Training of Dentists
The content of the education and training Undergraduate education and
necessary, and the titles of qualified training
dentists, as described in the Dental
Directives in Annexes 6 and 4 respectively. Mutually recognised diplomas guarantee
that, during the complete training
The separate recognition and training of programme, the student has acquired:
dentists is now a reality in all countries of
the EU/EEA. The existence of a class of • adequate knowledge of the sciences on
dentists (often known as stomatologists), which dentistry is based and a good
who were originally trained as medical understanding of scientific methods,
doctors is also a historical legacy in Austria, including the principles of measuring
Italy, Spain and Portugal, and most of the biological functions, the evaluation of
2004 accession countries - but for all of scientifically established facts and the
these countries membership of the EU has analysis of data;
brought substantial changes in dental
education.
• adequate knowledge of the
constitution, physiology and behaviour of
Across the EU/EEA, all dental
healthy and sick persons as well as the
undergraduate education and training
influence of the natural and social
takes place in universities – usually in
environment on the state of health of the
Colleges or Faculties of Medicine or
human being, insofar as these factors
Dentistry. Cyprus and Luxembourg do not
affect dentistry;
have dental schools and rely on other EU
trained dentists for their workforce. In
• adequate knowledge of the structure
2004, there were 177 publicly funded
and function of the teeth, mouth, jaws and
dental schools in the EU/EEA – from one
associated tissues, both healthy and
each in Estonia, Iceland, Latvia, Malta and
diseased, and their relationship to the
Slovenia, to 30 or more in Germany and
general state of health, and to the physical
Italy. However, although publicly funded,
and social well-being of the patient;
many of these dental schools charged
course fees to their students. Additionally,
Germany (1), Italy (1), Spain (4) and • adequate knowledge of clinical
Romania (9) had a total of 15 privately disciplines and methods, providing the
funded dental schools, where no public dentist with a coherent picture of
funding supported the institutions. Only in anomalies, lesions and diseases of the
the Denmark and Sweden were students’ teeth, mouth, jaws and associated tissues
maintenance or living costs met by the and preventive, diagnostic and therapeutic
government, to some extent. dentistry;
In 2003, in the dental schools of the • Suitable clinical experience under

(expanded) EU/EEA, including Romania, appropriate supervision.
there were over 50,000 dental students in
training. Approximately 9,200 graduate
each year (53% female). The duration and content of training
In most EU/EEA countries entrance into The criteria described below are the
dental school is by means of a competitive minimum training requirements. A Member
examination – with a strict numerus State may impose additional criteria for
clausus (restriction) on the numbers qualifications acquired within its territory.
admitted (it has been reported that this is It may not, however, impose them on
not always adhered to in Belgium and practitioners who have obtained recognised
Italy). In seven countries (Denmark, qualifications in another Member State.
Ireland, Malta, Norway, Spain, Sweden and
the United Kingdom) there is a secondary Duration
school leaving examination or matriculation
– and the results of these determine the A complete period of undergraduate dental
entry into dental school. In France, there is training consists of a minimum five-year
(joint) first year training with medicine, and full-time course of theoretical and practical
the entrance into the subsequent 5-year instruction given in a university, in a
dental course follows an end of year higher-education institution recognised as
competitive examination. having equivalent status or under the
supervision of a university.
To be accepted for such training, the Post-qualification education and
candidate must have a diploma or a training
certificate which entitles him/her to be
admitted to the course of study concerned. Vocational Training
Training in specialised dentistry involves a About half of all EU/EEA countries insist on
full-time course of a minimum of three further post-qualification vocational
years' duration supervised by the training (VT) for their new graduates,
competent authorities or bodies. before they are given full registration, or
entitlement to independent practice, or
Such training may be undertaken in a entitlement to participation in the state oral
university centre, in a treatment, teaching healthcare system as independent
and research centre or, where appropriate, clinicians. In some countries this vocational
in a health establishment approved for this training may be voluntary.
purpose by the competent authorities or
bodies. The trainee must be individually The nature of this VT, where it takes place
supervised. Responsibility for this may vary considerably – it is best to refer
supervision is placed upon the to the individual country sections to
establishments concerned. examine what takes place. However,
usually the training of the new graduate
Content takes place in a “sheltered” environment,
under the direction or supervision of an
The programme of undergraduate studies experienced dentist. There may, or may
must include the subjects listed in Annex 6. not be parallel formal learning, in an
educational establishment such as a dental
school.
Mandatory vocational training is

reported to take place in 2003 in:
No of No of
mnth mnth
s s
Czech 36 Poland 12
Republic
Denmark 12 Romania 12
Finland 12 Slovakia 36
Germany 24 Slovenia 12
Latvia 24 United 12
Kingdom
Lithuania 12
Table 2 – Mandatory Vocational

Training
In all but Latvia, VT is only mandatory for

those graduating from their own
universities, but in Latvia VT is mandatory
for all entrants into dental practice.
However, it had not been confirmed (in
2003) that this is allowable in EU law. VT
will be introduced in 2007 for all those who
commenced training in Belgium from 2002
onwards.
Continuing Education and Training
Every EU and EEA country has at least an

ethical obligation for dentists to undertake
continuing professional education of some
kind – and some arrangements to deliver
this. However, in 10 countries there is a
mandatory requirement to undertake a
minimum amount of such training. In a few
countries this is a new requirement, with
the amount to be completed not yet
announced at the time of writing this.
Mandatory Amount
CPE
Belgium 60 hours over 6 years,
with a minimum of 6
hours in any year
Germany Amount under
discussion in 2004
Hungary 250 hours over 5 years
Italy Situation still confused
in 2004
Latvia 250 hours over 5 years
Lithuania 200 hours over 5 years
Luxembourg Amount under
discussion in 2004
Poland Amount under
discussion in 2004
Portugal Amount under
discussion in 2004
Romania 200 hours over 5 years
Slovakia 5 days per year
Slovenia 10 courses per 7 years
Switzerland 10 days per year
United 75 hours of formal
Kingdom courses + 175 hours
informal, over 5 years –
and slightly more for
specialists
Table 3 – Mandatory Continuing

Education
Specialist Training
Specialists, as defined in the EU Directives,

are recognised in most countries of the
EU/EEA. Orthodontics and Oral Surgery (or
Oral Maxillo-facial Surgery), are the two
specialties which are usually recognised,
but not in Austria, Luxembourg and Spain,
where there is no recognition of specialists.
However, in Austria, Belgium, France and
Spain, Oral Maxillo-facial Surgery is
recognised as a medical specialty (only),
under the EU Medical Directives.
Many other specialties have de facto

recognition in various ways in different
countries (for example by formal training
programmes), but may not be formally
recognised under the Dental Directives.
Specialist Diplomas and certificates that

are mutually recognised in EU/EEA
countries are listed in Annex 5
There is no specialist training in Austria,

Cyprus, Iceland, Luxembourg, Malta and
Spain. See the individual country sections
to note the arrangements for training in
Cyprus, Iceland and Malta, where
specialists are recognised.
European Dental Education
The EU Directorate on Education

and Culture has funded an
innovative pan-European project
DentEd, www.dented.org to
promote a common approach to
dental education across Europe.
Over six years many dental schools
in the EU and accession countries
have received advice and peer
support from visiting teams of
dental academics, supported by
several international conferences
on trends and strands in dental
curricula. Work is continuing
through the Association for Dental
Education in Europe (ADEE) to
develop a profile for a graduating
dentist from a European dental
school. Much of the work
undertaken by DentEd and ADEE
will link to the need for dental
education in Europe to meet the
requirements of the Bologna
Declaration, which has a 2010
deadline.
Part 6 – Qualification and Registration
All countries of the EU/EEA require practitioner for the first time, must accept
registration with a competent authority – as sufficient evidence a certificate issued
more frequently this authority is separate by a competent authority in the Member
from the dental association, and may be State of origin or the State from which the
government appointed. person comes.
To legally practise in each country a basic Where the Member State of origin or the
qualification is always required (ie degree Member State from which the person
certificates), but a certain amount of comes does not require proof of good
vocational experience, evidence of EU character or good repute, the host Member
citizenship, a letter of recommendation State may ask for an extract from the
from a dentist’s current registering body "judicial record" or, failing this, an
and sometimes evidence of insurance equivalent document issued by the
coverage may be necessary. When appropriate competent authority.
examining the situation in a particular If a host Member State has detailed
country it is important to distinguish legal knowledge of a serious problem which has
registration to practice in any capacity occurred outside its territory before the
(usually with government department or person concerned took up residence in that
agency, sometimes as a ‘licence’) from State, it may inform the Member State of
registration with a social security or social origin or the Member State from which the
insurance scheme. Where registration is person comes. The aim is to verify whether
with the national dental association or the problem is likely to affect practice in
another non-governmental body a private the host country.
practitioner may also require a ‘licence to
practise’ from a government ministry. The Member State of origin or the Member
Registration with social security or State from which the person comes must
insurance schemes will often depend on verify the accuracy of the facts. The
different criteria, and may also entail authorities in that State decide on the
contractual as well as ethical obligations. nature and extent of the investigation to be
made. They then inform the host Member
For details in each country please see the State of any consequential action which
relevant country section of the Manual. they take about the certificates or
documents they have issued. Obviously,
the Member States ensure the
The use of academic titles confidentiality of any information which is
forwarded.
Provided that all the conditions relating to
training have been fulfilled, holders have Language
the right to use their lawful academic title
or, where appropriate, its abbreviation, in All member states insist on the applicant
the language of the Member State of origin for registration demonstrating linguistic
or the State from which they come. Some competence in the host country national
Member States may require this title to be language. However, in six countries
followed by the name and location of the (Austria, Belgium, Ireland, Italy, Portugal
establishment or examining board which and Spain) this is an ethical requirement,
awarded it. only. In the other countries the requirement
is more formal and may be enforced by
In some cases, the academic title can be examination or interview. This test may
confused in the host State with a title for apply to registration with the host
which additional training is necessary. In competent authority for all work as a
that event, the host State may require that dentist , or just with the appropriate
different, suitable wording be used for the authority for work in the state healthcare
title. system.
A complete list of titles is in Annex 4): Serious professional misconduct and

criminal penalties
Specific conditions relating to the The same procedure is followed in the case
right to practise of serious professional misconduct and
conviction for criminal offences. In that
event, the Member State of origin or from
Good character and good repute
which the person comes must forward to
the host Member State all the necessary
A host Member State which requires from
information about any disciplinary action
its nationals proof of good character or
which has been taken against the
good repute when they register as a dental
practitioner concerned, or criminal Duration of the authorising procedure
penalties imposed on him/her.
The procedure for authorising the person
If, for its part, the host Member State has concerned to work as a dental practitioner
detailed knowledge of a serious problem must be completed as soon as possible and
before registration, it may inform the not later than three months after
Member State of origin or the Member presentation of all the documents, unless
State from which the person came. The there is an appeal against any unsuccessful
procedure, which then follows, is the same application.
as that which governs good character and
good repute. If there are any doubts about the good
character, good repute, disciplinary action,
Physical or mental health criminal penalties, or physical or mental
health of the applicant, a request for
Some Member States require dentists re-examination may be made which
wishing to practise to present a certificate suspends the period laid down for the
of physical or mental health. Where a host authorisation procedure. The Member
Member State requires such a document State consulted must give its reply within
from its own nationals, it must accept as three months. On receipt of the reply or at
sufficient evidence the document required the end of the period, the authorisation
in the Member State of origin or the procedure is resumed.
Member State from which the person
comes.
Where the Member State of origin or from

which the person comes does not require a
document of this nature, the host Member
State must accept a certificate issued by a
competent authority in that State, provided
that it corresponds to the certificates
issued by the host Member State.
Alternative to taking an oath
Some Member States require their

nationals to take an oath or make a solemn
declaration in order to practise. Where
such oaths or declarations are
inappropriate for the individual, the host
Member States must ensure that an
appropriate and equivalent form of oath or
declaration is offered to the person
concerned.
Part 7 – Dental Workforce
Cyprus 2002 767,314 696 43% 649 43% 1,182
Cz e ch Re p 2003 10,182,471 7, 760 67% 6,911 69% 1,473
The dental workforce provides oral

De nm a rk 2002 5,368,854 6, 400 40% 4,892 46% 1,097
Estonia 2002 1,415,618 1, 081 91% 998 91% 1,418
healthcare and includes dentists, clinical

Fi nla nd 2002 5,183,545 5, 900 69% 4,720 69% 1,098
Fra nce 2002 60,200,000 42,541 34% 40,423 34% 1,489
Ge rm a ny 2002 82,398,326 79,965 37% 64,294 37% 1,282
dental auxiliaries and other dental Gre e ce 2002 10,665,989 12,788 46% 11,750 46% 908
Hunga ry 2002 10,075,034 5, 611 57% 4,992 56% 2,018
auxiliaries. In some countries Ice la nd 2002 288,000 310 69% 278 69% 1,036
Ire la nd 2002 3,897,000 2, 134 33% 1,800 33% 2,165
stomatologists or odontologists still exist Ita ly 2002 57,716,000 50,000 30% 50,000 30% 1,154
La tvia 2002 2,366,515 1, 692 85% 1,602 85% 1,477
(for a description of these two classes, see Li thua nia 2002 3,458,200 3, 051 82% 3,051 82% 1,133
Lu x e m b'rg 2003 448,300 288 28% 288 28% 1,557
below). M a lta
Ne thlds
2002
2003
397,500
16,150,511
164
9, 600
25%
23%
143
7,623
25%
23%
2,780
2,119
Norw a y 2002 4,552,200 5, 802 36% 4,140 36% 1,100
P ola nd 2003 38,662,660 30,063 79% 24,088 78% 1,605
In all countries, whatever classes of dental P ortuga l
Rom a nia
2003
2002
10,102,022
22,272,839
4, 500
8, 694
51%
66%
4,500
8,694
51%
66%
2,245
2,562
auxiliaries exist, most oral healthcare is S lova kia
S love nia
2002
2004
5,379,161
1,965,986
3, 084
1, 533
61%
61%
2,968
1,285
61%
67%
1,812
1,530
provided by dentists. As described in Part S pa in
S w e de n
2002
2002
40,077,000
8,877,000
19,678
14,043
41%
54%
15,000
7,594
41%
54%
2,672
1,169
2, the description of what a dentist may S w itz'la nd
UK
2002
2004
7,302,000
59,778,000
4, 250
31,160
20%
30%
4,250
28,500
20%
30%
1,718
2,097
provide is regulated by the Dental EU/EEA Tota ls 488,399,666 365,575 317,069 42% 1,540
Directives and EU countries do not have these countries: registered = active
the ability to enact laws which amend this.
However, the regulations relating to dental
auxiliaries are less circumscribed and are
governed only by General Systems
Directives. So, the permitted duties of such
Table 4: Numbers of dentists (those
as dental chairside assistants (nurses),
marked in blue are where “active” dentists
hygienists, therapists and clinical dental are reported the same as registered
technicians may vary from country to dentists)
country. However, in all countries, dental
technicians do not provide services directly
to patients, except for the provision of
repairs to prosthodontic appliances which
do not need intervention orally (see dental
auxiliaries).
Dentists
The numbers of dentists in each country is

known as in every one there is a legal
requirement to register with a competent
authority. Despite the continued increase in
the numbers, across the EU, many dental
associations report that the geographical
distribution remains uneven, with people in
rural areas often having large distances to
travel to the nearest service. Formal
incentive schemes are rare, and more
commonly a rural community will create an
opportunity itself to attract a dentist. Also,
in some countries, for example Germany,
there are geographical manpower controls,
with dentists prevented from setting up
practice in areas judged already to be over-
served.
The total number of registered dentists in to move away from the area of the dental
the EU/EEA including Romania in 2003 was school.
about 365,000. Some countries (Italy,
However a number of countries have
Lithuania, Luxembourg, Portugal, Romania,
reported longer term unemployment for
and Switzerland) are unable to assess how
dentists, because of the perceived over-
many of these dentists are “active”, so
supply of dentists qualifying from the
accurate figures for the number of such
schools. These countries were:
dentists are difficult to assess. But, not
more than 317,000 dentists in the EU/EEA
are “active”. Austria Germany
Belgium Greece
The Gender Mix of Practising Dentists
The Czech Republic Italy
The change of gender balance in some Denmark Slovakia
countries, with the increase in proportion of Finland Slovenia
female dentists, for example as in the UK,
who historically are unable to work for as
many hours as males, also alters the Table 5: dental association reports
measure of whole-time working unemployed dentists
equivalence of the total number of dentists,
even with the increased total numbers. Retirement
Across the EU/EEA an overall 42% of active All countries of the EU/EEA have a state
dentists are female. However, this figure retirement age, which is the age at which
disguised wide variations. So, generally, dentists working in the public dental
but not exceptionally, countries with strong services, or liberal (general) dentists with
public dental services (the Eastern contracts with a state system/sick fund
European and Nordic countries) had higher have to retire. However, there is no
numbers of female dentists - up to 91% in universal rule about this, and it will vary
Estonia – whilst countries with larger from country to country. However, all
private practice provision, lower countries permit continued private practice
proportions (Switzerland 20%). beyond the normal retirement age – with a
further upper age limit in a few countries.
Unemployment
The following chart shows the normal
Dentists are more likely to move to other retirement ages for males/females in each
countries than the one they graduated in, if country:
they are unable to find work as a dentist. It
is likely that in every country some short-
term unemployment is possible, perhaps
for days or weeks, immediately upon
qualification or completion of vocational
training, unless the new dentist is prepared
Austria 65/60 Lithuania 65/62

Belgium 65 Luxemb'rg 65
Cyprus 60 Malta 60
Netherland
Czech Rep 62 s 65
Denmark 65 Norway 67
Estonia 65 Poland 65/60
Finland 65 Portugal 65
France 65 Romania 65/60
Germany 68 Slovakia 60/57
Greece 65 Slovenia 58
Hungary 62 Spain 70
Iceland 67 Sweden 67
Ireland 65 Switz'land 65
Italy 65/63 UK 65/60
Latvia 65/62
Table 7: normal (state) retirement
ages – the first figure is for males,
the second for females, where there
is a variable age between genders.
NB: Slovakia has a variable
Table 8: Types of specialties, and numbers
retirement age for females with
in each (nb: endodontics and periodontics
children
are often combined as one specialty, so the
numbers shown for some countries may
Specialists actually be combined)
Yea r of Ortho- Ora l Pe rio- Pae do- Endo- Prostho- DPH Ora l Radiol- Stoma- Max -Fac Others
data dontics Surgery dontics dontics dontics dontics CommunityMedicine ogy tology
Belgium 2002 NK NK 350

Cyprus 2002 25 13
Czech Republic 2002 264 63
Denmark 2002 60 60
Estonia 2003 27 35 2
Finland 2002 140 84 137 268
France 2003 1,834
Germany 2003 3,266 1,456 40 450
Greece 2002 353 151
Hungary 2002 219 222 25 296 18
Iceland 2002 9 5 7 4 4 6 4 6 6
Ireland 2002 72 26
Italy 2000 1,100 20
Latvia 2002 16 6 37
Lithuania 2002 22 81 32 77 67 304 26
Malta 2003 3 5 1 2 1 1 1 6
Netherlands 2002 283 203
Norway 2002 182 43 84 21
Poland 2003 310 414 86 273 898 625 107
Portugal 2002 36 4 635
Romania 2002 153 4,938 107
Slovakia 2002 150 87 69 59 29
Slovenia 2002 79 29 37 34 34 15
Sweden 2003 430 251 202 171 198 70 51
Switzerland 2002 165 101 82 65
United Kingdom 2002 1,023 236 261 222 163 349 119 86 21
NK = Numbers Not Known

• Orthodontics and Oral Surgery/Oral Maxillo-facial are the two specialties which are
recognised formally in some way by almost all of the 29 European countries described (the
names, diplomas or other specialist qualifications recognised in each country are listed
above and more fully in Annex 5).
• Many other specialties have national recognition in various ways (for example formal
training, dental school departments) in different countries, but may not be formally
recognised under the EU Dental Directives.
• In many countries Maxillo-facial Surgery is treated as a medical rather than a dental
specialty (see above).
Austria, Spain and Luxembourg do not recognise the concept of specialisms. In Austria, it is
possible to train in any of the 3 universities in the “subspecialty” of oral surgery through a
further 3 years education (officially, oral surgery still is a sub-speciality of medicine).
In most countries patients may access specialists directly, without the need to go via a primary
care dentist. However, in Estonia, Ireland, Italy, Latvia, Portugal, Slovenia, Sweden and the UK
a referral from a primary care dentist is necessary first.
Dental Auxiliaries
There is a wide variation across Europe in the regulations concerning an auxiliary’s ability to
work in the patient’s mouth, and their level of independence from the instructions and
supervision of a dentist. Considerable international variation exists in the level of training
required, and the obligation to register with an association or other body. Additionally, in the
Netherlands, Dental Hygienists are not legally dental auxiliaries, as they form an independent
profession.
Table 9 illustrates the considerable variation in the level of recognition of dental auxiliaries.
Generally, in those countries where the dominant form of practice is dentists working alone in
independent or liberal practice there is less reliance on other dental professionals.
Table 9. Types of auxiliary recognised in each country
R = Registration with a competent authority necessary (always following formal

training and qualification)
N = No registration necessary to work
NN = No formal training for dental chairside assistants
NF = Formal training available for dental chairside assistants
Blank cell indicates that this class of dental auxiliary is not recognised
Country Dental Dental Dental Denturist/ Other

chairside hygienist technician Clinical
assistant Dental
(DCA) or Technician
nurse
Austria NF R Some DCAs specialise in oral
health prevention
Belgium NN N
Cyprus NN R
Czech Republic NF N N DCAs may give oral health
education and take impressions
Denmark NN R R R
Estonia R N There are some registered
Dental Therapists, trained in the
1950s.
Finland R R R R
France NF N
Germany R R R Also have specialised dental
nurses (ZMF/ZMP/ZMV)
Greece R R
Hungary R R R
Iceland R R R
Ireland NF R N
Italy NF R R
Latvia R R R There are some registered
Dental Therapists, trained in the
1960s, who work with children,
only
Lithuania NF N N
Luxembourg NN N
Malta NN R R
Netherlands NF5 R N R Hygienists are an independent
profession (and are not
auxiliaries)
Norway R R R
Poland NN N N
Portugal NN R R
Romania R R
Slovakia NF N R Hygienists duties are restricted
to oral health educational duties
Slovenia NN R First hygienists in 2005
Spain NN R N
Sweden NN R N There are registered Dental
Therapists and registered
orthodontic operating auxiliaries
Switzerland NF R R R There are Registered Dental
Therapists and Denturists in
some cantons
United Kingdom NF R R There are Registered Dental
Therapists in the UK, Expanded
Duties Dental Nurses and from
2005/6 Orthodontic Auxiliaries
and Clinical Dental Technicians.
Dental Nurses will need to
register from 2005/6
There are also Oral Health
Educators (who do not need to
be registered).
Dental Assistants
In all countries, dentists have staff variously called dental surgery assistants, dental nurses, or
dental chairside assistants, or dental receptionists who may assist with chairside duties.
However, the development is not as great in some countries (Belgium, Greece and Portugal)
where most dentists work without the help of another person at the chairside, and Cyprus,
France, Lithuania and Poland less than one third of dentists work with such help.
In about half of the countries there is a dental assistant or nursing qualification available, and
in half of these there is a registerable qualification, which the assistant may have to have to
work with the dentist.
Dental Hygienists
There are Dental Hygienists in 19 countries, although they do not need to register in 3
countries (the Czech Republic, Poland and Slovakia). In Slovakia their duties are limited to what
Oral Health Educators do in some other countries. Slovenia will have hygienists from 2005,
although there are no plans for registration of them.
Training generally takes place in special schools, sometimes – but not always - associated with
the dental schools. The training is for two years in most countries, usually following prior
training as a dental chairside assistant. Qualification nearly always leads to a diploma, with
which the hygienist has to register with a competent authority in most countries. By 2003,
hygienist training in most countries with such training was for 3 years, although a few were for
2 years and in Hungary one year only is necessary. Conversely, in the Netherlands, training
lasts 4 years.
5
Dental hygienists in the Netherlands are not referred to as dental auxiliaries – they are a
separate, independent profession
There are varying rules within the different countries relating to the degree of supervision of
hygienists, and the duties they may perform. Please refer to the individual country sections to
check the varying rules.
Dental Technicians
Dental Technicians, who provide laboratory technical services, are recognised in all countries.
Formal training is offered in 27 of the 29 countries surveyed (not Luxembourg and Cyprus) and
takes place in special schools. The training is for a variable number years (3 to 5). In 18
countries they must be registered to provide services.
Dental technicians provide services to Dental Therapists

dentists, only, although in most countries
they are permitted to repair dental In a few European countries there is formal
appliances directly for patients, provided recognition of another type of clinically
they do not need to take impressions or operating auxiliary – Dental Therapists who
otherwise work in the mouth provide limited clinical conservation and
exodontia services (Sweden, Switzerland
Clinical Dental Technicians and the United Kingdom) and Orthodontic
Auxiliaries (Sweden and the UK). Again, like
Only 4 countries (Denmark, Finland, the hygienists, there are different rules about
Netherlands and Switzerland in some the duties they may perform and the
cantons) allow Clinical Dental degree of supervision they may need.
Technicians/Denturists – who may provide
oral health services – specifically full In Latvia, therapists were trained in the
(complete) or partial dentures directly to 1960s, but few of these remain in practice
the public. This means that they are trained and further training has not taken place for
to work inside the mouths of patients. The many years.
United Kingdom will introduce this class of
auxiliary from 2005 or 2006. Other Auxiliaries
Many countries permit dental nurses to

provide oral health education to patients,
or have a formal class of auxiliary (without
registration) to provide this service.
Stomatologists/Odontologists
In many countries, until entry into the EU, a traditional method of providing oral healthcare was
by using stomatologists or odontologists. These were often medical doctors who had formal or
informal training in dentistry. They are reported on in the individual country sections of the
Manual. By 2003, large numbers are reported as still working in dentistry and they may have
gained “acquired rights” to work elsewhere in the EU.
Stomatologists are still being trained in France, but these are medical specialists who have
received 6 years medical training plus 4 years specialist training. They are not generally
accepted as dentists in other EU countries, even with “Acquired Rights” unless that country
also has stomatologists.
However, in Portugal, Odontologists, a grade of dental workers with less than the required
amount of training to be dentists, was introduced to meet the problem of a shortage of
dentists. They have been deemed illegal by the Commission and are no longer being trained.
These odontologists have not received “acquired rights” which would enable them to work
elsewhere in the EU.
In Estonia, in the 1950s, when all professionals currently known as dentists were doctors
trained as stomatologists, some school dental therapists were trained in a Vocational Training
School (and were actually called “dentists” at the time). Some came from the (former) Soviet
Union. Whilst they have permission to work as dentists until the end of their active practices,
their position relating to “Acquired Rights” in the EU is unclear.
Part 8 – Dental Practice in the EU
Although countries in Europe exhibit many set up in sparsely populated areas are also
wide variations in how general health care very rare. Most dentists, as with any other
is provided (for example, in terms hospital business, have to take out commercial
ownership, manpower structure, and the loans in order to purchase a practice. By
balance between primary and secondary buying an existing practice they usually
care), the provision of dental care, in most buy a list of patients as well.
countries, is dominated by non-salaried
practitioners, working from privately owned Many countries have some regulations
premises (“private” or “liberal” or which govern the location of premises
“general” practitioners). Over most of the where dentists may practise. For example,
EU/EEA these represent over 83% of in Germany since 1993, dentists have been
practising dentists, with several countries able to obtain a licence to practise under
(Belgium, Iceland, Luxembourg, Malta and the statutory health insurance scheme only
Portugal) reporting virtually 100% of if it does not exceed the needs-related
dentistry being provided this way. provision. This is to avoid over–provision.
Generally, across Europe dentistry in

general practice is carried out as small
G
businesses, with only one, two or a few
dentists practising together (in Greece, it is
only since 2001 that dentists can share a
clinic or dental chair). However, there are
large, multi-dentist practices in the United
Kingdom, with one company owning over
Pr
200 practices, employing several hundred
dentists.
Dental associations report that premises for

practices tend to be in converted houses or
apartments, or converted public clinics
(several of the new members of the EU
report this). Shopping malls do not seem to
be popular in Europe, for dental practices.
Table 10: Percentage of oral Public Dental Services

healthcare provided in general
Sweden
(liberal) practice (source: the
dental associations) For the purposes of the description of the
delivery of healthcare outside liberal
Only in countries where there is a large, (general) or private practice, we describe
publicly-funded dental service is the this as Public Dental Services. However,
numerical dominance of the general this is not strictly accurate as the
boundaries between self-employed/salaried
Slovenia
practitioner less pronounced. Even so,
since the public dental services are usually dentists, and privately owned/publicly
dedicated to providing care to special owned facilities have become blurred in
groups such as children, private recent years.
practitioners are without a doubt the main,
and often the only provider of care to the So, there are salaried dentists in private
adult population. practice - usually as assistants or
Finland
associates to the practice owner, although
these may be paid by the state, by way of
Liberal (General) Practice such as vocational training. In the same
way, whilst most liberal dentists own or
rent their premises from the private sector,
The methods of establishing a liberal or
in some countries (for example, Estonia)
general practice are similar across Europe,
Ireland
they may be renting the facility from the
with most younger dentists employed as
local health authority or municipality –
associates or assistants before they can
which may even be supplying the auxiliary
afford to buy their own practice. However,
staff, equipment and materials.
in countries where solo private practice
dominates (for example, France, Belgium
and Norway) starting positions as In some countries, the term “Public Dental
Services” also applied to liberal
Norway
associates or junior partners are very
difficult to obtain. Government incentive practitioners working within the NHS
schemes, usually to persuade dentists to system of that country. For the purposes of
the description in this section of the and Luxembourg, where any necessary
Manual, this term is being applied to those services are provided by private dentists).
who work in (usually) salaried practice, in The “culture” of dentistry provided from
state funded facilities (clinics and non- publicly funded clinics is especially strong
private hospitals), within any state system in the Nordic and Baltic countries, where,
or social insurance fund. with the exception of Estonia a large
proportion of active dentists work in them.
Public Clinics
Most countries have some form of state
service operating from publicly funded
clinics (there is no such service in Iceland
There are no public clinics in Belgium, Estonia (from January 1 st 2004), Iceland, Luxembourg
and Portugal; and, in many countries dentists only work part-time in such clinics – either
because they are females who stay home to look after their young families, or because low
salaries mean that they also work part-time in private practice.
Year of Population Numbe Public Hospital Armed

r
data Active clinics Forces
Austria 2002 8,188,207 4,077 418 NK 0

Belgium 2002 10,263,414 7,559 0 NK 10
Cyprus 2002 767,314 649 37 7
Czech Rep 2002 10,182,471 6,735 450 134 58
Denmark 2002 5,368,854 4,892 1,200 63 55
Estonia 2003 1,415,618 998 0 35 0
Finland 2002 5,183,545 4,720 2,076 55 24
France 2002 60,200,000 40,423 2,661 200 42
Germany 2002 82,398,326 64,294 450 200 447
Greece 2002 10,964,020 8,800 342 252 63
Hungary 2002 10,075,034 4,992 40 40 80
Ireland 2002 3,897,000 1,800 372 20 8
Italy 2002 57,716,000 50,000 2,100 NK NK
Latvia 2002 2,366,515 1,602 452 37 5
Lithuania 2002 3,458,200 3,051 610 40 18
Malta 2002 397,500 143 23 17 0
Nethlds 2003 16,150,511 7,623 120 0 97
Norway 2002 4,552,200 4,140 1,107 25
Poland 2003 38,662,660 24,088 7,000 147 400
Portugal 2001 10,080,000 4,200 0 NK 35
Romania 2002 22,272839 8,694 3,827 200 80
Slovakia 2002 5,379,161 2,966 249 NK 13
Slovenia 2001 1,974,139 1,248 571 3 0
Spain 2002 40,077,000 15,000 370 320 60
Sweden 2002 8,877,000 7,594 3,761 220 0
Switz'land 2002 7,302,000 4,250 150 50 0
UK 2002 59,778,000 29,055 1,800 2,000 300
Italy, Lithuania, Portugal, Romania, Switzerland & UK: number of registered dentists
NK: number unknown
Figures in red: the dental association is not sure which are in clinics and hospitals
Iceland and Luxembourg: no public dental service
Table 11: Dentists working in public dental services

In some countries, specifically the Czech numbers employed in each sector – clinic or
Republic, Cyprus, Malta and Slovakia, the hospital.
differentiation between clinics and public
The common services provided by most of
hospitals is not clear, so these countries were
the 27 countries with these clinics will include
unable to provide accurate data of the
emergency care, domiciliary care, dental
public health support, preventive services postgraduate training. These services are
and available to all citizens and often without
charges. However, in just over half the
countries, general dental care may also be
available to certain classes of patients – such
as the under-18s, the elderly, medically
compromised patients and low income
adults. These services also are often provided
without charges.
thought that the amount of oral healthcare
The Czech Norway delivered this way is very limited.
Republic Poland
Denmark Romania Dentistry in the Armed Forces
Finland Slovakia
France Slovenia Many countries of the EU/EEA, especially the
Hungary newly acceded countries, have national
Spain service in the armed forces. These
Ireland Sweden
Lithuania United Kingdom
Malta
Table 12: countries where full oral healthcare

services often provided in public clinics
Hospital Dental Services
As said above, the strict definition of what is

a hospital is not uniform across Europe. But,
for the purposes of this section we are
looking at premises which have facilities for
patients undertaking general medical care to
receive services for acute or chronic care,
either as in-patients for one or more nights,
and as out-patients. Dental schools without
these facilities are not part of this review.
All countries have hospitals which provide

services for trauma, oral maxillo-facial
surgery and pathological services. Most also
undertake postgraduate training for potential
surgeons. There are state-funded facilities in
every country, and some also have private
hospitals which provide some care. The
practitioners involved in providing the care
are usually salaried in public hospitals – but
in most countries they are also able to work
additional hours in private practice.
Whether these services are provided as part

of oral healthcare or medical healthcare
depends upon individual countries. Apart
from Iceland and Luxembourg salaried
personnel are available for this provision, and
there is often no charge for it.
In most countries there is provision for

emergency dental treatment for in-patients,
but this is often provided by local general
practitioners. However, in six countries
general dental care is provided for patients
who are not in hospital – often as part of
specialist services. These countries are
Cyprus, Ireland and Malta (with historical
links with the UK), Spain, Sweden and the UK.
Indeed, in the UK this service is very
developed, with nearly 10% of practising
dentists involved in providing this care, or
postgraduate training.
Dentistry in the Universities
Some dental care is provided in dental

schools, by academic dentists and (in most
countries) by dental students. However, it is
countries and many of those with volunteer attaches a monetary value to each point.
armed forces have formal arrangements to Sometimes the monetary values attached to
provide oral healthcare for their personnel, different treatments, is derived from an
either from Armed Forces Dental Units, or overall ‘target income’ figure for the average
from local arrangements with public clinics. dentist. In this way it is possible for
governments to exercise partial control on
However, in Germany, Poland and the UK the overall expenditure. However, although in
Armed Forces Units are well developed some countries the scale is one of maximum
because large numbers of dentists serve this fees, more often there are flexible rules
way. governing when a dentist can charge above
the standard fee.
Financial Matters Income levels
Dentists’ Remuneration
As part of the surveying for this Manual we
asked dental
Whether paid ultimately by a government
agency, a sick fund or directly by the patient,
fee-for-service (or fee-per-item) is the
dominant form of remuneration for ‘private
practitioners’ across Europe. However, the
level of fees, how they are fixed and how
much the patient pays varies considerably.
Only the UK (with over 1 million patients

registered for non-state care under a
capitation system) Latvia and Spain varied
from this. In nearly all countries, where a
patient pays all of their dental care costs
directly, the dentist is free to charge
whatever the individual patient accepts.
However, in the Czech Republic, the
Netherlands and Slovakia there is a control of
prices, even in fully private practice.
For dentists contracted to treat members of

sick funds or registered to treat patients for
the government health service, the level of
these fees are usually centrally fixed, but
there may be local flexibility, within certain
limits. Where systems of standard fees exist,
the dentist is usually bound by some form of
contractual agreement with the government,
or another body representing social
insurance organisations.
Dentists who work within hospitals or for the

public dental service tend to be salaried
employees, and considerable numbers in
general practice may work that way – either
as assistants to practice owners in fee-based
systems, or salaried within the state system
(the UK).
Liberal/General private practitioners often

contract to work part-time for the public
dental service on a fee-for-service basis.
Given that a ‘fee for service’ (or ‘fee-per-

item’) system dominates for all private
practitioners across Europe, and for some
dentists working from hospitals or
government health centres, the process of
establishing standard or maximum fees is an
important part of any oral health system. A
common model for deciding standard fees is
to have a points system attaching relative
values to each type of treatment, to reflect
relative cost. A separate process then
associations to provide information about
income levels, according to the types of So, for data, please refer to the individual
practice (liberal, public, hospital or country section. However, an approximation
academic), in each of two groups of dentists of the data, on average values, for those
– “Dentists 25 years old or 2 years after countries which were able to supply some
qualification” and “Dentists 45 years old or information shows the following for Liberal
20 years after qualification”. This proved too (General) dentists, working mainly in state or
difficult a task, with few countries being able social insurance funded care:
to supply all of this information and many
supplying none.
Liberal dentists: Income in € thousands (before

tax)
Switz'land
Denmark
Germany
UK
Italy
Iceland
France
Finland
Sweden
Romania
Slovenia
Greece
Lithuania
Hungary
Czech Rep
Slovakia
Latvia
0 25 50 75 100 125 150
In most reporting countries incomes for

Chart 6: Average Incomes of Liberal public service dentists were considerably
(General) dentists – none private earnings lower than for liberal dentists, although
(2001-03 period) often leading university dentists reported
higher earnings. Thus, associations
Public Ser
reported that frequently public service

dentists worked part-time in private
Chart 7: Average Incomes of dentists practice, often after normal working hours.
working other than in liberal practice –
none private earnings (2001-03 period) Tax Rates
Trying to produce relevant information

about tax rates across the EU/EEA would
have been a complex and confusing task.
However, we did ask about the top tax rate the prices that governments,
in each country – and the income levels insurance companies and
above which it would be levied. Most patients pay for dental care.
countries supplied this information.
Again, the levels of VAT levied
The highest rate reported was in Finland, across the different countries,
with a top rate of 60% levied on earnings is very complex. The highest
above €100,000. The top rate in most rate charged is 25% (Denmark,
countries was below 50%, with the lowest Sweden and Slovenia), but the
rates being in Estonia (24% on all earnings) average is about 18 to 20%.
and the Netherlands and Slovenia (25% on Often, where there are two
earnings above €5,000). levels of VAT, a lower level may
be charged on medicinal
products or equipment. In
VAT Malta, medicinals, certain
dental equipment and filling
The cost of oral healthcare is specifically materials are exempt from VAT.
exempted from VAT charges in all
countries, so dentists do not add VAT to the
bills that patients pay.
However, within their costs

dentists have to pay VAT on a
number of services and
consumables that they
purchase (but not dental
technicians’ labour costs) – and
these costs are included within
Part 9 – Professional Matters
Professional representation Republic Portugal Spain
Germany
Although all countries have a main national
dental association, some have two (for
The Lithuanian Dental Association reported
example, Belgium and Italy), and many are
in 2003 that discussions were being held
primarily federations of the regional
with a view to introducing mandatory
associations (for example Denmark,
membership. In the remaining countries,
Germany, Sweden and Spain).
membership is voluntary, and uptake very
mixed. So, whereas in Finland 98% of
The primary role of all national dental
dentists are members of the association, in
associations is to defend the interests of
Italy less than half of dentists (44%) are
individual members and the dental
members of either ANDI or AIO, the two
profession as a whole. However, although
main associations there.
the national dental association usually
plays an important role in determining the
Ethics
level of “standard fees”, in several
countries is the association is also the Dental practitioners in every European
official trade union for dentists. country have to respect ethical principles.
Whether formally expressed as laws, oaths
In several countries membership of the or as written guidelines these principles
dental association, or as more frequently relate to their relationship with patients,
known, the Chamber is mandatory – often other dentists and the wider public.
because the association/chamber acts as
the registration authority as well. In some The commonest method of providing
countries, as well as providing continuing dentists with ethical guidance is through a
education for dentists (and dental simple written code. This is usually
auxiliaries) the association/chamber is administered by the national dental
responsible for ensuring the participation in association or in some countries by the
it. separate regulating body (for example, as
in France, Ireland and the UK). The
In 2004, membership is mandatory in: application of these codes is usually by
committees at a local level. Dentists’
professional and other behaviour is usually
Austria Greece Romania
also governed by specific laws (such as the
Cyprus Hungary Slovakia Dental Acts in Norway and Iceland), more
Czech Poland Slovenia general medical laws (for example, in many
of the new member countries of the EU, Standards and Monitoring
and in Austria, where dentists must also
take the ‘Hippocratic Oath’) as well as laws
Although the threat of patient complaints is
on professional and business conduct.
probably still the strongest ‘control’ on the
standard of care, increasingly oral health
systems have other mechanisms for
monitoring dental practice. These include
external ‘prior approval’ of expensive or
complex treatments, incentives or rules for
participation in continuing education, as
well as more basic controls on the level of
billing and patterns of treatment of
individual practitioners.
Some of the widest variations in dental

practice across Europe relate to the
monitoring of standards. In most countries
monitoring is not of the quality of care, but
is simply an administrative control, to
ensure that the patient has been charged
the correct amount for the type and
amount of treatment received. Only in a
few countries are there “examining
dentists”, who re-examine the patients of
selected dentists, to see that the dentist
has fairly claimed payment for work done.
However, in these countries it is not usual
for examining dentists to visit at random,
and most re-examinations are the result of
patient complaints. In some countries the
threat of patient complaints offers the only
real form of pressure on dentists
maintaining the standard of care.
Advertising
There is tremendous variation across the

EU/EEA as to what constitutes
“advertising”, in its truest sense, when
applied to publication of information about
dentists and their dental practices. So, in
many countries even an entry in the
“Yellow Pages” classified telephone
directories could be counted as advertising.
In the following countries the rules are very
tight and practitioners are barred from any
form of public announcements:
Belgium Iceland Poland

Cyprus Ireland Portugal
France Italy Romania
Greece Luxembourg Slovakia
Hungary Malta
It was reported in 2003 that the

governments were undertaking reviews in
Ireland and Italy, with a view to liberalising
the rules in these countries.
Data Protection
By 2003 all the pre-2004 member countries

of the EU, except France, had adopted the
1995 EU Data Protection Directive into their
national legislation. However, articles in
the ethical code in France did cover this
item. Cyprus, Hungary, Malta, and Slovakia National laws in Iceland and Norway
all enacted a law which harmonised with EU covered this area of dental practice.
legislation, before accession. Estonia, Latvia, Lithuania and Poland also
have national data protection laws. The
position in the Czech Republic, Poland and
Slovenia has not been reported.
Indemnity Insurance
In all the 29 countries, professional

Indemnity Insurance, to protect dentists
against having to pay damages and legal
costs should a claim arise against them is
available and recommended. However, in
16 countries indemnity insurance is
mandatory:
Belgium Hungary Slovakia

Czech Iceland Spain
Republic Latvia Sweden
Denmark Luxembourg United
Finland Norway Kingdom
France Poland
Germany
This insurance is included in membership

fees of the Danish Dental Association.
Corporate Practice
Most countries permit dentists to set up

their practices as limited liability
companies (corporate bodies). Only in
Cyprus, Germany, Ireland, Luxembourg and
Malta is this barred completely. In the UK
there are a restricted number of such
companies, although this restriction is
being lifted during 2004.
In Austria, France, Iceland, Italy, Norway

and Switzerland only dentists are permitted
to own such companies. In the following
countries non-dentists may wholly or partly
own the company, but in all cases at least
one dentist must be employed:
Belgium Hungary Romania

Cyprus Latvia Slovakia
Czech Lithuania Slovenia
Republic Netherlands Spain
Denmark Poland Sweden
Estonia Portugal United
Finland Kingdom
Greece
European Dental Associations and

Committees
There are very many associations,

specialist societies and committees
representing dentists across the EU/EEA. The EU Dental Liaison Committee, which
The 3 main such organisations which have commissioned this manual, was established
access to the EU institutions are: in the early 1960s at the request of the
Department of Social Affairs of the
• The EU Dental Liaison Committee European Commission. It is a committee
(EUDLC) representing dental associations, who
• The European Union of Dentists (EUD) appoint 2 members each to its plenary
• The Council of the European Chief meetings – which are twice a year, once in
Dental Officers (CECDO) a host EU country, and once in Brussels.
Between plenary meetings an elected
board and working groups attend to
matters, and the DLC has a permanent
office and secretariat in Brussels.
The DLC’s primary task was to co-operate

with the European Commission in
developing the dental directives published
in 1978. Since then, the committee and
member associations have worked closely
with the European Institutions in a number
of matters.
The European Union of Dentists was

founded in 1974 to put dentists in touch
within the Common Market. It is a trans-
national organization which offers
individual membership to registered
dentists from any country (not just Europe).
To join you must be a registered dentist.
The EUD is organised into a network of
Special Interest Groups (SIGs).
The EUD is a non governmental

organisation [NGO] which enjoys
consultative status and is listed on the
central database of the Council of Europe,
Strasbourg. The EUD is permanently
represented among the NGOs which have
consultative status within the Council of
Europe and contributes to several working
groups. The EUD is represented by its Vice-
President, who sits on the Group Santé
(Health) of NGOs.
The Council of European Chief Dental

Officers (CECDO) was inaugurated in July
1992 and was registered as an association
under Dutch law with the Kamer van
Koophandel (Chamber of Commerce) Den
Haag in 1995.
The Council aims to provide a forum for the

exchange of views on dental matters which
affect EU/EEA member countries. It exists
to offer advice to National Governments, to
the Commission and others on matters
affecting European dentistry through the
creation and maintenance of a contact
organisation for European Chief Dental
Officers (CECDO).
There is exchange of knowledge and data

between CDOs, which can influence the
current and future policy of national
governments with respect of dental care.
This is achieved by organising two
meetings each year, preferably in the
country which holds the presidency of the
European Union, to provide a confidential
forum for this exchange of views.
The CECDO also co-ordinates pan-European

activities related to improvements in
technology, dental care and dental
education. The Council also takes a
proactive role in the development of
programs designed to improve the quality
of dental public health, publishes articles
and reports.
Part 10 – Individual Country Sections
Norway
Iceland
Swede
n
Denma
Finland
Germa rk
ny
Netherlan
ds
Estonia
Ireland
Latvia
Lithuania
UK
Poland
Czech Rep
Belgiu
m
Slovaki
Luxembo France a Hungar
urg y
Romani Austria
a
Sloveni
Portug a
al
Spain
Bulgari
Switzerla a
nd
Italy
Cyprus
Malta Greece
EU pre- EU new- EU 2007 EEA Non-

2004 2004 EU/EEA
Austria
In the EU/EC since 1995

Population (2002) 8.2 million
GDP per capita (2001)
€22,365
Currency Euro
(Active) dentist to population ratio 2,008
Main language German
Entitlement to receive funded healthcare in Austria

is through membership of health insurance
organisations (or sick funds). These are provided
by public compulsory and private supplementary
insurance. There are 4,275 dentists (95% are
Austri members of the dental association -
a Österreichische Ärztekammer, Bundeskurie
Zahnärzte). Specialists do not exist in Austria and
Government and healthcare in Austria

Austria is a landlocked, federal republic in covered by the compulsory schemes which
the geographical centre of Europe, are often called paragraph 2 insurance, if
surrounded by 8 adjacent EU states. they are with one of the large public
regional institutions. Employees, their
There is a bicameral Federal Assembly or dependants and retired people are either
Bundes-versammlung consisting of a members of one of the 9 regional “public
Federal Council or Bundesrat (64 members; health insurance institutions” (one in each
members represent each of the states on Bundesland), 4 occupational insurance
the basis of population, but with each state organisations (civil servants, railway
having at least three representatives; workers, farmers and craftsmen), or the 9
members serve a four- or six-year term) health insurance institutions of large
and the National Council or Nationalrat companies. The public compulsory
(183 seats; members elected by direct insurance schemes are funded mostly by
popular vote to serve four-year terms) members (89% of their revenue), with
consisting of 9 federal states. The employers paying half of each member’s
population of Austria in 2002 was contribution. The public sick funds also
8,188,207.The capital is Vienna. earn some revenue through patients’ co-
payments for treatment and retention fees
The federal government looks after all the (6% of revenue), and government subsidies
competences for healthcare, including (5%).
dentistry. There are departments for
healthcare in both the federal ministries for Supplementary private health insurance
health and women. mainly covers hospital care. The benefits
generally include a more comfortable room
In Austria entitlement to receive healthcare and greater choice of doctor for inpatient
is through membership of health insurance care. There are about 1 million private
organisations (or sick funds). These are health insurance contracts offering these
provided by public compulsory and private extra benefits and their total expenditure is
supplementary insurance. Approximately about one third of that of compulsory
99% of the 8.1 million inhabitants are health insurance schemes.
Anyone who is not covered by a public The proportion of GDP spent on general
insurance scheme, usually the healthcare, including dentistry in 2002, was
unemployed, is supplied with an insurance 7.9% (OECD Feb 2004). Of this
certificate (or Krankenschein) by their local expenditure, 68.5% was “public”.
authority. They have to pay €3.63 per
quarter for this, and it entitles them to free
care for most of their treatment needs.
Austri
Oral healthcare
a
The proportion of total governmental negotiations with the Austrian Medical

spending on dentistry is approximately Association (Dental Section). Since
0.8% of GDP (about 10% of healthcare dentists represent only about 10% of the
spending). membership of the Association, dentists’
earnings are influenced by the level of pay
Public compulsory health negotiated for other doctors. Every
regional Ärztekammer proposes and
insurance negotiates its own level of fees. The
average increase of the 9 regions then
Public compulsory health insurance determines the increase of the national fee
provides cover for 41 conservative and scale. Dentists may hold more than one
surgical items, and 11 removable contract in order to treat patients with
orthodontic and prosthodontic treatments. different insurance organisations.
Crowns and bridges, implants, fixed
orthodontic appliances and other complex As with general healthcare, approximately
or cosmetic treatments have to be paid for 99% of the population are entitled to
by the patients. There is a prescribed fee receive dental care in this way, with the
scale for all dentists who are contracted to rest holding a certificate from the local
the major public insurance organisations. authority.
Free or subsidised treatment is provided by
any dentist in exchange for a “dental There is no organisation entirely dedicated
treatment voucher” (or to children’s dental care. However, some
Zahnbehandlungsschein) which members larger cities have dental clinics for children
of the public health insurance schemes ("Jugendzahnkliniken"). Children are
receive from the company each quarter. covered by the social sickness insurance of
When this voucher is completed by the their parents and have the same rights to
dentist, with a record of the treatment dental treatment as their parents. This
performed, the dentist can reclaim fees means that parents have to pay the same
from the insurance scheme. percentages for the treatment of their
children as for themselves.
The small sick funds, largely those for There are institutions in every county
particular occupational groups, use the ("Bundesland") which offer caries
same list of items as a basis for dentists’ prevention programmes. These are mostly
remuneration but have different levels of educational programmes (how to brush
fees. Generally, standard items attract an teeth, what healthy food to eat, etc.). In
insurance subsidy of 100%, or 80% with almost all counties children’s teeth are
small funds, which is claimed by the dentist examined regularly. A federal programme
and the patient pays the remainder where of oral health surveys began in 1997. Each
appropriate. For more complex types of year the oral status in a subgroup of the
treatment, for example removable population (500 persons) is examined.
prosthodontic appliances the insurance
schemes provide subsidies of up to 50% of The 418 dentists who work for the public
the cost. In such cases, where the overall dental service are only allowed to offer
value of the care is high, the treatment treatments within the scheme of the social
plan may have to be agreed with the security system. There are very few
insurance organisation. dentists working in hospitals, mainly
practising oral maxillo-facial surgery, in
Approximately 70% of dentists in general emergency cases.
practice treat patients within this system
through the contracts with the public All payments to dentists are done by the
insurance institutions. The fees claimed by way of fees for treatments. Normally re-
dentists contracted with the major, public examinations would be carried out
sick funds are set by the Association of annually. Domiciliary (home) Care is
Austrian Health Insurances (Hauptverband available in an emergency.
der österreichischen
Sozialversicherungsträger) in annual
Private Care
For private patients who wish to pay the

whole cost of care themselves, the levels of
fees payable are decided by the individual
dentist and are not regulated.
In Austria, about 5 percent of people use

private insurance schemes to cover some
of their dental care costs. All such
schemes are personal, which supplement
the public health system, and individuals
insure themselves by paying premiums
directly to an insurance company. The
private insurance policies which people can
purchase may be dental-only or contracts
which provide a range of medical benefits
including dental care. Private insurance
companies are regulated by insurance law
only and thus accept all the financial risks
involved. Generally the level of the
premiums is linked to the age of the
insured individuals, and the insurance
company may refuse to provide cover if the
risk of costly treatments is high.
The Quality of Care
The quality and standards of dental care

are the responsibility of the Dental Section
of the Medical Association. Checks are
made mainly on the quantity of care
provided, and the correct and fair payment
of fees, as recommended by the
Bundeskurie Zahnärzte (private services
only). There are regional variations in
these monitoring arrangements but usually
they concentrate on newly established
dentists or those performing more than the
expected number of particular treatments
but random checks are carried out in some
regions. Sometimes the quality of care is
also monitored by dentists employed by
the insurance schemes.
Another measure of the quality of care, and

the only control for dentists providing care
to private patients, is patient complaints
(see Ethics).
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Education, Training and Registration
a
Undergraduate Training and
Qualification
are no formal linguistic tests, although
Austrian citizenship is generally awarded
In the past, to practise as a dentist in on the condition that German can be
Austria required a medical qualification (6 spoken. New dentists have to be a member
years’ training), followed by specialist of a local medical chamber, to be allowed
postgraduate training in dentistry. So, until to practise dentistry.
2004, in order to register as a dentist, a
practitioner had to have the recognised Until the end of 1998, non-Austrian dental
primary degree [Doctor of Medicine (Dr. degrees were not recognised. Since then
med. univ.) with the Specialist Certificate all EU dental degrees have been accepted,
(Facharzt für Zahn-, Mund-, und but dentists from non-EU countries have to
Kieferheilkunde), needed to demonstrate demonstrate the equivalence of their
Austrian or EU citizenship, and to provide education and training to an expert panel
evidence of professional indemnity. of the Universities of Vienna, Graz or
Innsbruck
However, in autumn 1998, to move
progress towards mutual recognition under Continuing education
the EU Dental Directives, a separate
curriculum for dentists was introduced. Legislation includes an obligation to
Since then all new dentists have had to participate in continuing education, but it is
study dental medicine. The study is divided not proscribed as mandatory and a dentist
into 3 sub-sections and lasts 6 years. There is free to choose the activity he wants to
are about 335 students in training (2003). join in.
Graduation takes place at the three
university dental schools: Graz, Innsbruck There are several institutions which provide
and Vienna. For universities’ information courses and training, including universities,
click here scientific societies, medical or
pharmaceutical companies, national and
The first dentists under the new system international medical congresses. Every
graduated in 2004. The title upon three years the dentist can apply for a
qualification (from June 2004) is Dr. med. diploma on education from the
dent. Bundeskurie Zahnärzte, by submitting the
approvals of the different types of training
Vocational Training he/she he has completed during this
period.
There is no compulsory post-qualification
vocational postgraduate training in Austria. Further Postgraduate and Specialist
Training
Registration
In Austria no dental specialties are officially
To achieve registration to practise in recognised, largely because dentistry itself
Austria applications must be made to the was formally a specialist area of medicine,
Bundeskurie Zahnärzte der until 1998. However, it is possible to train
Österreichischen Ärztekammer (the in any of the 3 universities in the
competent authority for dentistry) and to “subspecialty” of oral surgery through a
the regional medical associations for further 3 years education (officially, oral
dentistry. There is an annual fee for surgery still is a sub-speciality of medicine).
inclusion in the register of dentists of €170 There are no official guidelines to whether
(2002) to the Österreichische Ärztekammer the trainee is paid – this is a matter
(Chamber of Doctors) and €126 (2002) to between the trainee and the university.
the Bundeskurie Zahnärzte (Specialist
Group). There There are many associations and societies
for dentists with special interests. These
are most easily contacted via the dental
section of the Medical Association. Click
here
Workforce
Austri
Dentists
Total of dentists registered 4,275
a
In 2003 there were 4,275 registered (2003)
dentists in Austria – 67% male and 33% General practice* 3,195
female. The number of dentists is Public dental service 418
increasing, with 300 graduating each year. University 331
The (active) dentist to population ratio was Others (including dentists 133
2,008 (2003). without a university education)
Total active 4,077
There is a small increase of dental
* 657 of these general
workforce, so that the phenomenon of
practitioners are in fully private
jobless dentists has commenced. However, practice, with no insurance
there was a post-1945 population “bulge” contract
(which included a bulge of dentists) and as
a result many of these dentists will retire
early in this century, leading to an Specialists
expected reduction in the numbers.
In Austria no dental specialties are officially
recognised, but there were 120 Oral
Maxillo-Facial surgeons in 2002.
There is almost no movement of dentists Auxiliaries

out of Austria as far as can be established,
but there are a considerable number of In Austria, other than dental chairside
dentists, especially from Eastern Europe assistants (Zahnärztliche Assistentin),
and Germany, moving into Austria. dental technicians (Zahntechniker) are the
only other type of dental auxiliary. There
are no clinical dental auxiliaries.
Dental Technicians
Education or training is over a 4-year

period and is provided by qualified
technicians and the dental practitioner
confers the Diploma. As a “special
profession” there is a registerable
qualification which dental technicians must
hold before they can practise. The register
or list is administered by local trade
federations, which also have federal and
state groups.
The permitted acts of dental technicians

are the production of prostheses (crowns,
bridges, dentures and repairs), and they
are not allowed to work in the mouth of a
patient, or have direct contact with them.
In 2002 there were 650 dental technicians

(Zahntechniker), 90% of whom work in
separate dental laboratories and invoice
the dentist for work done. 10% work
directly with the dentist. There are no
available figures on technicians’ earnings.
Dental Chairside Assistants
Assistants are governed by the

Kollektivvertrag, (the labour agreement
between the union and the Bundeskurie
Zahnärzte) and follow 3 years training
under the authority of the dentist.
They are paid by salary. In 2002 there were

7,100 Dental Assistants.
Officially there are no dental hygienists
established in Austria, but there are some
Practice in Austria
dental nurses specialised in oral
prevention, who have obtained a diploma Working in Liberal (General)
after 3 years professional practice and Practice
following the specific education determined
by the Bundeskurie Zahnärzte. In Austria, dentists who practise on their
own or as small groups, outside hospitals or
schools, and who provide a broad range of
general treatments are in General Practice.
There were 3,195 dentists who worked in
this way in 2002, almost all in single
practice. This represented 78% of all
active dentists.
Dentists in general practice are self-

employed. They claim fees from the public
insurance organisations and directly from
patients, as described above. Those who
hold contracts with the insurance
organisations are often called ‘panel
dentists’. In 2002, 657 (about 20% of
dentists in general practice) did not hold a
contract with any of the public compulsory
insurance schemes (sick funds) and
accepted only private fee-paying patients.
Most of the “private dentists” are
concentrated in the cities.
Joining or establishing a practice
There are no rules which limit the size of a

dental practice in terms of the number of
associate dentists or other staff. Premises
may be rented or owned, but only by
dentists. There is no state assistance for
establishing a new practice and dentists
take out commercial loans from a bank.
Local health insurance organisations may
have a geographical plan of areas in need
of more dentists (a Stellenplan) but
‘private’ dentists, who are not contracted
with any public insurance scheme, may
locate their practices anywhere. Generally
there are very few places where additional
contracted dentists are needed.
Normally dentists buy existing practices,

mainly because that is the only way to
become a ‘panel dentist’. However, it is not
possible to receive a list of patients. The
only possibility for the transfer of patients
is that the seller of the practice informs his
patients about the new owner.
Dentists are not allowed to employ other

dentists (but dental assistants only) in their
single practices. Even the so called
“Wohnsitzzahnärzte” (residence or locum
dentists), who are practising in the absence
of another dentist - for example, in case of
illness, or maternity regulation - in a single
practice are not employed by the original
dentist during the absence.
To determine the relationship of the dentist

with their employees, the union for each
type of auxiliary has a contract which is
negotiated with the dental association. A
dentist’s employees are also protected by Working in Universities and
the national and European laws on equal
employment opportunities, maternity
Dental Faculties
benefits, occupational health, and
minimum wages. Occupational health and
safety regulations apply to all companies. There were 331 dentists working in
There are no standard contractual universities and dental faculties as
arrangements prescribed for dental employees of the university (2002). They
practitioners working in the same practice. are allowed to combine their work in the
However, dentists who are contracted with dental faculty with part-time work
the local health insurance organisation elsewhere and, with the permission of the
cannot employ another dentist to carry out university, accept any amount of private
the work. practice work outside the faculty.
There is no available information regarding The main academic position within an

the size of a normal dental “list”. Austrian dental faculty is that of head of
department Professor, Doktor and Dozent
(chairside teaching only). There are no
Working in the Public Service
formal requirements for postgraduate
training but most will have qualified by
The public insurance organisations also habilitation. This involves the submission
employ salaried dentists to provide care. of a thesis, and evidence of original
This service takes place in dental clinics, research.
health centres and hospitals – and
competes with, and is subject to the same There are no available figures on earnings.
standards as the other dentists contracted
with the insurance scheme. The care
provided is therefore available to the same
client groups, and provides the same range
Working in the Armed Forces
of treatments. Patients have a free choice
to go to these clinics or a private dentist, There are no dentists working full time for
but it was reported in 2003 that there is a the Armed Forces. Some dentists work part
political intention of the Bundeskurie time in hospitals of the Armed Forces.
Zahnärzte to increase the numbers of
patients seen in general practice, rather
than the public dental service.
The public dental service employed 418

dentists in 2002, within 87 different
institutions. The service is established by
contract between the Dental Section of the
Austrian Medical Association and the
Association of Austrian Health Insurances.
There is no staff grade structure and no
postgraduate training is required in order
to work in the service. Working within the
public dental service does not require
registration with the Austrian Medical
Association.
Working in Hospitals
In Austria the only dentists who work in

hospitals are those who have had
postgraduate training as oral surgeons, or
those employed to teach dentistry by the
universities. The oral surgeons work as
salaried employees of regional government
which owns most hospitals, or earn income
on a ‘fee-for-service’ basis for one of the
few private hospitals. Usually there are no
restrictions on seeing other patients
outside the hospital. The titles are the
same as those for hospital doctors;
assistant (in training), Oberarzt and
Primarius (head of department).
Austri
Austri
a
a
removed by terminating their contract with
Professional Matters the insurance company – although they
could they still work without an insurance
contract.
Professional associations
In cases of gross negligence a dentist may
The main organisation which represents be suspended immediately or lose the
dentists in Austria is the Dental Section of licence to practise altogether.
the Austrian Medical Association (the
Bundeskurie Zahnärzte der Advertising
Österreichischen Ärztekammer). The
Austrian Medical Association Advertising is allowed in Austria although
(Österreichische Ärztekammer) is a federal there are some legal limitations, as defined
body of the provincial medical associations. in a special code edited by the Austrian
It is self-financed through compulsory Medical Association. Limitations refer, for
members’ subscriptions, which are usually example, to the dimension of the
earnings-related and are deductible for the advertisement in print media and the
assessment of income tax. This form of
representation within the medical
association, which is the official
organisation for all doctors, reflects the
previous and existing training requirements
for dentists (or stomatologists) in Austria.
In 2003, the Dental Section was the largest

of the 44 specialist sections of the Medical
Association with 4,078 members. For the
BZOA click here
In addition to the Dental Section of the

Medical Association, there is an
organisation for dentists called the
Österreichische Dentistenkammer. This
body represents those practitioners who
have not had a university training. This
system of training Dentisten ceased in
1949 and the 133 (2002) who remain
practising will be retiring in the following
few years.
Ethics
Ethical Code
The Austrian Medical Association, or its

Dental Section, does not have a specific
code of ethics or any other guidelines of
good or ethical practice. However, dentists
in Austria have to work under Medical Law,
and take the Hippocratic Oath before they
can legally practise. The application of the
law and the oath is primarily the
responsibility of the Austrian Medical
Association (Dental Section).
Complaints by patients are administered at

regional level by the Medical Association,
and the Board of Arbitration is always
convened before court action can be
considered. The examining committee
consists of dentists and of delegates of
associations for consumer protection. If a
complaint is upheld then the most likely
form of sanction is a warning from the
insurance company. In extreme cases the
right of the dentist to practise can be
interdiction of declaration of prices or
Financial Matters
Austri
services. Advertising on radio or TV is not
allowed at all, except for commentary on
a
medical and subject-specific issues. Dentists’ Incomes:
Dentists are allowed to promote their There is no information available about the
practices through websites but they are range of incomes earned by
required to respect the code of the Austrian dentists in Austria.
Medical Association, which is more
restrictive than the guidance of the EU Retirement pensions and
Dental Liaison Committee.
Healthcare
Data Protection
Retirement pension premiums are paid at
Every dentist is bound to the duty not to varying levels at an average rate of 22.8%
disclose confidential information in no way of earnings, half by employer, half by
to anybody, including health information on employee. Dentists are legally obliged to
patients or any other data. The regulations be members of two schemes: one
of data protection are subject to Austrian organised by the Österreichische
federal law. Ärztekammer, and one with a main public
insurance company. Retirement pensions
Corporate Dentistry in Austria can be up to 80% of a person’s
average salary during the 15 years of
Dentists are allowed to form a so called highest-earnings. The normal retirement
“Gruppenpraxis”, which is a form of age in Austria is 65 years for men and 60
company, but for the moment these years for women, although dentists may
companies are only allowed to work outside practise beyond these ages.
of the social security system. A non-dentist
cannot be a part-owner and/or on the board For the majority of the Austrian population
of such a company. general health care is paid for at about
6.8% or less of annual earnings, half of
Indemnity Insurance which is paid by an individual’s employer.
At present this contribution is made up to a
maximum assessment (Höchstbemessung).
Liability insurance is not compulsory for
dentists. However, insurance may be
obtained from almost all private insurance Taxes
companies and provides cover for
compensation if negligence is proven. The There is a national income tax: The highest
cost of the premium depends on the rate of income tax is 50 % on earnings over
maximum amount insured. about € 50,870 per annum
Health and Safety at Work VAT

VAT at 20 % is payable on certain types of
Workforce Inoculations are not compulsory
purchase, including most dental equipment
and there are no authorities to survey
and consumables.
compliance.
Regulations for Health and Safety Various Financial Comparators @ July

2003
For Administered by
Zurich = 100 Vienna
Ionising radiation district government
("Bezirkshauptmannschaft Prices (excluding rent) 84.2
") Prices (including rent) 85.2
Electrical "Bezirkshauptmannschaft" Wage levels (net) 52.3
installations Domestic Purchasing Power 57.3
Infection control "Bezirkshauptmannschaft"
Medical devices "Bezirkshauptmannschaft" Source: UBS August 2003
Waste disposal "Bezirkshauptmannschaft"
Austri
Austri
a
Other Useful Information
a
Main national associations and
Information Centre:
Bundeskurie Zahnärzte Scientific Society of Dentists
der Österreichischen Ärztekammer (membership: 80% of all dentists):
Weihburggasse 10 – 12 Österreichische Gesellschaft für Zahn-,
1011 Wien, Mund- und Kieferheilkunde
AUSTRIA Verein Österreichischer Zahnärzte
Tel: +43 1 512 51 26 Weihburggasse 10 – 12
Fax: +43 1 512 51 26-67 1011 Wien, AUSTRIA
Email: office@bkzahn.at Tel: +43 1 512 51 26
Website: Fax: +43 1 512 51 26-67
Email: office@bkzahn.at
Website: www.oegzmk.at
Competent Authority: Publications:
Bundeskurie Zahnärzte The publications of the regional
der Österreichischen Ärztekammer medical associations advertise many
Weihburggasse 9/3/22 posts for dentists. New ‘panel
A-1010 Wien, AUSTRIA dentists’ are often jointly appointed by
Tel: +43 1 512 51 26 the regional dental association and
Tel: +43 1 512 51 26 - 67 the relevant insurance organisation.
Email : office@bkzahn.at
Website:
Dental Schools:
Vienna Innsbruck
Universitätsklinik fur ZMK Wien Universitätsklinik fur ZMK Innsbruck
Währinger Strasse 25a, A-1090 Wien Anichstrasse 35, A-6020 Innsbruck
Tel: +43 1 4277 - 0 Tel: +43 512 504 – 71 80
Fax: +43 1 4277 - 9670 Fax: +43 512 504 – 71 84
E-mail: ik@univie.ac.at E-mail: ilse.quaritsch@uibk.ac.at
Website: www.univie.ac.at/uni-zahnklinik/ Website: www.uibk.ac.at
Dentists graduated 2003: 61 (all under old Dentists graduated 2003: 27 (all under old
training) training)
Number of students: 210 all with the new Number of students: 60 all with new training
training
Graz
Universitätsklinik fur ZMK Graz
Auenbruggerplatz 12
A-8036 Graz
Tel: +43 316 385 – 22 48
Fax: + 43 316 385 – 33 76
E-mail: zahnklinik@email.kfunigraz.ac.at
Website: www.kfunigraz.ac.at/zmkwww/
Dentists graduated 2003: 11 (until February
03)
Number of students:23 with the old training
42 with the new training
Belgium
Population 10.3 million
(2002)
GDP per capita (2001) €24,664
Currency Euro
Main languages Dutch & French
General health care is mainly funded by deductions

from salaries, which also cover retirement
pensions, and a supplementary child tax. The
amount contributed depends on income. There
were 8,512 dentists in 2002, who may belong to
one of 3 dental associations, depending upon their
language. The use of dental specialists is
widespread but there has been no development of
clinical dental auxiliaries. Continuing education for
Belgium
Government and healthcare in Belgium

Belgium has been independent, as a representation to serve four-year terms).
parliamentary monarchy, since 1830. The As a result of the 1993 constitutional
land area is just over 30,000 sq km. There revision that furthered devolution into a
is a well-established system of regional as federal state, there are now three levels of
well as national government. It is also a government (federal, regional, and
country with three languages (the main linguistic community) with a complex
ones being Flemish, just under 60% and division of responsibilities; this reality
French just under 40%). This affects leaves six governments each with its own
dentistry because there are Flemish and legislative assembly.
French Dental Schools and Dental
Associations (see later). The Institut National d'Assurance de
Maladie et d'Iinvalidité
In 2002 the population was 10,263,414. (INAMI)/Rijksinstituut voor Ziekte en
The capital is Brussels. Invaliditeits Verzekering (RIZIV) is the body
responsible for managing the health
The bicameral Parliament consists of a system. The Institut acts as the adviser to
Senate or Senaat in Dutch, Senat in French the Minister of Social Affairs, who makes
(71 seats; 40 members are directly elected decisions on behalf of the King. The King is
by popular vote, 31 are indirectly elected; required to sign every application for new
members serve four-year terms) and a laws.
Chamber of Deputies or Kamer van
Volksvertegenwoordigers in Dutch, Health care is mainly funded by deductions
Chambre des Représentants in French (150 from salaries which also cover retirement
seats; members are directly elected by pensions, and a supplementary child tax.
popular vote on the basis of proportional The amount contributed depends on
income. There are two different schemes:
one for employed which provides full cover,
and another for the self-employed. Self-
employed people only have to pay for high
cost risks such as hospital care, but can
elect to insure against lower cost
treatments such as dentistry and general
medicine.
Individuals can choose to belong to one of

over a thousand sick funds, which operate
in five major groups. For all sick funds
central co-ordination ensures that the
rules, fees and reimbursements are the
same. Although the total budget for
healthcare is decided by the government, it
is divided between the five groups using a
formula which takes into account social and
economic factors, the number of people in
each scheme, and occupational differences
in health risk (eg the mine workers’ fund
receives more resources). Every three
months the budget of all of the sectors are
examined to determine what measures
must be taken to control any expected
overspend.
The proportion of GDP spent on general

healthcare, including dentistry in 2002, was
9%. Of this expenditure, 71.7% was
“public” (OECD Feb 2004).
The health budget in 2003 was €15 billion,

of which dentistry was €0.467billion, 3.25%
of the total. There is a legally approved
increase of 4.5% per year in health care
expenditure, with amounts above this
having to be justified separately, for
example by lobbying from the dental
profession.
The following ministers are responsible for

different aspects of health care:
Minister of Social Affairs decides treatment

tariffs and oversees relations
with sick funds
Minister of Health decides registration, and
how many dentists are
required
Ministers of Education (2) control the basic
education of dental students
in each region
Belgiu
Oral healthcare
m
Oral health care is organised in the same There is an agreed scale of fees for dental
way as general health care. All sectors of treatments, called the convention. This is
the population are able to access dental jointly agreed by the 3 dental associations
services, including the self-employed and and the sick funds working as a
unemployed people. Almost all dental care commission within the Institut. Dentists
is provided in private practice together with generally charge patients for each item of
a very small amount in hospitals and treatment, and then patients reclaim a
universities - so small that it becomes proportion of the fees from their sick fund.
irrelevant. Some free dental care is also However, a “third party payment system”
available for homeless people in Brussels. also exists, where some dentists choose to
receive reimbursement directly from the Quality of Care
sick fund.
There are several ways in which standards
About 3.25% of all government spending
of dental care are monitored. The Institut
on healthcare in 2002 was spent on
has an administrative body which regulates
dentistry.
the non-clinical administrative forms used
in dentistry. It also has an independent
The dentist-to-population ratio was 1:1,357
control department staffed by medical
in 2002 and almost the whole population is
doctors (not dentists) which checks that the
within a 15 minute bus access of a dentist.
treatment codes recorded agree with the
However, only approximately a third of the
actual treatment undertaken. The Institut
population attend a dentist regularly, one
may not comment on the quality of the
third when necessary and the remainder
dental treatments, but has the right to
almost never or in an emergency. The
examine any patient. This usually happens
result is that many dentists work part-time,
only after a complaint (see ethics).
some for only a few hours a week. There is
concern that this may lead to inadequate
Within the convention there are some
experience for some practitioners.
quality standards. For example, a denture
must include six stages of construction at a
Patients normally attend for re-
minimum of five visits. There is a
examinations every 6 months to the age of
possibility in the future that fees will be
18 years, then annually after then.
increased if more standards are included.
As part of the convention a voluntary
quality assurance accreditation system has
been organised since 1998.
Private Insurance
There are a few private insurance schemes

mainly in the form of group contracts for
employees. The cover they offer is varied,
as are the premiums charged. In 2003
there were no private dental care plans.

Undergraduate Training
Quality assurance for the dental schools is
provided by the Ministry of Education.
There are six dental schools, three French-
speaking and three Dutch-speaking.
Primary dental qualification
Dental schools are part of the Faculties of
Medicine in universities. Within each
There are two titles awarded for clinical
language group there is a Catholic
dentists graduating from Belgian dental
(private), State and a Free (private)
schools, after a 5-year course:
university, but these titles have very little
religious meaning (for further information
see dental schools). • Flemish Tandarts
Entry to basic higher education is

• French Licencie en sciences
dentaires
unrestricted (by regional law), so the initial
number of dentists being trained is (in
Qualification and Vocational Training
principle) uncontrolled. But, from the
academic year 1998 onwards, in the
Vocational Training (VT)
Flemish dental schools, there has been an
“entry examination”, and this resulted in an
Students entering dental faculties from
immediate dramatic drop of the intake.
2002 were informed that they could not
Although it is too early to predict long-term
practise as a generalist after their basic 5
variations, it may be that the formerly
years of education and would have to
reported increased rate of growth of the
follow vocational training after graduation -
numbers of graduates will decrease.
1 year for general dentistry, 3 years for
periodontology and 4 years for
In 2003, 170 entered into dental schools
orthodontics. Therefore, in the year 2007
and 80% were female. About 165 graduate
(only) there will be no practising graduates.
annually.
Belgiu
Despite the absence of a numerus clausus Further Postgraduate and
(by the Department of Education) for the Specialist Training
m
intake of students into the universities the
new federal law introducing new titles has
limited the number of places for vocational Continuing education
training to 145.
Until 2002, Belgium had a voluntary based
All registered dentists in 2002 obtained the system. Within a 5 year cycle, 15 hours per
new title of General Dentist year had to be reached, spread over all
automatically. Some of them can aspects of the profession (general
apply for specialisms in medicine, radiology, prevention, practice
periodontics or orthodontics, if they management, conservative dentistry,
match the criteria for these. orthodontics, prosthodontics, …), in order
to receive a premium of about €2,000 per
year. Since a new law on the new titles
A graduate may work in another EU country
(June 2002), continuing education is
without undertaking this additional
mandatory in order to keep the title. The
vocational training year. Diplomas from
requirement is 60 hours over 6 years, with
other EU countries are recognised without
a minimum of 6 hours in any one year.
the need for vocational training for
specialists (orthodontists, periodontists),
Specialist Training
but general dentists need to undertake a
one year vocational training before being
In 2002 the Minister of Health limited the
able to practise within the sick fund
number of (specialist) licences awarded
system.
The main degrees which may be included
Registration
in the register are:
On qualification a dentist must obtain a
• Algemeen Tandarts, Dentiste
legal stamp on their diploma
Généraliste
(homologation) and then must register with
one of the Provincial Medical Councils, of tandarts specialist in de Orthodontie,
which there are 10 within the Ministry of Dentiste Spécialiste en orthodontie
Health, and obtain a licence. They must tandarts Specialist in de
then ask for a National Health System Parodontologie /, dentiste Spécialiste en
Number. Once they have this number then Parodontologie.
their patients may claim reimbursements
via the health insurance system. Specialist training is undertaken at the
universities - for general dentists 1 year,
There are no formal linguistic tests or other orthodontics 4 years, for periodontics 3
tests in order to be registered. years (including the vocational training).
Trainees are paid by the Ministry of Health.
Workforce
Dentists other sectors
In 2002 there were 7,559 active dentists in The (active) dentist to population ratio was
Belgium - 42% female. Most dentists 1,357 (2002).
practise in general practice – although
some also work in hospitals and dental It is reported that that the workforce is
faculties. slowly reducing in the Flemish part,
although in 2003 there was some reported
Total 8,551 unemployment amongst dentists in
Belgium. The reduction
Active General 7,559
practice*
Hospitals Not
absolutely
known
University 200
Armed Forces 10
* this includes dentists
who also work in the
Belgiu
Auxiliaries
m
is thought to be the result of the
introduction of an entrance examination There are two types of auxiliaries in
into Flemish dental schools in 1998, with a Belgium, dental technicians and dental
resulting drop in intake. chairside assistants. There are no clinical
dental auxiliaries.
Movement of dentists across borders
Dental technicians
There is a small, but insignificant
movement of dentists from Belgium to its Dental technicians have a protected title,
neighbouring countries (especially the under the governance of the Ministry of
Netherlands), and a small amount from the Economic Affairs, and receive
Netherlands into Belgium. undergraduate training in special schools (3
years) or in the dental laboratories
Specialists (“patronal training”).
Three specialist titles are recognised in They are registered by the Ministry of
Belgium, orthodontics, periodontics and Health. In 2002, there were 870 dental
general practice. Maxillo-facial surgery is laboratories, employing 2,300 technicians.
also recognised as a medical specialty
There are illegal denturists who are
A precise curriculum is being established pressing the government for legal status.
for orthodontics and periodontics, in due
course. Chairside assistants
Because the new registration rules are Dental chairside assistants are trained by
ongoing, the numbers of dental specialists and work to the direct instructions of
was unknown in 2003, although in 2001 dentists. There is no formal training, nor
there were thought to be 350 Maxillo-facial registration, for dental assistants. In 2000,
surgeons, of whom 266 were active. FDI reported that there were 800 chairside
assistants. There is no known later figure,
but anecdotally it has been suggested that
one in five dentists use a chairside
assistant, meaning that there were about
1,500 in 2003.
Practice in Belgium
Working in General Practice As mentioned under Oral Healthcare in
Belgium the convention is negotiated
between the national dental associations
In Belgium, dentists who practise on their
and the sick funds working as a committee.
It is re-negotiated every two years.
Dentists then have to decide whether or
general treatments are said to be in
not to participate in the convention,
General Practice. There are about 7,500
through elections which are held in each
dentists who work in this way. This
canton in the country. If 40% or less object
represents 99% of all dentists actively
to the proposals then the system continues.
practising in the country. Most dentists in
In 2003 the “no” vote was 20% in Flanders,
general practice are self-employed and
44% in Brussels and 31% in Walloon. If an
earn their living through charging patients
area votes 'no', then the Minister of Social
fees. Dentists have a fee scale agreement
Affairs can impose a fee scale on all
known as the convention with the social
dentists. However in some cantons where
security. The convention sets the level of
there has been a 'no' vote the Minister has
reimbursement for patients for many types
not taken action.
of dental care but crowns, bridges, inlays,
implantology and periodontology are
If dentists are “in the convention” they are
excluded. Equally Orthodontics is only
obliged to charge the appropriate fee and
included if treatment starts before the age
the patient claims a reimbursement.
of 14 years. Private fees can be set for all
Outside the convention they can, in
of these items in which case there is no
principle, charge any fee but the patient
reimbursement to the patient. These fees
can still claim a reimbursement to the level
are only restricted by a professional ethic
allowed by the agreement. A dentist does
not to charge unreasonably high amounts.
not have to tell a patient whether or not
he/she is in the convention, but sick funds
hold a list of all dentists who are. The Dentists use a five-point system for
benefit to the dentist of being in the prioritising different types of treatment
convention is related to pension rights on within the system. Generally preventive
retirement. work is given a high priority, and
extractions are a low priority. As there is
insufficient funding to pay for all types of
treatment, those with a lower ranking may
not be reimbursed. Each year changes can
be made either to the priority list, the size
of the fee, or the level of reimbursement.
For example, for restorative dentistry for
children, reimbursement has changed
during the 1990s from 75% to 95% of the
convention fee.
Prior approval for treatment is only

required for orthodontics. There are also
limits to the number of times patients can
receive a subsidy for certain treatments
e.g. one panoramic radiograph per year,
removable dentures every seven years,
and once again for orthodontics there is a
maximum of 36 monthly forfaits. A forfait
is a fixed payment for a month in which
treatment has been carried out, no matter
how many visits are involved. Where
active orthodontic treatment is suspended
the dentist may receive a contention fee for
monitoring the patient.
To overcome the above restrictions, the

sick funds offer a supplementary insurance
to meet the additional costs incurred.
All payments to dentists are by way of fees

for treatments (Item of service).
There are no rules which limit the number
of associate dentists or other staff in a
dental practice. Premises may be rented or
owned, and there are no limitations as to
where they may be opened. There is no
state assistance for establishing a new
practice, so dentists must negotiate
commercial loans. As the number of
dentists has increased it has become
increasingly difficult to obtain loans.
A practice must be registered at a specific

address. Some health funds own
polyclinics. A dentist may sell equipment
and the practice buildings but cannot
charge a premium for acquiring contact
with existing patients. However there is a
system where a vendor may charge 'for
the doorstep' which
is usually based on the practice income of dental health education is included.
Belgiu
the previous three years. No strict rules Working in Hospitals
apply and a free market operates.
m
There are two types of hospitals in Belgium
There are no specific contractual - private and university. A few dentists are
requirements between practitioners employed full-time in university hospitals
working in the same practice. However a but most work part-time in private hospitals
dentist’s employees are protected by the and practice. Dentists can either be paid a
National and European laws on equal salary or, more usually, charge fees under
employment opportunities, maternity the convention arrangements for their
benefits, occupational health, minimum patients attending.
holiday entitlement and health and safety.
There are specific regulations about Working in Universities and

radiation protection and clinical waste Dental Faculties
disposal including the installation of
amalgam separators. For waste disposal Compared to other dentists, faculty
the Flemish Dental association has a group members are not well paid. In Belgium
contract which cost €125 a year (2003). very few dentists work full-time in
Approved collectors take the waste away universities and dental faculties, as
in special containers. See also Regulations employees of the university. They are free
for Health and Safety. to combine their work in the dental faculty
with part-time work elsewhere.
The official authorities charge a one-off
payment for the registration of radiation The main academic title within a Belgian
equipment, of about €275. In addition, university is gewoon hoogleraar/professeur
there is an annual maintenance ordinaire. Other titles include
subscription of €160. buitengewoon hoogleraar/professeur
extraordinaire, hoogleraar/chargé de cours,
No domiciliary care is offered in Belgium. docent/chargé d’enseignement and
assistent/assistent. Professors generally
Working in the Public Dental qualify by a doctorate, aggregation and
scientific experience and promotion
Service depends upon the number of years of
teaching and numbers of publications in
There is no public dental service in
international scientific publications.
Belgium. Some schools initiate a service
directly with dentists for dental health
surveillance. Health education is also part Working in the Armed Forces
of the school curriculum, but in reality
individual teachers decide how much In 2003, there were about 10 dentists
working full time for the Armed Forces.
Professional Matters
Professional associations Membership of a dental association is not
compulsory. In 2003, VVT had 3,336
members, the CSD 1,063 and the SMD 950.
There are 3 national dental associations
recognised by the social security system
Ethics
(RIZIV-IMAMI):
Ethical Code
• the Chambres Syndicales Dentaires
(CSD) for French-speaking dentists Dentists in Belgium have to work within
one of two different but congruent ethical
• the Société de Médecine Dentaire
codes, depending on which dental
(SMD) also for French-speaking association they belong to. Codes cover
dentists and relationships and behaviour between
• the Verbond der Vlaamse Tandartsen dentists, the contract with the patient,
(VVT) for Dutch speaking dentists.
For more information about these consent and confidentiality, continuing

associations click here education and advertising. They are
administered by the associations.
Patients may complain to the Provincial Data Protection
Belgiu
Medical Council. The disciplinary body
comprises doctors, pharmacists, dentists, Belgium has implemented the EU Directive
m
nurses and midwives. If a complaint is on Data Protection.
upheld, the Council can suspend the dentist
from practice. There is also an appeals Insurance and professional indemnity
process.
Liability insurance is compulsory for
Within the Dental Associations there is an dentists. Professional liability insurance is
ethical commission which also considers provided by private insurance companies.
complaints. However this mostly handles Some dental associations also arrange
disagreements between dentists and tries group insurance, which provides cover to
to mediate in these cases. 95% of dentists reflect the responsibilities of a dentist’s
are included in this process. individual contract. The cost of the
insurance varies according to the cover, for
Advertising example, providing implants approximately
doubles the premium.
Advertising is limited by law, to a small
plate on the practice building which is not Corporate Dentistry
allowed to be prominent. The Dental
Associations also control the type of Dentists are permitted to form companies
advertising that may appear in publications in Belgium. These must be registered at a
such as Yellow Pages, where bold type specific address. Non-dentists may be
characters are not permissible. The shareholders or fully own the company.
Associations strongly believe that a Health and Safety at Work
clientele should not be based on
advertising. Innoculations against Hepatitis B are
compulsory for the workforce (administered
The Belgian ethical codes were also being by the Ministry of Health). A separate
adapted (in 2003) to include the EU independent department of control inside
guidelines on Electronic Commerce. the Institut monitors compliance.
Regulations for Health and Safety
For Administered by
Ionising radiation Central government
Electrical Central government
installations
Infection control Ministry of Health
Medical devices Ministry of Health
Waste disposal Regional
government
Financial Matters
Dentists’ Incomes:
The income ranges dentists would have expected to earn is not available.
Retirement pensions and Healthcare
Normal retirement age is 65 for men and women, but is not compulsory. There is an official but
very low retirement scheme for independent workers (€600 per month). There are many
pension schemes on a voluntary basis.
Taxes
National income tax:

The highest rate of income tax is 55% on earnings over about €50,000.
VAT/sales tax
There is value added tax, payable at a rate of 21% on purchases, including dental equipment
and materials. Dental services are not included in VAT.
Various Financial Comparators @ July 2003
Zurich = 100 Brussels

Prices (excluding rent) 79.2
Prices (including rent) 75.7
Wage levels (net) 56.0
Domestic Purchasing 64.5
Power
Source: UBS August 2003
Belgiu
m
Dental Schools:
Brussels (Flemish) Brussels (French)
Vrije Universiteit Brussel Tandheelkunde Ecole de Médecine Dentaire et de Stomatologie

Instituut Avenue Hippocrate, 15
Laarbeeklaan 103 B-1200 Bruxelles
B-1090 Brussel BELGIUM
BELGIUM TEL: +32 2 764 57 21
Tel:: +32 2 477 49 00 FAX: +32 2 764 57 22
Fax: +32 2 477 49 22 EMAIL: larose@mden.ucl.ac.be
Email: Website: www.md.ucl.ac.be/mden/mden
Website: http://www.vub.ac.be Dentists graduating each year: 25-30
Dentists graduating 2002: 15 Number of students:
Number of students:
Brussels Gent (Flemish)
Le Directeur Universiteit Gent

Université Libre de Bruxelles Dienst voor Mond-Tand-en Kaakziekten
Hôpital Universitaire Saint-Pierre De Pintelaan 185
Rue Haute 322 B-9000 Gent
1000 Bruxelles BELGIUM
BELGIUM Tel: +32 9 240 40 01
Tel: +32 2 538 00 00 Fax:
Fax: Email:
Email: Website: http://www.rug.ac.be
website: http://www.ulb.ac.be Dentists graduating 2002: 25
Dentists graduating each year: 23 Number of students:
Number of students: 100
Leuven (French) Liège (French)
Ecole de Médecine Dentaire Le Directeur

Pathologie Buccale et Chirurgie Maxillo-Faciale Université de Liège
K.U Leuven Institut de Dentisterie
Kapucijnenvoer 7 Espace Bavière
3000 Leuven Boulevard de la Constitution
BELGIUM B-4020 Liège
Tel: +32 16 33 24 07 BELGIUM
Fax: +32 16 33 24 84 Tel: +32 4 343 43 3
Email: Fax:
Daniel.vansteenberghe@uz.kuleuven.ac.be Email:
Website: www.kuleuven.ac.be Website: http://www.ulg.ac.be
Dentists graduating 2002: 48 Dentists graduating each year: 30-35
Number of students: Number of students:
Belgiu
m
Competent Authority and Information Centre:
Ministère de la Santé Publique
C A E Quartier Esplanade (6e étage)
B 1010 Brussels
Fax: +32 2 210 4746
Email: Vera.Decloedt@health.fgov.be
Website: www.health.fgov.be/
Dental Associations:
Flemish (Dutch) language: French language French language
Verbond der Vlaamse Chambres Syndicales Société de Médecine Dentaire

Tandartsen (VVT) Dentaires (CSD) (SMD)
Vrijheidslaan 61 Boulevard Tirou 25 bte 9 Avenue de Fré 191
1081 Brussel 6000 Charleroi 1180 Brussel
BELGIUM BELGIUM BELGIUM
Tel: +32 2 413 00 13 Tel: +32 71 31 05 42 Tel: +32 2 375 81 75
Fax: +32 2 414 87 27 Fax: +32 71 32 04 13 Fax: +32 2 375 86 12
E-mail: verbond@tandarts.be E-mail: E-Mail: info@dentiste.be
Website: www.tandarts.be administration.csd@incisif.org Website: www.dentiste.be
Website: www.incisif.org
Publications:
VVT: Contactpunt (monthly) CSD: L’Incisif (monthly) SMD: Le Point (monthly)
Editor: Elie Lagrain Boulevard Tirou 25 bte 9 Editor: Marc Nacar
Vrijheidslaan 61 6000 Charleroi Avenue de Fré 191
B-1081 Brussel BELGIUM 1180 Brussel
Tel: +32 3 827 46 59 Tel: +32 2 375 81 75
Fax: +32 3 464 05 86 Fax: +32 2 375 86 12
Email: E-Mail: info@dentiste.be
elie.lagrain@tandarts.be
Cyprus
(2002)
Currency Cyprus
Pound
0.59 = 1€ (2003)
Main languages Greek, Turkish
and
English
In Cyprus oral healthcare is provided largely

through fully liberal, private general practice, as
Cyprus the public sector is very small. There were 696
registered dentists in 2003, all of whom were
members of the Cyprus Dental Association. The
Government and healthcare in Cyprus

The Republic of Cyprus is on an island in the eastern Mediterranean Sea. Turkey lies to the
north and Syria to the East. The land area of the island is 9,250 sq km, which makes kit the
third largest island in the Mediterranean. The highest point on the island (Mt Olympus) is 1,951
m. The capital, Nicosia is near the geographical centre of the island.
Independence from the UK was approved in 1960 with constitutional guarantees by the Greek,
Turkish and UK governments. However, following military intervention by Turkey in 1974, the
island has been de facto divided, with a northern 37% being controlled as "Turkish Republic of
Northern Cyprus", declared in 1983, recognised only by Turkey, and unaccepted as a legal
entity by the rest of the world. There have been UN-led direct talks between the two sides to
reach a comprehensive settlement to the division of the island from time to time but no
progress has been made. The Republic of Cyprus became a member of the EU in 2004. The
Acquis Communautaire will not be applied in the north part, for the time being.
The Republic is governed as a presidential democracy. The legislative power is administered

through the House of Representatives and the judicial power is executed by the Supreme
Court and the District Courts. There are six administrative districts.
The population in 2003 was 771,657. About 80.7% are Greek-Cypriots (including about 9,000
Maronites, Armenians and Latins), 11.0% Turkish-Cypriots and 8.3% foreign residents and
workers.
In Cyprus, a National Health System had not yet been established by 2003. Health care is
provided by the government (public sector), the private health care sector, and some schemes
covering specific population groups. According to Cypriot national legislation, health care in
the public sector is provided by the Government Medical and Dental Services and is governed
by the Government Medical Institutions and Services General Regulations of 2002. Current
legislation in Cyprus (2003) stipulates that financial criteria must be taken into account to
define eligibility for receiving health care by the public sector. Public healthcare expenditure is
regulated by Parliament, on an annual basis.
In 2001 the proportion of GNP spent on general healthcare was 6%, including dentistry.
Cyprus
Oral healthcare
Oral health care in Cyprus is provided by of the GHS will be involved in this process.
dentists and dental auxiliaries employed by It was expected in 2004 that the Council of
the government (Dental Services of the the GHS will include stakeholders from the
Ministry of Health) and by private (non- social partners, and be appointed by the
governmental) dentists and dental Council of Ministers. At least one dentist
auxiliaries financed by payments by will be appointed by the GHS Council.
patients or a source other than the
government. Some dentists have contracts The proportion of the population receiving
with workers´ unions or other semi- oral healthcare regularly (in a two-year
governmental organisations, as well as period) is not known, but there is data for
insurance companies. They would normally the public sector. In 2000 and 2001, dental
be paid on an item of service system. attendances in the public sector totalled
433,058.
As mentioned earlier, access to public oral
healthcare depends on income. Primary Oral examinations would normally be
school children receive free preventive undertaken annually, or more frequently
treatment from the public sector. The where active disease is present. There is an
services provided by the public sector also uneven distribution of dentists in Cyprus,
include conservative and surgical items, but as the roads are in a very good
but not orthodontics or fixed prosthetics. condition, and Cyprus is a small place,
These items have to be paid for by the there is no actual problem of access.
patients. Special groups (such a poorer
Domiciliary care is normally provided by
adults and children with special needs) are
the Public Service, in certain cases.
exempted from charges, or pay a reduced
amount, for their dental treatment offered Only 1% of the budgeted amount to the
by the public sector. Ministry of Health is allocated to the Dental
Services of the Ministry.
For the rest, there is a set rate for the oral
healthcare provided by the public sector, Private Insurance
depending on the income and status of the
patients (for example, civil servants are
entitled to reduced fees). However, Only a very small proportion of the
different levels of contribution do not affect population is covered by private insurance
the level of entitlement to care. companies.
For the public sector the Law governing the Quality of Care
provision of Dental Services is applied.
There are fixed prices for the specific items For the time being, a Committee is set up
offered, but depending on the income of at the level of the Ministry of Health,
the patient, as mentioned above. For the comprising representatives from the public
private sector, the patient pays directly and and private sector dentists and from the
the price is not regulated. In the case of Ministry of Health, to set standards and to
insurance company involvement, the fees perform dental audit. However, there are
are agreed between the dentist and the no routine checks, but they rely on
company. someone making a complaint (see Ethical
Code).
With the implementation of a new General
Health System (GHS) in Cyprus, the Council

Undergraduate Training a student wishes to study in other
countries he/she has to fulfil the
There are no dental schools in Cyprus. The requirements imposed by the country
majority – about 75% - of dentists concerned.
practising in Cyprus have graduated from
Greek Universities (Athens and Qualification and Vocational Training
Thessaloniki). To study in Greece, a
student has to pass the entry exams Vocational Training (VT)
organised by the Ministry of Education of
Cyprus (there are usually 15 posts There is no post-qualification training in
allocated for Cypriot citizens each year). If Cyprus.
had set up a committee consisting of
It was reported in 2003 that the Ministry of representatives from the Ministry of
Health of Cyprus Health, the Dental Services of the Ministry
of Health and the Cyprus Dental
Association, who will prepare a proposal
for the introduction of post-qualification
vocational training.
Registration
According to the Articles 19A (1) and (2) of

the amended Dentists’ Registration Law
2004:
(1) A dentist national of a Member State

who holds one of the titles referred to
in Annex V and is a resident of an EU
Member State has the right to
provide services in the Cyprus
Republic without being registered
with the Dental Council. (In this case
he/she is registered in a record kept
by the Dental Council)
State of origin or the Member State
(2) In accordance with this article, the from which the foreign national
Dental Council keeps a record of the comes, given that this is updated (not
names of dental practitioners who more than three months since the
provide services. date of issue up to the date of its
presentation).
According to the amended Dentists’ e. Any person who has not ceased to
Registration Law 2004 Article 4(1) the practise because of professional
Cyprus
following persons shall be entitled to be misconduct
registered as a dentist, if the Dental
Council’s requirements are met:
a. Any person whose age is 21 years old Further Postgraduate and

and above Specialist Training
b. Any person who is a national of the
Republic of Cyprus or is married to or Continuing education
is a child of a national of the Republic
of Cyprus who has his permanent
place of residence in, or is a national, Continuing education was not mandatory in
of a Member State 2003. However, the Ministry of Health was
c. Any person who holds a diploma, setting up a Committee to deal with the
certificate or other title applied to introduction of a Programme of Continuing
Annex III or holds a diploma or title Education for Dentists. The Dental Services
which is not applied to Annex III but of the Ministry of Health, with the
complies with the requirements at collaboration of the Cyprus Dental
Annex IV, which is recognized by Association, organises seminars and
KYSATS and approved by the Dental workshops on contemporary dental topics
Council or covered by the provisions in Cyprus, with instructors from EU
in article 4A. countries (mainly from Greek Universities)
d. Is a person of good character
presenting a certificate of the Specialist Training
"judicial record" or, in the case of
nationals of Member States, an There is no specialist training in Cyprus. All
equivalent document issued by a specialists train overseas.
competent authority in the Member
Workforce
Dentists
In Cyprus, until 2003 only two dental
specialities were recognised by the Dental
In 2003 there were 696 registered dentists Council. The specialties of oral surgery and
in Cyprus, all being “active”. 43% were dento-alveolar surgery were recognised as
female. Most dentists (94%) practise in soon as the new harmonised amended
private practice. dentists’ registration law
All dentists practising in Cyprus qualified

overseas. In 2001 about 66% qualified in
EU/ EEA countries, with the remainder
qualified in third countries.
received approval from the House of
Total Registered (2003) 696 Parliament, early in 2004. So, the
recognised specialties now are:
In active practice 696
Private practice 652 • Orthodontists who have received at
Public and hospital dental 37 least 3 years’ training, and
service • Oral Surgeons, who have received at
Armed Forces 7 least 3 years’ training, and
• Oral Maxillo-facial surgeons, after at
least 4 years’ specialist training, and
The active dentist to population ratio was
1,109 in 2003. • Dentoalveolar surgery, after at least 4
years’ training
There is no reported unemployment
amongst dentists in Cyprus.
Numbers of specialists
(2002)
Specialists
Cyprus
Orthodontists 25 Auxiliaries
Oral-Maxillo-facial surgeons 13
There are two kinds of auxiliaries in Cyprus,
Dental Hygienists and Technicians:
There were 38 specialists actively working
in 2002. Specialists usually practise in the
towns but as Cyprus is small there is no Numbers of auxiliaries
actual problem for patients to access them. (2001)
Among the 13 recognised Oral-Maxillofacial Hygienists 7
surgeons, 8 have dental training only and 5 Technicians 180
have received medical and dental training.
Assistants 235
The specialty of Oral-Maxillofacial Surgery
is also recognised by the Cyprus Medical
Council.
Dental Hygienists
Dental hygienists are trained abroad as

there are no dental schools in Cyprus. They
are not registered nor regulated in Cyprus.
Dental hygienists are paid a set fee for
every patient who is seen.
Dental Technicians
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.
They have to be registered with the Dental

Technicians’ Council, comprised of 7
members, 1 public dental technician, 1
public dentist, 1 private dentist and 4
private dental technicians. There is no
reported illegal practice.
In the public sector a technician earns

about €900 a month. No data is
available for the private sector.
Dental assistants 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.
Practice in Cyprus
Only 37 dentists (5.7%) work for the Public normally see in a day, but in the public
Health Services in the Dental Services of sector a dentist can examine about 15
the Ministry of Health (2003), and in the patients daily.
Armed Forces (7) - these dentists cannot
practise privately. The others are private Working in General Practice
practitioners.
There is no data available for the private Most dentists in Cyprus work in a
sector relating to how many patients would completely liberal, private, fees for service
system, in general practice. However, there There is no available data about the
is a minimum price list set by the Cyprus earnings of private general dental
Dental Association. practitioners.
Joining or establishing a practice Working in Hospitals (the

There are no specific rules about the
Public Dental Service)
location of a practice, for the time being,
but a Committee set up in the Ministry of There are 5 public district hospitals in
Health will deal with this subject. Likewise, Cyprus. The 37 Public Health Service
there are no rules which regulate the size Dentists work in these urban and rural
of a dental practice, but in the future health centres, owned by the state. They
special regulations are expected to be are all salaried and are not permitted to
administered. undertake private practice. The treatment
they may provide includes oral surgery,
There is no government assistance to set oral maxillofacial surgery, endodontics,
up new practices, and these are usually restorative dentistry, paedodontics,
funded through bank loans. removable prosthetics and dental public
health. This was described earlier in Oral
Most dental practices in Cyprus are solo Healthcare.
practices. Only a small percentage of
general dental practitioners work as A Public Health Dentist would have
assistants or associates. There are no expected to earn about €1,100 monthly, in
specific regulations for the time being but 2003.
in 2004 it is expected that new special
regulations will apply. There are also a few small private
hospitals, but only 3 or 4 clinicians provide
services there, mostly oral maxillofacial
surgery.
In 2003, there were 7 dentists working full

time for the Armed Forces, including one
female.
Cyprus
Cyprus
Professional associations withdrawal of the licence for a specific
duration
There is a single main national association,
the Cyprus Dental Association. In 2003 all
dentists were members. The Association
represents private and public health
dentists and combines this role by trying to
emphasise to common, professional
matters.
In order to be allowed to practice Dentistry

in Cyprus, registration with the Cyprus
Dental Association is mandatory. First, one
has to be registered with the Cyprus Dental
Council for recognition of his/her title and
then in order to practise the dental
profession he/she has to be registered with
the Cyprus Dental Association (professional
body). Exempted from the registration with
the Cyprus Dental Association are the
dentists who would like to provide services
according to the relevant sectoral
directives.
The local dental associations have

representatives in the Board of the CDA.
The CDA is co-housed with the Cyprus

Medical Association and a staff of 3 people
work there. For more information how to
contact the Cyprus Dental Association click
here.
There is also a Dental Council: this body is

made up of 4 dentists from the private
sector and 3 from the governmental sector.
The Dental Council is appointed by the
Council of Ministers. It is the competent
authority for the registration of dentists in
Cyprus and for the recognition of dental
specialities.
Ethics
Ethical Code
Dentists work under an ethical code which

covers relationships and behaviour
between dentists, the contract with the
patient. The ethical code is administered by
the Cyprus Dental Association.
Complaints from patients are presented to

the Cyprus Dental Association and to the
Court, depending on the nature of the
complaint. The Disciplinary Committee of
the Cyprus Dental Association judges the
complaints. Dentists from both the public
and private sectors sit as members of the
committee. A complaint may be referred to
the courts, depending on its severity.
Usually the remedies have to do with

monetary compensation. The final sanction
of the professional body could be the
of time. The final sanction of the court Corporate Dentistry
could be a sum of
money to be paid to the patient as penalty. This is permitted in Cyprus. Non-dentists
may wholly or partly own the company, but
The right of appeal is based on the National in all cases at least one dentist must be
Law. employed
Data Protection Health and Safety at Work
Cyprus has been harmonised with EU Most members of the dental workforce
Legislation in regard to data protection. have been vaccinated with Hepatitis B
vaccine, but this is not mandatory.
Advertising
Advertising is not generally allowed. A
dentist can display the title he/she bears, if
this title is recognised by the Dental For Administered by
Council. However, when a young dentist is Ionising The Ministry of Labour and
starting practice he or she may put an radiation the Ministry of Health
advertisement in a newspaper.
Electrical The Ministry of
installations Communication and Works
Dentists may use websites to inform the
in collaboration with the
patients on general dental issues or inform
Electricity Authority of
their colleagues on a special kind of service
Cyprus
they provide.
Infection The Ministry of Health
Insurance and professional indemnity control
Medical devices The Ministry of Health and
In 2003, there was no mandatory the Ministry of Commerce,
professional indemnity cover in Cyprus. Industry and Tourism
However, discussions were being held in Waste disposal The Ministry of Agriculture,
the Parliament on this topic. Natural Resources and
Environment.
Cyprus
Financial Matters
The income ranges dentists would have expected to earn in 2003 (in Euros):
Liberal or General Not given

Practice
Public €13,200 per

Health/Hospital year
Pensions for the dentists in the public sector are monitored through the Pensions Law of the
civil servants (retirement at 60 years of age). Public health workers receive a pension based on
the years of service they have had in the civil service and on their final salary.
Dentists in the private sector can work past this retirement age. They claim their pension
according to their contributions to the Social Insurance fund during their working life.
Taxes

In addition to income tax, social insurance premiums are paid as a percentage of salary, a
6.3% contribution each by the employer and employee. However, civil servants are entitled to
a reduced health care provision to the fund.
VAT/sales tax
There is a value added tax, payable at a rate of 15% on purchases. Medical and dental
services are not included.
Main national association and Information Main information Centre:

Centre:
Cyprus Dental Association Dental Services
14 Thassou Nicosia General Hospital
Rita Court 17, 5th Floor office 501 1450 Nicosia
1087 Nicosia Cyprus
CYPRUS Tel; +357 22 801811, +357 99 685190
Tel: +357 22 2316812 Fax +357 22 669148, +357 22 592606
Fax: +357 22 2316937 Email: Plambrou@ds.moh.gov.cy
Email: cda@cytanet.com.cy Website: Under construction (2003)
Website: www.dental.org.cy
Main Professional Journal Competent Authority:
Dental Revue (ODONTIATRIKO VIMA) Cyprus Dental Council
14 Thassou 14 Thassou
Rita Court 17, 5th Floor office 501 Rita Court 17, 5th Floor office 501
1087 Nicosia 1087 Nicosia
CYPRUS CYPRUS
Tel: +357 22 2316812 Tel: +357 22 2316812
Fax: +357 22 2316937 Fax: +357 22 2316937
Email: cda@cytanet.com.cy Email: cda@cytanet.com.cy
Website: Under construction (2003) Website: Under construction (2003)
There are no dental schools in Cyprus

The Czech Republic
(2003)
Currency Czech
Crowns
The Czech Main language Czech
Rep
There is compulsory membership of all citizens in
the health insurance system. This is provided by 9
(state-approved) health insurance companies.
Around 6% of the public healthcare budget is spent
on dentistry. About 70% of dental care is paid from
the state system and the balance is through fully
liberal practice. There are 6,735 practising dentists
and about 90% of care is provided by general
practice. Membership of the dental association
(Česká stomatologická komora – CSK) is
compulsory for all dentists. Specialists are
Government and healthcare in the Czech Republic
The Czech Republic is a small country in inhabitants) and land area coverage
terms of population (10,182,471 (78,864 sq km).
the employer and employee share in the
The Czech Republic is a sovereign, united payment of premiums, where the employee
and democratic country. Its government is pays one third of the whole amount and the
divided into three branches - the employer the remaining two-thirds - 4.5%
legislative, represented by Parliament, the and 9% of income respectively, in total
executive, represented mainly by the 13.5%.
President and the government, and the
judicial branch, represented by courts at Self-employed individuals participating in
various levels. The country is administered the public health insurance pay premiums
as 13 counties. Praha, the capital, has themselves in the form of a monthly
county status, too. deposit, and following end-of-year
accounting.
Czech healthcare is founded on the
following principles of solidarity (“spreading The State is the premium payer for some
the risk”), a high level of autonomy, multi- individuals who are participants in public
source financing by predominantly public health insurance, by transferring the legally
health insurance, the free choice of required amounts from the State budget to
physician and health care facility, the free the insurer. This group includes unprovided
choice of health insurer in the framework of children (up to 26 years old), pensioners –
public health insurance, and equal receiving pension from the Czech pension
accessibility to services provided for all insurance scheme, mothers on maternity
insured. leave or those who take full-time care of at
least one child up to 7 years old or two
Healthcare is provided predominantly on children up to 15 years old, national
the basis of obligatory public health servicemen, persons in custody or serving
insurance. The public health insurance their sentence, and others.
system is provided by 9 (state-approved)
health insurance companies. The system Persons with permanent residence in the
(sick fund) provides a legally prescribed CR but who are neither employees nor self-
standard package of healthcare. employed persons, nor persons for whom
Contractual health insurance is only of a the state pays the premiums, are required
supplementary nature. to pay the due premium deposit payments
to their insurer.
Persons participating in public insurance
are required to pay premiums regularly. The proportion of GDP spent on general
Public health insurance payers are various healthcare, including dentistry in 2002, was
and include: employees, employers, self- 7.3%. Of this expenditure 91.4% was
employed individuals and the State. “public” (OECD Feb 2004).
If the participant in the system of public

health insurance is an employee, then both
Oral healthcare
The Czech
Republic
About 6% of the public healthcare budget is fixed orthodontic appliances in adults have
spent on dentistry. The healthcare budget to be paid for completely by patients.
is annually estimated according to the Crowns and bridges, partial dentures and
expected amount of money in the removable orthodontic appliances are paid
insurance fund. partly from sick funds and partly by the
patient. The percentage is different for
Oral healthcare in Czech Republic is various prosthodontic items, for example:
coordinated by the Czech Dental Chamber
(Česká stomatologická komora – CSK). For • metallo-ceramic crown = 20% sick
further details of the CSK click here. fund, 80% patient,
• partial dentures with casting
Public compulsory health framework = 30-60% sick fund, 40-
insurance 70% patient.
The insurance fund is a compulsory public There is no prior approval for treatment
health insurance system, administered and no provision for domiciliary (home)
through health insurance companies (the care.
Sick Funds), who provide the cover. The
health insurance system is provided by 9 Children under 18 years receive health
insurance companies – Czech inhabitants insurance system cover for the higher cost
have a statutory duty to be registered in (the adult patient co-payment) part of their
one of them (which one is the choice of the dental care (for all types of fillings, all types
citizen). Fees from citizens (registered of endodontic treatment, and the higher
employees, enterprisers, businessmen, cover element of prosthodontic items).
tradesmen, small traders …) and from the
State (for registered children, the Less than 1% of dentists (mainly in Praha
unemployed and pensioners, the State and in the other larger cities) work
pays the fees to the Sick Funds entirely) completely outside the system of health
are collected in the insurance company and insurance, in fully liberal practice. The
then distributed to the health care prices of dental care in their practices are
providers. The system of money contractual and their patients must pay the
distribution is limited by government health full cost of their dental care, directly
policy. negotiated with the dentist. So the fees are
totally unregulated (according to a
About 70% of dental care is paid from the feedback of the market).
health insurance system and the balance is
through fully liberal practice. The Sick A full-time working dentist would normally
Funds are self-regulating under national have 1,650 patients regularly attending.
legislation. Oral re-examinations normally would be
carried out for most adult patients at a
The dental services are delivered through a period of 6 months.
system of university clinics, municipal
health centres, or by private dentists and In some parts of Czech Republic there is a
dental laboratories. In 2003, about 90% of shortage of orthodontists and specialists for
dental care was delivered by private oral surgery, periodontology or paediatric
dentists. dentistry.
The insurance system provides cover for all The Quality of Care
standard conservative items such as
amalgam fillings, basic endodontic
treatment (canal filling using any suitable The Dental Chamber becomes involved
paste material), surgical and periodontal when a patient complains about the quality
items and for a few basic prosthodontic of care. The complaint may be made:
items. There is no co-payment by the
patient for the standard items (the list of • to the health insurance company
items and their description is presented by • to the Dental Chamber
the insurance institutions). There is no • to the state health officer
annual limit of treatment range, for an
individual patient. By law, the CSK is empowered to access
and examine complaints filed against
Cosmetic fillings and non-basic endodontic dentists. Final complaints are processed by
treatment (methods of lateral or vertical the regional, professional board of
condensation of gutta-percha points or examination – Regional Dental Chambers´
Thermofil-type systems), implants and Auditing Boards. The authority to examine
a dentist’s professional malpractice or immediately). Any serious break of the law
ethical misjudgement is carried by the can be referred to court and even result in
relevant professional disciplinary bodies – imprisonment. The complaint is heard by
the Regional Dental Chambers’ Honorary the professional body – the regional
Councils and the Czech Dental Chamber’s Auditing Board of the Czech Dental
Honorary Council. Chamber. The rightful compliant is
submitted to the regional Honorary Council
The outcome of a complaint may be a of the Czech Dental Chamber and the
reprimand, a penalty or even the loss of dentist has a right of appeal to the higher
licence (the dentist cannot be suspended degree of Honorary Council.
The Czech
Republic
Undergraduate Training Qualification and Vocational Training
To enter dental school students must

successfully finish high school, with a
school-leaving certificate. They must
Upon qualification, there is a programme of
successfully pass a theoretical entrance
vocational postgraduate training for 36
examination and an examination of
months, under the guidance of skilled
practical ability. No other vocational entry
dentists (with a certificate of the Dental
is needed.
Chamber). The training is not completed by
examination – the certificate of completion
Dental schools are known as
of training is given by the tutor and only
Stomatologická klinika Lékařské fakulty, of
then is the dentist able to be fully licensed
a university (Stomatological Clinic of the
and to own a dental practice. During the
Faculty of Medicine of the University).
training the dentist is a salaried employee.
There are 5 dental schools, all state
This post-qualification training has a
funded. In 2002, student intake was 130
practical part (participant has to fulfil a list
and 60% of students were female. The
of prophylactic, diagnostic and treatment
same year, 81 of the 124 graduates were
items) and a theoretical part of training
male.
(compulsory attendance on recommended
courses and lectures).
The course of study in 2003 was different
in the five Czech dental schools: 5 years,
This system of vocational training is likely
5.5 years, or 6 years. The training is not in
to continue until the first MDDr graduates
common with medical study (it is
are produced in 2009, when the graduates
completely separated and independent).
will have had comparable education and
From 2004 dental studies are under a new
training with the rest of the EU – and they
a curriculum, according to the standards of
will be able to work in other EU countries
the EU – and the courses will all be 5 years
immediately upon qualification. It is not
.
clear what arrangements will exist during
The responsibility for quality assurance in
the transitional period from 2004 to 2009.
the faculties is by the Ministry of Education,
the Chancellor of the University and the
Czech vocational training is not compulsory
Dean of the Faculty.
for graduates of other EU countries’ dental
schools.
Registration
In 2003, the title on qualification was
MUDr., the same title as for a doctor in
Dentists must register with the Ministry of
general medicine, but the text on the
Health, the Czech Dental Chamber (CSK)
diploma is specified: “Medicinae universae
and the Regional Authority. To register, a
doctor in disciplina medicinae
dentist must have a recognised
stomatologicae”. The legislation for a
qualification, permission for permanent
change of title has been approved and the
residence in the Czech Republic, a work
title for a dentist will be “MDDr”. The
permit, and knowledge of Czech language
change of title will be in relation with new
by test.
formed study of dentistry from the year
2004 – the first “MDDr.” will finish studies
The CSK statutorily maintains a register
in 2009.
containing the dentists´ data, including
qualifications and professional performance
data.
Requirements for foreigners to practice dentistry in the Czech Republic (as at April 2003)
The Czech
Republic
1. Recognition of a university diploma under the authority of the Ministry of Education of the Czech Republic
and of the universities
2. Adequate knowledge of the Czech language – successful completion of a test of qualification in the Czech
language
3. Permission for long-term or permanent residence
4. Authorisation for the practice of dentistry on the territory of the Czech Republic is under the authority of
the Ministry of Health of the Czech Republic and consists of
– a professional written examination
– a professional oral examination
– thereafter, 6 months of fieldwork and a final oral examination.
5. Membership in the Czech Dental Chamber.
The CSK registers all who:
- have duly completed studies at a school of medicine at a Czech or foreign university and successfully
completed a final examination in dentistry – are authorised to practice dentistry on the territory of the
Czech Republic
• The fulfilment of the requirements stated above leads to authorisation to practice.

• In order to begin private practice, it is subsequently necessary to fulfil the requirements of the CSK for the
Further Postgraduate and higher settlements for dental care (about

Specialist Training 10% higher) from the system of health
insurance - the patient does not pay more.
Continuing education
Specialist Training
Participation in continuing education is on a
voluntary basis. The system is delivered There is specialist training in two
mainly by Czech Dental Chamber but also recognised dental specialties: orthodontics
other providers accepted by Dental and oral-maxillo-facial surgery. To enter
Chamber can take part in the system. specialist training a dentist must have
There are organised theoretical and completed 30 months in general dental
practical lectures. practice (or, for oral surgery, medical
practice is acceptable). It takes at least 6
The result of the continuing postgraduate years of practice after graduation to
education cycle is the obtaining of a complete the specialist training and it is
Certificate of Proficiency, issued by the finished by examination. Training takes
Czech Dental Chamber – CSK (numbers place in clinics in universities and is
holding these in 2002 are in brackets): undertaken by university teachers who
have been accredited for specialist training.
• Dentist Practitioner with Certificate of
Proficiency The titles a specialist receives on gaining
• Dentist Practitioner with a Certificate of their diploma are:
Proficiency in Periodontology
• Dentist Practitioner with a Certificate of
Proficiency in Oral Surgery • Orthodontics: attestation in maxillo-
• Dentist Practitioner with a Certificate of facial orthopaedics (atestace z čelistní
Proficiency in selected areas of Paediatric ortopedie)
dentistry • Oral Surgery: attestation in oral and
maxillofacial surgery (atestace z orální a
The Certificate of Proficiency is evidence of maxilofaciální chirurgie)
the education of the dentist, for patients.
The attendance of dentists on The responsibility for registration of
recommended practice-oriented courses or specialists lies with the Czech Dental
theoretical lectures is evaluated by credits Chamber under the State Educational
– in 2002 the CSK registered 933 training System in healthcare. The dentists in
lectures or courses. The participant in specialist training are usually salaried
continuing postgraduate education can employees (or part-time employees) of the
receive the Certificate if the required universities where the training is held.
amount of credits and the prescribed
spectrum of educational actions, during In 2001, 30% of orthodontic trainees were
two years, is fulfilled. The Certificate is male, and 90% of oral surgery trainees
valid usually for 3 years – it can be then were male.
repeated, if the conditions of postgraduate
education (10 days over 3 years) are
fulfilled. The holder of a Certificate has
Workforce
Dentists
In 2003 there were 7,7760 registered
The Czech
dentists in the Czech Republic, of whom
Republic
67% were female. It was estimated that
6,911 were actively working (69% female).
It was reported that there were

unemployed dentists – but less than 1%.
Totals (2003) 7,76

0
In active practice 6,911
General practice* 6,117
Graduates in post–qualification 336
training
Hospitals 78
University 134
Armed Forces 58
Public dental service 450
* this includes dentists in
hospitals, universities and the
armed forces
The population per active dentist (including

orthodontics and oral-maxillo-facial
surgery) was 1,473.
The Czech Dental Chamber expects that

the active dental workforce will decrease
shortly. About 40% of active dentists are
older than 50 years, and it is presumed
that during the next few years more
dentists will leave their practices due to
reaching retirement age than will join the
profession.
Specialists
There are specialists in orthodontics and

Oral-Maxillo facial Surgery. Additionally,
4,447 dentists (out of 6,735 – or 66%) held
a Certificate of Proficiency, which entitles
them to higher fees – see above. This
included practitioners with a General
Dental proficiency.
Numbers of specialists Orthodontics 10

(2002) Oral Surgery 382
Orthodontists 264 Periodontology 284
Oral Maxillo-facial 63 Paediatric Dentistry 18
Surgeons
Whilst a referral by a generalist to a
Certificates of specialist is the norm, patients are not
Proficiency in: precluded from making direct access to
specialists (or dentists with the certificates Hygienists would normally be salaried and
of proficiency). would earn €400 - €600 per month (2001)
Auxiliaries Dental Technicians
There are two kinds of clinical auxiliaries in Technicians normally work in commercial
the Czech Republic – Dental Hygienists and laboratories, only a few are employees of
Dental Technicians. Additionally, there are dentists or of clinics. There are two ways of
dental nurses and receptionists. training for dental technicians: either 4
years study in a high school specifically for
dental technicians, or study in a higher
Numbers of auxiliaries
school specifically for dental technicians (3
(2001)
years of study following 4 years in any high
Hygienists 200 school) – those with a higher degree of
Technicians 4,570 education also receive a DiS. They
Assistants 7,060 construct prostheses for insertion by
dentists.
Dental Hygienists Technicians would normally be salaried and
would earn €300 - €600 per month (2001)
Hygienists are permitted to work in the
Czech Republic, provided they have a In 2001 the Chief Dental Officers of Europe
diploma (DiS). They train in a special higher reported that there were 8 illegal
school specifically for dental hygienists (3 denturists/clinical dental technicians in the
years), following 4 years in any high school. Czech Republic.
They work under the supervision of a
dentist, only, and their duties include Dental Assistants (Nurses)
scaling, cleaning and polishing, removal of
excess filling material, local application of
Dental nurses are general nurses with the
fluoride agents, the insertion of preventive
training by the dentist. They are educated
sealants and Oral Health Education.
in high school for nurses, for 4 years, with a
leaving examination. Besides assisting the
They do not need to be registered if they
dentist they are permitted to undertake
work as an employee of the dentist. In
oral health education and take impressions.
2001 it was reported that just under half
(80) of hygienists were unemployed.
Practice in the Czech Republic

Working in Liberal (General)
Practice
other expenses – added to pension and sick
Fee scales fund costs, and a profit of about 30% for
the dentist). Each item is then set to a time
For dentists working within the system of price (per minute).
(State) health insurance it is obligatory (by
law) that they complete a price list of items For those items partially covered by the
partially covered by the insurance system, insurance scheme, the insurance element
or items which are fully covered by the is taken out of the calculated price.
patient. The prices must not be created
haphazardly they have to be calculated in So, the rate varies in each practice (for
each dental practice on the principles of example, the common range of price for
calculating prices. The method of the price metallo-ceramic crown is between 2,500 –
calculation includes a formula reflecting the 3,500 Czech Crowns, (about €80-€115).
expenses of the individual dental practices. Control of the price-lists is maintained by
This formula uses the costs from the the financial authority and is checked
previous year (including rent, energy costs, routinely, by audit of bills and
labour costs, materials and documentation, or as a result of a
complaint by a patient.
The prices of items fully covered from €1,250 per month
insurance system are in fact the same in all
health insurance companies and are valid Working in the Public Clinics
for a half year. The new prices can be
The Czech
Republic
scheduled as a result of negotiation

between health insurances, delegates of In 2003, about 450 salaried dentists were
dentists (usually the President and Vice- employed in 274 local health authority
president of the CSK) and the Ministry of clinics (municipal ambulatory dental
Health. departments).
For payment, the contractual dentist sends These municipal ambulatory dental
an invoice with the list of patients and the departments offer common dental
provided dental care, to the health healthcare for any citizens, with no special
insurance company (usually monthly and tasks – indeed, the same scope of work as
on the floppy disk) – the payment by the private dentists. The difference is only in
insurance company follows in 3-4 weeks. the ownership of the type of practice – a
publicly owned health centre.
Fully private dentists do not have to use
the method of the price calculation
mentioned above.
There are no stated regulations which

specifically aim to control the location of
dental practices. There are also no other
regulations or factors which effectively
restrict where dentists may locate. Any
type of building may be used which fulfils
the legislative claims to dental practice.
But rules exist which define, for example,
the minimum size of rooms for dental
practice.
There is no limit to the maximum number

of partners etc.
Anyone can own a dental practice (non-

dentists need a dentist present, as a
warranty of proficiency), and there is also
provision for them to be run as companies.
There are 203 non-state (private) health
companies in Czech Republic.
The selling of a list of patients is not yet

allowed, by legislation. The state offers no
assistance for establishing a new practice,
and generally dentists must take out
commercial loans from a bank.
To establish a new practice private dentists

have to gain the approval of the health
officer and the registration of local health
state authorities. If the applicant fulfils all
the necessary conditions (qualification,
blameless, hygienic bylaws, equipment of
the practice) there is no ground to refuse
his application. The new practice has no
claim for the contract with any health
insurance company – it depends on the will
and demand of the health insurance
companies.
About 220 graduates work as assistants in

private practices.
Dentists in general practice would normally

have incomes in the range of €500 to
Their income would be in the range of €300
to €800 per month.
Dentists who work in hospitals (university

or big regional hospitals) are normally
salaried employees. Hospitals are usually
publicly owned, and the dental services
provided are usually oral surgery.
These dentists will also assist in the

education and training of dental
undergraduates. Their income would be in
the range of €300 to €800 per month.
In 2003, about 78 dentists worked in

hospitals. About a half are specialists, the
others in training. They usually must not
work concurrently in private practice – the
employers do not like this.
Working in Universities and

Dental Faculties
There are 5 dental schools, in which about

134 dentists work. They normally are full-
time employees of the University, and their
salary range is €300 to €800 per month.
Only a few of them are allowed the
combination of part-time teaching
employment and private practice (with
permission of university).
All the dentists in Universities are “MUDr.”

The titles of university teachers are:
assistant (title As. docent (title Doc.),
professor (Prof.).
For the positions of docent and professor it

is necessary to pass “habilitation” - this
involves a further degree (publication
activities and a record of original research)
and a public lecture in front of the Scientific
Council of University. The study for a PhD is
also required (earlier it was adequate to
have a CSc., leading to the PhD). The CSc. –
candidatus scientiarum, was a scientific
degree used in the Czech Republic until
1990. The study for obtaining of a CSc. was
similar to a PhD. The PhD has been used in
the Czech Republic since the 1990s.
In 2003, 58 dentists served full-time in the

Armed Forces - 33 (57%) of these were
females.
The
The Czech
Republic
Republic
Professional associations appeal is possible to the higher disciplinary
Czech
body of the Czech Dental Chamber.
The Czech Dental Chamber (Česká
Advertising
stomatologická komora – CSK) was
established in 1991, based on the Act No
Advertising is permitted under the
220/1991. The CSK is a regular member of
framework of the ethical code, but this
the FDI World Dental Federation and
does not include the use of advertisements
reported 7,580 members in 2003 Annual
on the TV or radio. Czech dentists may use
Report of the FDI. It is an independent, self-
websites, within the ethical code – although
governing, non-political, professional
the code does not include a specific section
organisation, forming an association of
on the issue.
dentists with the purpose of protecting
common interest, maintaining a
Indemnity Insurance
professional level and ethics. The CSK
resolves complaints and executes
Liability insurance is compulsory (by the
disciplinary powers toward its members. It
law) for all dentists in the Czech Republic –
defines requirements on operating a dental
amount of cover is not predetermined, the
practice and confirms compliance with the
dentists choose usually the range from
dentists´ professional performance
1,000,000 - to 5,000,000 CZK (€32,000 -
requirements.
€160,000). Costs are up to €200 per year
for this insurance.
The CSK is organised on territorial basis
with Regional Dental Chambers (61)
Corporate Dentistry
forming the basic organisational units. The
supreme body of the Chamber is the CSK
Dentists are allowed to form corporate
Assembly consisting of 92 members
bodies (companies). There are 203 non-
elected by Regional Dental Chambers. The
state (private) health companies in Czech
Assembly elects the President, Vice-
Republic. The parties of the next company
President, the Board (15 members), the
have to prepare and present a report
Auditing Board (7 members), and the
(settlement) about their activities, about
Honorary Council (9 members). All bodies’
relations inside the company etc. and then
persons are elected for a 4-year term.
they need to request judgement for
registration in the Companies Register.
All the dentists practising on the territory of
the Czech Republic, by law, must be
Health and Safety at Work
members of the CSK.
By ministerial regulation (in 2004), dentists
The Czech Dental Chamber prepares
and those who work for them have to be
medical school graduates for licensing as
inoculated against Hepatitis B and later be
independent professionals. The CSK is
checked regularly for sero-conversion. The
engaged in life-long learning programmes
employer usually pays for inoculation of the
for dentists. The CSK confirms compliance
dental staff.
with life-long learning requirements by
issuing the Certificate of Proficiency. For
the address of the CSK, click here.
Ethics
For Administered by
Ethical Code Ionising radiation State office for Nuclear
Security
There is an ethical code in the Czech Electrical The State accredits
Republic, which is administered by the installations electrical technicians
Czech Dental Chamber. Breaches of the Waste disposal Local government
ethical code are administered by Regional
Auditing Boards of Czech Dental Chamber
and Honorary Councils of Czech Dental Infection control Ministry of Health and
Chamber. The penalties were described local authorities
above – click here to read them again. An
Financial Matters
The Czech
Republic
Dentist 25 Dentist 45 years

years old or old or 20 years
2 years after qualification
after
qualificatio
n
Liberal or General 6,000 12,000 – 15,000 a
Practice year
Hospital 4,000 8,400 – 10,000 a
year
Public Health 4,000 7,800 – 8,400 a year
University 4,000 7,800 – 8,400 a year
331.200 + (and
Retirement pensions and Healthcare more)
The normal age for retirement is 62,

although dentists and staff can work past
then.
VAT
There is a state-funded system of pensions,
of which dentists and their staff are a In Czech Republic there are two VAT rates:
normal part. The pension would be about 5% and 22%.
50% of last declared income. This is the
same for employed and self-employed The main dental materials (filling materials,
dentists. Any additional insurance pension impression materials, instruments) have
depends on the individual contract and the 5% VAT, disinfection solutions, examination
amount insured. gloves and auxiliary materials, such as
radiographic materials have 22% VAT. The
Taxes cost of dental health care (and other health
care too) is VAT free.
There is a national income tax (31 CZK - €1
at 1/4/03)
Various Financial Comparators @ July

Total annual Annual tax (Czech 2003
income Crowns = CZK)
0 – 109.200 15% Zurich = 100 Prague
109.200 – 16.380,- CZK + 20% Prices (excluding rent) 40.5
218.400 38.220,- CZK + 25%
218.400 – 66.420,- CZK + 32%
331.200 Wage levels (net) 12.4
Domestic Purchasing Power 32.0

The Czech
Republic
Main national association: Competent Authority:
Czech Dental Chamber Contact Name: MUDr. Jiří Zemen, Ph.D.
Ceska Stomatologická Komora Tel: +42 060 392 7134
Jecna 3, Praha 2 Fax: +42 037 744 6746
120 00 E-mail: j.zemen@volny.cz, or
Czech Republic zemen@tiscali.cz
Tel: +42 022 491 8613 Website: www.dent.cz/cs/csk
Fax: +42 022 491 7372
E-mail: csk@dent.cz
Website:
Details of information centres:
Name: Ústav zdravotnických informací Name: Ministerstvo zdravotnictví ČR
a statistiky ČR Tel: +42 022 497 1111
Tel: +42 022 497 2243 Fax:
Fax: +42 022 491 5982 E-mail: mzcr@mzcr.cz
E-mail: sekretariat@uzis.cz Website: www.mzcr.cz
Website: www.uzis.cz
Details of indemnity organisations:
Name: Kooperativa pojišťovna, a.s. Name: Česká pojišťovna, a.s.
Tel: +420 800 105 105 Tel: +420 800 133 666
Fax: Fax:
E-mail: info@koop.cz E-mail: info@cpoj.cz
Website: www.koop.cz Website: www.cpoj.cz
Dental Schools:
City: Plzeň City:Praha

Name of University: Lékařská fakulta Name of University: 1. lékařská fakulta
Karlovy univerzity v Plzni Karlovy univerzity
Tel: +42 377 593 400 Tel: +42 224 961 111
Fax: +42 377 593 449 Fax: +42 224 915 413
E-mail: E-mail: info@lf1.cuni.cz
Renata.Peterikova@lfp.cuni.cz Website: www.lf1.cuni.cz
Website: www.lfp.cuni.cz
City:Hradec Králové City:Olomouc
Name of University: Lékařská fakulta Name of University: Lékařská fakulta
Karlovy university v Hradci Králové univerzity Palackéh
Tel: +42 495 816 111 Tel: +42 585 632 010
Fax: +42 495 513 597 Fax: +42 585 223 907
E-mail: dekanats@lfhk.cuni.cz E-mail:
Website: www.lfhk.cuni.cz pilikova@tunw.upol.cz
Website: www.upol.cz
City: Brno
Name of University: Lékařská fakulta
Masarykovy university
Tel: +42 542 126 111
Fax: +42 542 213 996
E-mail: dekan@med.muni.cz
Website: www.muni.cz
EU Manual of Dental Practice
2004_______________________________________
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of Dental Practice 2004
Denmark
In the EU since 1973
Denma
rk Currency Kroner
7.35Kr = €1
(2003)
Main language Danish
Denmark has a highly decentralised National

Health Service, largely funded by general
taxation. There are over 6,400 dentists (4,900 are
described as “active”) About 90% of these active
dentists are members of the Danish Dental
Association/Dansk Tandlaegeforening – just over
half being male). Oral healthcare is free for
children (0-18) and subsidised for adults. There
are two specialist degrees in Denmark – oral
Government and healthcare in Denmark
Denmark is a very well developed country despite its small size in regards to both land area
(43,094 sq km) and population (5,368,854 at July 2002).
It is governed as a constitutional monarchy with a unicameral parliament (Folketing) of 179

seats, whose members are elected for 4-year terms under a proportional representation
system. The country is administered as 14 counties and 275 municipalities. The capital,
Copenhagen, and the capital area called “Frederiksberg”, have both county and municipality
status.
Denmark has two dependencies; Greenland and the Faeroe Islands. They are both independent
in health matters – but follow the Danish national legislation. Information about them can be
found below.
Denmark has a national health service funded by general taxation. There are no additional
special taxes or private insurance contributions involved. The management of health care is
highly decentralised, with the individual counties running most services and the municipalities
responsible for some public health commitments.
Dental care is only partly subsidised by the government. The amount paid by the patients is
dependent on the treatment – but in general the patients pay most of the treatment costs
themselves.
The National Board of Health is responsible for the legislation concerning dentistry, and is
based in Copenhagen.
The proportion of GDP spent on general healthcare, including dentistry in 2002, was 8.6%. Of
this expenditure, 82.4% was “public” (OECD Feb 2004).
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119
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Oral healthcare
rk
In Denmark oral healthcare is provided in

one of two ways. For children under the On average patients pay around 80% of
age of eighteen all care is free of charge costs with the regional government paying
and is usually provided at school. For about 20%. However, for preventive care
adults a system of government subsidies is and essential treatments the subsidy is
available through private dental higher, and for expensive treatments such
practitioners for most common types of as oral surgery it is lower. The main
treatment. treatments for which subsidies are paid
include examination and diagnosis, fillings,
Governmental spending on healthcare oral surgery, periodontology, and
(2001): €9,280m endodontics. For most adults,
Public dental service (children 0-18): orthodontics, crowns and bridges, and
€230m removable prosthodontics have to be paid
Spending on adult care: for in full by the patient. Subsidies are also
€156m higher for 18 to 25 year-olds.
So, spending on oral healthcare Free dental care is only available for adults
represented about 4.2% of the total public if the treatment needs to be carried out in
healthcare spend in 2001. a hospital or if the patient belongs to one of
two special groups. These are
Public health care handicapped patients and those of low
economic status, and/or retired. People
Dental services for children receiving social security may have their
expenses for dental care paid by the
Dental services for those aged 0 to 18 are municipality and those who do not receive
organised by the municipal government (or unemployment benefits (Bistandsklient),
the kommuner) and is free of charge. such as the homeless or victims of drug
There are about 275 kommuner in and alcohol abuse, usually receive free
Denmark and more than 200 of them care.
employ their own dentists and have their
own premises for examining and treating For adult patients who have all their dental
schoolchildren. costs paid by the state (Bistandsklient)
there is a requirement to seek prior
From January 2004 children can choose to approval to provide treatment from the
receive dental care from a private regional board.
practitioner instead of the service provided
by the Kommune – but have to pay 35% of Payments to dentists
the costs.
All payments to dentists are by way of item
In about 70 kommuner, in more rural areas, of service fees. Adult patients would
the Kommune contracts with local private normally attend for oral examinations an
practitioners to do this work. Within these average of every 8 to 9 months and about
services all treatment is free, including 65% of the population visit a dentist
orthodontic care. annually. A small amount of domiciliary
care is undertaken by private practitioners.
At the age of 16 children may change to a
The most recent amendment to the Oral
private practitioner with the full cost of
Health Care Act in 1994 adds another
treatment still being met by municipalities
objective to the public dental care system.
until they are 18 years old.
Dental care for the elderly living in nursing
homes and for mentally and physically
Dental services for adults
handicapped living in their own homes but
who are not able to use the normal dental
For adults, a system of subsidies for
care system is now part of the objective of
healthcare is operated by the regional
the municipal dental care service.
governments (the Amter), in collaboration
with the Danish Dental Association (the
Dansk Tandlægeforening). Under this Private dental care
system the patient pays a part of the fee to
the dentist who reclaims the remainder A substantial number of Danish adults
from the regional government. (about 25%) buy private health insurance.
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121
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There is a single scheme, “Health The Quality of Care
Insurance Denmark” (Sygeforsikringen
Danmark) which is a personal scheme with The County Society of the regional
the premium paid by the individuals governments monitors standards of oral
concerned. Cover may be obtained within health services. This is mainly done by
one of three groups depending on the auditing the treatment figures which every
items of care included. About 62% of all dentist has to submit in order to claim
oral healthcare spending is on private government subsidy payments. Any
dentistry. dentist who carries out particular
The government introduced regulations in treatments by more or less than 40% of the
2003 making it mandatory to publish on regional average has to provide an
the internet and/or inside practices explanation.
information about the cost of treatment Apart from this monitoring, the quality of a
which is not covered by the state scheme, dentist’s work may only be examined after
and therefore receives no subsidy. a patient has initiated a complaint.
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rk
Undergraduate Training have received degrees from Danish
universities, or have had other
To enter dental school a student needs to qualifications recognised. In order to be a
be a secondary school graduate, as principal in private practice and receive
“Student” or similar. There is no vocational government subsidy payments dentists
entry, such as being a qualified dental must also register with the regional branch
auxiliary. of the Danish Dental Association (DDA) and
with the
There are two dental schools, which are
both state-funded. The tuition fees are not
paid by the students. Training lasts 5 years.
In 2002, student intake was about 140 and
81% were female. The same year, there
were 110 graduates and 71% were female.
The quality of the training is monitored by

the Council of the Faculty.
For a list of schools, see Dental Schools
The main degree which may be included in

the register is: Bevis for
tandlaegeeksamen (kandidateksamen) and
a certificate issued by the
Sundhedsstyrelsen (National Board of
Health) certifying that the applicant has
worked as an employed dentist for a
required period.
There is no formal post-qualification

vocational training as such – the graduate
only needs 1440 hours of employment after
graduation (“Jus Practicandi”). As a Danish
graduate a dentist should be able to work
anywhere in the EU – but in some countries
with their own vocational training, such as
the UK – this is not permitted. EU qualified
dentists can work in Denmark without the
“Jus Practicandi” – but need it if they would
like to open their own practice. There is no
theoretical component to the “Jus
Practicandi”
Diplomas from other EU countries are

recognised without the need for vocational
training.
Registration
Although the National Board of Health
administers an initial national register of
dentists, it is primarily a list of those who
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123
2004_______________________________________
Sundhedsstyrelsen (National Board of experience. Trainees are paid by the
Health) who certify that he/she has worked hospital or dental school. There is formal
as an employed dentist (or candidatus) for training in 2 specialties:
a required length of time - currently one
year. Dentists who work in the public • Orthodontics
dental service are not required to register • Oral Surgery
with the DDA. Directors of public clinics
must be authorised by the National Board In 2003 there were 29 dentists undertaking
of Health. specialist training – 13 males and 16
To be registered with the DDA or the APHD females.
a dentist must first hold a recognised
primary degree or diploma in dentistry. For In both specialties, 5 years of specialised
all dentists who qualified outside the training is required, based in hospital and
European Union the National Board of university departments. For specialists in
Health has the right to require further oral surgery this experience must be
courses to be taken, and may conduct an gained in departments of Oral Surgery, Oral
oral and written language test in Danish, Pathology and Medicine, Ear Nose and
conducted by the National Board of Health. Throat and Anaesthetics. Specialists in
Orthodontics have to train within a
For the address of the competent authority Department of Orthodontics. During the
click here training period the trainee is paid by the
hospital or university. There is no
Further Postgraduate and particular specialist degree.
Specialist Training A third specialty, histopathological
diagnosis has now been authorised, which
Continuing education requires a minimum of 5 years of approved
postgraduate training. By 2002 only five
Continuing education (CE) is usually individuals had been trained in this
organised by the dental associations, specialty and they are not permitted to use
dental schools or private companies. CE is the title ‘Specialist Dentist’.
not compulsory in Denmark. To contact these training schools click here.
Specialist Training
To undertake specialist training a graduate

must have had at least 2 years of working
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Workforce
rk
Dentists treatments. Following this the patient

returns to their practitioner for the rest of
their care. Patients are also able to consult
dentists in Denmark – 40% female. 4,892
a specialist without a referral and have free
were reported as being “active”, 46%
choice both of the dentist and specialist
female. 70% of active dentists were in
that they wish to visit.
private practice. The Danish Dental
Association reported that 54% of members There are many societies which represent
were male and 46% female. special interests in dentistry, especially at
the regional level. the Danish Dental
The (active) dentist to population ratio was Association is the best initial point of
1,083. contact for questions about these societies.
Total registered 6,400 Auxiliaries

(2003)
There are 3 classes of dental auxiliaries in
In active practice 4,892 Denmark, besides dental assistants:
Private (general) 3,432
practice
Public dental service 1,200 Numbers of Registere Employed
University 142 auxiliaries (2002) d
Hospital 63 Chairside assistants 7,200
Hygienists 935 887
Others (including armed 55
forces) Technicians 1,600
Clinical technicians 386
The workforce was stable in 2003 – but it

will be decreasing over the following 10 Dental Hygienists
years as more Danish dentists will be
retiring than are training. Until 2003 there There is a registerable qualification which
was a trend for dentists to wait longer dental hygienists must hold before they
before retirement but that trend had can practise. They undertake 2.5 years
ceased. About half all dentists are over 50 training at dental school in Denmark. A
years of age. In 2003 the DDA reported register of qualified dental hygienists is
that the number of vacant positions in administered by the National Board of
dentistry is higher than the numbers of Health.
dentists available.
Hygienists may work in practice after
There is little movement of dentists in and graduation but they must register to be
out of Denmark. able to own their practice, without
supervision of a dentist, which is permitted
Specialists in Denmark.
There are 2 classes of specialists in Their earnings would be about €40,000
Denmark: (2002)
Numbers of Dental Technicians

specialists (2003)
Orthodontists 60 Training for dental technicians is for up to 2
years at special dental technician schools.
Oral Surgeons 60
There is theoretical and practical training.
There is no registerable qualification for
Most specialists in oral surgery in Denmark dental technicians, so there is no list of
work in hospitals. Oral surgeons and registered dental technicians.
orthodontists may run their own practices. Dental laboratory technicians work mostly
But most orthodontic specialists are in laboratories, hospitals or dental faculties
employed in the Public Health System. and are salaried, but some are employed
by dentists in private practice.
Usually a dental practitioner refers a
patient to a specialist for selected
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125
2004_______________________________________
All of their work may be carried out without
the supervision of a dentist. There is no They may take payment from a patient,
available information on their earnings and be part of the NHS.
Clinical Dental technicians There is no available information on their

earnings
Clinical dental technicians/denturists need
a licence from the National Board of Health Dental Assistants (Nurses)
to be allowed to practise independently.
They must undertake a 4-year training These may provide any kind of assistance
period in a special dental technician school to the dentist at the chairside. Training is
and there is some time spent in practice. carried out either on the School for dental
They may provide full removable dentures Assistants, Hygienists and Technicians
without the patient being seen by a dentist. (SKT) or on Technical Schools in several
However for partial dentures, a treatment municipalities.
Denma
plan from a practitioner is required, and a
patient presenting any pathological
rk
changes must be referred to a dentist.
Denma
Practice in Denmark
rk
Working in Private Practice employed dentists or other staff. Premises
may be rented or owned and there is no
In Denmark dentists who practise on their state assistance for establishing a new
own, in small groups, or employed by practice. Generally dentists must take out
other dentists outside hospitals or schools, commercial loans from a bank to finance
and who provide a broad range of general new developments.
rather than specialist care are said to be in Other than for reclaiming Government
private practice. There are about 3,500 subsidy payments there is no additional
dentists in private practice. This requirement to register when working in
represents 70% of all dentists registered private practice. There are no standard
and practising in Denmark. contractual arrangements prescribed,
although the ethical code of the Danish
All dentists in private practice are self- Dental Association provides some
employed or employed by the owner of the guidelines. Dentists who employ staff,
practice and earn their living partly must comply with minimum wages and
through charging fees for treatments and salaries regulations, and must meet
partly by claiming government subsidies occupational health and safety regulations.
for adult care. The government pays for Maternity benefit is payable four weeks
all dental treatment of children, up to the before and 24 weeks after birth. Once a
age of eighteen. Very few (less than 1%) dentist employs more than four employees
dentists in private practice accept only strict rules on occupational security will
fee-paying patients. In more rural areas apply.
where it may be uneconomic to organise a
separate public dental service for children Monitoring the standards of private dental
some practitioners may be contracted by practice is the responsibility of the Society
the kommune/municipality to provide this of the 11 regional bodies with the Danish
service. Dental Association. The monitoring
consists of statistical checks and official
Once registered with the region a dentist in procedures for dealing with patient
private practice may generate two-column complaints. These have been described
bills, one column to be paid directly by the earlier.
patient, the other to be claimed by the In 2001 an average private practitioner
dentist from the government. The dentist earned about 760,000 DKK (€110,000)
may present a bill to the patient after each each year.
visit or after a complete course of
treatment, depending on what has been
agreed.
Before dentists may establish their own

practice they must gain authorisation from
the National Board of Health. There are no
rules which limit the size of a dental
practice and the number of associate or
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The quality of dental care in hospitals is
Working in the Public Dental assured through dentists working within
Service teams under the direction of experienced
consultants. In hospitals any complaints
Of the 275 kommuner/municipalities in are handled through committees
Denmark, more than 200 employ salaried administered by the Ministry of Health.
dentists. These dentists work in municipal
government health centres or schools. They are salaried and earn about €75,000
People who are unable to take care of their to €90,000 per year.
own oral health are also treated within the
public dental service. The size of the public
dental service is stable.
Dentists within the service may carry out
management roles (for example as a
Surgeon Commander or as a Chief of the
Practice) or clinical roles (Dentist,
Specialist in Orthodontics, or Candidatus).
There are no further official requirements
to work as a dentist in the public dental
service, apart from orthodontists who must
be qualified in that specialty in the way
already described and chiefs of public
practices who should be registered with the
National Board of Health.
The quality of dentistry in the public dental
service is assured through dentists working
within teams, which are led by experienced
senior dentists. The complaints procedures
are the same as those for dentists working
in other settings, as described below.
In general within the public dental service it
is possible to work full or part-time as a
dentist, and hours are often more flexible,
or shortened to reflect the length of the
school day.
In 2001 public dental service salaries were
about €44,000 to €53,000 a year, and a
chief dentist €72,500.
In 2003, about 1,200 salaried dentists were
employed in public health clinics
In Denmark, about 60 dentists work in

hospitals, mostly as specialists in oral
surgery. All dentists are the employees of
the hospitals, which are owned and run by
regional government. Dentists may treat
patients as oral surgeons (Hospital Dentist)
or combine this role with management
responsibilities (as a Surgeon Dentist
Commander, or Head of Department).
The official training requirement for

dentists in hospitals is the five years post-
graduate training which is required for
recognition as a specialist in orthodontics
or oral surgery.
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Denma
Professor/Senior Lecturer or above will

Working in Universities and generally have a PhD. a Doctorate or other
rk
Dental Faculties postgraduate scientific qualification.
The quality of clinical care, teaching and

In Denmark dentists who work in research in dental faculties is assured
universities or dental faculties, are all through dentists working within teams,
employees of the university. They are able under the direction of experienced teaching
to work part-time and usually spend their and academic staff. In addition, the Dental
remaining time in practice. Schools and other teaching institutions are
audited by a State Evaluation Centre, which
Dentists working in universities all have a submits reports to Parliament. The
teaching role, but may have additional complaints procedures are the same as
responsibilities to treat patients in the those for dentists working in other settings,
School (Clinical teacher), conduct research as previously described.
(Lecturer), or have a mixture of
management, research and student They are salaried and earn about €60,000
supervisory responsibilities (Professor, or to €90,000 per year.
Assistant Professor/Senior Lecturer). There
are also External Teachers who provide
teaching on specialties, which are not Working in the Armed Forces
available within the School.
In 2002 there were 55 full-time dentists in
Although there are no official requirements the Danish Armed Forces, 66% female.
for formal postgraduate training, dentists
at the grade of Assistant
Professional associations Nye Landsforening with about 1,200
members in total.
The national dental association is called
Dansk Tandlægeforening, (Danish Dental The Association of Public Health Dentists in
Association). 90% of Danish dentists are Denmark organises dentists employed in
members, just over half being male. In municipal health care services.
2002 the Association had 6,182 members, It was founded in 1985 and works for better
most of them working in general practice. pay and employment conditions and the
This included over 450 students and about Association has declared health care policy
1,000 retired members. So, about 4,500 goals.
were active members.
The Danish Dental Association is an

“interest and health” organisation, covering
all aspects of dental care for dentists in
Denmark. The association was established
in 1873 and is the oldest dental association
in the Nordic countries.
The main goals of the association are:
• to look out for the interests of all

dentists in all aspects of the profession
• to promote oral health within the
Danish society
• and further develop all aspects of
dental care to the Danish population
For the address of the DDA click here.
There is also a Public Health Dentists

Association (APHD) called Tandægernes
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expense of others. Sponsorship is also
Ethics permitted and the use of radio and
websites. However the use of television is
Ethical Code not permitted.
In Denmark the practice of dentistry is In 2003 the DDA reported that the Directive
mainly governed by an ethical code. This on Electronic Commerce was (for the time
applies to all dentists, but with slight being) of no direct concern to its members,
variations between dental services. Other as they believed that no dentists in
laws and regulations exist which relate to Denmark were involved in E-commerce and
negotiating the system of subsidies, there was very little dental activity through
monitoring the billing of patients and the internet.
dealing with patient complaints. These are
described where appropriate in the Indemnity Insurance
relevant sections.
Liability insurance is provided by the
The clauses of the The Code of Ethics and
Danish Dental Association, and is
Professional Statutes of the Danish Dental
compulsory for private dental practitioner
Association describe:
members. It provides cover for
1. Purpose of the code occupational injuries for owners and staff,
2. The position of the dentist within legal expenses insurance, patient injuries
society and damage to patients’ belongings and
3. The dentist’s relationships with the HIV infection. A dental practitioner pays
patient approximately €100 annually (2003) for
4. The dentist’s relationship with the legal expenses insurance; for the other
public, public authorities etc. elements health insurance companies
5. The dentist’s relationship with deduct a percentage from income.
colleagues
6. The dentist’s relationship with his Corporate Dentistry
staff
7. The dentist’s relationship to the Dentists are allowed to form companies,
association and profession and non-dentists may be on the board of
8. Special provisions such a company.
Denma
Apart from the ethical requirement that all
care should “preserve and improve the Health and Safety at Work
rk
health of his patients” there are few
restrictions on the treatments which a Workforce Inoculations, such as Hepatitis B
dentist may provide. A dentist should not are not compulsory in Denmark.
however carry out any care to which the
patient has not consented, or for which the Regulations for Health and Safety
dentist does not possess the necessary
specialist knowledge. for administered by
Advertising Ionising radiation Radiation Institute,
(National Board of Health)
Advertising must be matter-of-fact, sober Electrical Kommuner /Municipality
and adequate and it is illegal to promote installations government
oneself or one’s practice at the Infection control DS2451-12 and Statens
Serums Institut
Occupational Danish Ministry of Labour,
Health Safety Arbejdstilsynet
Administration
(OHSA)
Waste disposal Kommuner/Municipality
government
Arrangement of Danish Ministry of Labour,
working places and Arbejdstilsynet
staff security
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129
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Greenland and the Faroe Islands
In Greenland all dental care is provided as a free public service, to children and adults. All
dentists, except one private practitioner, are employed by the Greenland government and
there is a constant need for more staff. The demand for dentists in Greenland is likely to
increase as old arrangements for free flights to Denmark for Danish nationals are phased out.
However, new arrangements, including short-term contracts of three or six months, free
accommodation and a free return flight should make working in Greenland more attractive to
non-Danish dentists. Nearly all dentists work with Inuit interpreters.
The Faroe Islands are governed as a single Danish municipality. Until recently, as in
Greenland, all dental services were provided as a free public service. However, in an
increasing number of areas dental care for children is being separated from adult services for
which people now have to pay. In time it is expected that the system for the provision of
dental services in the Faroe Islands will be the same as in Denmark as a whole.
Any specific queries about working as a dentist in Greenland or the Faroe Islands should be
directed to the Danish Dental Association.
Financial Matters
General Practice €110,000 National pension insurance premiums are

Public Health €44,000 to paid at about 10% of earnings.
€72,500
While the government pays approximately
Hospital €75,000 to 85% of the national costs of healthcare,
€90,000 15% comes from individuals through co-
University €60,000 to payments for treatment. For dental care
€90,000 this ratio is reversed since the national cost
of caring for adults’ dental health is 20%
government-funded, with the remaining
80% paid by patients.
Normal retirement age is 65 but dentists

may practise beyond this age.
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instruments and materials are subject to
Denma
VAT and will be reflected in the prices

Taxes
rk

There is a national income tax (dependent 2003
on salary). The lowest rate is 28 % and the
maximum is 55.3 % for income over about Zurich = 100 Copenhagen
€65,000 per year.
VAT/sales tax Prices (including rent) 97.9
VAT is also payable on certain goods and
services at 23%. Dental treatment is
Power
excluded from VAT. However, costs related
to purchase of dental equipment,
Main national associations and Competent Authority:

Information
Centre:
The Danish Dental Association Sundhedsstyrelsen (National Board of
Dansk Tandlægeforening Health)
Amaliegade 17 Amaliegade 13, Postboks 2020
Postboks 143 DK 1012 København K
DK 1004 Copenhagen K, Tel: +45 33 91 1601
DENMARK Fax: +45 33 93 1636
Tel: +45 70 25 77 11 Email: sst@sst.dk
Fax: +45 70 25 16 37 Website: www.sst.dk
E-mail: dtf@dtf-dk.dk or om@dtf-
dk.dk
Website: www.dtfnet.dk Publications:
Association of Public Health Dentists in The Danish Dental Journal

Denmark Tandlægebladet
Kompagnistraede 14D c/oThe Danish Dental
DK-1208 Copenhagen K Association/Dansk Tandlægeforening
DENMARK and
Tel: +45 33 14 00 65 The Danish Journal of Public Health
Fax: +45 33 14 03 24 Dentistry, from the APHD
Email: tnl@tnl.dk
Website: www.tnl.dk
Dental Schools:
Copenhagen Århus
School of Dentistry Royal Dental College

Faculty of Health Sciences Faculty of Health Sciences
University of Copenhagen University of Århus
Nørre Alle 20, 2200 Copenhagen N Vennelyst Boulevard, 8000 Århus C
Tel: +45 35 32 67 00
Fax: +45 35 32 65 05 Tel: +45 89 42 40 00
Email: Fax: +45 86 19 60 29
Website: www.odont.ku.dk Email: odonls@adm.aau.dk
Website: www.odont.au.dk
Dentists graduating each year: 55
__________________________________________________________________
131
2004_______________________________________
Number of students: 400 approx Dentists graduating each year: 50
Number of students: 300 approx
Estonia
Population 1.4
million (2003)
Estonia Currency Kroon
(EEK)
15.65 = €1
(2003)
(2002)
Main languages Estonian (65%)
Russian (28%)
In Estonia healthcare is funded through general

taxation, with an additional special tax for health,
which is paid by employer 13% of salaries. Much
Government and healthcare in Estonia

setting Estonia as a democratic
The Republic of Estonia, Eesti Vabariik in parliamentary republic – with a President,
Estonian, lies on the eastern shores of the Prime Minister and Cabinet and
Baltic Sea. The name Eesti is apparently
derived from the word Aisti, the name
given by the ancient Germans to the
people living northeast of Visla. Estonia is
situated on the level north-western part of
the East-European platform, on which there
are only slight variations in elevation. The
average elevation is only about 50m and
the highest point (Suur Munamägi) is only
318m above sea level.
With the Gulf of Finland in the north, and

the Baltic Sea in the west, Estonia shares
land borders with Russia to the east and
Latvia to the south. Estonia comprises an
area of 45,215 sq. km., making it larger
than, for instance Denmark, Switzerland,
the Netherlands, Belgium and Albania in
Europe. The capital, Tallinn, is on the
Northern shore.
In 1991 Estonia gained its independence as

a state. The new Constitution of 1992
established the principles of the State,
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132
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remaining 5% are the unemployed who are
a State assembly known as the Riigikogu. not on the list of unemployed persons
Elections to the Riigikogu take place every actively looking for a job. For employed
4 years. Local governments, separated people, the employer pays 33% from the
from the central power, are based on 15 salary to the Fund, comprising 20% social
counties. The population in 2002 was tax and 13% health insurance tax. Estonian
1,415,618. health insurance is solidarity insurance, so
for all retired persons their health care is
Healthcare delivery in Estonia is provided covered by a sick fund.
through private practice and a statutory
health insurance system (Sick Funds). The In 2002 the proportion of GNP spent on
membership of the system is appointed by general healthcare was 5.9%, including
the Parliament. Local governments can also dentistry. The budget is set annually by the
provide support. About 95% of Estonian Estonian Parliament.
population is a member of a Sick Fund. The
__________________________________________________________________
133
2004_______________________________________
Estoni
Oral healthcare
a
Public dental care

In some private clinics dentists give a
About 90% of oral healthcare in Estonia is guarantee for the technicians work only if
provided through general (private) the patient visits the dentist every 6
practice. Dental care services for adult months for two years.
patients (over 19) are paid by patients and
reimbursed by the sick fund although Access to oral healthcare may be difficult
emergency care (traumas, infections) is for patients who live in some urban areas,
actually paid by the sick fund, but only for as well as all those in rural areas, as
those who are members of it. Patients who salaries there are generally too low for
do not have insurance can have only first what is almost private care, with the low
aid. reimbursements. Indeed, there may be
difficulties for patients, all over Estonia,
Since October 1st 2002 the Sick Funds have obtaining prosthetic treatment under the
provided this limited financial support for scheme.
oral healthcare. Treatment is provided and
is free for children under 19 years of age,
provided they visit a dentist with a contract Private dental care
with the Sick Fund. Other patients may
receive a reimbursement for the fees they About 90% of all adult dental treatment is
have paid, up to €10. The health insurance provided under fully (liberal) private
provides this cover for 41 conservative and contract between patients and their
surgical items but crowns and bridges, dentists. There is no regulation of private
implants, fixed orthodontic appliances and fees and there are no dental insurance
other complex or cosmetic treatments have schemes in Estonia.
to be paid for fully by the patient.
Pregnant women, or nursing mothers The Quality of Care
whose child is less than one year of age,
can receive reimbursement of up to €19. There are no routine quality checks, so the
Pensioners (over the age of 63) may system relies on a complaint from a
receive reimbursement of up to €96 once in patient, for monitoring purposes. A
a 3-year period, for one prosthodontic complaint by a patient is investigated by a
appliance – all these reimbursements at “Treatment Quality Commission”, which is
2003 prices. appointed by the Ministry of Social Affairs,
Health Department’s Supervision
Oral examinations would normally be Department. Patients may also write an
undertaken every 6 to 12 months, more application to the Consumer Protection
frequently for patients with periodontal Service, but they send their complaint to
conditions. There is no prior approval the Health Department’s Supervision
system for treatment. The Estonian Dental Department first. For more information, see
Association reports that they believe that Ethical Code.
most of the population visit a dentist within
any 2-year period. This is what dentists In 2002, the proportion of total
ask from patients. governmental spending on healthcare
which was spent on dentistry was 4.5%.

Undergraduate Training There is one dental school, which is
situated within the Faculty of Medicine in
the University of Tartu. It is publicly funded.
To enter dental school a student has to
The dental course in Estonia has been “EU-
have completed secondary school (usually
compliant”, so most Estonian graduates are
at the age of 18). There is an entrance
able to work elsewhere in the EU from May
examination. Student intake is usually
1st 2004.
about 35 a year, and 30 to 35 graduate
annually. In 2003, 85% of undergraduates
Quality assurance for the dental school is
were female. Undergraduate training lasts
provided by the Ministry of Education and
5 years.
Social Affairs.
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Further Postgraduate and

The primary degree which may be included Specialist Training
in the register is “DDS Dentist”.
Continuing education is not mandatory, but

under Estonian legislation there is a
general requirement to keep skills updated.
There is no vocational training for dentists
Postgraduate education is delivered
in Estonia.
through the Tartu University Postgraduate
Training Centre and the Society of
Registration
Stomatology.
To register in Estonia, a dentist must have
Specialist Training
a recognised degree or diploma awarded
by the university, or from another EU
There is training in 3 specialties:
country. The register is administered by the
Healthcare Board/General Dental Council,
• Orthodontics
within the Commission for Licence (the
competent authority). For the address of • Oral Maxillofacial Surgery
these organisations, click here • Clinical Dentistry
Estoni
There are no formal linguistic tests in order Specialists train in the University. There is
to register, although dentists from outside no minimum of years pre-training (working
a
the EU are expected to speak and as a dentist after basic education), before
understand Estonian. entering specialist training. Training lasts
for 3 years for Orthodontics, and for Oral
Maxillofacial Surgery and Clinical Dentistry,
5 years and includes a University
examination. The specialist education and
training also leads to a degree, “Specialist
in Orthodontics”, “Maxillofacial Surgeon” or
“Specialist in Clinical Dentistry”. Specialists
in Clinical Dentistry undertake training in
endodontics, periodontics and
prosthodontics.
Only orthodontics is recognised by the

Healthcare Board/General Dental Council
and registered as a specialty, in addition to
Oral Maxillo-facial surgery, which officially
is a dental specialty under a law introduced
in 2002. It is anticipated that Specialists in
Clinical Dentistry will be recognised and will
need to register, after 2004.
Workforce
Dentists Hospitals 35
In 2003 there were 1,081 registered University 31
dentists in Estonia - 91% female. 38% of
active dentists provide some public service The (active) dentist to population ratio was
dentistry and 2% work in the university. 1,418 (2003).
The remainder work in solely private
practice. There is no reported unemployment
amongst dentists in Estonia.
Total Registered 1,081
(2003) Some dentists practise in more than one
sphere of practice.
In active practice 998
(private)
Movement of dentists across borders
__________________________________________________________________
135
2004_______________________________________
Nurses follow 3.5 years training of Medical
It is reported by the Dental Association in Nurse, and then are trained in dentistry by
2003 that there are some foreign dentists the dentist, with institutional support. They
working in Estonia illegally (from Italy), and receive a diploma, which they must register
one registered legally (from Finland). with the Healthcare Board. Their duties are
to assist the dentist, including the cross
Specialists infection control. They are paid by salary
by their employers.
Specialists work mainly in private practice
and patients access them by referral from
other dentists.
(2002)
Orthodontists 27
Clinical dental specialists 2
Oral Maxillo-facial 35
surgeons
Auxiliaries
The system of use of dental auxiliaries is
developing in Estonia. However, in 2003
the only type of dental auxiliary is a
medical nurse trained by dentist as an
assistant.
In 2002, it was reported that there were 2

hygienists in Estonia, who had been trained
outside the country, but they were only
permitted to work as dental assistants. In
the new register of medical specialities in
2003, there was no such dental auxiliary
specified as “hygienist”.
Dental Technicians
The title is legally protected and there is a

registerable qualification which dental
technicians must obtain before they can
practise. 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. Typically they
would earn about €5,500 to €7,500 per
year.
In 2002 it was reported that there were 232

dental technicians. There is no reported
illegal activity.
Dental Nurses
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136
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Estoni
In 2002 there were 1,042 medical Dental School (and were actually called “dentists”
Nurses working in dentistry. at the time)in parallel with nurses and
a
midwives. Some came from the (former)

Dental Therapists Soviet Union. Whilst they have permission
to work until the end of their active
In the 1950s, when all professionals practices, their position relating to
currently known as dentists were doctors “Acquired Rights” in the EU is unclear.
trained as stomatologists, some school
dental therapists were trained in Vocational In 2003, about 20 were still practising.
Training
Practice in Estonia
Working in General (Private) Practices can be found in all types of

Practice accommodation. Within practices, there is
a minimum limit to the size of rooms and
the facilities supplied. The state offers no
In Estonia, dentists who practise on their
own, or as small groups, outside hospitals
and generally dentists must take out
or health centres, and who provide a broad
commercial loans from a bank. There are
range of general treatments are said to be
no rules relating to the numbers of dentists
in private practice. In 2003 there were
or partners in the practice.
about 1003 dentists who worked this way,
although many only work part-time in
private practice. About 38% of private Working in Public Dental
dentists provide some kind of publicly Service
funded or assisted oral healthcare, mainly
for children, as adult subsidies are very Public Dentistry ceased to exist from the
restricted (see Oral Healthcare, above). beginning of 2004. The last dental clinic
About 90% of private practitioners work in was privatised. Local government can
single dentist practices. partly own clinics or support them
financially.
Most dentists in private practice are self-
employed and earn their living through
charging fees for treatments. The patient
pays the dentist in full and some then
reclaim partial or full reimbursement from
the local office of the sick fund.
Fee scales
Until 2003, the Estonian Dental Association

and Society of Stomatology were consulted
about fee scales, but any changes were
decided by the Sick Fund Price
Commission, only. Since September 2003,
the partner for the negotiations is the
Estonian Dental Association, assigned by
Sick Fund Price Commission.
There are no rules which limit where a

practice may open, but this has led to
problems, as most dentists want to work in
either Tallin or Tartu, where the dentist to
population ratio has fallen to 1:750. The
opening of a practice is subject to the
approval by the local health department.
Existing practices are also bought and sold
on the open market.
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137
2004_______________________________________
In 2002/2003, 20 salaried dentists were
employed in public health clinics. Their
salaries were in the region of €480 to €700
per month.
Hospitals in Estonia are all publicly owned.
In 2003, about 35 Oral maxillo-facial
surgeons worked in hospitals, as salaried
employees. They undertake mostly surgical
treatments.
There are generally no restrictions on these

dentists seeing other patients outside the
hospital, in private practice. The quality of
dental care is assured through dentists
working in teams under the direction of
experienced specialists. The complaints
procedures are the same as those for
dentists working in other settings.
Their salaries were in the region of €500 to

€1,000 per month in 2002.

Dental Faculties
In 2003, 31 dentists worked in the dental
school, as salaried employees of the
university 15 full-time and 16 part-time -
they are allowed to combine their work in
the faculty with part-time employment in
private practice, elsewhere.
The senior academic title within the

Estonian dental faculty is that of university
professor, who since 2002 must be DDS.
Other titles include docents and teachers.
There are no formal requirements for
postgraduate training but docents and
professors will have completed a PhD, and
most will also have received a specialist
clinical training. To be elected to the post
of professor a dentist must have published
scientific research of at least 3
dissertations. Apart from these there are no
other regulations or restrictions on
promotion.
The quality of clinical care, teaching and

research in the dental faculty is assured
through the old traditions of Tartu
University (formed in 1632) and a Ministry
of Education curriculum which has been
accredited by the international commission
2002, following a DentEd visit in 2001.
Their salaries were in the region of €480 to

€700 per month in 2002.

In 2003, there were no dentists working full
time for the Armed Forces.
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Estoni
Estoni
a
a
Professional associations to the Treatment Quality Commission. A
patient will be examined, if it is necessary,
There are two professional associations, by a commission appointed by the dental
the Estonian Dental Association (EDA) - councillor. If it is reported to the Treatment
Eesti Hambaarstide Liit and the Estonian Quality Commission that quality is below
Society of Stomatology (ESS). Both standard, then they may call to order the
organisations have been working together dentist and demand that he undertakes
regarding legislation and postgraduate and passes courses, or they may suspend
training. It is anticipated that they will be temporarily the
amalgamated into one organisation by
2005.
In 2003 about half of all dentists were

members of the EDA. The Association
represents private and public health
dentists and combines this role by trying
to emphasise common, professional
matters. The EDA represents Estonia at
international meetings.
The EDA is run by a Board, secretary and

40 (elected) council members. It is
established to protect dentists as liberal
professionals, and represent members in
negotiations with local authorities,
ministries and legal bodies. It provides
members information about changes in
legislation and offers advice to dentists on
legal affairs. Together with the Society, the
EDA arranges lectures and conferences.
The ESS had 538 members in 2003, and

was first founded in 1921. Annual dental
meetings are organised by the ESS.
There is also an Estonian Dentistry

Students Association.
Ethics
Ethical Code
Dentists are subject to an ethical code

which is based on the EU Dental Liaison
Committee Ethical Code (Annex 9).
Supervision of this is by the Estonian

Dental Association. However, the Ethical
Code is not mandatory, it is only
recommendable, so dentists may receive
only a written warning, on non-compliance,
or removal as a member of the Association.
If this is unsatisfactory for patients then

they may make a claim to the Consumer
Protection Bureau. For disciplinary
purposes there is a Treatment Quality
Commission. There is one dentist, who is
appointed by the Ministry of Social Affairs
Health Department, as a dental councillor,
__________________________________________________________________
139
2004_______________________________________
working permit, until the reported
deficiency is removed. The Dental
Councillor is a member of the board of the
Estonian Dental Association.
For appeals against what they consider an

adverse decision the patient or the
doctor/dentist may complain to the Court.
Data Protection
Estonia has a Data Protection Law and all

dentists who apply for the permission to
work, have to first have permission from
the Data Protection Service.
Advertising
Advertising is permitted, provided that it is

legal, decent, honest and fair – and may
take place in any of the mediums such as
TV, radio and the press. However,
comparison of skills with another dentist is
not permitted.
Dentists are allowed to promote their

practices through websites subject to the
usual rules of “legal, decent, honest and
fair”, but they are required to respect the
legislation on Electronic Commerce, and
the data protection law.
Insurance and professional

indemnity
Estonian dentists have a “Responsibility

Insurance”, but this is voluntary.
Corporate Dentistry
Dentists are allowed to form “limited

companies” and non-dentists may be part
or full owners of such companies.
Hepatitis B vaccinations for dentists and

their staff are not mandatory, and the
practice owner must pay for any voluntary
inoculations undertaken.
For Administered by
Ionising radiation Radiation Protection
Centre
Electrical Health Protection Bureau
installations
Infection control Health Protection Bureau
Medical devices Heath Protection Service
Waste disposal Health Protection Bureau
__________________________________________________________________
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__________________________________________________________________
141
2004_______________________________________
Estoni
Financial Matters
a
The income ranges dentists would have month, but private pensions would depend
expected to earn annually in 2002 (in on a person’s contributions.
Euros):
Dentist 25 Dentist 45 Taxes

years years National income tax:
old or old or
2 20
years years The rate of income tax is 26%
after after
qualif qualifi VAT/sales tax
icatio cation
n There is a value added tax, payable at a
Liberal Practice Not given Not given rate of 5% on purchases. Medical and
dental services are not included.
Hospital €6,000 €12,000
Academic €6,144 €8,400 Various Financial Comparators @ July
2003
Retirement pensions and

Zurich = 100 Tallin
Healthcare
The national retirement age is 65 but Prices (including rent) 46.1
(liberal) dental practitioners may work Wage levels (net) 11.9
until any age. The national insurance Domestic Purchasing 15.6
premiums include a contribution to the Power
national pension scheme. Retirement
pensions in Estonia are typically €120 a
Dental associations and information centres:

Estonian Dental Association Estonian Society of Estonian Dentistry Students
Ravi 27-250, Stomatology Association
10138 Tallinn Clinic of Stomatology, Tartu Raekoja plats 6
ESTONIA University 50013 Tartu
Tel: +372 64 59 001 Raekoja Platz 6 ESTONIA
Fax: +372 64 59 001 51003 Tartu
Email: ehleda@online.ee ESTONIA
Website: www.ehl.ee Tel: +372 7319 855 Office:
Fax: +372 7428 608 Nooruse 7-901
Email: 50408 Tartu
mare.saag@kliinikum.ee ESTONIA
Website: Tel: +372 7 381 241
Fax:
Email: info@ehyl.ee
Website: www.ehyl.ee
Competent authorities: Tartu Dental school:
Healthcare Board The General Dental Council The Dean Docent Mare Saag
Hiiu 42Tallinn 11619 29 Gonsiori Str, Tallinn Dep of Stomatology
Estonia Estonia Faculty of Medicine
Tel: +372 6509840 Tel: University of Tartu
Fax: +372 6509844 Fax: 8 L. Puusepa str.
Email: Email: EE 2400 Tartu
info@tervishoiuamet.ee Website: ESTONIA
Website: Tel: +372 7 448 235
www.tervishoiuamet.ee Fax: +372 7 448 224
E-mail:
Website:
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Finland

Finland (2002)
Currency Euros
Main language Finnish (95%)
Swedish (5%)
In Finland healthcare is funded largely through

general taxation, with an additional special tax for
health which is paid by everyone including those
who have retired. There are 5,900 dentists (98%
are members of the Finnish Dental Association).
The use of dental specialists and the development
Government and healthcare in Finland
Finland is a Nordic country with a population of 5,183,545 (2002). The land area is 2,628 sq
km and the country has Norway, Sweden and Russia as adjacent neighbours. The capital is
Helsinki (the northernmost capital in Europe).
The national parliament has 200 members, elected under a system of proportional
representation. The President of the Republic is elected by direct popular vote. In the regular
course of events, a Presidential election takes place every six years. Finland has a unicameral
Parliament with 200 seats. The minimum age for voting and standing for election is currently
18. The Prime Minister is elected by Parliament and thereafter formally appointed to office by
the President of the Republic. The President appoints the other ministers in accordance with a
proposal from the Prime Minister. In 2003 there were 18 ministers in the Cabinet.
Regional government is organised through 6 provinces, and 452 municipalities (or Kunta).
In Finland healthcare is funded largely through general taxation, with an additional special tax
for health which is paid by everyone including those who have retired.
The Primary Health Care Act (PHC Act) of 1972 reformed the planning of primary health
services by establishing a network of health centres funded by the municipalities. These
provide a range of local public services, including medical services, radiology, laboratory and
dental services - although the latter varies between health centres.
The proportion of GDP spent on general healthcare, including dentistry in 2002, was 7%. Of
this expenditure, 75.6% was “public” (OECD Feb 2004).
__________________________________________________________________
143
2004_______________________________________
Finlan
Oral healthcare
d
In Finland the responsibility for planning under 40 years of age would have access
oral healthcare lies with the Ministry of to this care. After 2002 it was no longer
Social Affairs and Health, but the actual possible for the centres to select patients
service is usually provided by on the basis of age, and it is anticipated
municipalities. The government social that public health centres may eventually
insurance agency (the Kansaneläkelaitos or come to treat one half of all adults.
KELA), also provides some assistance in However, in late 2003 it was reported by
paying for healthcare, again under the the Finnish Dental Association that the
strategic direction of the Ministry. The number of people seeking municipal care
agency is self-regulating, under the treatment had greatly exceeded capacity,
supervision of the Finnish parliament, has so new patient selection criteria were being
its own budget, and 328 branch offices in reviewed.
municipalities. However if the KELA has a
budget deficit the government is obliged by While there are charges for treating
law to make up the total spent, from patients over 19 years of age, such
taxation. treatment may nevertheless be cheaper
than private dental care. Access to
In 2002 the proportion of total treatment, and the scope of treatment
governmental spending on healthcare provided, will vary according to
which was spent on dentistry was 7% geographical region.
About 70% of the population receive oral
healthcare regularly (in a two-year period) In Finland, in 2003 less than 1% of the
and oral examinations would normally be public used private insurance schemes to
undertaken every 1-2 years. cover their dental care costs.
The dental services are delivered either

through the system of public health The Quality of Care
centres, or by private dentists, denturists
and dental laboratories. At present about Although the state authorities provide
36% of dental care is state-funded (half by recommendations for dentists, for example
the municipalities, half by central for filling materials and practice hygiene,
government) and 56% is paid for directly the standards of dental care are not
by households. 7% of the balance is paid by actively monitored in private practice in
KELA and 1% by employers. Finland. The only routine system is random
checks on billing by the KELA. They assess
Until 2002, part of the adult population had the average cost per patient and ensure
to pay all the costs of their oral healthcare that the calculated bill reflects the amount
themselves, with no assistance from KELA - of work done. Care provided in health
nor was there a possibility to obtaining centres is subject to quality assurance.
treatment from municipal health centres.
About 1 million children (under the age of Patient complaints are generally managed
19) received municipality based care and a by the National Authority of Medicolegal
further 1 million were also treated at health Affairs (click for address) or the Consumer
centres which provide care, on average, at Complaints Board, supplemented by a
one third of the cost. patient ombudsman system. Also, since
From December 2002 the age limits the Patient Injury Act in 1987 there has
applied for KELA subsidies in private care been a Patient Insurance Centre which may
and age limits in health centres were indemnify injuries which occur during
abolished. At that time public health treatment. Liability insurance is, however,
centres treated about one third of the adult included in the membership fee of the
population, and local authorities had been Finnish Dental Association (see below). X-
free to decide, for example, that only those rays are actively monitored by the
authorities.

Undergraduate Training at the age of 18). There is an entrance
examination, which is similar to that of
To enter dental school a student has to medical students. The intake into the
have completed secondary school (usually schools is about 83, and about 60 graduate
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_ ____EU Manual
annually. In 2003, 70% of the 445
undergraduates were female. The
undergraduate course lasts for 5 years. Quality assurance for the dental schools is
provided by the Ministry of Education.
Two of the four original dental schools
(known as Hammaslääketieteen laitos) Primary dental qualification
were closed 1998, leaving two (Helsinki and
Oulu) open. However, the dental school in The primary degree which may be
Turku University reopened as an included in the register is: Licentiate in
undergraduate facility in 2004, because of Odontology (hammaslääketieteen
a shortage of dentists (it had remained as a lisensiaatti) (HLL).
postgraduate school only before then).
Dental schools are part of the Colleges of Qualification and Vocational Training
Medicine.
Graduates can only register in Finland

when they have completed 9 months’
salaried, supervised training, working as a
dentist under the supervision of an
experienced dentist.
__________________________________________________________________
145
2004_______________________________________
At least 6 months of this training must be Maxillofacial Surgery, 6 years) and includes
undertaken in health centres, and up to 3 a University examination. Specialist
months can be done in a private surgery. In education leads also to a degree, like
principle there are educational targets, but specialist in orthodontics. To become a
it is only up to the employer how to fulfil Doctor in Odontology a thesis (like a PhD)
these. There is no theoretical training. must be completed.
They are salaried as “junior” health centre
dentists, with salaries of approximately Oral Surgery was combined in 1999 with
€40,000 a year. maxillo-facial surgery, as a medical
specialty. There are about 60 post-
Diplomas from other EU countries are graduate positions in the country, so there
Finlan
recognised without the need for vocational is a limit to how many can train. Trainees
training. are paid approximately €36,000 a year.
d
Registration There is training in 4 main specialties:
To register in Finland, a dentist must have • Orthodontics

a recognised degree or diploma awarded • Dental Public Health
by the universities, and have completed 9 • Oral Maxillo-Facial Surgery
months supervised training. The register is • Clinical Dentistry
administered by National Authority for
Medicolegal Affairs (the competent Clinical Dentistry is a specialty with 5
authority). subgroups. These are:
There are no formal linguistic tests in order
to register, although dentists are expected • cariology
to speak and understand Finnish (or • periodontology
Swedish in certain areas).
• prosthetics
• oral radiology
Further Postgraduate and • oral pathology
Specialist Training
The title obtained by specialists in
Continuing education orthodontics and oral surgery, the two
specialisms recognised by the EU, are:
Continuing education is not mandatory but
under Finnish legislation there is a general • 'todistus erikoishammaslaakarin
requirement to keep skills updated. oikeudesta oikomishoidon alalla/bevis
Postgraduate education is delivered om specialisttandlakarrattigheten
through the Finnish Dental Society (for inom omradet tandreglering'
address click here). (certificate of orthodontist) issued by
the competent authorities.
Specialist Training
• 'todistus erikoishammaslaakarin
Specialists train in Universities; also, in oikeudesta suukirurgian (hammas- ja
health centres and hospitals which have suukirurgian) alalla/bevis om
contracts with the universities. specialisttandlakarrattigheten inom
omradet oralkirurgi (tand- och
There is a minimum of 2 years pre-training munkirurgi)' (certificate of oral or
(working as a dentist after basic dental and oral surgery) issued by
education), before entering specialist the competent authorities.
training. Training lasts for 3 years (Oral and
Workforce
Dentists In active practice 4,720
In 2002 there were 4,720 active dentists in General (private) 2,540
Finland - 69% female. Many dentists practice
practise in more than one sphere of Public dental service 2,076
practice. The number of dentists
University 105
graduating each year varies from 30 to
about 60. Hospital 55
Armed Forces 24
Total Registered 5,900 Student Health Service 63
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The (active) dentist to population ratio was

1,101 (2002).
There is a decrease in the workforce as

more dentists retire than are being trained.
So, a dental school in Turku which had
been closed was reopened in 2003. It was
calculated that by year 2020 there would
be approximately 3,700 dentists in active
practice, but with the reopening of the
school the number is now estimated at
approximately 4,000 (against the 4,700 in
2003).
There is some small reported

unemployment amongst dentists in Finland
(between 10 to 20 dentists) - the
unemployment benefits are good.
__________________________________________________________________
147
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Finlan
Movement of dentists across borders Dental hygienists work in all services only
under the prescribed instructions of a
In 2003 there were 160 foreign dentists dentist. They work usually as part of the
d
working in Finland (30 EU/EEA and 130 non- team although they can work
EU/EEA graduates) and 255 Finnish independently. They may undertake
qualified dentists working abroad. infiltration local anaesthesia. They take
legal responsibility for their work and they
Specialists may accept payment from patients, if they
have a practice of their own. This is very
In Finland 4 dental specialities are rare – only some 20 hygienists in the
recognised under the National Authority for country operate like that.
Medico-legal Affairs and there were 629
specialists actively working in 2002. They are normally salaried and typically
would earn about €25,000 per year.
Numbers of
specialists (2002) Dental Technicians
Orthodontics 140
Oral Surgery 84 registerable qualification which dental
Public Health 137 technicians must obtain before they can
Clinical Dentistry 268 practise. Like hygienists, there is an
entrance examination into a polytechnic,
where they undertake 3.5 years education
and training. A register is held by the
Patients can go directly to specialists,
National Authority for Medicolegal Affairs.
without referral.
Their duties are to prepare dental
prosthetic and orthodontic appliances to
Auxiliaries the prescription of a dentist and they may
not work independently.
well developed in Finland and much oral Individual technicians are normally salaried
health care is carried out by them. In and work in commercial laboratories which
Finland, apart from chairside dental surgery bill the dentist for work done. Typically they
assistants, there are three types of clinical would earn about €35,000 per year.
dental auxiliary:
Denturists
• Dental hygienists
• Dental technicians In Finland, denturists are operating
• Denturists auxiliaries who can provide complete
dentures to the public. There is a
qualification and the register is held by the
Numbers of auxiliaries National Authority for Medicolegal Affairs.
(2002)
Dental Hygienists 1,545 They train in the same school as
Dental Technicians 517 hygienists/technicians, and there is an
entrance examination. Their training lasts
Denturists 346
an additional half-year (the person must be
Dental Assistants 6,172 a dental technician first).
Dental Hygienists They work mostly in their own private

practices. Whilst they do receive referrals
The title is legally protected and there is a from dentists, generally their patients come
registerable qualification which dental directly from street. Whilst they cannot
hygienists must obtain before they can provide partial dentures it is reported that
practise. There is an entrance examination they do so, illegally. There is control of their
into a polytechnic, where they undertake ethics and practices by the authorities, as
3.5 years education and training, which with dentists, but their fees are not
includes basic professional studies and regulated. Their average earnings are
studies to boost occupational skills. The unknown but they are thought to be less
register is held by the National Authority for than dentists.
Medico-legal Affairs.
Assistants follow 2.5 years training under

the authority of the dentist and with
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148
_ ____EU Manual
institutional support. They receive a Medico-legal Affairs and they are paid by
diploma, which they need to register. salary by their employers.
Registration is by the National Agency of
In 2002 there were 6,172 Dental Assistants.
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149
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Finlan
d
Practice in Finland
Oral health services are provided in both majority of dentists stay within a 15-30%
the public and private sectors with about range. Prior approval for treatment is not
required for any treatment under any of the
half of dentists in each sector.
schemes for receiving free care or a
subsidy.
Working in General Practice
In Finland, dentists who practise on their
own or as small groups, outside hospitals or There are no rules which limit the size of a
health centres, and who provide a broad dental practice or the number of associate
range of general treatments are said to be dentists or other staff working there.
in private practice. In 2003 there were However, private group practices are
2,540 dentists who worked in this way, supervised by the provincial government.
providing approximately 60% of the care Apart from this there are no standard
for the adult population. About 40% of contractual arrangements prescribed for
private practitioners work in single dentist dental practitioners working in the same
practices and approximately 400 are practice. Premises may be rented or
employees of private dental care firms, owned and are normally in houses, flats or
either PlusTerveys or small companies of business premises - not usually in shops or
two or three (see below). purpose-built clinics. The state offers no
Most dentists in private practice are self- and generally dentists must take out
employed and earn their living through commercial
charging fees for treatments. The patient
pays the dentist in full and some then
reclaim partial reimbursement from the
local office of the KELA.
Fee scales
As already described, Public health

insurance (KELA) used to reimburse a
certain part of the dental treatment costs
of patients born in 1956 or later who
sought treatment in private dental
surgeries. From the beginning of December
2002 these age limits were abolished. This
compensation amounts to 35 to 40% of the
fees charged by private dentists, as the
nominal rates applied in the compensation
calculations have remained unchanged
since 1989. A private practitioner is free to
decide the price for treatment (fee-for-
service) but the compensation is calculated
from KELA’s price list.
Treatments which do not attract a

government subsidy include fixed and
removable prosthetics and most
orthodontics or dental laboratory costs.
Orthognatic surgery cases are normally
covered – a prerequisite is a statement
from orthodontist and oral surgeon. War-
veterans have some better benefits, like
their prosthodontic care being included in
the scheme (at partial reimbursement).
The Finnish Dental Association is not

allowed - due to competition law - to make
any recommendations for fees and prices
are set by the market. However, the
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150
_ ____EU Manual
loans from a bank. When starting a new received both in health centres and in the
practice private dentists have to inform the private sector. There is no major difference
local health authorities. in the treatment between the sectors and
also the sectors work together well.
The premises for the surgery are usually However, health centres cannot offer
rented, but the equipment is usually owned continuing care as often as is offered as the
by a single practitioner or by the (small) private sector - especially in the big cities.
company owned by the working dentists. The main emphasis has so far been on
The auxiliaries are usually employees for children and a range of (so called) “special
this company but the dentists can be either groups”.
employees or (more frequently) working as
independent dentists. The procedure for handling of complaints is
the same as in the private sector -
Working in the Public Dental however, the Consumer Complaints Board
is only for the private sector.
Service
Public services are provided mainly in

health centres organised by municipalities
singly or collectively. Dental services are
part of other local health services. A local
chief dental officer is responsible for
arrangements, together with other local
authorities.
Before December 2002 it was possible to

limit dental services to concern special age
groups only. Municipalities in Finland are
very independent and some limitations
were in use in many of them. According to
the new law, since December 2002
limitation by age is not possible any more,
but the municipalities can still organize the
services in their own way to some degree.
The main principle is that municipalities are
in general responsible for the health
services for people in need, but also the
Ministry of Social Affairs ensures that
municipalities act within the new law.
Municipalities get funding for these

services from the central government, but
most of the financing must come from their
own internal funds, through taxes. Patients
also pay quite a large co-payment. Despite
these fees the charges are about half of
what patients pay in private sector.
Despite the new law, it has not been

possible to arrange all dental services in
health centres, because of the limited
municipal resources. However the intention
was not the organisation of all dental
services into the public sector, but was to
give patients choice. There will be some
change in the content of dental care in
health centres, which will mean more
patients will be seen, with more adults and
older patients.
Health centres have proved popular as

working places, by dentists. Surveys have
shown that patients have attached great
value to the dental service they have
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151
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In single municipalities, there are different They are salaried and earn about € 52,000
Finlan
types of procedures for monitoring quality, per year.

but there is no national quality system in
d
public health sector. Working in Universities and

A dentist working in a health centre can get
Dental Faculties
a higher position usually through specialist
training or by being chosen for the position In 2003, 105 dentists worked in dental
of a local chief dental officer. schools, as salaried employees of the
university. They are allowed to combine
The provision of domiciliary (home) care is their work in the faculty with part-time
not very common in Finland, and is usually employment or private practice elsewhere.
provided by public health dentists.
The main academic title within a Finnish
In 2003, 2,076 salaried dentists were dental faculty is that of university
employed in public health clinics. Their professor. Other titles include teachers and
salaries were comparable to that of private assistants. There are no formal
practitioners. requirements for postgraduate training but
senior teachers and professors will have
completed a PhD, and most will also have
received a specialist clinical training. Apart
from these there are no other regulations
In 2003 about 55 dentists work in hospitals or restrictions on promotion.
as salaried employees of the local
municipality (or a federation of The quality of clinical care, teaching and
municipalities), or one of the small number research in dental faculties is
of private hospitals. They undertake mostly assured through dentists working in
surgical treatments, but also other teams under the direction of
demanding treatments and “normal” experienced teaching and academic
treatment to hospital patients. staff. The complaints procedures are
the same as those for dentists
There are generally no restrictions on these working in other settings.
dentists seeing other patients
outside the hospital. The quality of
dental care is assured through
dentists working in teams under the
direction of experienced specialists. In 2003, there were 24 dentists working full
The complaints procedures are the time for the Armed Forces, all male.
same as those for dentists working in
other settings
Professional associations Dentists are subject to the same ethical
code as their medical colleagues. For
There is a single main national association, example, they must only use proven
the Finnish Dental Association. In the techniques and must constantly update
Annual Report of FDI in 2002/03, 4,679 their clinical skills. There is also a special
dentists are shown as members, which is law to protect patients’ rights, consent and
about 98% of active dentists. The confidentiality. The Finnish Dental
Association represents private and public Association has its own ethical code (see
health dentists and combines this role by homepage www.hammasll.fi)
trying to emphasise to common,
professional matters.
For more information about the Finnish

Dental Association click here
Ethics
Ethical Code
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152
_ ____EU Manual
There are no specific contractual
requirements for dentists working in the Data Protection
same practice. A dentist’s employees
however are protected by the national and In 1993, a law on patients’ rights came into
European laws on equal employment force. The law concerns patients' right to
opportunities, maternity benefits, information, the right to see any medical
occupational health, minimum vacations documents concerning them and the right
and health and safety. to autonomy. A medical ombudsman was
also introduced by the law. However, the
Supervision of the practice of the medical ombudsman’s role is advisory only, to the
and dental professions is by the National patient.
Authority for Medicolegal Affairs, with about
15 complaints being made against dentists Advertising
each year. Another avenue for complaint
can be the provincial government. There is Advertising is permitted, subject to national
Finlan
also a Consumer Board, which is only for legislation and a professional code of
private practitioners. This receives about ethics. Dentists are permitted to use the
d
30 complaints against dentists a year post, press or telephone directories,
without obtaining prior approval.
The consequences of a complaint which is
upheld can be a written warning, a Dentists are allowed to promote their
reminder of duty to exercise proper care, practices through websites but they are
an admonition or even a restriction on the required to respect the legislation on Data
right to practise dentistry. Protection and Electronic Commerce.
There are also local consumer Insurance and professional indemnity

Ombudsmen. When a problem arises, a
consumer can get in touch with the
Under the Patient Injuries Act 1987
consumer advisor in his or her own
(amended in May 1999), the aim was to
municipality. The advisor will provide the
withdraw from fault liability as a
consumer with information on his or her
prerequisite for compensation, i.e. “no-
position, consumer goods, their quality and
fault insurance”. Patient insurance is
marketing. Municipal consumer advice is
therefore compulsory for doctors and
provided free of charge.
dentists, and the Finnish Dental Association
provides an optional scheme for those
members who work in private practice. The
scheme provides cover for all patient
injuries caused during dental care. Within
this cover negligence is not a prerequisite
for compensation - no proof of malpractice
is needed and compensation is provided for
financial losses over €170 (thus excluding
insignificant injuries).
The insurance only covers bodily injuries

which are likely to have resulted from
treatment, so 100% certainty is not
necessary. However, the law does not
mean that all injuries that occurred in
connection with medical and dental
treatment are compensated for. In other
words, certain consequences that patients
might suffer were left outside of the scope
of this insurance.
When considering whether a consequence

could have been avoided, the evaluation is
based on the standard of an experienced
medical professional and top specialist
skills are not presumed.
Compensation is paid for bodily injuries

which are likely to result from treatment
__________________________________________________________________
153
2004_______________________________________
injury, a defect in the equipment, an dental practitioner would pay €444
infection which originated from treatment annually for this. Failure to insure by a
(in certain cases), an accident which is dentist leads to an eventual increased
connected with an examination or insurance premium – a penalty premium
treatment, wrongful delivery of may be as high as ten times the normal
pharmaceuticals or other unreasonable rate; in practice it is three times higher.
injury. Corporate Dentistry
The compensation covers medical and PlusTerveys is built only for dentists and
dental treatment expenses, other physicians, but other companies can vary
necessary expenses caused by the injury, and non-dentists may own or part own
loss of income, pain and suffering, these companies and share in any profits,
permanent functional defect and this is not being regulated.
permanent cosmetic injuries. Claims for
compensation have to be presented to the Health and Safety at Work
Patient Insurance Centre within three years
of the date at which patient has learned or There is legislation in the field of employee
should have known about the injury. protection. HepB vaccination is not
Notwithstanding this, compensation has to mandatory, however most dentists and
be claimed not later than ten years from dental nurses have had it administered.
the event that led to injury.
In 2001 the Patient Insurance Centre
received 430 claims from dental patients, For Administered by
61% from private sector and 39% from
public sector. 38% of these patients Ionising radiation Government owned
obtained compensation. Most common company
dental injuries were root canal perforations, Electrical Government owned
during root canal treatment, or nerve installations company
injuries connected to teeth extractions. Infection control National Agency for
Mean compensation was approximately Medicines www.nam.fi
€1700. Medical devices National Agency for
Medicines www.nam.fi
Fees for the insurance do not vary
according to the type of treatments Waste disposal Local municipality
undertaken by dentists. In 2003 a general government
__________________________________________________________________
154
Financial Matters
Finlan
d
Dentist 25 Dentist 45
years old or years old or
2 years 20 years
after after
qualificatio qualification
n
Liberal or General appr €35, 000 appr €50-

Practice 60,000
Hospital €45,000 €55 000
Public Health €45,000 €55,000
Academic €35,000 €45,000
The national insurance premiums (4.6% of earnings) include a contribution to the national
pension scheme. Retirement pensions in Finland are typically 60% of a person’s salary on
retirement. The official retirement age in Finland is 65, although the average age of retirement
is 59. Dentists practise, on average, to little over 60 years, although they can practise past
this age.
Most of general health care is paid directly through income tax.
Taxes
There is a national income tax (dependent on salary), a municipal tax (which varies according
to municipality: in Helsinki 17.5%) and a church tax (which church non-attenders do not have
to pay).

In addition to income tax, national insurance premiums are paid at 4.6% of salary, and
sickness insurance fees are paid at 1.5% of salary.
VAT/sales tax
There is a value added tax, payable at a rate of 22% on purchases. Medical and dental
services are not included.
Various Financial Comparators @ July 2003 (Source: UBS August 2003)
Zurich = 100 Helsinki

Prices (excluding 86.1
rent)
Power
2004_______________________________________
Finlan
d
Main national associations and Information Centre:
Suomen Hammaslääkäriliitto Specialist associations and societies:
(Finnish Dental Association) Dentists’ scientific organisation:
Fabianinkatu 9 B Finnish Dental Society Apollonia
00130 Helsinki, FINLAND Bulevardi 30 B
Tel: +358 9 622 0250 00120 Helsinki, FINLAND
Fax: +358 9 622 3050 Tel: +358 9 680 3120
Email: hammas@fimnet.fi Fax: +358 9 646 263
Website: www.hammaslaakariliitto.fi E-mail: toimisto@hmlseura.fi
Website: www.apollonia.fi
National Research and Development
Centre
for Welfare and Health (STAKES)
PO Box 220
00531 Helsinki, FINLAND
Tel: +358 9 36 671
Fax: +358 9 761 307
Website: www.stakes.fi
National Authority for Medicolegal The Finnish Dental Journal
Affairs (Suomen Hammaslääkärilehti-Finlands
PO Box 265 Tandläkartidning- Finnish Dental Journal)
00531 Helsinki Fabianinkatu 9 B,
Finland 00130 Helsinki, FINLAND
Tel: +358 9 7729 20 Email: hammas@fimnet.fi
Fax: +358 9 7729 2138 Homepage: www.hammaslaakariliitto.fi
Email:
Website:
Dental Schools:
Helsinki Turku
University of Helsinki University of Turku
Department of Dentistry Department of Dentistry
Mannerheimintie 172 Lemminkäisenkatu, 2
POB 41 20520 Turku, Finland
00014 Helsingin yliopisto, Finland Tel: +358 2 333 81
Tel: +358 9 1911 Fax: +358 2 333 8413
Fax: +358 9 1912 7519 E-mail: jorma.tenovuo@utu.fin
E-mail: jukka.meurman@helsinki.fi Website: www.utu.fi/med/dent/
Website: www.Helsinki.fi Dentists graduating each year:
Dentists graduating each year: 30 Number of students:
Oulu
University of Oulu
Department of Dentistry
Aapistie 3
90220 Oulu, Finland
Tel: +358 8 537 5011
Fax: +358 8 537 5560
E-mail: sinikka.vuoti@oulu.fi
Website: www.oulu.fi/hamm
Dentists graduating each year:
Number of students:
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France
Population 60.2
million (2003)
Currency Euros
(Active) dental surgeon to population ratio
1:1,489
Franc
Main language French
e
The social insurance system is established by law and is
divided into 3 major branches, the Sickness Funds
(Assurance Maladie), Pension (Retraite) and Family
(Allocations Familiales). Each of these is managed by
Councils which are independent of the state. Most oral
healthcare is provided by ‘liberal practitioners’ according
to an agreement called the Convention. Almost all
chirurgien-dentistes (dental surgeons) - 98% - practise
within the Convention. There are about 40,000
practising dental surgeons, all compulsory registered in
the Ordre National. The main professional union for
dental surgeons is the Confédération Nationale des
Government and healthcare in France

France is a democratic republic with a The social insurance system was
President, elected by universal suffrage. established by law in 1945 and is divided
There is a bicameral Parliament or into three major branches, the Sickness
Parlement, which consists of the Senate or Funds (Assurance Maladie), Pension
Senat (321 seats - members are indirectly (Retraite) and Family (Allocations
elected by an electoral college to serve Familiales). Each of these is managed by
nine-year terms; elected by thirds every Councils which are independent of the
three years) and the National Assembly or state. The councils are made up of
Assemblée Nationale (577 seats - members representatives of the employers and
are elected by popular vote under a single- employees who finance the systems. The
member majoritarian system to serve five- Caisse d’Assurance Maladie of the sickness
year terms). There is a third chamber, le branch, is administered by a board with an
Conseil Economique et Social, the elected president and a government-
Economic and Social Council, with an appointed director. Social security is a
advisory function, composed of “private law
representatives of the associations and the
professional world. The liberal professions
are represented and two dental surgeons
have a seat within this Council.
Although the organisation of government is

centralised, two political and administrative
structures exist below the national level
where there are 22 regions and 100
departments (including 4 overseas). Most
French institutions exhibit strong liberal
traditions and this is mainly reflected in the
medical and dental professions. The
population is 60,180,529 (2003). The four
Overseas Territories (Nouvelle Calédonie,
Polynésie Française, Wallis-et-Futuna) are
fully part of the French Republic. However,
territorial governments are totally
independent in the field of health.
__________________________________________________________________
159
2004_______________________________________
France
association”, under the control of the state. the State and local collectives, 12.2% by
private insurance and 11.1% of costs were
Since reforms in 1996, the social insurance paid by the insured individuals (co-
system functions in the following way. payments).
Every year a conference of national health
officials makes recommendations, in Generally, hospital expenses are paid by an
consultation with the health professions, individual’s insurers, and primary care
after which the government prepares a costs directly by the patient who is then
plan, which is submitted to Parliament. reimbursed by the sickness fund, in part or
The Parliament discusses and votes on the in full.
plan, which includes the new annual
budgets of the sickness funds. Finally the In 2001, approximately 91% of hospital
government invites the Caisse d’Assurance expenses were
Maladie to implement the approved
proposals and the ‘Caisse’ translates the
agreement into individual plans for each
health discipline, including dentistry. Work
beginning in June 2004, a great reform of
social protection, may question this
functioning.
Within the Assurance Maladie there are

three major Caisses: the CNAMTS (Caisse
Nationale d’Assurance Maladie des
Travailleurs Salariés), which covers salaried
workers and their dependants (82% of the
total population); the CANAM (Caisse
Nationale d’Assurance Maladie des
Professions Indépendantes) for
independent professionals; and the UCCMA
(Union des Caisses Centrales de la
Mutualité Agricole) for agricultural workers.
The Assurance Maladie itself is funded by
personal contributions and income tax.
All citizens have an equal and

constitutional right to receive healthcare,
and the system is organised in the same
way throughout the country. Every
individual is automatically affiliated to one
of the three caisses according to their
economic status. This obligatory insurance
gives them the right to be totally or
partially reimbursed for their health
expenses including dental treatment for
themselves and their dependants. In 2001,
76.7% of the total national expenditure on
healthcare was covered by social security,
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__ ____EU Manual of
covered, compared with 64.2% of expenses 9.5%. Of this expenditure, 76% was
for ambulatory care and medicines. “public” (OECD Feb 2004).
Oral healthcare
Public compulsory health conservation and prosthodontics,

insurance respectively.
Most oral healthcare is provided by ‘liberal A Universal Sickness Insurance (Couverture

practitioners’ according to an agreement Maladie Universelle, CMU) was created on
called the Convention. Almost all dental 1st January 2000 to promote the access to
surgeons (98%) in France practise within care for the “weaker” part of the
the Convention. If a dental surgeon is not population. Practitioners are directly paid
in the Convention then the patient cannot by Social Security Caisses and
reclaim all or part of the cost. complementary insurances. The fees for
conservative and surgical care are set by
All those legally resident in France are the Convention. For prosthetics there is a
entitled to treatment under the Convention. different scale of fees. The fees for
Scaling and fluoride tablet administration is prosthetics have never been negotiated by
also reimbursed in full as one preventive the dental profession and are said to be
treatment. From the age of 13 to 19 years much inferior to the fees required for the
children can benefit for the next three economic well-being of dental practices.
years of their lives from an annual
prevention consultation which includes oral
hygiene and diet advice, prevention
measures such as sealants (till 14 years)
and, if necessary, a course of conservative
treatment. All fees (100%) for this care are
paid directly by the Sécurité Sociale to the
dental surgeon. If radiographs are
necessary, they are also reimbursed on a
contract price basis.
For conservative and surgical treatments

the practitioner must charge fees within
the agreement and the patient can reclaim
up to 70%. For other treatments e.g.
orthodontics and prosthodontics, dental
surgeons may set their own fees, having
informed the patient of the estimated cost.
The Caisse, subject to prior approval,
usually covers a part of these fees on the
basis of a scale which has remained
unchanged for more than 40 years. The
patient pays the whole fee to the dental
surgeon and is then issued with a form with
which to reclaim the relevant amount from
the Caisse. There is no restriction on how
often treatment can be received.
Within the Convention, each item of

treatment is allocated to a price category
or ‘quotation’. This is established by a
special commission attached to the Health
Minister (Commission de la Nomenclature
Générale des Actes Professionels). There
are four types of ‘quotation’ each with a
different monetary value set by the
Convention, for surgery, orthodontics,
__________________________________________________________________
161
2004_______________________________________
These fees have not been reviewed since such as those ill or disabled. Once
their creation on 1st January 2000. requested, a dental surgeon must provide
this care.
About two-thirds of the population visits a
France
dental surgeon at least once a year.
Total governmental spending on dentistry

was €7,114 billion in 2001, about 5.53% of
the total expenditure on health (€128,533
billion in 2003).
Private insurance for dental

care
Approximately 90% of people use
complementary insurance schemes, either
by voluntary membership or through the
CMU to cover all or part of their treatment.
There are many such schemes. The
financial risk is taken by the insurance
company. With regard to conservative and
surgical care, these complementary
insurances cover the 30% of the fees not
covered by mandatory insurance. For
prosthetic and orthodontics, these
complementary insurances cover at least
the 30% of the fees not covered by
mandatory insurance. It is to be noted that
some of these schemes may cover more
than the responsibility costs of the social
security caisses.
There are two types of complementary

insurance: the “mutuelles”, covered by the
“code de la mutualité” and for which the
member, in most of the cases, has no need
to provide a health questionnaire; and
private insurances, covered by the
insurance code and for which the members
have, in most instances, to provide a health
questionnaire. The dental surgeon has no
role in selling those products.
The Quality of Care

The statutes for social insured citizens
allow patients to ask for the expertise of
the treatment received to be examined, if
he/she is not satisfied. These complaints
can be sent either to the Social Security
Caisses, or to the departmental Council of
the Ordre National, or follow a normal legal
procedure. In case of litigation, the
practitioner may be assisted by a
colleague. When it is a conventional
conflict, the case of the dental surgeon is
studied by a committee composed of
chirurgiens-dentistes conseils and of
representatives of professional
organisations, which have contracted to the
convention.
Domiciliary care can be provided on

request, by a limited number of patients,
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Undergraduate Training The list of dental surgeons is held primarily
by Departmental Dental Councils, but a
Access to dental studies is open after national list is also available. The Council
Baccalaureat (12 years of primary studies). has a consultative role in the monitoring of
Access to dental faculties is by examination educational standards in the universities.
at the end of the first year (in common with
medicine). The number of students Practitioners have to pay an annual charge
admitted to 2nd year is set annually by the in order to remain on the register (€306 in
Ministry in charge of Health together with 2003).
the Ministry in charge of Education. The
duration of dental studies is 6 years,
ending with an examination. A thesis in
necessary to obtain the title of doctor in
dental surgery and required to practise.
The 16 dental schools are all state funded.

For more information see dental schools. In
2004, student intake is 950 (an increase
over the previous figures of about 800 a
year, because of a predicted shortage of
dentists by 2010). The percentage of
females is over 50%. Since 1998 there
have been about 800 graduates also each
year, but again the proportion of females is
unknown. In the 1990s the numbers of
graduates was higher (845 in 1996, 901 in
1995, 984 in 1994 and 1,050 in 1993).

the Chancellor of the University and the
Dean of the Faculty.
The degrees which may be included in the

register are:
Diplome d'état de chirurgien dentiste

(Dental Surgeon) – before 1972
or
Diplome d'état de docteur en chirurgie
dentaire (Doctor in Dental Surgery)
There is no post-qualification vocational

training in France.
Registration
One of the functions of the Ordre National

is to administer the registration of dental
surgeons. It ensures that the dental
surgeon has the legally required diploma. It
also controls processes of de-registration
for disciplinary or health reasons.
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education during his professional life. Since
March 2003, the convention signed with
A further role of the Ordre National is to the social security caisses mentions a non-
check the conditions of registration of mandatory, conventional continuing
foreign dentists (automatic recognition) education for the dental surgeons who
including appropriate diploma and French have contracted with the convention. In the
language ability. case of a legal litigation against a
practitioner, proof of participation in
Stomatologists continuing education will be more
favourable to him/her, and indeed since
October 2003 participation in continuing
Stomatologists are doctors specialised in
education has been written into the law.
stomatological sciences (medical
specialty). They provide the same care as
Specialist Training
qualified dental surgeons, plus cervical and
facial surgery. The duration of their training
France has one recognised dental specialty
is 6 years (medical studies) plus 4 years of
- Orthodontics. The Ordre National and
specialist internship. They then obtain a
other professional organisations agreed (in
diploma of doctor in medicine plus a
2003) to introduce the specialty of Oral
diploma of qualification (DES Diploma of
Surgery as soon as legislation permits.
Specialised Studies).
Training for the speciality in orthodontics
lasts for four years, part-time and takes
In 2003 they were still being trained. There
place in university clinics. A national
is no minimum time before they gain
specialist diploma is then awarded by the
“Acquired Rights” to work in other EU
authority recognised competent for this
countries – it depends on the recognition of
purpose: “Certificat d’études cliniques
this medical specialty in the host country.
spéciales, mention orthodontie”.
The professional title is: “Médecin
The professional title is: “ chirurgien-
spécialiste qualifié en stomatologie”
dentiste spécialiste qualifié en orthopédie
dento-faciale”
Specialist Training Oral Maxillo-facial surgery is a specialty
under the Medical Directives. They receive
Continuing education the title: “Médecin spécialiste qualifié en
stomatologie” (as noted above).
The ethical code gives the moral duty to
every practitioner to undertake continuing
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Workforce
Dentists
surgeons are registered on the special list
There were 42,541 dental surgeons on the
of the Ordre National. This list includes, on
register in 2002 of whom 28,002 were men
a voluntary basis, dental surgeons who
(66%) and 14,519 (34%) were women. The
have emigrated without knowing whether
number of students admitted to 2nd year of
they will practise dentistry once out of the
dental studies has been stable since 1998
country.
because of the numerus clausus, but, in
2003 an increase to 850 was decided by
Specialists
the public authorities, because of a
predicted shortage of dental surgeons by
Only one dental specialty is recognised in
2010.
France – orthodontics. There are 1,834
dental surgeons specialising in
orthodontics, 4.3% of all dental
Total 42,541 practitioners (2003). Most orthodontists
In active practice 40,423 work in private practice. There is no referral
General (liberal) 36,961 system in France for access to specialists –
practice patients may go directly to them.
Hospitals 200
There are specialists in Maxillo-Facial
University 250 Surgery, but, as stated earlier, this is a
Armed Forces 42 medical specialty. Oral surgery in due
Salaried dentists* 2,661 course will become a dental specialty.
Stomatologists 1,461
* they may be employed by a Auxiliaries
liberal dentist in a private
practice. About 2,144 worked in In France no auxiliaries are allowed to work
local communities – mutuelles in the mouth. The only recognised
and centres municipaux auxiliary personnel are dental assistants,
receptionists and dental technicians.
The population per active dental surgeon Dental Technicians

was 1,489 (2002).
Dental technicians (prothesistes dentaires
It was reported by the CNSD that there de laboratoire) do not need to be
were no unemployed dental surgeons in registered. They undertake a minimum 3
2003 years training in laboratories and schools.
They have no direct contact with patients,
Movement of dentists working under the prescription of the
dental surgeon.
In 2002, 850 foreign dentists were
practising in France. Most dental surgeons use independent
laboratories and there are 5,500 craft or
Total 850 industrial laboratories employing about
EU graduates 355 14,000 salaried workers (2003). Some
practitioners employ technicians directly in
EEA graduates 14
their own private laboratories.
Reciprocal 359
arrangements* There is a reported problem in the France
Others (Minister’s 122 with illegal denturists/clinical dental
discretion) technicians – prosecutions are mounted
each year by the CNSD – about 5 a year –
and on each occasion the technician has
* These are reciprocal arrangements with been found guilty of illegal practice.
the Central African Republic, the Republic
of Congo, Chad, Gabon, Togo and Mali. Dental Assistants
Although the exact number of French Dental assistants qualify after 2 years
dental surgeons currently practising abroad alternative training in dental practice and
is unknown, 265 French dental one of 7 schools. This training is mainly
governed by a “parity” body: the
Commission Nationale de Qualification
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165
2004_______________________________________
(CNQAOS). It is estimated that there are
16,500 assistants (2003).
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Practice in France
Working in Liberal (General) special geographical areas, the
Practice practitioners can get tax deductions
Funding and Remuneration

In 2002, about 87% of dental surgeons
worked in “liberal practice”; that is on their Oral Healthcare in France is penalised by a
own or in association with one or more fee scale that is out of date and has not
other dental surgeons. Liberal practitioners adapted to new techniques and new
earn their living entirely through fees from materials. It is estimated that remuneration
their patients. at the level of endodontic care in France is
one and a half to two times less than in
many other countries. Above all,
It is compulsory for dental surgeons remuneration takes little account of the
working in the same practice to be in a real cost which should be calculated
contract with each other. The Ordre depending on the technical difficulty and
National produces different types of time required for each treatment. On the
collaboration and association agreements other hand, prosthetic fees are higher in
and has a register of agreed contracts. For France than in other countries but the
a practice’s employees the dental surgeon coverage by statutory insurance is very
must respect an employment code which small. In general, the percentage of
regulates all types of worker and covers available funding distributed to sectors of
equal employment opportunities, maternity dentistry in France is 60% for general care
benefits, occupational health, legal and surgery, 35% for prosthetics and 5%
duration of work (35 h/week), minimum for orthodontics. Dental surgeons working
vacations and health and safety. under the convention benefit from social
Furthermore, they must respect the
collective agreement, which regulates the
employment of all staff covering for
example continuing education, and salary.
Collective agreements are negotiated
jointly by dental organisations and
employees unions.
A dental surgeon would normally look after

about 1,500 patients on his “list”. An adult
patient would normally attend an average
of about 1.5 times every year.

associate dental surgeons or other staff.
Dental surgeons can work on their own, in
association or with an assistant-dental
surgeon, but a dental surgeon may only
have one assistant.
Premises may be rented or owned.

Generally new practitioners buy the
practice of a retiring dental surgeon. When
negotiating the price three elements are
included, the building, the equipment
(which can be set against tax), and the
right of access to the existing patient list.
The value of the last factor is based upon
the previous three or four years of
accounts. There is no state assistance for
establishing a new practice, so dental
surgeons must take out commercial loans
with a bank. However, in some suburbs or
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competitive examination. Hospitals also
advantages in the fields of retirement employ Attachés, who work only a few
pensions and social protection. hours a week and may run their own
private practise outside the hospital. Part-
Average net earnings before tax in 2002 time odontologists may also work as liberal
were €47,651 to €75,531. practitioners outside the hospital.
Standards Working in Universities and

The Social Security Caisses ensure that the
Dental Faculties
“conventioned” practitioner has coded the
services provided according to the The education training of dental surgeons
Nomenclature Generale des Actes is carried out in Centres de Soins,
Professionnels, and the actual fees. The d’Enseignement et de Recherche Dentaires
practitioner is directly paid by the patient. (CSERD: Dental Care, Education, and
A signature proves that the dental surgeon Research Centres). There are 16 such
has been paid by the patient and is centres employing 250 dental surgeons in
required for reimbursement to the patient. University Hospitals. Their operation is
The dental surgeons Conseil of the Caisses financed jointly by the ministries
may check the conformity of the responsible for education
treatments with the current state of the
art. (See Ethics for further information)
Working in the Public Dental

Service
There is no real public dental service in

France. However, a small number of
practices are owned by the Caisses,
municipalities, or mutual insurance
companies (Mutuelles). About 5% of dental
surgeons (2,144) work in these practices,
are salaried, and can treat any kind of
patient. The organisations that own these
practices receive fees according to the
Convention. The Mutuelles are regulated
by a code (the Code de la Mutualité) which
allows them, among other things, to
advertise.
Every University Hospital Centre (CHU) has

a dental service for every type of patient
(in- or outpatients). Treatments can be
provided by hospital practitioners,
university-hospital practitioners and dental
students. There also can be dental services
in a CHU with no dental faculty.
The conditions which may be treated

include maxillo-dental pathologies, oral
pathologies and dental trauma. In some
regional hospitals, these facilities will
include a “general odontology”
department. The dental surgeons in
charge of these departments are recruited
through a national competitive
examination. Dental surgeons employed in
hospitals may be part- or full-time, and will
usually have the title Odontologiste des
Hôpitaux (Hospital Odontologist) and are
also recruited through a national
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and health. The Hospitals provide clinical Professeurs des Universités - Praticiens
experience and the universities theoretical Hospitaliers who are recruited through
France
and practical education. However, staff national competitive examinations, and are
typically have a function in both hospital usually less than 55 years old. They work
and university and receive a salary for part-time and have spent at least three
each, as well as having some research years as a Maître de Conférence and
responsibilities. Staff may be employed as: obtained a certificate of ability to conduct
research (Habilitation à diriger des
Assistants Hospitaliers Universitaires are recherches) or a doctorate (Doctorat
recruited through local competitive d’Etat).
examinations and are appointed for a
limited period of 4 years, without Other practitioners may also take part in
permanent tenure. They are employed the training of dental surgeons. They are
part-time (20 hours per week) and usually recruited directly by the hospital centre or
have a Masters degree in biological and university and work as Chargés
medical sciences. d’Enseignement (junior lecturer) for
theoretical or clinical courses, or as
Maîtres de Conférence des Universités - Attachés Hospitaliers for limited periods.
Praticiens Hospitaliers who are recruited These practitioners, as well as part-time
through national competitive examinations, Hospitalo-Universitaires, may also continue
less than 45 years old, and have tenure work as dental surgeons within their own
after one year as a trainee. The posts are practice.
either part-time or full-time and staff will
normally have worked for at least two Working in the Armed Forces
years as an assistant and have obtained a
Diplôme d’Etudes Approfondies which is an
additional Postgraduate Diploma. In 2003, 42 dental surgeons served full-
time in the Armed Forces – the number of
females is not recorded.
Professional associations • Oral health prevention
The main professional union for dental • Taxes
surgeons, with about 17,000 members, is the • Pension
Confédération Nationale des Syndicats • Training of the dental staff
Dentaires (CNSD) founded in 1935, • International affairs
encapsulating 100 departmental unions,
representing about 50% of the practising The French Dental Association (ADF),
dental surgeons in France. For details of how founded in 1970, embraces the whole dental
to contact the CNSD, click here. profession in France (liberal dental surgeons,
specialists, academics, hospital, individual
It is the privileged partner with the members of professional unions, scientific
government in planning oral healthcare. The societies etc). The 2002/03 FDI Annual
CNSD is also conventional partner with the Report reports 20,800 French dental
Caisses and is recognised as the surgeons as members.
representative union by the public
authorities; as such, the CNSD is able to deal
with every aspect of dental health politics.
The CNSD through its structures and

commissions supports and defends the
dental practitioners, by analysing all issues
influencing dental practice. On this basis, it
defines strategies and politics in the fields of:
• Initial dental education

• Professional capacity
• Professional demography
• Professional practice and definition of
the relationship with public authorities and
social structures
• Continuing education
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2004_______________________________________
• It controls access to the profession by
The ADF is managed by a conseil registration process: administrative
d’administration, composed of all the competence
member organisations and a board of 12 • Its steps in the regulation of the
directors elected for 3 years. A general profession according to legal methods: lawful
assembly defines the action programme competence
every year, upon a proposal of the board of • It controls the profession and more
directors. Statutory commissions work on specifically at a disciplinary level:
permanent issues (institutional, legal, jurisdictional competence.
technical) of the profession: annual congress
organisation, continuing education, The Order achieves its missions through
international affairs, information, departmental councils, regional or
professional legislation, hospital-university interregional councils and the National
life. Advisory commissions work on specific council. There are two levels of jurisdiction:
issues such as health economics, medical the regional council (first level) and the
devices, quality etc. disciplinary chamber of the national council
(appeal level). Over all, the Conseil d’Etat
To contact the ADF, click here. can broker an appeal decision on its formal
and proceeding aspects. Sanctions may be a
Ethics simple warning, up to the banning from
practice.
Ethical Code
The Ethical Code covers the contract with
The organisation of the profession concerns the patient, consent and confidentiality,
the Ordre National des Chirurgiens- continuing education, relationships and
Dentistes, entrusted by law with a mission of behaviour between dental surgeons and
public service. To contact the Ordre, click advertising.
here.
Under normal judicial procedures, a court
The Order compulsorily covers all dental makes a judgement based on evidence from
practitioners in France (departments and an expert witness
overseas territories included), whatever the
form of practice, and its central finality is All dental practitioners elect the members of
patients’ and public health protection. their departmental councils. The members of
the departmental council elect the regional
The law defines the competencies and the councillors. The departmental councillors in a
roles of the Order. It watches the respect of region or inter-region elect the National
the principles of morality, probity, councillors.
competence and devotion, essential to the
practice of the profession and of the Advertising
professional duties and rules observation
enacted by the Code of Public Health and General guidance is given in Article 12 of the
Ethical Code. It ensures the defence of the Code of Ethics which states that dental
profession’s honour and its independence. It surgeons are “notably forbidden any form of
studies questions and projects submitted by direct or indirect advertising”. This is further
the Ministry for Health, or the Ministry for developed in:
Education, and represents the profession
with national and European authorities. Article 13: defines information that a dental
surgeon is allowed to put in the telephone
To achieve this, the Order has three main book as: “surname, first names, address,
prerogatives: telephone and fax numbers, opening hours,
speciality”. Any entry that is charged for is
considered as advertising and is thus
forbidden.
Article 14: defines information that a dental

surgeon is allowed to mention on a
professional plaque at the entrance of a
building, or practice, with the professional
title of “chirurgien-dentiste”, and: “surname,
first names and speciality”. The dental
surgeon must add the name and location of
the establishment or examining board which
awarded his/her diploma, and may add the
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opening hours and the floor and telephone data protection and are the corner stones of
number of the practice. a Charter edicted by the Ordre, whose aim is
the regulation of the publicity on
A dental surgeon may operate a website, but professional websites.
only according to the recommendations of
the Ordre National. Indemnity Insurance
Data Protection Liability insurance is compulsory for all

health professions since a law in March 2002
By 2004 France had still not fully was enacted. For CNSD members, it is
implemented the Data Protection Directive. included as a part of association membership
Only the Senate had adopted a draft law, in as a group insurance. Different insurance
April 2003. companies provide professional civil liability
cover for a dental surgeon’s patients during
However, for health data protection, Articles their working life. There are different prices
5, 5.1 and 5.2 of the Ethical Code give for different types of practice. For example a
guidance for professional secret and liberal practitioner who is a CNSD member
personal health data protection as well as for will pay €115 annually, plus a €230 implant
the dental surgeon and his employees. supplement, while non members will be
Consultation is not allowed on line. The law charged €290 for civil and professional
and the Code of Ethics regulate health liability with legal assistance, or €715 with
personal implantology and €175 and €600
respectively without legal assistance (2003
fees).
Corporate Dentistry
Dental surgeons may run practices as

corporates, on their own or in association
with others. However, a non-dentist cannot
be a part or full owner of a practice, except
in the case of a Société d'Exercice Libéral
(SEL, which is an incorporated practice),
where an ayant-droit (legal successor) of a
dead dentist can inherit the practice for five
years. After that time, and if the ayant droit
is not successful in the practice, he or she
must sell his or her participation. This is new
rule.
Other than this, when a dental surgeon dies,

non-dentist successors do not have the right
to own a practice. However, they can be
allowed by the Ordre National to contract
with a dental surgeon manager during a
variable time, allowing them to sell the
practice in the best possible way, or if one of
the successors had started a course in dental
education, to wait the end of the course.
An individual who, in a public or private care

or prevention establishment, practises a
professional activity exposing him/her to
contamination risks, has to be immunised
against Hepatitis B, diphtheria, tetanus, and
poliomyelitis (it means anybody working in
the practice, staff or dental surgeon). This is
supervised by the Health General Direction.
For Administered by
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171
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France
Ionising radiation Independent body (OPRI*)
Electrical Local town planning
installations authority
Waste disposal Direction Regionales des
Affaires Sanitaires et
Sociales (DRASS)
Medical devices Health General Direction
Infection control Health General Direction
*OPRI: Office de protection contre les

rayonnements ionisants, which is dependent
on the Health Ministry
Financial Matters
The income ranges dental surgeons would have expected to earn in 2002 (in Euros):

years old or 2 old or 20 years
years after after
qualification qualification
Liberal or General €47,651 €75,531

Practice
The figures for other dental surgeons are not known
As non-salaried workers liberal dental surgeons contribute to a special retirement scheme, the
CARCD (Caisse Autonome de Retraite des Chirurgiens-Dentistes) which is a caisse attached to
the Ministry of Social Affairs. A basic dentists’ retirement pension scheme has been
established by law since 1948. It has been amended by the ‘Complementary Retirement
Scheme since 1955. The CARCD is administered by a board whose members are elected jointly
by the contributors and the beneficiaries.
The normal retirement age in France is 65, but they can practise beyond that age and there is
no legal age limitation.
In 2002, a dental surgeon who had made an annual contribution of €9,000 (at a 2002 value) for
40 years, received a retirement pension of about €38,000 per year.
Taxes
There is a national income tax, and also a general social tax (Contribution Sociale Généralisée -
CSG) and an additional tax on salaries called the Contribution destinée au Remboursement de
la Dette Sociale (RDS) which is planned to be implemented until 31 st January 2014. CDG and
CRDS are based on gross salaries, indemnities, allocations and bonus. They are calculated
before social security salaried contributions and other contributions.
The highest rate of income tax is 49.58% on earnings over about €47,131.
VAT
Normal rate: 19.6% (alcohol, tobacco etc, and the rate charged to dental surgeons for
equipment, materials and instruments)
Reduced rate: 5.5% (food)
Super-reduced rate: 2.2% (refundable drugs)
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Zurich = 100 Paris

Power
(Source: UBS August 2003)
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173
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France
Main national associations:

Confédération Nationale des Syndicats Association Dentaire Française
Dentaires (CNSD) 7 rue Mariotte
22 Avenue de Villiers 75017 Paris
75017 Paris FRANCE
FRANCE Tel: +33 1 58 22 17 10
Tel: +33 1 56 79 2020 Fax: +33 1 58 22 17 40
Fax: +33 1 56 79 2029 Email: adf@adf.asso.fr
Email: genin@cnsd.fr Website: http://www.adf.asso.fr
Website: www.cnsd.fr
Competent Authority and information
centre:
Conseil National de l’Ordre des Chirurgien-
Dentistes
22 rue Emile Menier
75116 Paris
FRANCE
Tel: +33 1 44 34 78 80
Fax: +33 1 47 04 36 55
Email: europe@oncd.org
Website: www.ordre-chirurgiens-dentistes.fr
Publications with information on
vacancies for dentists:
Le Chirurgien-Dentiste de France
22 Avenue de Villiers
75017 PARIS
Tel: +33 1 56 79 2052
Fax: +33 1 56 79 8049
Email: cdf@cnsd.fr
Website: www.cnsd.fr
MACSF, Service Assurance Dentaire
Tel: +33 1 40 68 80 92
Fax: +33 1 40 68 88 92
E-mail:
Website: www.macsf.fr
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Dental Schools:
Paris Paris
Université Paris V (René Descartes) Université Paris 7 (Denis Diderot)
Faculté de Chirurgie-Dentaire de Paris V Faculté de Chirurgie Dentaire de Paris 7,
1 rue Maurice Arnoux UFR d’Odontologie
92120 Montrouge, Paris 5, rue Garancière,
Tel: +33 1 58 07 67 00 75006 Paris
Fax: +33 1 58 07 68 99 Tel: +33 153 10 5010
Email: bernardpellat@odontologie.univ-paris5.fr Fax: +33 153 10 5011
Website: http://www.univ-paris5 Email: mandree@ccr.jussieu.fr
Bordeaux Brest
Université Victor Segalen Bordeaux II UFR Université de Bretagne Occidentale
d’Odontologie Faculté d’Odonotologie de Brest
16, cours de la Marne 22 avenue Camille Desmoulins
33082 Bordeaux Cedex 29271 Brest Cedex
Tel: +33 5 57 57 1800 Tel: +33 2 98 01 6489
Fax: +33 5 57 57 3010 Fax: +33 2 98 01 6932
Email: georges.dorignac@odonto.u-bordeaux2.fr
Clermont Ferrand Lille
UFR d’Odontologie Université de Lille 2 – Droit et Santé
11 boulevard Charles de Gaulle Faculté d‘Odontologie
63000 Clermont Ferrand Place de Verdun,
Tel: +33 4 73 43 64 00 59000 Lille
Fax: +33 4 73 17 73 09 Tel: +33 3 20 16 7900
Email: ufr-odontologie@u-clermont1.fr Email: lafforgue@pop.univ-lille2.fr
Website: http://webodonto.u-clermont1.fr
Lyon Marseille
Université Claude Bernard Lyon 1 Faculté d’Odontologie
Faculté d’Odontologie 27 Boulevard Jean Moulin
rue Guillaume Paradin 13385 Marseille Cedex 5
69372 Lyon Cedex 08 Tel: +33 4 91 78 4670
Tel: +33 4 78 77 8600 Fax: +33 4 91 78 2343
Email: doury@laennec.univ-lyon1.fr Email: salvador@odontologie.univ-mrs.fr
Website: http://molaire.timone.univ-mrs.fr
Montpellier Nancy
Faculté d’Odontologie Université Montpellier 1 Faculté de Chirurgie Dentaire –
545 avenue du Professeur J.L. Viala UFR d’Odontologie
BP4305, 96 av du Ml de Lattre de Tassigny, BP3034,
34193 Montpellier Cedex 5 54012 Nancy Cedex
Tel: +33 4 67 10 4470 Tel: +33 3 83 36 34 00
Fax: + 33 4 67 10 4582 Fax: +33 3 83 35 4101
Nantes Nice
Faculté de Chirurgie Dentaire–UFR d’Odontologie Faculté de Chirurgie Dentaire UFR d’Odontologie
1 Place Alexis Ricordeau, BP84215, Parc Valrose, ave Joseph Vallot
44042 Nantes Cedex 2 06108 Nice Cedex 2
Tel: +33 2 40 41 2901 Tel: +33 4 92 07 6986
Fax: +33 2 40 20 1867 Fax: +33 4 93 52 9968
Reims Rennes
Faculté de Chirurgie Dentaire Faculté de Chirurgie Dentaire
2 rue du Général Koenig UFR d’Odontologie
51100 Reims 2 Place Pasteur,
Tel: +33 3 26 05 3450 35000 Rennes
Tel: +33 2 99 63 1955
Fax: +33 2 99 38 1745
Strasbourg Toulouse
Faculté de Chirurgie Dentaire de l’Université Faculté de Chirurgie Dentaire UFR d’Odontologie
Louis Pasteur – Strasbourg 1 Toulouse III – Université Paul Sabatier
1 Place de l’hôpital, 3 chemin des Maraichers
67000 Strasbourg 31062 Toulouse Cedex 4
Tel: +33 3 88 21 2621 Tel: +33 5 62 17 2929
Fax: +33 3 88 21 2620 Fax: +33 5 61 25 47 19
Email: resdental@adm.ups.tlse.fr
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Germany
(2002)
Currency Euros
Main language German
Germany
In Germany there is a long established insurance
based healthcare system of “sick funds”, which are
not for profit organisations. Almost 90% of the
population belong to one of the 355 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 a member of the
local Dental Chamber. The national federation of
Chambers is known as the
Bundeszahnärztekammer (BZAEK). The use of
Government and healthcare in Germany
Germany is an economically powerful Prime Minister) is elected by an absolute

country. The capital is Berlin. With a majority of the Federal Assembly for a four-
population of 82,398,326 (2002) the year term;
country represents over one sixth of the
In Germany there is a long-established
total population of the expanded EU. Its
statutory health insurance system where
Federal system of government delegates
health care depends on membership of a
most of the responsibility for expenditure
“sick fund”. Sick funds are state-approved
and many policy decisions to the regional
health insurance organisations, and there
level which also has additional powers to
are currently (2003) over 355 in the
raise local taxes.
country. As well as the state-approved sick
Germany has a bicameral Parliament, funds there are also private insurance
which consists of the Federal Assembly or organisations.
Bundestag (603 seats; elected by popular
vote under a system combining direct and
proportional representation; a party must
win 5% of the national vote or three direct
mandates to gain representation; members
serve four-year terms) and the Federal
Council or Bundesrat (69 votes; state
governments are directly represented by
votes; each has 3 to 6 votes depending on
population and are required to vote as a
block).
Elections for the Federal Assembly are held
every 4 years (or less). There are no
elections for the Bundesrat; the
composition is determined by the
composition of the state-level governments
so the Bundesrat has the potential to
change any time one of the 16 states
(Länder) holds an election
The President of Germany is elected for a
five-year term by a Federal Convention
including all members of the Federal
Assembly; the Chancellor (equivalent to
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The majority (88.5%) of the German
population are members of a sick fund,
which provides a legally prescribed
standard package of healthcare. The sick
funds are not ‘for profit’ organisations,
which employees with incomes less than
€3,375 gross/month must join. On average
the premiums paid are 13.8% of total
income up to a maximum of €3,375 (in
2002), of which the employer and
employee each contributes 50%. If an
individual is already a member of a sick
fund, when their income exceeds the
minimum, they may retain their
membership or change to a private
insurance scheme. However, the self-
employed, and those whose income
exceeds the minimum when they take up
their appointment, are excluded from
membership.
Most of the population who are not
members of legal sick funds are members
of private insurance schemes, which are
regulated by insurance law only and may
thus offer more flexible packages of care.
For example, the schemes carry all the
financial risks of treatment or reimburse
only a defined percentage of the costs and
the premiums vary according to the level of
cover required and the age or past health
of the member. Membership of a private
sick fund is also a personal contract, so
dependants must be separately insured.
The actual provision of health care in the
statutory system is managed jointly by the
sick funds, and the doctors’ and dentists’
organisations. As with many other aspects
of German government, this takes place at
both the Federal level and at the regional
level of the Länder.

10.7%. Of this expenditure, 74.9% was
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Oral healthcare
Public health care
The key organisations in oral healthcare delivery are:
Sick funds There are over 350 sick funds in Germany, organised broadly into five main groups.
They are self-governing state-approved not-for-profit insurance bodies, jointly managed
by employers’ and employees’ representatives. They generally insure employees and
their dependants whose incomes are less than a specified amount.
Private Insurances These are ‘for-profit organisations’ which may insure those who are not
compulsory members of a sick fund. The activities of the private insurance companies
are only regulated by general insurance law.
KZVs KZVs are the 22 self-governing regional authorities, which every dentist has to be a member of in
order to treat patients in the social security system. The KZVs are the key partners with
the sick funds, holding budgets and paying dentists.
KZBV This is the national legal entity, which together with the sick funds defines the standard package
of care benefits within the legal framework. It also provides support services for the
regional KZVs.
Dental Chambers The 17 Dental Chambers (Zahnärztekammern) at the Länder level are the traditional
professional associations (legal entities) with the overall responsibility for defending the
interests of the profession, but also with a duty to protect the public’s health. Every
dentist has to be a member of a Dental Chamber.
BZÄK The Bundeszahnärztekammer is the voluntary union of the Dental Chambers at a national level. It
represents the common interests of all dentists on a national and international level
FVDZ The Freier Verband Deutscher Zahnärzte e.V. (Liberal Association of German Dentists) promotes
and represents the professional interests of about one third of German dentists
The delivery of oral health care in the legally based system is organised by the Federal dental
authority (the Kassenzahnärztliche Bundesvereinigung or KZBV) nationally, and locally by the
regional dental authorities (the Kassenzahnärztliche Vereinigungen, or KZV) in partnership with
the sick funds. There are 22 KZVs within the 16 German Länder and they represent all the
dentists who can treat patients covered by a ‘sick fund’, and are therefore members. From
2005 these will be reduced to 17 KZVs (one for each Länder, with two for Nordrhein-Westfalen,
the largest state).
The main functions of the KZVs are:
• to ensure the provision of dental care to all members of sick funds and their dependants
• to supervise and control the duties of its member dentists
• to negotiate contracts with regional associations of sick funds
• to protect the rights of member dentists
• to establish and manage committees for the examination and admission of dentists, and
the resolution of disputes
• to collect the total fees from the sick funds and distribute them to member dentists
• to keep the dental register
• to appoint dental representatives on admission, appeal and contract committees and for
regional arbitration courts
Benefits in the legal system percent of the cost of the care. Advanced
treatment such as crowns and bridges,
In principle, membership of a statutory sick attract a contribution of 50% and
fund entitles all adults and children to orthodontics for children, 80 percent.
receive care from the statutory health Implantology is not included in the benefits.
insurance system. For radiographic In a typical year approximately 80 percent
investigation, examinations, diagnoses, of adults and 60 to 70 percent of children
fillings, inlays, oral surgery, preventive use the system.
treatments, periodontology and
endodontics, the sick funds pay 100
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Before seeking general care from the state
oral health system the patient must have a
voucher from the sick fund. This voucher is to care, and if care is given is also the
both a certificate to demonstrate dentist’s claim form. The patient hands the
entitlement voucher to the dentist at the first visit. The
dentist then treats the patient without
charging them and forwards the completed
vouchers quarterly to the KZV, which
checks the invoices, sends them to the
‘sick funds’, collects the money from the
‘funds’ and pays the total amount to the
practitioner. However, from January 2004,
for each dental visit per quarter adult
patients must pay a €10 “practice fee”,
which the dentist has to transfer to the
legal sick funds.
For prosthetic treatment all legally insured

persons may choose between a private
health insurance or the statutory scheme –
but it is mandatory to be insured in one or
the other.
Oral re-examinations would normally be

carried out for most adult patients on an
annual basis.
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The proportion of total governmental committee on guidelines for dental care
spending on healthcare spent on dentistry, (the Bundesausschuß). Both the sick funds
through the sick funds is about 9% (2003). and the federal authority for dental care
(the Kassenzahnärztliche
Private insurance for dental Bundesvereinigung) are represented on
this committee. Its main role is to establish
care within the legal framework the range of
Persons not required or not entitled to treatments which are necessary and can be
participate in the statutory scheme can legally provided as a part of the sick fund
apply for insurance cover from a private system. This includes approving new
health insurance company – for example, treatments or the use of new materials.
freelance workers and members of the Another responsibility of the committee is
liberal professions, civil servants and to determine the value of any treatment
employees with incomes above the limit for relative to other items of care.
compulsory insurance. The content of cover
is contractually agreed and flexible - that is Routine monitoring is carried out by the
to say part cover can be taken out if KZV and consists of checking invoices and
required. the amount of work provided by each
dentist. Those carrying out substantially
As at the end of 2001, 7.7 million people more or less than the average of particular
had comprehensive private health treatments are required to explain the
insurance policies. In 2003, there were anomaly. Other measures of quality are
about 90 private health insurers, with the patient complaints (see below) and expert
legal form either of public limited opinion procedures.
companies or of mutual insurance funds,
organised on a cooperative basis. The For dentists in free practice the controls for
private health insurance companies differ monitoring the standard of care are those
appreciably in economic significance and described above. The same monitoring
size - the three largest companies, with framework also applies for patients who
some 3.3 million comprehensively insured pay the whole cost of care themselves;
persons, account for more than 40% of the their bills do not need to be submitted to
total. any external body for approval, but
influence is exercised by the insurance
Less than 2% of all dentists in private companies who reimburse the invoices.
practice treat only patients with private The threat of patient complaints has a
insurance schemes, that is to say they direct effect on the quality of care for most
have no contract with the statutory dentists.
sickness funds.
Domiciliary (home) care is undertaken by
The Quality of Care dentists in free practice for their patients at
home, or they may have a contract with a
residential home for the elderly or another
The standards of dental care are monitored
institution.
by a federal

Undergraduate Training In 2002, there were 1,396 places at the
publicly funded dental schools, for entry
each year (thus, excluding any figures for
the private university at Witten-Herdecke).
have passed the general qualification for
However, more students actually enter
university entrance (Abitur/ Allgemeine
dental schools, because there are more
Hochschulreife) and a successful result in a
applicants and dental schools are forced to
Medical Courses Qualifying Test.
accept the excess students (Numerus
Clausus) who pass the entrance
There are 31 dental schools, 30 of them
examinations. So, the real number of
publicly funded and part of the Colleges of
students entering dental schools in 2001
Medicine of universities. There is only one
was 2,365, and the estimated number of all
private dental school, in Witten-Herdecke.
dental undergraduates is approximately
The undergraduate course lasts 5 years.
10,000. The actual number of dental
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graduates in the year 2001 was 1,713
(almost 50% female).
provided by control mechanisms and
regulations of the universities, and the
Ministry of Science and Education in each
state.

the register is: Zeugnis über die
zahnärztliche Staatsprüfung (the State
examination certificate in dentistry).
In order to register as a dentist in Germany,

and provide care within the legal sick fund
system, a German dentist with a German
diploma must have two years of approved
supervised experience. This is in addition to
the five years of a university dental
training. A dentist can then apply to the
admission committee of the
Kassenzahnärztliche Vereinigungen (KZV).
The conduct of an independent dental

practice providing treatment under the
statutory health insurance scheme
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demands extensive professional and minimum number of 120 to 150 points are
management knowledge and skills: obtained.
knowledge of law applicable to health
insurance practitioners and to the The new legislation on health care (decided
profession, as well as of management, of in September 2003: Gesundheitssystem-
Germa
educational skills for the training of dental Modernisierungsgesetz, GMG)

auxiliaries, organisational talent in the
ny
conduct of a practice and familiarity with

the institutions involved in dental self-
government and their functions. Hence
work as an assistant is intended principally
to prepare young dentists to cope with the
many different kinds of problems
associated with the running of a practice of
their own.
There is no obligatory formal training for

the assistants – however, courses on a
voluntary basis are offered to assistants
where a broad and systematic knowledge
in all aspects of running a practice are
offered by most of the dental chambers.
There is no leaving examination - it is
sufficient to prove the participation as an
assistant for two years, to the admission
committee. Assistants working only part
time have to do more than 2 years.
Dentists from EU member countries with an

EU diploma are not required to have the
additional two years experience, but must
participate in the introductory seminar.
Registration
Applications to the KZV have to be

supported by degree certificates, a letter of
good standing from the dentist’s current
registering body.
There is a legal requirement to be able to

understand German in order to
communicate with patients.

Specialist Training
In Germany there is an ethical obligation to

participate in continuing education. The
costs for participation in continuing
education courses are deductible from
income tax as a practice expense.
The German Dental Association in

cooperation with most dental chambers on
state (Länder) level and the DGZMK (German
Society of Dento-Maxillo-Facial Sciences)
have agreed on a points system for
assessing participation in CE. A certificate of
CE is awarded after three years of
participation in the relevant forms of CE, if a
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introduced from January 2004 compulsory Oralchirurgie/Mundchirurgie' (certificate of
CE, and regular monitoring in the form of oral surgery), issued by the
recertification, after a 5 years period. The 'Landeszahnärztekammern’. For
content and amount of the compulsory CE periodontists the same as for orthodontists
is expected to be defined by the KZBV, in and oral surgeons (certificate of
agreement with BZÄK, by June 2004. periodontology issued by the
Zahnärztekammer Westfalen-Lippe) is
Specialist Training awarded, for Dental Public Health the
dentist will receive the title “Zahnarzt für
Four dental specialties are recognised, Öffentliches Gesundheitswesen”, if he has
although not in all seventeen Länder: passed an examination at a academy for
public health (Akademie für Öffentliches
• Oral Surgery Gesundheitswesen).
• Orthodontics
• Periodontology In principle, there is no limitation in the
• Dental Public Health number of trainees, because there are
sufficient dentists in free practice with the
Periodontology is only recognised in permission to train a dentist in
Westfalen. orthodontics or oral surgery. However,
since all dentists who want to specialise
Training for all specialties lasts four years have to attend one year at the university,
and takes place in University clinics or there is in fact a limitation in the number
recognised training practices, except dental of trainees. The trainee has the status of
public health, which trains in its own an employee and gets a salary from his or
environment. An orthodontist would receive her employer (the dentist in free practice
the 'Fachzahnärztliche Anerkennung fur with the special permission to train
Kieferorthopadie' (certificate of specialising dentists, the university or a
orthodontist), issued by the hospital). After completion of the
'Landeszahnärztekammern' (Chamber of specialised training the trainee has to pass
Dental Practitioners of the 'Länder'), as the an examination organized and in the
outcome to training. Similarly, an oral responsibility of the dental chamber. He or
surgeon would receive the she then gets the approval as specialist.
'Fachzahnärztliche Anerkennung fur He or she is registered by the dental
chamber as a specialist.
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Workforce
Dentists specialists to other dentists in Germany
and there is no compulsory referral system
In 2002 there were 40,526 (63%) male for access to them. In general, patients are
dentists and 23,768 (37%) female dentists referred from the general dentist to a
working in Germany. Just over 1,700 new specialist, however the patient may also
dentists graduate each year and the visit the specialist without referral.
numbers of dentists are increasing.
However, this growth has slowed in the
early years of the century. The BZAEK
believe that there are too many dentists (in
2003).

Liberal practice 61,361
Hospital Perhaps 200
University 2,100
Armed Forces 447
Other Approx. 25
The (active) dentist to population ratio

was 1,281 (2002).
There is some small reported

unemployment amongst dentists in
Germany.
Movement of dentists across

borders
Immigration figures relating to the

movement of dentists across German
border show 2,994 dentists entered
Germany in 2002.
Specialists
Specialists work mainly in private practice,

hospitals and universities but those
specialists in dental public health are
largely located in the public dental service
or are employed directly by the sick funds.
There are many regional associations and
societies for specialists.
Numbers of
specialists (2002)
Orthodontists 3,266
Oral Surgeons 1,456
Periodontologists Ca. 40
Dental Public Health 450
There are no limitations on the ratio of
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Auxiliaries • Zahnmedizinische
In Germany, auxiliary personnel can only Verwaltungsassistentin (ZMV):
work under the supervision of a dentist, requires a minimum 350 hours
who is always responsible for the training at a Dental Chamber, and
treatment of the patient. They cannot their duties include support in
practise independently. The range of organisation, filing and training of
auxiliaries is fairly complex, leading Zahnmedizinische Fachangestellte.
progressively (with training) from chairside
assistant (Zahnmedizinische There is no available data about numbers
Fachangestellte) to Dental Hygienist. of each group.
Registered Zahnmedizinische
Fachangestellte may qualify as
Numbers of
Zahnmedizinische Fachassistentin (ZMF),
auxiliaries (2002)
Zahnmedizinische Verwaltungsassistentin
(ZMV), Zahnmedizinische Hygienists ca 250
Prophylaxeassistentin (ZMP) or Dental Technicians ca 65,000
Hygienist. These registerable Chairside Assistants ca
qualifications do exist in almost all Länder 140,000
and are co-ordinated by the
Bundeszahnärztekammer.

(Zahnmedizinische Fachangestellte)
The main type of dental auxiliary is

Zahnmedizinische
Fachangestellte. After 3 years in
dental practice, attendance at a
vocational school and a
successful examination by the
Dental Chamber they are
awarded a registerable
qualification.
In 2002 there were about 140,000 Dental

Chairside Assistants.
Zahnmedizinische Fachassistenten
There are 3 grades of Zahnmedizinische

Fachassistenten: ZMF, ZMP and ZMV, all
specialisations of Dental Chairside
Assistants (Zahnmedizinische
Fachangestellte):
• Zahnmedizinische Fachassistentin
(ZMF): requires 700 hours training at
a Dental Chamber, and their duties
include support in prevention and
therapy, organisation and
administration, and training of
Zahnmedizinische Fachangestellte.
• Zahnmedizinische
Prophylaxeassistentin (ZMP):
requires a minimum 350 hours
training at a Dental Chamber, and
their duties include support in
prevention/prophylaxis, motivation
of patients and oral health
information.
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Dental Hygienists Dental Technicians (Zahntechniker)

ny
Dental technicians are also not permitted

To become a hygienist a student needs to
to treat patients. They train for 3 years,
undertake 3 years training and examination
40% in vocational school and 60% in the
as a dental chairside assistant and 300 -
dental laboratory. After a successful
700 hours training and examination as ZMP
examination by the Chamber of handicraft
or ZMF first. There is a further 800 hours
they are awarded a registerable
training, followed by examination by the
qualification. However, only those who run
dental chamber.
a technical laboratory register (with the
dental technicians’ guild).
Their duties include advice and motivation
of patients, in prevention, therapeutic
The dentist may employ a Zahntechniker
measures for prophylaxis and scaling of
but most use independent laboratories.
teeth.
They produce prosthodontic appliances
according to a written prescription from a
They are normally salaried but their typical
dentist. They do not deal directly with the
earnings are not reported.
public.
There were about 65,000 dental

technicians working in 2002. There is no
available information about salaries.
Practice in the Germany

Working in Free (Liberal or treatment are described and a value in
General) Practice Euros is set. Depending on the difficulty of
the treatment required the dentist may
increase the basic value of his invoice by
In Germany, dentists who practise on their up to 3.5 times the recommended value.
own or as small groups, outside hospitals or 2.3 times is the average fee for an average
schools, and who provide a broad range of difficult treatment with the extra time
general and specialist treatments are said needed. Over 2.3 times, the invoice must
to be in Free Practice. More than 60,000 include evidence to justify the increase. An
dentists work in this way, which represents invoice higher than 3.5 times needs written
95% of all dentists registered and agreement from the patient. Although
practising. Most of those in free practice there is no direct link between the GOZ and
are self-employed and earn their living the private insurances, the private
through charging fees for treatments. Very insurances co-ordinate their fees with the
few dentists (less than 2%) accept only GOZ system and reimburse for treatment
private fee-paying patients. up to 3.5 times the standard fee.
Once registered with a KZV a dentist in free

practice may treat legally insured persons
and claim payments from the sick fund via
the regional KZV. The fees are not
nationally standard. Negotiations between
the national association for dental care (the
KZBV) and the major sick funds establish
the standard care package for people
insured with legal sick funds. Using a
points system, relative values are allotted
to each type of treatment. It is then up to
the regional associations and sick funds to
decide the monetary value of each point for
payments in each region.
For private patients, whether insured or not

insured, the levels of private fees payable
are governed by federal law
(Gebührenordnung für Zahnärzte - GOZ).
Under this law the different types of
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Practices are usually sited in offices or
Joining or establishing a practice private houses or apartments, not in shops
or malls.
dental practice in terms of the number of Number of patients on a “list” of a full-time
associate dentists or other staff. Premises dentist has been estimated at about 1,000.
may be rented or owned, but any
obligations to the owner of the practice
must not influence the clinical autonomy of Working in the Public Dental
Germa
the dentist. There is no state assistance for Service
establishing a new practice and dentists
ny
must take out commercial loans or other There is a public dental service to oversee
contracts with a bank. and monitor the healthcare of the total
population. The care provided is restricted
There are no special contractual to examination, diagnosis and prevention.
requirements for practitioners working in The service employs about 450 dentists as
the same practice but a dentist’s Zahnarzt für öffentliches Gesundheitwesen
employees are protected by National and and its size is stable. Working in the public
European laws for equal employment dental service requires postgraduate
opportunities, maternity benefits, training and examination by an academy of
occupational health, minimum vacations public health. Currently the specialty of
and health and safety. dental public health is represented in all
but one of the 16 Länder.
Dentists can set up completely new
practices, they can buy existing practices The quality of dentistry in the public dental
or they can buy into existing joint practices. service is assured through dentists working
In 2002 (old German states), 24% of all within teams which are led by experienced
new establishments were new solo senior dentists, and the complaints
practices, 46% were acquisitions of an procedures are the same as those for
existing solo practice and 30% were dentists working in other services.
practice partnerships, either establishing a
new practice partnership or joining an In general there is more part-time work
existing one. By buying an existing practice available in the public dental service than
they usually buy a list of patients as well. in other types of dental practice, and
working hours are more flexible, or are
Establishing a new practice means to shortened to reflect the length of the
acquire totally new patients. Since 1993, school day and the percentage of female
dentists have been able to obtain licences dentists working in the public dental
to practise under the statutory health service is much higher. They are permitted
insurance scheme only if it does not exceed to work in liberal practice as well as in
the needs-related provision. That means public health.
over–provision of dentists is then avoided.
The specified rate of provision is one They are salaried and earn €40,000 to
dentist to 1,280 persons in urban areas and €50,000 per year, full-time.
one dentist to 1,680 persons in all other
areas. So, the proportion of closed (over- Working in Hospitals
provided) planning zones increased from
11.1% in 1993 to 29.2% by April 2003. A It is thought that maybe up to 200 dentists
further limitation on the practice of the work in hospitals. They would all be Oral
dental profession was imposed in 1993, Maxillo-Facial Surgeons. Because Oral
with a blanket age limit for dentists’ Maxillo-Facial Surgeons may register with
participation in the statutory health either a dental or a medical chamber – and
insurance scheme: since 1999, the licence probably most register with a medical
to practise as a statutory health insurance chamber, there is no accurate data
dentist expires at age 68. relating to actual numbers. In Germany,
surgeons who need in-
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patient care for their patients with severe requirements for postgraduate training but
diseases may use beds in public or private professors usually qualify for the title
clinics/hospitals, but they are working in through a process called habilitation. This
free practice and are not employed by the involves a further degree, a record of
hospitals. Very few dental ambulatories original research and earning the “right to
with employed dentists exist, for example teach” by delivering a special lecture to
some owned by the sick funds (AOK). So, the faculty. Professorships are mostly
there are normally no restrictions on filled by external candidates through
seeing other patients in private practice. competition. Apart from these there are
no other regulations or restrictions on the
Working in Universities and promotion of dentists. The complaints
procedures are the same as those for
Dental Faculties dentists working in other areas, as
described earlier.
Approximately 2,100 dentists work in
universities and dental faculties as Their salaries differ considerably from
employees of a university. With the assistant to professor. Since professors
permission of the university, may carry out have the right to treat patients privately
some private practice outside the faculty. their private incomes will augment the
As all dental schools are combined with normal salary paid by the university. The
dental clinics for outpatient and inpatient salary of a university professor is
care, almost all employees at universities estimated at about €80,000 from the
and dental faculties treat patients in the universities.
associated polyclinics and clinics.
The main academic title in a German
dental faculty is that of university
professor. Other titles include university In 2003, there were 447 dentists working
assistants, Oberarzt, and academic full time for the Armed Forces, an
dentists. There are no formal unreported (but small) number female.
Zahnärztekammern (Dental Chambers)
Zahnärztekammern (or Dental Chambers) are the traditional bodies which represent the
interests of dentists working in all of the oral health systems. Every dentist has to be a
member of a Dental Chamber. The Chambers are also responsible for other defined legal
tasks. There are 17 Dental Chambers in 16 Länder and also, in some parts of the country,
some subdivisions of the chamber, which work at a more local level. They are democratically
elected organisations with strong traditions of self-regulation. Their main duties are:
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Germa
• to create and maintain uniform professional ethics

ny
• to advise and support members

• to organise and promote dental undergraduate and continuing education, including the
training of auxiliaries
• to represent professional interests to authorities, legislative bodies, associations and in
public
• to monitor the professional duties of its members
• to assure a dental emergency service
• to support quality assurance and continuing education
• to arbitrate disputes between dentists, and between dentists and patients
The Bundeszahnärztekammer (BZÄK)
The Bundeszahnärztekammer - BZÄK, Arbeitsgemeinschaft der deutschen Zahnärztekammern

e.V. (German Dental Association), is the professional representative organisation for all
German dentists, at federal level. Members of BZÄK are the dental chambers of the federal
states ("Länder"), which send delegates to the Federal Assembly, the supreme decision-taking
body of the Bundeszahnärztekammer. The Presidents of the dental chambers of the federal
German states form the BZÄK-Board, together with the federal President and the Vice-
presidents.
The Bundeszahnärztekammer represents the health-political and professional interests of the

dentists. In 2003, its supreme mission was to strive for a liberal future-orientated health care
system, with the patient as centre of its efforts and objectives in the dental field, and with the
objective of establishing and developing a relationship between dentist and patient without
any outside influence.
The field of activities of the Bundeszahnärztekammer include in particular:
• the representation of the dental profession towards politics, media and the broad public
at federal level
• the initiative of intense efforts concerning the establishment of basic conditions for the
provision and recognition of dental services which follow the principles of liberal professional
exercise and which are orientated towards the patient's autonomy
• the co-ordination and implementation of general, cross-border missions of the members
of BZÄK
• the co-ordination and further development of dental education, dental continuing
education and postgraduate dental education in co-operation with dental scientific
organisations
• the promotion of public health care
• the defence of the interests of the dental profession at European and international level
• a specific PR-activity, in the interest of the dental profession and the patients.
Since 1993 the Bundeszahnärztekammer has also had its own representation in Brussels, with
a full-time office based near the European Commission. This office also handles the
administrative functions of the EU Dental Liaison Committee.
Related bodies
Zahnärztliche Mitteilungen (zm) is published twice a month. It is a communication means of

both the German Dental Association and Federal Dental Authority (KZBV). It informs about the
topics of national and international professional politics, health and social politics, of topical
scientific findings and innovations as well as of dental events and meetings. It offers services
covering the whole range of dental subjects: dental exercise, dental management, and dental
economy.
Institut der Deutschen Zahnärzte (IDZ) the Institute of German Dentists is an institution of both
the German Dental Association and Federal Dental Authority. The task of the IDZ is to initiate
and implement research and practice-oriented work in the interest of the professional politics,
and to act as a scientific advisory body for BZÄK and KZBV in their fields of activities.
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Zahnärztliche Zentralstelle Qualitätssicherung (zzq) Agency for Quality in Dentistry in the IDZ
gives advice and support to BTÄK and KZBV in all matters of dental quality.
The Freier Verband Deutscher Zahnärzte e.V.
With over 20,000 Members, Freier Verband Deutscher Zahnärzte e.V. (Liberal Association of
German Dentists) is the largest liberal professional association of dentists in Germany. Since it
was established in the 1950s, the FVDZ has advocated a liberal health policy in Germany, vis-
à-vis politicians and the German Parliament - a health policy which is centred around the
patient.
In addition to its activities at national level, FVDZ plays an active role in European and
international professional dental policy. The FVDZ is active in the EU Dental Liaison Committee,
as well as being an associate Member of the European Regional Organisation of the Fédération
Dentaire Internationale (FDI).
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The objective of the FVDZ is to promote and represent the professional interests of German
dentists in accordance with the principles set out in the following preamble:
• The purpose of the Liberal Association of German Dentists is to safeguard the free
exercise of the dental profession in the best interest of the patients.
• Dentists can only discharge their professional and ethical duties to their full extent if they
can practise freely, without patronisation and with financial security.
• It is the objective of the Liberal Association of German Dentists to further the confidential
relationship between patients and dentists that is necessary for dentists to discharge
their professional duties.
• The Liberal Association of German Dentists wishes to enforce these basic demands in the
statutory dental corporations too.
• The entire profession is called upon to help in realising these basic demands.
Ethics A dentist is obliged to maintain professional

secrecy. The duty of preserving medical
Ethical Code confidentiality is an element both of the
dentists’ professional codes and of the
Dentists in Germany must work within an criminal law. The duty of secrecy applies to
ethical code which includes the all facts that have been entrusted or
relationships and behaviour between become known to the dentist in his or her
dentists, contracts with patients, consent capacity as a medical or dental
and confidentiality, continuing education practitioner. Professional secrecy must be
and advertising, although the latter is very observed not only by the dentist himself or
strongly regulated. This code is herself, but also by his or her employees
administered by the regional dental and agents and by persons working in the
chambers and varies slightly from region to practice.
region. The BZÄK provides a sample ethical
code on which variations may be based. Patient data protection in accordance with
the Federal Data Protection Law is very
important owing to these implications for
The contract with the patient is usually
medical professional secrecy.
verbal, but for complex treatments or those
requiring prior approval from the sick
funds, for example crowns and
prosthodontic appliances, written consent
and payment terms must be recorded. All
treatment carried out must be recorded by
the dentist and must demonstrate informed
consent.
If a patient complains about maltreatment,

both the Dental Chamber and the KZV have
grievance committees. Following a
complaint a second opinion is sought from
an experienced, impartial dentist,
appointed by the local dental chamber. If
this dentist judges that the original care
was unsatisfactory then the work must be
repeated at no extra charge to the patient.
Under both grievance procedures the
dentist has a right of appeal to the
grievance committee. For serious
complaints about malpractice the dental
chambers have installed boards of
arbitration and courts of professional law.
The sanctions from the court of
professional law may be: an oral or written
rebuke or admonition, administrative fine
(up to €50,000), or temporary or
permanent withdrawal of licence. Heavier
sanctions are very seldom.
Data Protection
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Advertising
A dentist may inform the public about his

professional qualifications and priorities,
key aspects of his activity and of the
equipment in his practice. The information
must be factual, adequate, verifiable and
not misleading. The regulations on
advertising in dentistry were very much
softened and liberalised in 2001/02 through
judgements of the Federal Constitutional
Court (Bundesverfassungsgericht). The
Electronic Commerce Directive has not
been implemented, because existing
regulations in Germany are even stronger.
Insurance and professional indemnity

dentists. Insurance is provided by private
insurance companies and covers costs up
to a predetermined maximum,
usually €100,000. An average practitioner
pays approximately €250 annually for the
insurance.
Corporate Dentistry
Companies or non.-dentists are not allowed

to be the owner of a dental practice – this
must be a dentist. However, in 2003 this
position was being reviewed with a view to
easing and liberalisation of the rules, in this
respect.
Infection control is regulated by law and

has to be followed by the dentist and his or
her team. The responsible health
authorities monitor the compliance. Non-
compliance causes sanctions.
For Administered by
Ionising Dental Chambers
radiation
Electrical Factory Inspectorate
installations
Infection control The responsible health authorities
Medical devices Bundesinstitut für Arzneimittel
und Medizinprodukte (BfARM)
the Federal Institute for drugs and
medical devices
Waste disposal Dental Chambers and local
authority
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Financial Matters
ny
Liberal or General Practice

(2000) €96,000
Older states €81,000
Newer states
Public Health Up to €50,000
Academic Up to €80,000
The normal retirement age is now 62 to 68, depending upon individual circumstances and
preferences. At the age of 68 dentists treating patients insured in the legal sick funds have to
retire.
Retirement pensions in Germany average 60% of the salary on retirement. Any additional
(insurance) pension depends on the individual contract and the amount insured. Dentists in
free practice are members of a so called Altersversorgungswerk, a special pension fund/pool
for the liberal professions, especially physicians and dentists, which is organised and supported
by the chambers. Some of these old age pension funds are organised in cooperation with the
physicians’ chambers, some are for dentists only.
Taxes
The highest rate of income tax is 48.5% on earnings over about €55,000 for single persons,
and €110,000 for married persons.
VAT/sales tax
There is a value added tax, payable at a rate of 16% on purchases.
Zurich = 100 Berlin

Power
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Main national associations and BZÄK Brussels office

Information Centre:
Bundeszahnärztekammer (BZÄK) Bundeszahnärztekammer (BZÄK)
Chausseestr. 13 Büro Brüssel
10115 Berlin 1, Avenue de la Renaissance
Tel: +49 30 40005 0 1000 Brüssel
Fax: +49 30 40005 200 Belgien
Email: info@bzaek.de Phone: +32 2 7 32 84 15
Website: www.bzaek.de Fax: +32 2 7 35 56 79
E-mail: info@bzak.be
Freier Verband Deutscher Zahnärzte e.V.,
Mallwitzstraße 16,
53177 Bonn;
Tel: +49 22 88557 0
Fax: +4922 8347967
Email: info@fvdz.de
Competent Authority:
(For articles 2 & 3) (For specialist diplomas contact the
Bundesministerium für Gesundheit Zahnärztekammern of the relevant "Lander")
Am Probsthof 78a
53121 Bonn
Lists available from the
Tel: +49 228 308 3515
Bundeszahnärztekammer
Fax: +49 228 930 2221
Email: info@bmgs.bund.de
Website: www.bmgs.bund.de/
Publications: Employment bureaux, and other bodies or

publications with information on
vacancies for dentists:
Zahnärzliche Mitteilungen, Employment bureaux:
and regional dental journals (each Bundesanstalt für Arbeit
Zahnärztekammer and Kassenzahnärztliche Zentralstelle für Arbeitsvermittlung
Vereinigungen publishes its own dental Villemombler Str. 76,
journal) 53123 Bonn
Email:
Website: www.arbeitsamt.de/zav/
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Dental Schools:
ny
Aachen Berlin
Medizinische Fakultät an der Klinik und Poliklinik für Zahn-,
Rhein – Westf. Techn. Hochschule Mund- und Kieferheilkunde
Aachen, Universitätsklinikum Assmannshauser Strasse 4-6,
Paulwelsstrasse 30, 14197 Berlin
52057 Aachen Tel: +49 30 8290-1
Tel: +49 241 800 Fax: +49 30 8290-91
Fax: +49 241 80 – 82 457 Email: ralfj.radlanski@medizin.fu-berlin.de
Email: info@ukaachen.de Website:
Website: www.rwth-aachen.de www.fu-
Dentists graduating each year: erlin.de/einrichtungen/fachbereiche/medizin/zahn/
Number of students*: 53 Dentists graduating each year:
*
The figures refer to places at the dental school
for entry each year, due to Numerus Clausus.
The actual number of students may exceed
these figures, because there are more
applicants. However dental schools are forced
to accept some more students.
Bonn Berlin
Zentrum für Zahn-, Mund- und Kieferheilkunde Zentrum für Zahnmedizin
Welschnonnenstr. 17, Universitätsklinikum
53111 Bonn Charité - Campus Virchow-Klinikum
Tel: +49 228 287-0 Medizinische Fakultät der
Fax: +49 228 287 2444 Humboldt-Universität zu Berlin
Email: mkg@uni-bonn.de Augustenburger Platz 1
Website: www.zmk.uni-bonn.de/ 13353 Berlin
Dentists graduating each year: Tel: +49 30 450-562626
Number of students: 34 Fax: +49 30 450-562962
Email: ilona.wilken@charite.de
Website:
www.charite.de/kieferorthopaedie/zentrum/homepa
ge.htm
Dresden Dusseldorf
Universitätsklinikum Carl Gustav Zentrum für Zahn-, Mund- und Kieferheilkunde
Carus der Technischen Der Heinrich-Heine-Universität,
Universität Dresden, Zentrum für Westdeutsche Kiefer-klinik Moorenstr. 5,
Zahn-, Mund-, und Kieferheilkunde 40 225 Düsseldorf
Fetscherstrasse 74, Postfach 101007,
01307 Dresden 40001 Düsseldorf
Tel: +49 351 458 2812 Tel: +49 211 81 18142
Fax: +49 351 458 4312 Fax: +49 211 81 16280
Email: www.uniklinikum-dresden.de Email: D.Drescher@uni-duesseldorf.de
Website: www.tu-dresden.de/medzmk/zmk.htm Website: www.kfo.uni-duesseldorf.de
Dentists graduating each year: Dentists graduating each year:
Number of students: 40 Number of students: 46
Erlangen Frankfurt
Klinik und Polikliniken für Zahn-, Mund, und Zentrum der Zahn-, Mund- und Kieferheilkunde
Kieferkrankheiten des Klinikums der Johann Wolfgang Goethe-
der Universität Erlangen-Nürnberg Universität
Glückstr. 11, Frankfurt Theodor-Stern-Kai 7,
91054 Erlangen 60590 Frankfurt am Main
Tel: +49 9131 / 8533632 Tel: +49 69/6301 1
Fax: +49 9131/85 2055 Fax: +49 69/ 6301 741
Email: info@dent.uni-erlangen.de Email: d.heidemann@en.uni-frankfurt.de
Website: www.dent.uni-erlangen.de Website: www.klinik.uni-frankfurt.de/zzmk/
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Germa
Freiburg Giessen
ny
Universitätsklinik für Zahn-, Mund- und Med. Zentrum für Zahn-, Mund- und Kieferheilkunde
Kieferheilkunde am Klinikum der justus-Liebig-Universität Gießen
Hugstetter Str. 55, Schlangenzahl 14,
79106 Freiburg i.Br. 35392 Gießen
Tel: +49 761/270 4701 Tel: +49 99 46200 –46201
Fax: +49 761/270 4788 Fax: +49 99 46 209
Email: keine@angegeben.de Email: geschaeftsfuehrung@dentist.med.uni-
Website: www.uniklinik-freiburg.de giessen.de
Number of students: 46 Website: www.uni-giessen.de
Göttingen Greifswald
Zentrum Zahn-, Mund- und Kieferheilkunde
Der Universität Göttingen Ernst-Moritz-Arndt-Universität Greifswald
Robert-Koch-Syt. 40, Zentrum für Zahn-, Mund- und Kieferheilkunde
37075 Göttingen der Medizinischen Fakultät Rotgerberstrasse 8
Tel: +49 551/39 0 17487 Greifswald
Fax: +49 551/ 39 2800 Tel: +49 3834/86 7110
Email: Thomas.attin@med.uni-goettingen.de Fax: +49 3834/86 7113
Website: www.mi.med.uni-goettingen.de/ZMK/ Email: shensel@uni-greifswald.de
Number of students: 40 Website: www.dental.uni-greifswald.de
Halle Hamburg
Martin-Luther-Universität Halle-Wittenberg Universitäts-Krankenhaus Eppendorf, Klinik und
Medizinische Fakultat, Zentrum für Zahn-, Poliklinik für Zahn-, Mund- und Poliklinik fur Zahn
Mund-Und Kieferheilkunde Mund-und Kieferkrankheiten
Grosse Steinstrasse 19, Martinistr. 52,
06097 Halle/Saale 20246 Hamburg
Tel: +49 345/557 3741 Tel: +49 40/4717 1
Fax: +49 345/2024687 Fax: keine Angabe
Email: juergen.setz@medizin.uni-halle.de Email: kahl-nieke@uke.uni-hamburg.de
Website: Website: www.uke.uni-hamburg.de/zentren.de.html
www.gesundheitsnetzwerk.de/gesund/Anbieter/ab19 Number of students: 47
08.htm
Hannover Heidelberg
Medizinische Hochschule Hannover
Zentrum Zahn-, Mund- und Kieferheilkunde
Klinik und Poliklinik für Mund-, Kiefer- und Kieferkrankheiten Im Neuenheimer-Feld 400
Gesichtschirurgie 69120 Heidelberg
Carl-Neuberg-Straße 1 Tel: +49 6221/56 6032
30625 Hannover Fax: +49 6221/56 5074
Tel: +49 511/532-4747 Email: hans-joerg_staehle@med.uni-
Telefax: +49 511/532-8747 heidelberg.de
Email: MKG-Chirurgie@mh-hannover.de Website: www.med.uni-heidelberg.de/mzk/mzk-
Website: mkg/
www.forschung-in- Number of students: 39
niedersachsen.de/seiten/fue2237.htm
Homburg (Saar) Jena

Universitätsklinik und Poliklink für Zahn-, Mund- und Zentrum für Zahn-, Mund- und Kieferheilkunde an
Kieferkrankheiten der Medizinischen Fakultät der
66421 Homburg/Saar Friedrich-Schiller-Universität Jena
Tel: +49 6841/16 0 An der alten Post 4,
Fax: keine Angaben 07743 Jena
Email: info@uniklinik-saarland.de Tel: +49 3641/633335
Website: www.uniklinik-saarland.de Fax: +49 3641/633248
Number of students: 22 Email: glockmann@med.uni-jena.de
Website: www.med.uni-jena.de/zahn/
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Kiel Köln
ny
Klinik für Zahnerhaltungskunde und Parodontologie Zentrum für Zahn-, Mund- und Kieferheilkunde
im der Universität zu Köln,
Universitätsklinikum Schleswig-Holstein Kerpener Str. 32
Arnold-Heller Str. 16, 50931 Köln
24105 Kiel Tel: + 49 221/478/4748
Tel: +49 431/597-2781 Fax: + 49 221/478/3892
Fax: +49 431 597 2950 Email: Gabriele.Kirmis@medizin.uni-koeln.de
Email: albers@konspar.uni-kiel.de Website: www.uni-koeln.de/med-fak/zahn/home/
Website: www.uni-kiel.de/konspar/ Number of students: 58
Leipzig Mainz
Zentrum für Zahn-, Mund- und Kieferheilkunde Johannes Gutenberg-Universität,
der Universität Leipzig Klinik und Polikliniken für Zahn-
Nürnberger Str. 57, Mund- und Kieferkrankheiten
04103 Leipzig Augustusplatz 2,
Tel: +49 341/9721 022 55131 Mainz
Fax: +49 341/9721 09 Tel: +49 6131/ 17 30 22
Email: zzmk@medizin.uni-leipzig.de Fax: +49 6131/ 17 34 34
Website: www.uni-leipzig.de Email: nur über Internet möglich
Number of students: 50 Website: www.klinik.uni-mainz.de/ZMK
Marburg a. d. Lahn München
Med. Zentrum für Zahn-, Mund- und Kieferheilkunde Ludwig-Maximilians-Universität
der Philipps-Universität Klinik für Zahn-, Mund- und Kieferkrankheiten
Georg-Voigt-Str. 3, Goethestr. 70,
35039 Marburg 80336 München
Tel: +49 6421/28 3200 Tel.: +49 89/ 5160-32 11
Fax: +49 6421 28 3204 Email: michael.ehrenfeld@mkg-i.med.uni-
Email: www.uni- muenchen.de
marburg.de/zahnmedizin/adressen/email_dt.htm Website: www.dent.med.uni-muenchen.de
Website: www.uni-marburg.de/zahnmedizin/ Number of students: 52
Münster Regensburg
Zentrum für Zahn-, Mund- und Kieferheilkunde, Klinikum der Universität Regensburg
Waldeyerstr. 30, Franz-Josef-Strauss-Allee 11,
48149 Münster 93053 Regensburg
Tel: +49 251/ 83-47001 Tel: +49 941/ 9440
Fax: +49 251/ 83-47182 Fax:
Email: ehmer@uni-muenster.de Website: www.uni-regensburg.de
Website: www.uni-muenster.de/institute/zmk/ Number of students: 38
Rostock Tübingen
Universität Rostock, Medizinische Fakultät, Klinik und Zentrum für Zahn-, Mund- und Kieferheilkunde,
Polikliniken für Zahn-, Mund- und Kieferheilkunde, Osianderstr. 2 – 8,
Postfach 100888, 72076 Tübingen
18055 Rostock, Tel: +49 7071/ 29-82162
Tel: +49 381/ 494-6500 Fax: +49 7071/ 29-3488
Fax: +49 381/ 494-6503 Website: www.uni-tuebingen.de
Email: heinrich.von_schwanewede@med.uni- Number of students: 31
rostock.de
Website: www.uni-rostock.de
Ulm Witten-Herdecke
Universitätsklinik für Zahn-, Mund- und Fakultät für Zahn-, Mund- und Kieferheilkunde
Kieferheilkunde Alfred-herrhausen-Str. 50,
Albert-Einstein-Allee 11, 58448 Witten
89081 Ulm Tel: +49 2302/ 926-660
Tel: +49 731/ 500-23656 Fax: +49 2302/ 926-661
Fax: +49 731/ 500-23673 Email: dagmark@uni-wh.de
Email: Bernd.Haller@medizin.uni-ulm.de Website: www.uni-wh.de
number of students: 22 number of students: approx. 20
Würzburg
Klinik und Polikliniken für zahn-, Mund- und
Kieferkrankheiten
Pleicherwall 2,
97070 Würzburg
Tel: +49 931/ 201-72010
Fax: +49 931/ 201-72020
Email: mkg@mail.uni-wuerzburg.de
Website: www.uni-wuerzburg.de
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number of students: 39
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__ ____EU Manual of
Greece
(2003)
Currency Euros
(Active) dentist to population ratio 908
Main language Greek
General healthcare in Greece is provided by a

complex mixture of private practitioners, social
security organisations 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 12,788 dentists
registered in Greece, of whom 46% were female.
There are only two recognised 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
Greec
e
Government and healthcare in Greece

Geographically, Greece is a very rural and Presidential Parliamentary Republic form of
mountainous country, but the population of Government:
10,666,000 (2003) is urbanising rapidly,
with over 4 million people (nearly half the Legislature is exercised by the
population) living in the capital, Athens. Parliament and the President of the
Republic.
The Constitution of 1975, which was twice
revised (in 1986 and 2001), introduced a
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• The Executive is exercised by the European Union, as well as the superior
President of the Republic and the effect of such organisations’ legislation.
Government.
• Judicial function is exercised by So, in 2004 Greece possesses a
Courts. Decisions are executed in the name Constitution which enjoys political and
of Greek people. historical legitimacy, is modern, is adapted
to international developments, and despite
The President of the Republic is elected by possible reservations on particular issues,
the Parliament. Members of the Parliament, provides a satisfactory institutional
who are elected directly by the citizens, framework for Greece in the 21st century.
cannot be less than 200 or more than 300.
There are many small islands in Greece,
Through the revision of 2001, the which makes the planning of many services
responsibilities of the President of the more difficult. There are 13 regions but no
Republic were curtailed to a significant regional governments and many services
extent, whereas decentralisation was are provided locally by 54 prefectures,
reinforced. Regional organs of the State each headed by an elected prefect and
have general decisive competency for the with a public health department. There are
affairs of their region - whereas central also several layers of regional
organs of the State lead, coordinate and administration, each with different legal
control the legitimacy of the actions of the responsibilities. Access to health services
Regional organs. has been a constitutional right since 1975.
It is important to add that the Constitution Healthcare in Greece is provided by a

provides for the participation of Greece in complex mixture of social security
International organisations and the organizations and since 1983, a basic
framework of state-funded national health
services has been established. The laws
which established and modernized the
National Health System (NHS or ΕΣΥ)
afterwards, were intended to cover all the
Healthcare requirements and demands of
the whole population of Greece. The
Hellenic NHS is therefore a partially unified
system of public hospitals in large cities,
supported by a system of rural health
centers and regional medical centers
staffed by full-time and exclusive salaried
doctors.
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However, on the level of Primary Electricity Organization,

healthcare, IKA (Institute of Social Security) Telecommunications, Means of
covers approximately 60% of the Transportation ) are unified within IKA
population - its insured people as well as pension scheme, and renamed IKA-ETAM
OGA’s (see below) insured, providing (Institute of Social Security-Unified Security
healthcare services through its own Scheme for salaried people). IKA-ETAM
outpatients’ health departments. IKA (see continues to provide healthcare services to
below) is the only Social Security its insured people, as well as to OGA’s
Organisation owning hospitals (secondary insured people of all ages, directly through
healthcare services) which will be, most its own health departments.
probably, absorbed in the near future by In the meantime, another major security
NHS. scheme has been organized, to include
tradesmen, craftsmen, and employees in
The Social Security System in Greece has the sector of Tourism. In the future another
been reformed in order to abolish the 300 scheme is going to absorb all occupational
social security schemes (mostly schemes covering Liberal professionals -
occupational schemes) which formerly Scientists (ie Doctors, Dentists, Lawyers,
existed and to replace them by or unify Engineers, Architects etc.)
them in 3-4 major ones.
The OGA, the insurance organization for healthcare, including dentistry in 2002, was
agricultural workers, remains just the 9.4%. Of this expenditure, 56% was
same, as before. “public” (OECD Feb 2004). The Ministry of
Finance decides the publicly funded
Specifically by the Law 3029/02 , all Social amount, annually.
Security Schemes covering salaried people
(employees of Banks,
Oral healthcare
Public health care patients, free of charge. Adults over the
age of 67 also get social security subsidies
Preventive services are offered free of if they are on low incomes, as well as those
charge by the NHS Dental Clinics to all handicapped due to accidents or birth
children under the age of 18. This apart, defects.
oral healthcare in Greece is almost entirely
provided by private practitioners, with IKA, the main social security organisation
patients paying the entire cost of the care via its Dental Clinics, or its dentists working
themselves. This is reflected in that one for the System provides Primary Oral
third of the total expenditure on private Health Care to directly insured or retired
healthcare in Greece is on oral health, and adult people, plus full and/or partial
about 80% of dentists are in private dentures. Crowns, bridges and inlays are
practice. Those who are not self-employed not available. In 2003, via the Paediatric
private practitioners work in hospitals (as Dental Clinic located in Athens, a full
NHS employees), in NHS rural health coverage in Paediatric Dentistry (plus
centres, or are employed part-time by the General Anaesthesia cases), as well as
IKA. The IKA has its own outpatient Orthodontic Services, is provided.
departments in many urban areas,
providing dental care to insured people of
all ages.
In spite of the aim of the NHS to provide

free healthcare to all, in reality, dental care
is only provided by the NHS to two groups.
Firstly, NHS health centres provide
preventive and other simple treatments to
children under the age of 18 and the social
security agency pays 75% of the dental
care for children up to 16 years of age – the
parents have to pay the balance. Secondly,
within NHS hospitals dentists provide
preventive care and emergency or full
treatment as needed to all hospitalised
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by the patient, and are then reclaimed from
Although NHS dental services are free at the company concerned.
point of delivery, under the social security
schemes, there is no uniform system of Private insurance companies are self-
contributions and benefits for the other regulating and bear all the financial risks of
existing insurance schemes. Broadly treatment. Generally the level of the
speaking, however, a member’s premiums is not linked to the level of risk
“professional status” will determine their or current health status of the person as it
contribution levels, and therefore the is the case with other medical insurance.
benefits to which they are entitled. Also dentists play no role in promoting or
Generally, if a patient is treated in an selling this insurance. In Greece there are
outpatient health department, which is run a limited number of private dental care
by their insurance scheme, they will pay no plans - schemes where the dentist or a
fees. If however, a member receives group of dentists bear most of the risk.
treatment from a private practitioner,
regardless if he/she is contracted or not
with the insurance scheme, usually they
have to pay the whole of the fee by
themselves, and the insurance company
then partially reimburses the patient. The
level of reimbursement to the patient
depends on the insurance scheme and the
treatment provided and varies from 50 to
70% if the providing the treatment dentist
is contracted, and from 20-30% if not. This
is due to the fact that there are insurance
schemes which give the benefit of the free
choice of dentist, while some others do not.
Dentists may have contracts with any
number of social security organisations,
each with its own fee scale, coverage and
subsidy levels of treatments.
A dentist working full time at the NHS

would look after about 1,500 – 1,800
children and young people under 18 years,
as an average estimate, depending on the
area). Patients typically return to their
dentist for routine oral re-examinations
annually.
Greece spends 1.1% of GNP on oral health

care (about 12% of health spending).

care
In Greece, very few people (approximately

1%) use private insurance schemes to
cover their dental care costs. It only exists
as a supplementary cover to medical
insurance. Individuals insure themselves
by paying premiums directly to the
insurance company. Any dental costs are
still paid in full
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__ ____EU Manual of
The Quality of Care are monitored by dentists employed part-

time by the Schemes. They examine the
The National Government has the ultimate mouths of patients after treatments which
responsibility for the payment of fees, the required prior approval, but do not perform
quantity and quality of work and, together random checks. For ethical reasons they
with the Hellenic Dental Association - the are restricted to judgement about whether
HDA (see below) – ethical behaviour. For treatment has been completed - the
work carried out on behalf of the Social “quantity” of treatment, and may not
Security Schemes, standards of dental care comment on the quality of the work carried
out.

Undergraduate Training Registration
There are two dental schools in Greece. In order to practise in Greece, a dentist
One is the Dental School of the National & must have a recognised diploma, obtain a
Kapodistrian University, located in Athens, licence to practise from the Competent
and the other is the Dental School of the Authority, the Prefecture, have no criminal
Aristotle University, located in Thessaloniki. record, and be registered with one of the
Approximately 300 students are accepted 52 competent Regional Dental Societies.
each year for enrolment to the two Schools. All regional Societies are
To enter university students have to
participate in National exams, where the
written part plays the most crucial role.
The dental course lasts 10 semesters (5

years). There are approximately 1,800
dental undergraduates. In 2002, there were
110 male (38%) and 179 female graduates
(62%) from the two Schools.
The main qualifications which may

be included in the dental register
are:
• Diploma in Dentistry ('Ptychio

odontiatrikis tou Panepistimiou') and
• Licence to Practise Dentistry
from the Competent Authorities
(Prefecture)
• Registration to a Regional Dental
Society.
There is no structured, regulated post-

qualification vocational training in Greece.
However, for those graduates who are
applying for enrolment in a postgraduate
programme, in a clinical dental specialty, a
2 year period of clinical experience after
graduation is required, on the basis of an
“unwritten law” and as an extra
requirement for acceptance into the
programme.
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Greece
and 48 months of specialty training. It is
automatically members of the Hellenic both a Dental and a Medical specialty.
Dental Association (HDA). Dentists pay an
annual fee, in order to be registered with Apart from the above two specialisations,
the competent Regional Societies. Out of with Ministerial Decisions 107060/B7 and
this fee, a fixed amount (€39 in 2003) is 92449/B7/3.12.2002 (revising a decree of
contributed to the HDA. 1998),for the Dental School of Athens, the
Ministry of Education approved and
Dentists from other member-states of the recognised the existence of postgraduate
EU, who wish to practise within the programmes in clinical Dental
National Health Service, or under a Specialisations, leading to a Master’s
contract with a social security scheme, Degree. The duration of these programmes
need to show competency in using and is 2- 3 years, at the end of which a
communicating in Greek language. Private certificate along with the Master’s Degree
practitioners from outside Greece have to is awarded in one of the following
make a “declaration of responsibility”. This specialisations:
is an oath including a statement that the
dentist can speak and understand the • Prosthodontics,
Greek language. • Orthodontics,
• Oral Biopathology oriented to Oral
Further Postgraduate and Surgery,
Specialist Training • Endodontics,
• Paediatric Dentistry,
Continuing Education • Oral Biopathology oriented to Oral
Diagnosis and Radiology,
For dentists practising within the NHS, • Oral Pathology,
continuing education is required by law • Operative Dentistry,
(No. 1397/83). However, since there is no • Dental Biomaterials,
structured continuing education
programme available, there are no
sanctions connected with non-compliance.
Although a large number and variety of

scientific activities take place annually all
over the country for all dentists, no
continuing education system exists, in a
mode of mandatory and point-earning
attendance of lectures, seminars, symposia
and conventions. The Board of the Hellenic
Dental Association has already asked the
members of its Scientific Committee to
submit their proposals on the above
referred subject, and the Oral Health
Committee of the Ministry of Health and
Welfare has discussed some early
proposals.
Specialist Training
In Greece two dental specialties are

recognised by the Ministry of Health and
Welfare, namely Orthodontics and Oral and
Maxillofacial Surgery.
Orthodontic training takes three years,

again in a dental school.
By the new Law 3209/2003 (published on

Dec. 24, 2003) the training period for the
acquisition of the specialty has been
increased to 5 years altogether, including
General Surgery
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• Periodontics, • Fixed Prosthodontics-Implantology
• Implants Biology • Removable Prosthodontics
• Oral Biology • Endodontology
• Community Dentistry • Oral Surgery –Implantology and
Dental Radiology
With the Ministerial Decisions 331/4-5-94 • Operative Dentistry
and 1099/7-8-03, the Ministry of Education • Periodontology-Implantology
approved and recognised for the Dental • Oral Pathology
School of the Aristotle University of • Preventive and Community Dentistry
Thessaloniki the existence of postgraduate
programmes leading to the following There are various purely scientific societies
specialisations: for specialists. These are best contacted
via the Hellenic Dental Association.
• Orthodontics
Workforce
Dentists
In 2002, there were 12,788 registered
Taking into account the graduates of the
dentists in Greece, 46% of whom were
two dental schools the HDA estimates that
females. It is estimated that about 11,750
they are training the correct number of
are actively working.
dentists. However, taking into account
graduates from other countries (EU and
The population per active dentist was 908.
Third countries’ diplomas) who are entering
Greece to practise, it is reported that there
Total number of 12,788 is an annual increase in the number of
dentists (2002) dentists in Greece.
General practice* 10,185
Specialists
NHS Health Centres 342
NHS Hospitals 252 There are two categories of recognised
Universities 223 specialists in Greece:
Armed Forces 63
• Orthodontists
New Registrants, unclear 682
status • Oral Maxillo-facial surgeons
* 1,188 also work in Most Orthodontists work in private practice,
salaried employment at the while most surgeons work in Hospitals and
same time private practice.
There were 682 new registrations who had Number of specialists

not then clarified their professional status (2002)
(salaried, or in general practice). The
number registered is increasing annually Orthodontists 353
and there were 289 new graduates in 2002. Oral Maxillo-facial 151
surgeons
Citizens from other European Union
member-states practising dentistry in Besides the two categories of recognised
Greece numbered 25 and citizens from specialists there is a considerable number
third countries were 123. of specialists who are working in private
practice or at a university, and they are
The workforce is growing, with increasing
covering all the common specialisations in
competition for work and so in 2003 there
dentistry. Most of them have been trained
was about 6% unemployment amongst
abroad (mainly in USA), whilst, since 2001,
dentists in Greece. The average age for
the two dental schools started producing
dentists was 45 years old, with nearly
Greek-trained specialists.
4,000 (about one third) over the age of 50.
Patients usually consult specialists on
referral from a primary care dentist but
they are permitted to go directly to
specialists.
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Auxiliaries Dental chairside assistants
Dental Technicians In Greece the main type of dental auxiliary

is the chairside dental assistant, who may
To be a dental technician in Greece it is not work without the supervision of a
necessary to train for 3 years in a Technical dentist. Dental chairside assistants must
Professional Institute or Lyceum and work hold a diploma, certificate or other
in a dental laboratory. Registration, evidence of formal qualification, after a two
following exams, is with the Ministry of year course at a Private Technical College
Health and Welfare. (including 6 months in a dental office) then
at least 6 months post-qualification in a
In 2003 there were approximately 5,000 practice. They must be registered with the
dental technicians. They are allowed to Ministry of Health and Welfare.
work independently by establishing a
private office or a laboratory - working Their duties include the preparation of the
under the strict prescription of the dentist - dental office, infection control, secretarial
but they are not allowed to work in the duties and assisting the dentist at the
mouth of a patient. However, and in spite chairside.
of the strict restrictions on this, there are
some cases of Dental Technicians who In 2003 there were 159 dental assistants -
have violated this rule and they have been the majority of dentists work without
caught working in the mouth of patients. assistants.
Greek justice has intervened, imposing
penalties. There are no hygienists or therapists in
Greece.
Icelan
Practice in Greece
d
Working in General (Private) approval for treatment must be sought, or
Practice how the treatment provided may be
checked. For treatments where the patient
In Greece, dentists who practise on their is paying the total amount of the cost,
own, and who provide a broad range of there is no externally regulated scale of
general treatments are said to be in Private fees per work at the most (upper limits),
Practice. There are about 10,185 dentists while there is a regulated price at the least
who work in private practice. This (lower limits).
represents about 79.6% of the total
number of dentists. Dentists in private practice would expect to
earn about €1,180 to €10,000 a month,
Fees depending upon age and experience
Dentists in private practice are self- (2002).
employed, and earn their living through
charging fees for treatments (item of
service). Approximately 10% of dentists in
private practice are also part-time salaried
employees of the IKA, of other social
security funds or are part-time academics
or military dentists. The terms of any
contracts with social security organisations
state that insured members must be
accepted as patients, and a prescribed
scale of fees, decided by the State, must be
used. There are also some other social
security organizations which have a fixed
amount of fee per work, which the patient
is entitled to have (reimbursed), regardless
if the dentist is “Contracted to the
Organisation” or not (free choice of
dentist). The contract also describes other
conditions which must be met for working
on insured patients, for example when prior
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Greece
The creation of the NHS in 1983
A Presidential Decree in 2001 (84/2001) successfully brought the majority of
provides for the function of Private Agents hospitals in Greece into public ownership.
of Provision of Primary Health Services (ie Hospital dentists work as salaried
Dental Clinics). This decree, which had employees of the government, the army or
been expected since 1992, provides that a university - treating patients who are
dentists can share the clinic or dental chair, confined to hospital, have other special
as well as establish Dental Companies needs or need emergency care. Hospital
(“Multi-dental clinics”: Orthodontic care, dentists are always employed in “full and
oral maxillofacial care, etc). exclusive occupation”, a secure form of job
tenure which does not allow other private
The legal status of such companies may or part-time work.
vary. Only in Limited Companies can
people other than Health professionals Dentists in hospitals may be employed as a
(fund holders such as businessmen etc) director, or one of three grades of
participate. supervisor. For each grade there is a
minimum age (lowest grade, 35; highest
There is no state assistance for establishing grade, 50) and a minimum number of years
a new practice, but there is a central fund of required experience. The whole process
which may lend up €3,000. Since at least of appointing a hospital dentist is governed
€30,000 is typically required, to open a by law and the final decision lies with an
practice dentists usually take out a appointments committee. In 2003 there
commercial loan from a bank. New dental were 252 dentists working in hospitals.
practices may be located anywhere, except There is a disciplinary committee at the
from regions characterised as “purely hospital where the dentist works, in case of
residential area” and there is no limitation complaint. A law ensures that statutory
on the number of practices. Social Security Organisations must act
jointly with the Consortium or Union of
For dentists in private practice, the controls Social Security to:
for monitoring the standards of care are
the same as described previously. • co-operate and enter into policy
contracts with the Ministry of Health
Working in Public Clinics and Welfare. These contracts will
specify charges for the care provided
Out of the 594 dentists employed in the as well as the diagnostic tests
NHS, 342 (in 2003) worked in the health (clinical and laboratory).
centres, providing services to children
under the age of 18. They are full-time • Negotiate with private clinics and
salaried employees in ‘exclusive foreign hospitals with the permission
occupation’ - without other part-time work of the Minister of Labour and Social
commitments. These centres also provide Affairs and the Minister of Health and
emergency services to adults and the Welfare
elderly.
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instructor, lecturer, assistant professor,
Hospital dentists cannot work concurrently, associate professor and professor. “Faculty
part-time in private practice. members” (ie. those at lecturer grade and
above, with secure job tenure) must hold a
Working in Universities and PhD. or equivalent. When faculty posts
become vacant they are filled by open
Dental Faculties competition, with the final decision made
In Greece 223 dentists work in dental by the Assembly of the Electorate.
faculties as employees of universities
(2003). Employed both as full-time and A senior academic dentist, Assoc.
part-time staff in the University they are Professor, and Professor, would expect to
free to work in private practice. Those who earn about €2,000 and €2,800 a month
do work as such, they must contribute 15% respectively (2002)
of their earnings to the University.
The main academic titles within a Greek
dental faculty are full-time clinical 63 Dentists work in the Armed Forces. 2 of
them are women (2003).
with complaints. Where complaints are not
due to misunderstandings, a patient may
There is a single national association, the
be examined by an expert dentist from a
Hellenic Dental Association (for address
university.
click), which is a federation of 52 regional
societies. All Greek dentists must belong to
The theoretical ultimate sanction for either
the HDA.
a private practitioner or a NHS-employed
dentist is the forfeiture of the right to
Ethics
practise. However the sanctions which are
typically applied are usually restricted to
Ethical Code
warnings and financial penalties. Dentists
have a right of appeal within this process,
Dentists in Greece have to work within an
to the disciplinary board of the Hellenic
ethical code which covers relationships and
Dental Association.
behaviour between dentists, and
advertising. The ethical code is
Ultimately patients also have the right to
administered by the Regional Dental
appeal to Greek civil and criminal law.
Associations and the Hellenic Dental
Association.
Advertising
If a dentist has employees, they are
Legally, advertising in the health sector is
protected by the national policies and
not allowed and dentists are only allowed
European laws on equal employment
to publish a notice three times in the
opportunities, maternity benefits,
newspapers, when they open a practice.
occupational health, minimum vacations
and health and safety.
Dentists may provide information by way of
a website, but they must conform to the
Serious complaints by patients are referred
European Code of Ethics relating to the
to the Central Disciplinary Council of the
Electronic Commerce Directive.
Ministry of Health and Welfare and within
the NHS there are also disciplinary councils
in hospitals and in local health centres.
Furthermore the disciplinary boards of each
local dental association will deal
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Data Protection refusing to be vaccinated have to sign a
special form explaining the reasons.
The EU Directive on Data Protection has
been enacted through Law 2472/97. This Regulations for Health and Safety
Greece
law has introduced an independent body
for data protection. For Administered by
Indemnity Insurance Ionising radiation Greek Atomic Energy
Commission
Liability insurance is not compulsory for Electrical Ministry of Health and
dentists. However, professional indemnity installations Welfare
insurance is available from private general Waste disposal Common Ministerial
insurance companies. A dental practitioner Decision 37591/
will pay approximately €8 minimum fees 2031/2003, Ministry of
annually for this, if he/she is insured Health and Welfare,
through a group-insurance plan – with Ministry of the Interior,
his/her Regional Dental Society - and not Ministry of the
individually. Practitioners may increase Environment, Central
their cover beyond the minimum. Union Of Municipalities
and Communities,
Corporate Dentistry Ministry of the Finance,
Public Administration,
See - Joining or establishing a practice Ministry of Labour
Medical devices Hellenic Drug
Health and Safety at Work Organization
Inoculations, such as for Hepatitis B, are Infection control Centre for Disease
not compulsory for dental workers. Control, Athens
However, since 1995, all faculty members University-School of
and all undergraduate level students at the Dentistry, Regional
University of Athens, School of Dentistry Dental Society of Attica
are inoculated for Hepatitis B. Students
Financial Matters
Dentists’ Incomes: TΣAY (Insurance and Retirement Fund of
Health Professionals) and consequently, are
The income ranges dentists would have entitled to get a pension from TΣAY.
expected to earn in 2002: Dentists who are exclusively self-employed,
get a full pension from TΣAY. Dentists
entitled to other pension schemes, get a
Annual Income
reduced pension from TΣAY, and a
General Practice Average €17,000 supplementary one from where they
Range: €14,000 – provide their services. For example, a
€120,000 dentist employed by IKA will also take a
pension from IKA, or a dentist in the NHS
NHS Hospital Registrant (approx): will take a
€24,650
Director (approx):
€28,760
NHS Public Clinic Same as NHS hospital
Junior Academic €24,000
Senior €35,000
Academic(Full
Professor)
Retirement Pensions and Healthcare
All dentists who practise, whatever their

working status (self-employed, employees,
NHS) are obligatorily registered with the
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209
2004_______________________________________
pension from TΣAY and also a pension from

the public sector.
The full pension of TΣAY for an exclusively

self-employed dentist who has been
practising for at least 39 years is
approximately €1,180 (after taxes) a
month.
Normal retirement age is 65 years, but this

is not compulsory and dentists may work
beyond this, in private practice.
Taxes
The highest rate of income tax is 45% on

earnings over about €23,400.
VAT
There are two rates of VAT/sales tax. They

are 8% and 18% depending on the
category of goods sold. VAT (at 18%) is
payable on most dental materials and
equipment. No VAT applies on the payment
of dental fees.

2003
Zurich = 100 Athens

Power
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211
2004_______________________________________
Main national association and Competent Authority and

information Information
centre centre for NHS
posts:
Hellenic Dental Association Ministry of Health and Welfare
38, Themistokleous Street 17-19 Aristotelous Street
GR- 106 78 Athens GR- 101 87 Athens
Tel: +32 10 38 13 380 Tel: +32 10 52 32 821-9
+32 10 33 02 343 Fax:
Fax: +32 10 38 34 385 Email: webmaster@mohaw.gr
E-mail: eoo@otenet.gr, or Website: www.ypyp.gr
heldenas@.gr
medical-
law@ath.forthnet.gr
Publications:
Journal of the Hellenic Dental Association
Hellenic Stomatological Review
Dental Schools:
Athens Thessaloniki
National & Kapodestrian University of Aristotle University of Thessaloniki

Athens Faculty of Dentistry
Faculty of Dentistry University Campus
2 Thivon str., Goudi GR-541 24 Thessaloniki
GR - 115 27 Athens Tel: +32 31 0995 022, 99 94
Tel: +32 10 7461120, 12 11 71-73
19117 Fax: +32 31 0999 474
Fax: +32 10 7461187 Email: info@dent.auth.gr
Email: psakel@dent.uoa.gr Website: www.dent.auth.gr
Website: www.dent.uoa.gr Dentists graduating each year: 135-
Dentists graduating each year: 150 140
Number of students: 950 Number of students: 1,090
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Hungary
Population 10.1
million
Currency Forint
(HUF)
265 HUF = €1
Main language Hungarian
A National Health Insurance (NHI) Fund was

Hung
ary
introduced in 1993 with the goal of being self-
supporting, based on compulsory payroll
contributions from both employers and
employees (and a very limited investment
portfolio). Dental services are provided through
the NHI, or by private dentists. In 2002 there
were 5,611 dentists registered of whom 57%
were female, and 4,992 of these were actively
practising (56% female). There is a well
developed system of specialists and dental
hygienists are also widely used. Continuing
Government and healthcare in Hungary
Hungary is a landlocked, strategically A Constitutional Court has power to

located country astride the main land challenge legislation on grounds of
routes between Western Europe and the unconstitutionality.
Balkan Peninsula, as well as between the
Ukraine and the Mediterranean basin. The The Local Government Act of 1990 shifted
country is adjacent to 7 other countries. the responsibility for the ownership and
The north-south flowing Duna (Danube) management of health and social services
and Tisza Rivers divide the country into to local and municipal governments.
three large regions.
The population in 2002 was 10,075,034.
The Republic of Hungary is an independent,

democratic constitutional state with an
elected parliament. The current
constitution dates from 1972. The country
is administered as 19 counties + Budapest
(capital). The President of the Republic,
elected by the National Assembly every 5
years, has a largely ceremonial role but
powers also include appointing the Prime
Minister. The Prime Minister selects
cabinet ministers and has the exclusive
right to dismiss them. The unicameral
National Assembly is the highest organ of
state authority and initiates and approves
legislation sponsored by the Prime Minister.
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A Health Insurance Fund was introduced in
1993 with the goal of being self-supporting, The major investments like construction
based on compulsory payroll contributions and maintenance of premises, or
from both employers and employees (and a equipment purchasing are financed by the
very limited investment portfolio). The owner, or co-financed from the Ministry of
contributions are funded from the employer Health. All expenditures for day to day
who pays 11% and the employee 3%. The operations, including salaries of health care
self-employed contribute the full 14% and professionals, are financed by the National
unemployed people do not contribute. Health Insurance Fund. However, rates can
be too low to cover the real costs of
There is a global amount decided each year providing the services. The lack of
by Parliament for public health adequate funding has led to the
expenditure. continuation of informal payments and use
of public facilities for private practice
The proportion of GDP spent on general businesses, to enable health care staff to
healthcare, including dentistry in 2002, was supplement their incomes.
6.8%. Of this expenditure, 75% was
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Hunga
ry
Oral healthcare
Public compulsory health recommendation for each item, but it is not
insurance compulsory for dentists to keep to this.
Those who belong to the age group 0-18,

Dental services are delivered either and those who are over 60, do not have to
through dentists contracted with the pay for the dental treatment, but there is a
National Health Insurance System, or by co-payment for the technical costs – for
private practitioners. example: for orthodontic devices between
The basic principles of establishing dental 0-18 years 15% of the technical costs will
care facilities, subsidised by the National be paid by the patient and 85% by the NHI.
Health Insurance, are defined with respect For those aged above 60 for partial
to the number of inhabitants of a given dentures 50% of the technical costs will be
geographic area. The facilities are assessed paid by the patient and 50% by the NHI.
partly on the basis of a stipulated monthly
allowance and partly on the basis of the There is prior approval for treatment in
output. The assessment is carried out on special cases: for example, in patients who
the basis of a care delivery score system, have allergies. The National Health
which is defined by the Ministry of Health, Insurance Company will decide about the
having considered the suggestions of the level of patient contribution for the
National Board of Dentistry. This board has treatment.
23 members, all dentists. The president is The allocation of funding to dentists is
appointed by the Minister of Health. They managed by the National Health Insurance
hold a meeting 4 times a year. Company and also local
Representatives of other bodies (like the
National Public Health and Medical Officers
Service, Ministry) can be invited to the
sittings.
There are about 8 million registered (NHI)

patient visits in a year for 10 million NHI
registered people in Hungary. As some
people visit the dentist more than once a
year and others do not visit at all it is
estimated that 50% of the population will
visit a dentist in any one year. There are
no data from the private sector.
Oral examinations would normally be

carried out annually for regular adult
patients, twice a year for children.
However, there are also special cases,
where a more frequent care is needed.
Domiciliary care is rare.
Emergency care, examination and

diagnosis, conservative dentistry, including
fillings and endodontics, and extractions,
are free in each of the three defined age
groups (0-18, 19-60, above 60). Crowns
and bridges, implants, fixed orthodontic
appliances and other complex or cosmetic
treatments have to be paid for by the
patients. Among those aged 18 to 60 years,
in active employment, the patient pays
100% of the dental and technical costs.
Only active workers have to pay, and the
amount is not set – it is dependent upon
the type of treatment. The Medical
Chamber has a minimum-price
__________________________________________________________________
215
2004_______________________________________
providers, to the National Public Health &
government. The quantity of work done by Medical Officers Service, or to the court.
a dentist is monitored by routine reports to (Ethical complaints are judged by the
the National Health Insurance Company Ethics Committee of the Medical Chamber –
about treatments done in the practice, see below). There are authorised regional
every month. legal representatives for patients, who help
with obtaining remedy for them.
A dentist would typically have up to 4,000
regular patients on his “list”. For basic Whilst in theory a penalty may result in a
general dental treatment there are no dentist being suspended, in reality this has
difficulties in accessing public health care, not happened in Hungary by 2002.
but there are geographic areas where
specialist treatment (for example
orthodontics) is difficult to obtain.
In the NHI, dental procedures are allocated

a certain number of points. The monetary
value of each point is determined every
three months in the following way. The
total number of points earned in the period
is divided into the amount of money in the
budget. Thus the value of a point varies
monthly.
Re-examinations normally are carried out

for most adult patients annually
Spending on oral health services in 2000

was 3%.
Private Care
There are only 140,000 people, who have a
private health insurance in Hungary (2002),
at one of the 42 private insurance
companies (just 9 private insurance
companies have more than 5,000
members) – so they have little significance
in the dental health care system.
About 30% of dentists work wholly
privately, outside the State system (2002).
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 which are not
covered by the insurance scheme. For
those dentists who are in private practice,
their patients pay for all of their care.
The Quality of Care

There is a compulsory internal quality
insurance system for those dental care
providers who are contracted with the
National Health Insurance Company.
Patients’ complaints about State or Private

care can be sent to the dental care
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ry
Undergraduate Training Qualification and Vocational Training
To enter dental school students must Vocational Training (VT)

obtain the General Certificate of Education
and then successfully pass an entrance Until 2004, upon qualification, there was a
examination. No other vocational entry is programme of mandatory vocational
possible. postgraduate residency training for 26
months, under the guidance of a skilled
Dental schools are known as dentist and based on a government decree.
Fogorvostudományi Kar Dental Faculty The programme is organised by the
(Semmelweis University, Budapest and the Universities/Dental Schools and is totally
University of Debrecen), financed by the Ministry of Health, which
Fogorvostudományi Szak Dental “section” pays the salaries. Residents, known as
(University of Pécs and Szeged, where Központi gyakornok, must hold Hungarian
there is no extra faculty for dentistry, but it citizenship. The residents are mainly
is part of the Medical Faculty). For dental employed in the public sector. The program
schools, see below. consists of a theoretical part which covers
all fields of dentistry including practice
management, legal requirements and first
There are 4 dental schools, all state aid and a practical part which is undertaken
funded, although some of the students either at the University clinics or in other
have to pay their own fees. Student intake polyclinics accredited by the University.
is about 185 (including about 36 overseas The residents work
students) and 66% of the approximate total
of 910 undergraduate students are female.
The Hungarian undergraduate dental
training is 5 years, with minimum of 5,000
contact hours. Approximately 160 students
graduate each year.
There are courses offered to foreign

students in Budapest Semmelweis
University and the University of Debrecen.
At Semmelweis, in 2003, there were 76
undergraduates from non-EU countries,
from Greece, Cyprus, Israel and some
countries in the Middle East, being taught
mainly in English. There is also one course
in German, with 34 undergraduates (an
annual intake of less than 8 students). At
Debrecen, there were 64 undergraduates
from outside Hungary, all but 4 being from
outside the EU. The course for them is in
English. For individual school
undergraduate numbers, see Dental
Schools.
Quality Assurance is monitored and

checked by the National Accreditation
Committee. The course has been revised in
the light of advice, and alterations were
made in 1996. Since then the course has
been compliant with the EU Directives on
the training of dentists.
The title upon qualification is: Fogorvos

Dentist (DDS)
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For further training, 2 years must have
under the supervision of a tutor and the elapsed after qualification, and vocational
whole program is supervised and training must have been completed.
coordinated by mentors appointed by the Specialist Training takes place in
Dental Schools. universities and is 3 years for all
specialties. A special committee (EFSzSzTB)
Residents must complete the courses, is responsible for this training.
meet the practical and theoretical
requirements, and pass their midterm There are four recognised specialties for
exams in each dental subject successfully, training in Hungary:
in order to take the licence exam at the
end of the 26 month training program. At
completion of the program they will be
qualified to open a private general dental
practice or be employed by municipal or
private practices.
This vocational training was compulsory for

all graduates, including those of other EU
countries’ dental schools. However,
changes to the law abolished the
mandatory general dentistry residency
programme, giving full access to liberal
private practice, from 2004.
All dental graduates have all the rights for

free practice after graduation.
Registration

Health and the Hungarian Medical
Chamber.
For the recognition of non-EU diplomas it is

necessary to pass an exam. Additionally, a
Hungaro-logic test (which tests knowledge
of the insurance and legal systems) must
be passed by all, to work in Hungary. The
test is conducted in Hungarian.

Specialist Training
Participation in continuing education has

been mandatory since 1999. The system is
delivered mainly by the Dental Section of
the Hungarian Medical Chamber, which is
responsible for the supervision.
There is a scoring system, with accredited

continuing education courses. A dentist
must achieve 250 points in 5 years. This
represents 250 hours, and some reading is
allowed to be counted. The ultimate
sanction for non-compliance is suspension
from practice and the first audit of
compliance will take place in 2004.
Specialist Training
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• Orthodontics, with the title: Oral and maxillofacial surgery, since 2002,
Fogszabályozó szakorovs has been available for medical doctors,
ry
• Periodontology, with the title: only. However, also from 2002, the new
Parodontológus speciality, Dento-alveolar surgery was
• Paediatric dentistry, with the title: introduced and accredited by the
Gyermekfogorvos government, and is only for dental
• Dento-alveolar surgery, with the title: graduates. This has a three year residency
Dento alveoláris szájsebész programme. Its competency level covers
only the dento-alveolar region up to minor
Until 2002, Oral Surgery was the only sinus operations.
specialisation in oral surgery open for both
medical and dental doctors. Those working A new speciality on Restorative Dentistry
in hospitals and head and neck surgery and Prosthodontics was introduced from
departments needed double qualification, 2004. It replaces the old “stomatologist”
both MD and DMD degree. Those working degree. The new speciality basically covers
in polyclinics could be licensed only with family dentistry or general dental
DMD academic degree. It is no longer a practitioners, and also requires a 3-year
dental specialty. training.
Workforce
Dentists specialists (2002)
In 2002 there were 5,611 registered Orthodontists 219
dentists in Hungary, of whom 57% were Dento-alveolar surgeons 10
female. It was estimated that 4,992 were Periodontists 25
actively working (56% female). 452
Paediatric dentists 296
dentists were from outside Hungary.
Oral (and maxillo-facial) 212
surgeons
Total (2002) 5,61
1
Specialists work in both the public and
private sector. Patients may access
General practice 4,600 specialists directly, or by referral.
Hospitals 40
University 200
Armed Forces 80
The population per active dentist was

2,017.
The Hungarian Dental Association reports

that the workforce is decreasing as the
government is training fewer Hungarian
dentists than those retiring or otherwise
leaving full-time work as a dentist. Figures
show that there a large number of dentists
(both male and female) over the age of 50
– about 2000 - who will be retiring in the 10
years to 2013, which is more than the 120
or so Hungarian nationals per year being
trained in the four Hungarian dental
schools.
There were no reports of unemployed

dentists, in 2003.
Specialists
Numbers of
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They normally work in commercial
The National Health Insurance Fund will laboratories. They construct prostheses for
make contracts only with specialists. insertion by dentists and they invoice the
dentist for the work that is done.
Auxiliaries
It is presumed that there are illegal
denturists in Hungary because of the
There are two kinds of clinical auxiliaries in complaints that are received from patients.
Hungary – Dental Hygienists and Dental
Technicians. Additionally, there are dental
nurses.
Hygienists (in 2003) 526
Technicians (estimated 2,200
in 2000)
Assistants (in 2003) 4,100
Dental Hygienists
Hygienists are permitted to work in

Hungary, provided they have a Certificate.
They train in one of 7 State financed
schools specifically for dental hygienists,
for 1 year, following 2 year’s training as a
dental assistant.
They work under the supervision of a

dentist, only, and their duties include
scaling, cleaning and polishing, the
insertion of preventive sealants and Oral
Health Education. Their work is governed
by the Ministry of Health. They are usually
paid a set fee for every patient they treat.
In 2003 they do not have to be registered,
but registration is planned for the future.
In 2000 fewer than 50 were thought to

work full-time.
Dental Technicians
Technicians train in one of 4 State financed

training schools and the training period is 3
years. Theoretical training is undertaken at
the school and practical training in special,
contracted laboratories. They receive a
certificate on the satisfactory completion of
their training. Laboratories are registered.
Only technicians who have passed a
“masters” examination are registered.
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Dental Assistants (Nurses) one of 22 specialised secondary schools,
after leaving secondary school with the
Dental nurses assist the dentist at the general certificate of education. They have
chairside. They are trained for two years, in to be registered with the Ministry of Health.
Practice in Hungary
Working in General (Private) In some towns there are dental clinics
Practice owned by the local government. Dentists
may work in these clinics and participate in
the NHI system on the same terms as
A dentist can buy or rent a practice, join an
liberal dentists, although they are salaried
existing practice, but can also establish a
employees of the clinic. So, patients may
completely new practice. A general
receive fillings, surgery and endodontics
practice may be located in a shop, a house
within the NHI, but will have to make co-
etc. However, when a dentist buys a
payments for prosthetic appliances.
practice it is just the equipment and
facilities which are bought, and there is no
amount for “goodwill” – ie, the patient list.
Anyone may own a dental practice (see
Corporate dentistry).
The state offers no assistance for

establishing a new practice. When starting
a new practice private dentists have to get
the permission from the local health
authorities – the National Public Health and
Medical Officers Service. There are only
restrictions on setting up practices which
provide dental care in the national health
insurance system (contract with the
National Health Insurance Company). The
restricting factor is the population (4,000
people have to be on the “list” of a
practice).
There are no limits for the size of a practice

in terms of associate dentists or other staff.
There are minimum requirements for
establishing a new practice - for example,
the size of the treatment room for one
piece of equipment (a dental unit) has to
be a minimum of 16 sq metres. This is
prescribed and strictly checked by the
National Public Health and Medical Officers
Service.
There are no restrictions for setting up

private dental practice

€1,500 per month (2001)
Working in Public Clinics
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combination of part-time teaching
Quality Assurance would be given by the employment and private practice (with the
heads of the clinics. permission of the university).
In 2000 there were 40 salaried public They normally are full-time employees of
dentists. They earn in the range of €500 to the University, and their salary range is
€700 per month. €700 to €3,000 (for the Heads of
Departments) per month.
Assistant Lecturer, Senior Lecturer,
In 2000 there were 40 salaried dentists
Associate Professor or Professor - this
working full-time (about 42 hours a week)
involves a further degree (publication
in hospitals or university clinics, as
activities and a record of original research)
specialists in oral surgery. All the hospitals
leading to a PhD and habilitation (second
are State-owned. A part-time hospital
round of PhD).
dentist may work concurrently in private
practice.
A hospital dentist would earn about €700 to
€900 a month (2002) In 2003, about 80 dentists served full-time
in the Armed Forces - 50% of these were
Working in the University females. These would be normally officers
Dental Faculty undertaking national service.
There are 4 dental schools, in which about

200 dentists work. They are allowed the
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ry
The Hungarian Medical (Association)
There is equal status for both physicians
Chamber is the national professional
and dental practitioners and the Chamber
association, in which all dentists must be
is divided into regional chambers (19
members. All the physicians and dental
provinces and Budapest), with a Hungarian
practitioners who intend to practise
Medical Assembly as the "parliament of the
medicine or dentistry in Hungary have to
medical profession" in Hungary, where
belong to the chamber, as these are the
democratically elected representatives
chambers that award the right to practise
meet as delegates. The term of office for
medicine or dentistry.
officers is 4 years.
The Hungarian Medical Association
Dental practitioners are represented at all
(www.mok.hu) is an independent,
organisational levels of the Medical
professional, democratic, public body of all
Chamber. The representation of dental
physicians and dentists working in
practitioners is secured in the Supreme
Hungary. Its aims, objectives and activities
Medical Council, and one of the two Vice-
are determined by statute (Hungarian Law
Presidents has to be a dentist.
XXVIII/1994 on Chambers).
A Supreme Medical Council represents the medical and dental professions at the state level,
and regional councils at regional levels. The Board consists of 9 elected members.
The Hungarian Medical Association (Chamber) has a Dental Section – see below
The tasks of the Hungarian Medical Association (and its Dental Section) are:
• exercising care over conscientious practice, protecting the prestige of physicians and dentists
• preparing, performing, controlling and updating of decisions concerning the quality and conditions of
medical practice, expressing its opinion on matters concerning public health and health policy of the
state with its national and provincial local bodies, in cooperation with other associations and
institutions in Hungary and in foreign countries: Communication of the standpoints of the medical
profession on matters of health policy and medicine
• setting the principles of professional ethics. Ethical Code: regulate ethical and professional
obligations of doctors among themselves and vis-à-vis patients
• defending individual and collective interests of members, offering mutual aid and other form of
assistance to members
• expressing its opinion on matters concerning postgraduate education of physicians and dentists,
taking part in its realisation
• promotion of quality assurance
The Hungarian Medical Association performs the tasks by means of
• keeping the register of physicians and dentists

• cooperation in working out the general conditions of contractions between physicians and the
National Health Insurance Fund
• delivery of opinions on draft legislation concerning the protection of health and practising as a
physician
• making decisions with respect of inability to practise as a physician or a dentist
• professional and ethical supervision of members
• negotiating conditions of work and remuneration
• defending individual and collective interests of the members
There is an ethical code in Hungary. There

Ethics are both local and national ethical
committees that enforce the code. It is a
Ethical Code joint system with the medical profession
but the ethical committee always has a
dental member. The most serious penalty
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is that a dentist may lose their licence to
Hunga
practise, but this is very rare. A member
may also be admonished. It is possible to
ry
appeal to an upper level and finally to the
courts.
Advertising
Advertising is permitted under the

framework of the ethical code, but this is
very limited. It is restricted to information
on name, title, telephone number/address,
specialisation and consultation hours. It
does not include the use of advertisements
on the TV or radio. Hungarian dentists may
use websites, within the ethical
considerations – although the code does
not include a specific section on the issue.
Data Protection
The rules for data protection in Hungary

follow the EU Directives. There is a Data
Protection Ombudsman.
Corporate Dentistry

bodies (companies). Anyone may own or
invest in a dental surgery. The person
undertaking the dentistry must be a dentist
but there is no requirement for the
investors to be a dentist.
Indemnity Insurance
This is compulsory for all dentists in Hungary. There are many insurance companies offering
this service. Costs are approximately €150 to €250 per year.
.
Dentists, and those who work for them, must be inoculated against Hepatitis B. The employer
usually pays for inoculation of the dental staff.
For Administered by
Ionising radiation National Public and Medical Officer’s Service
Electrical Compulsory annual checks by MEEI
installations
Waste disposal National Public and Medical Officer’s Service
There is compulsory contracting with special companies who transport
and dispose of waste
Medical devices Institute for Medical and Hospital Engineering (ORKI) (A professional,
non-profit organisation structured in the form of an institute, performing
tests and conformity assessment of medical and hospital equipment. In
the frame of international co-operation ORKI maintains contact with
foreign medico-technical institutes and with other organisations
involved in this field).
Infection control National Public and Medical Officer’s Service
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Financial Matters
The income ranges dentists would have
A further compulsory private scheme
expected to earn annually in 2002 (in
commenced in 1998, in which contributions
Euros):
are made at the rate of 20% by the dentist
and 80% by the government.
years old years old or Taxes
or 2 years 20 years
after after There was a tax rate of 40% above an
qualificatio qualification income of about €5,000, in 2002.
n
Liberal €6,000 €18,000 VAT
General From 2004 there are three VAT rates: 5%
Practice (for medicaments), 15% (materials) and
Public Health €6,000 €8,400 25% for equipment, instruments and
disposables).
Hospital €8,400 €10,800
University €8,400 €36,000
2003
Healthcare
Zurich = 100 Budapest
The normal age for retirement is 62,
although dentists and staff can work Prices (including rent) 57.3
past then. Wage levels (net) 15.6
There is a state-funded system of Power
pensions, of which dentists and their
staff are a normal part. The pension
would be €200 per month. Source: UBS August 2003
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Hunga
ry
Main National association and Main specialist association:

information centre
Dental Section of the Hungarian Medical (Magyar Fogorvosok Egyesülete, MFE)

Association (Chamber) Tel: +36 1 318 5222 (Prof Gera István)
Szondi u 100 Email: gera@szajseb.sote.hu
H – 1085 Budapest
Tel: + 36 1 354 0469
Fax: + 36 1 353 2188
E-mail: kamara@fogorvos.hu
Website: http://www.kamara.fogorvos.hu/
Publications:
Name: Magyar Fogorvos Name: Fogorvosi Szemle
Tel: +36 4366100 Tel: +36 13171094
Fax: +36 14366124 Fax:
E-mail: dental@geomedia.hu E-mail:
Website: www.magyar.fogorvos.hu Website:
Dental Schools:
Budapest Debrecen
Name of University: Semmelweis University Name of University: University of Debrecen
Tel: +361 266 0453 Tel: +36 52 417 571
Fax: +361 266 1967 Fax: +36 52 419 807
E-mail: kovesi@szajseh.sote.hu E-mail:
Website: www.sote.hu Website: www.klte.hu
Dentists graduating each year: 60 Dentists graduating each year: 50
Number of students (Hungarian): 310 Number of students (Hungarian): 137
Number of students (not Hungarian): 110 Number of students (not Hungarian): 64
Szeged Pécs
Name of University: University of Szeged Name of University: University of Pécs
Tel: +36 62 545 283 Tel: +36 72 536 200
Fax: +36 62 545 282 Fax: +3672 536 201
E-mail: E-mail: dekani.hivatal@aok.pte.hu
Website: www.szote.u-szeged.hu Web site:
Number of students (Hungarian): 160 Number of students (Hungarian): 132
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Iceland
In the European Economic Area

Icela
nd Population 288,000
(2002)
Currency Kroner
€1 = 88 Ikr (2003)
Main language Icelandic
There is a comprehensive state healthcare system

funded mostly by general taxation. Care provided
within hospitals is free at the point of delivery,
except some accident and emergency care. But, In
contrast to general healthcare, almost all oral
healthcare is paid for by private individuals and
households, on a fee-per-item basis. Assistance in
paying for these dental fees is limited to the
reimbursements from the Icelandic social security
agency. There are 310 dentists and 307 are
members of the Icelandic Dental Association
(Tannlæknafélag Íslands). The use of dental
Government and healthcare in Iceland
Iceland is a large mountainous island situated in the Atlantic Ocean, just south of the Arctic
Circle. It is 798 km from its nearest European neighbour, Scotland. The highland interior is
largely uninhabitable and most of the population centres are situated on the coast. 180,000
people, over 64% of the total population, live in the greater Reykjavík area.
Settled since 874AD, the present republic was founded in 1944 and is governed by the Althing
(Parliament) whose members are elected every four years. There is also a President, who is a
former minister of the parliament. The President has no role in day to day politics. The
economy is heavily dependent on fisheries, with marine products constituting over 75% of all
exports.
There is a comprehensive state healthcare system funded mostly by general taxation. Care
provided within hospitals is free at the point of delivery, except some accident and emergency
care. People visiting a doctor’s surgery pay a set nominal amount per visit, but a large
proportion of the cost of treatment is paid to the doctor by the social security agency (the
Tryggingastofnun ríkisins). The social security agency also administers payments for some
dental care, retirement pensions, and sickness benefits for those out of work due to ill health.
The proportion of GDP spent on general healthcare, including dentistry in 2002, was 9.2%. Of
this expenditure, 82.9% was “public” (OECD Feb 2004). The governmental spending on
healthcare was 54,000 million krónas, (€613m) where the social security agency spent 15,000
million krónas (€170m).
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Oral healthcare
d
In contrast to general healthcare, for which The Quality of Care

a comprehensive state-funded system
exists, almost all oral healthcare is paid for Only the dental care which is provided
by private individuals and households, on a under the social security system is
fee-per-item basis. Assistance in paying for monitored. There is basic statistical
these dental fees is limited to the analysis of the patterns of treatment
reimbursements from the Icelandic social provided by each dentist, and any
security agency, mostly for treatments on practitioner whose profile differs
children aged 17 years and under. substantially from the norm may be
questioned by the social security agency.
The other population groups who attract a For most minor issues the agency will issue
social security subsidy are those aged 67 a warning to the dentist; more serious
and over who are on low incomes, and cases are referred to a liaison committee
people who are handicapped due to where both the agency and the dental
accidents or birth defects. The social association have their representatives.
security agency operates the system
independently within the framework of Other control on the quality of care is
health policy set by the Ministry of Health. through patient complaints, who may
It spends an annual budget of central complain directly to the social security
government funds, which is set by the agency, to the Chief Medical Officer, to a
Ministry of Finance. Within the Ministry of special committee established by Icelandic
Health there is a Chief Dental Officer Dental Association (TFÍ) and The
(yfirtannlæknir) who promotes dental policy Consumers' Association of Iceland, or to TFÍ
and also has a public health role monitoring who can set up an arbitration committee.
oral health at a national level. The social
security agency also has its own Chief The liaison committee meets when
Dental Officer (tryggingayfirtannlæknir). necessary and has 3 representatives from
the Icelandic TFÍ and 3 from the social
There is no official statistic existing of what security agency. The Committee decides
percentage of the whole population access which complaints should be upheld and
dentistry in a 2-year period but the dental determines the resulting penalties,
association believes this is about 50%. A including warnings or fines but usually
re-examination is normally carried out for paying back the cost of treatment. In
most adult patients at 6-12 monthly extreme cases a dentist may have their
intervals. right to practise, within the TFÍ/social
security agency contract, temporarily
All practising dentists are contracted with limited.
the social security system, which is the
official oral health system recognised by The monitoring of the quality of care and
the government. the handling of complaints is the same in
each of the practice circumstances where
There are no formalised arrangements for dentists practise.
domiciliary care.
In 2001 spending on dentistry was 950

million kronas (€11m), or 6.67% of the
healthcare budget.

Undergraduate Training This small faculty offers undergraduate
training in dentistry. The course normally
Iceland has one dental school or lasts six years and the first term is devoted
http://www.hi.is/pub/tann (the Faculty of to chemistry, dental morphology and an
Odontology at the Icelandic University in introduction to anatomy and physiology. At
Reykjavík), which trains 6 new dentists the end of the first term there is a
each year, taught by 23 dentists who are competitive examination from which the six
employed part-time. students with the highest average mark are
permitted to continue into the second term.
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Although instruction is in Icelandic, the
course texts are in English and students per teacher in the clinical courses,
examinations in the first year may be which has ensured a very high standard of
written in English. Tuition in Icelandic is clinical training. The course fee is
available in the University and after the approximately €305 per year.
first year all instruction and examinations
are in Icelandic. Class sizes are small with Primary dental qualification
normally only six
The title on qualification is the degree
candidatus odontologiae, which is
recognised as a dental qualification
throughout the European Economic Area.
There is no post-qualification vocational

training, in Iceland.
Registration
The Ministry of Health and Social Security is

the competent authority responsible for
issuing dental qualifications. A
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230
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dentist seeking recognition in Iceland faculty will give its recommendations to the
should therefore approach the Ministry for Ministry. >>> Info.
application. If the applicant is a national of
a EU/EEA Member State and holds a dental Further Postgraduate and
qualification awarded on completion of Specialist Training
training in a member State he/she is
eligible to benefit under the Dental
Directive. In addition to an application the
following documents must be submitted:
Continuing education for dentists is not
mandatory. Nevertheless, the Icelandic
• a certified proof of citizenship in a EEA Dental Association has an active continuing
country. education system for Icelandic dentists. For
• a statement from the competent details click or http://www.tannsi.is
authorities in the home country of
the applicant that his/her training for
basic qualifications complies with the
training standards laid down in the
Directive.
• a certified copy of the diploma showing
that the applicant is registered as a
dentist in the home country.
• a certified copy of the applicant’s
licence as a specialist (if applying for
a specialty).
• a certificate of good standing with the
competent authority in the Member
State of origin or last residence. This
certificate must not be older than
three months.
• a translation of any document in
English certified as correct by
government authority or official
translator.
• a curriculum vitae (not compulsory)
When the Ministry has made the formal

assessment the applicant will become fully
registered and the licence to practice will
be issued.
If the applicant is not a national of a EEA

Member State the procedure for
recognition is more complicated, but the
same documents have to be submitted,
then the qualifications of the applicant will
be assessed by a special board under the
medical faculty of the University of Iceland,
responsible for evaluating the dental
training in Iceland. The board always
contacts the applicant’s university directly.
Full address and telephone/fax numbers of
that university are therefore needed. In
individual cases more documents may be
needed.
When the confirmation of the applicant’s

university has been received the applicant
has to pass an examination, where his/her
knowledge in the Icelandic language is
tested, and in most cases the applicant
also has to pass other tests, including
public health and health legislation. When
these requirements are fulfilled the medical
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The purpose of organised continuing training must last at least 3 years and be
education for dentists is to promote the at an approved institution, approved by
maintenance of professional knowledge the Icelandic University and the Ministry of
among the greatest number of dentists for Health.
the benefit of themselves and their patients
(clients). The name of the continuing Continuing education arrangements are
education project is “Active Continuing limited to one lecture series in the spring
Education for Icelandic Dentists” (ACEID), semester about subjects related to
and a Professional Committee is appointed dentistry and weekend courses on
to oversee the continuing education irregular schedule. Teaching is in
system. Dentists presenting confirmation of Icelandic.
having attended courses, congresses and
lectures recognised by the ACEID board
acquire points for accumulation of units
within ACEID.
The reading of articles in recognised
professional journals also merits points for
up to 5 hours of units per year. The
Professional Committee have to approve
the articles. Dentists can then send
responses into the ACEID Professional
Committee and thus earn units. Annually,
certificates are issued to dentists fulfilling
the ACEID requirements. To be deemed
active in ACEID, dentists must have
attended recognised continuing education
courses for at least 20 hours per year.
The Professional Committee consists of

three members:
- One appointed by the Iceland Dental

Association (TFÍ) board of directors.
- One from the University of Iceland's
Faculty of Dentistry.
- One elected at the TFÍ annual
meeting.
The chairman of the professional

committee is a member of the TFÍ board.
The professional committee sits for a three-
year term. One member of the committee
is elected at the TFÍ annual meeting. The
committee's function is to evaluate the
courses, lectures, congresses and article
reading worth units in ACEID. It sets more
detailed rules for itself on unit evaluation
and presents them at the TFÍ annual
meeting. The committee keeps a record of
dentists' participation in ACEID and sees to
it that they receive certificates at the
beginning of the year for their participation.
Dentists active in ACEID may display their
certificates in their waiting rooms and, in
addition, may use ACEID after their names
in the telephone directory.
Specialist Training
The Faculty of Odontology has no

specialist training programs. Specialist
training courses are only available at
universities outside Iceland. To be
accredited by the Ministry of Health
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d
Workforce
Dentists Prosthodontics, Paedodontics, Dental Public
Health/Community, Oral Radiology and
In 2002 there were 278 active dentists in others (unspecified).
Iceland - 69% female.
Patients may go directly to a specialist,
Total Registered 310 without the need for a referral from a
In active practice 278 primary dentist.
General (private) 278
practice Auxiliaries
University (all are in 23 In Iceland, other than dental chairside
private practice, also) assistants, there are two types of dental
auxiliary:
1,035.
210 practising dentists live, and work, in

the greater Reykjavík area. 30% of all
dentists are female.
Dental practice was not financially easy for

dentists in 2003, especially in the Reykjavik
area, where it was reported that there were
approximately 850 patients per dentist. At
Akureyri (the second largest city) there
were 1,000 patients per dentist. The TFI
estimates that with year 2003 disease
levels the optimum would be at least 2,000
patients per dentist.
There is little movement of dentists (for

practising) into and out of Iceland, with
only one dentist moving to Norway in 2003.
Specialists
In 2002 there were 46 dental specialists

working in Iceland, all in private practice,
although some do part-time work at the
dental school.
Numbers of
specialists (2003)
Orthodontists 9
Oral Surgeons 5
Periodontists 7
Endodontists 4
Prosthodontists 6
Paedodontists 4
Oral Radiologists 6
Others 6
There are 10 dental specialties recognised

– Orthodontics, Oral Surgery,
Periodontology, Endodontics,
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There is a school for Dental Technicians in
• Dental hygienists Reykjavik, near the Dental School, and
• Dental technicians training lasts for 4 years. Dental
technicians are usually self-employed,
working in their own laboratories or
Numbers of auxiliaries workshops – although some technicians are
(2003) employees of an individual dentist or group
Hygienists 25 practice.
Technicians 80
Chairside Assistants 300 Technicians can work without supervision,
but not clinically directly with patients, and
the dentist is ultimately responsible for the
Dental hygienists quality of the prostheses. There is no
available information about their earnings.
Dental hygienists must hold a recognised
qualification and (in 2004) such training is The number of working technicians was
only available outside Iceland. Training about 80 in 2003. There are no denturists
must have been for a minimum of 2 years. in Iceland.
The Ministry of Health decides which
external diplomas are recognised and Dental Chairside Assistants
awards licences to hygienists to practise.
Since 1990 there has been a qualification
They work in private practices and at the for dental chairside assistants and it is in
dental school as salaried employees. Whilst fact a requirement to have this in order to
they can diagnose, they can only practise work for a dentist. However, because there
under the supervision of a dentist. They is a shortage of employees with this
may give local anaesthetics and they take diploma, it is not possible to pursue this
their own legal responsibility for their work. requirement. Training is for 2 years in high
school and 1 year in dental school.
There were about 25 hygienists in 2003 Registration is under the auspices of the
and 20 of these were members of the Chief Medical Officer.
Union of Dental Hygienists. They are paid
by salaries or fees. There is no available There are about 300 dental chairside
information about their earnings. assistants. They are normally salaried and
typically would earn about €25,000 per
Dental technicians year.
Icelan
Icelan
Practice in Iceland
d
d
Working in General (Private) reimbursement from the social security
Practice agency.
The main treatments, for which the level of

In Iceland, dentists who practise on their reimbursement is fixed and automatic, are
own or as small groups, outside hospitals or examination and diagnosis, fillings, X-ray
schools, and who provide a broad range of investigation, periodontology, endodontics
general and sometimes specialist and prevention. Reimbursements for oral
treatments are said to be in private surgery, crowns and bridges or
practice. All dentists in Iceland are in orthodontics are only decided after prior
private practice. A dentist would normally approval of the treatment plan by the
look after about 800 regular patients on social security agency.
his/her “list”.
The dentist only receives a payment
All dentists are self-employed and earn directly from the social security agency in
their living partly through charging fees for particular circumstances which include
treatments and partly by claiming treating the institutionalised elderly, those
government subsidies for some types of with learning difficulties or patients
patient. Children under the age of 17 and receiving subsidised treatment for birth
elderly people 67 years and older get fixed defects and other handicaps. The effects of
price dental treatment costs, reimbursed some serious accidents are also covered.
by the state. For the majority of these
groups the patient has to pay the total fee The fee scale for social security subsidised
to the dentist directly, and then reclaim the treatment is a highly detailed list of over
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100 possible treatment items. Specialists
may charge up to 32% above the stated
fixed fee for social security subsidised The TFÍ Moralizing Rules
work.
Premises may be rented or owned, but
Because of the laws on competition, cannot be in the same part of a building as
dentists are not allowed a common scale of another dentist without that practitioner’s
charges. consent, or for up to two years after the
original dentist has left the property. There
Joining or establishing a practice is no state assistance for establishing a
new practice, so normally dentists take out
There are no rules which limit the size of a commercial loans from a bank.
dental practice in terms of the number of Occasionally small communities will create
associate dentists or other staff. However, incentives to attract or keep a dentist in
most dentists own their own practice, with their area, for example by providing cheap
a few younger practitioners who work with accommodation or buying the dental
colleagues, often in dental centres. There equipment and leasing it back to the
are no standard contractual arrangements dentist at a low cost.
prescribed for dental practitioners working
in the same practice. The clinics are housed in all ordinary
buildings, in malls, among offices & etc.,
where the need for dental care or
convenience for people for a visit is the
priority.
There are no private practitioners

practising completely outside any state or
insurance system. Dentists are able to form
companies/corporate bodies.
In Iceland no dentists hold positions in

hospitals. Instead hospitals hold lists of
dentists who are contracted to be on call
for any patients, usually emergency cases,
which require dental treatment. Urgent
care may be provided in an operating
theatre, but since there are no dental
clinics within any of the hospitals in
Iceland, most treatment is deferred until
the patient can attend a private practice.
Working in the University

Dental Faculty
In Iceland about 23 dentists work in the

dental faculty, but only as part-time
employees of the University of Iceland, in
Reykjavík. They also work in private
practice outside the faculty.
Within the faculty there are three main

grades of staff, Professors, Assistant
Professors and Lecturers who have typically
received at least three years’ postgraduate
training; and general part-time teachers
who only require the basic Cand. Odont.
qualification.
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The US Navy base at Keflavik has its own
dental service, operated by the Navy.
However, the soldiers and their families can
visit Icelandic specialists outside the base.
In that case it is based on a special
agreement between the navy and those
specialists who want to be a part of such
agreement.
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Professional associations People in the health care profession are

forbidden to advertise their businesses.
However, they are allowed to have their
There is a single professional association,
own internet homepage with the following
the Icelandic Dental Association
information: name and profession, address,
(Tannlæknafélag Íslands or TFÍ) to which
opening hours, telephone number and fax.
over 99% of dentists belong.
The home pages may also carry a picture
of the staff and/or of the building.
It is funded totally by members’
subscriptions and has a permanent office in
Reykjavík. As well as advising members on
ethical and disciplinary matters, the
association also has a role in negotiating
conditions of work and pay, in conjunction
with the government social security
agency.
The Icelandic Dental Association had (at

March 2003) 310 members, 278 practising,
18 are graduate students at foreign
universities and 14 are retired.
All specialties are represented within a

single Society of Specialists, the Félag
sérfræðimenntaðra tannlækna, which is
best contacted through the Icelandic
Dental Association.
Ethics
Dentists in Iceland work under an ethical

code which covers relationships and
behaviour between dentists, contact with
patients, consent and confidentiality,
continuing education and advertising. The
code is administered by the Icelandic
Dental Association through an ethical
committee. Within the laws governing
dentistry many of the same ethical issues
are also monitored by a government
committee chaired by the Chief Medical
Officer.

requirements between practitioners
working in the same practice. A dentist’s
employees however are protected by
national laws on equal employment
and health and safety. Furthermore, a
contract between the Icelandic Dental
Association (TFÍ) and the Association of
Chairside Assistants (the Félag tanntækna
og aðstoðarfólks tannlækna, or FTAT) sets
a minimum wage for qualified dental
chairside assistants.
Advertising
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Only dentists may be part-owners and/or

Insurance and professional indemnity on the board of the small companies
allowed in Iceland.
Liability insurance is a compulsory for
dentists. It is called patients insurance. All Regulations covering health and safety at
insurance is provided by private insurance work:
companies. The normal cost would be
about Ikr 66,000 (€750) per year. Inoculations, such as Hep B, are not a
compulsory for the workforce, but highly
Data protection recommended. The TFÍ every 5 years
organise inoculations for dentists and their
Clinical records must be kept in a safe staff.
place and access restricted to those
workers who must use them. The Data Regulations for Health and Safety
Protection Commission is authorized,
pursuant to the Act on the Recording and for administered by
Presentation of Personal Information, to
give access to information contained in Ionising radiation The Ionising Radiation Agency
clinical records, including biological Electrical The Electrical Society Agency
samples, for the purposes of scientific installations
research, provided that the research meets Waste disposal Environmental Health and
the conditions for scientific research, cf. Protection Offices in each
Article 2 (4) of this Act. Such access may commune in the country, eg.
be subject to conditions considered Reykjavik
necessary at each time. Every time a Medical Devices Icelandic Medicines Control
clinical record is examined for the purposes Agency
of scientific research, this must be entered
into the record, in keeping with paragraph Infection Control Environmental Health and
1 and 2. >>> Info. Protection Offices in each
commune in the country
Corporate Dentistry
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Financial Matters
d
up to a maximum of 30% (depending upon
age) of net relevant income to a money
purchase plan. The retirement age in
Euros):
Ireland is 65. Dentists may practise
beyond 65 years of age.
years old or years old or 20 The government funds approximately 85%
2 years after years after of health care costs with remaining costs
qualification qualification being paid for privately. VHI and BUPA pay
for private hospital care up to the level at
Public Health €52,018 to €52,018 to
€56,801 €84,483 which an individual is insured. Sickness
benefit usually comes from the state in the
General Practice, Hospital and No information case of an employed person, or from
University private health insurance in the case of a
self employed person.
Retirement pensions and Taxes

Healthcare
There is a national income tax (dependent
For state-employed dentists, the dentist on salary), and Pay Related Social
contributes about 5% of earnings, plus Insurance (PSRI). The highest rate of
1.5% widows and orphans contribution. income tax is 42% on earnings over about
€35,000 (married person), €28,000 (single)
In Defined Benefit Schemes the retirement
pension in Ireland is typically 50% of a VAT
person’s salary on retirement, with a lump
sum of one and a half times the final salary. VAT/sales tax: Payable at 21% on some
This assumes a minimum number of years goods; including dental equipment and
service. All other dentists can arrange consumables.
private pension schemes, contributing
Main National association and Competent Authority:

information centre
Tannlæknafélag Islands Ministry of Health and Social Security

Icelandic Dental Association Laugavegi 116
Síðumúla 35 IS-150 Reykjavik
Box 8596 Tel: +354 545 8700
IS-128 Reykjavík Fax: +354 551 9165
Tel: +354 57 50 500 E-mail: postur@htr.stjr.is
Fax: +354 57 50 501 Website:
Email: tannsi@tannsi.is http://htr.stjr.is/interpro/htr/htr.nsf/pages/forsid-
Website: http://www.tannsi.is ensk
Publication:
The Icelandic Dental Journal – information can be found at:
http://um.margmidlun.is/um/tannsi/vefsidur.nsf/index/1.0010?open
Dental School:
The Dental Faculty
The University of Iceland
Tel: +354 525 4871 & - 4850
Fax: +354 525 4874
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Email: givars@hi.is
Website: http://www.hi.is/pub/tann
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Ireland
Population 3.9
million
Currency Euro
Irela Main language English
nd Irish
Oral healthcare in Ireland is provided through a

complicated mix of publicly funded NHS
schemes and fully private provision. In 2002
there were 2,134 dentists registered (of whom
33% were female), and 1,900 of these were
actively practising. About 82% of dentists are
members of the Irish Dental Association. There
is a well developed system of specialists, and
dental hygienists are also widely used.
Government and healthcare in Ireland
The Republic of Ireland is one of the Money Bills and these must be made within
smaller countries of the European Union. 21 days as against 90 days for non-Money
The population in 2002 was 3,897,000. The Bills.
capital is Dublin. Compared with most
other European countries Ireland has a In addition to its legislative role, each
relatively high percentage of civilian House may examine and criticise
employment in agriculture. Government policy and administration.
However, Dáil Éireann is the House from
Ireland is a parliamentary democracy. The which the Government (the Executive) is
National Parliament (Oireachtas) consists of formed and to which it is responsible.
the President and two Houses: Dáil Éireann Should the Government fail to retain the
(the House of Representatives) and Seanad support of the majority of the Members of
Éireann (the Senate) whose powers and Dáil Éireann, the
functions derive from the Constitution of
Ireland enacted by the People on 1 July
1937. The method of election to each
House is different. The 166 Members of Dáil
Éireann are directly elected by the people,
by proportional representation. Of the 60
Members of Seanad Éireann some are
nominated and some elected.
The sole and exclusive power of making

laws is vested in the Oireachtas subject to
the obligations of Community membership
as provided for in the Constitution. The
primacy of Dáil Éireann in regard to the life
of the Parliament is recognised in that a
general election to Seanad Éireann must
take place not later than 90 days after the
dissolution of the Dáil. In matters of
legislation the Constitution provides that
Seanad Éireann cannot delay indefinitely
the passage of legislation. Bills to amend
the Constitution and Money Bills i.e.
financial legislation, can only be initiated in
Dáil Éireann. Seanad Éireann can make
recommendations (but not amendments) to
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result can either be the dissolution of the General Medical Service from the regional
Ireland
Dáil and a General Election or the health boards
formation of a successor Government.
The General Medical Service (or GMS)
The Houses have separate constitutional provides standard public, primary care
identities. However, in recent years the services to low-income families, all persons
setting up of a well organised system of of 70+ and dependants of those working in
Joint Committees (i.e Committees of both another EU member state. The services
Houses sitting and voting together) has are provided free.
resulted in Members of both Houses having
additional opportunities to participate to an
even greater extent in specialised
parliamentary work in several areas. The
proceedings of the Houses and
parliamentary committees are televised.
In Ireland general healthcare is

administered largely by the Department of
Health and Children, with about 80% of
healthcare costs provided by the State.
However, a significant proportion of
healthcare is privately funded, and the
private sector is subsidised through tax
allowances for health insurance premiums.
State-financed healthcare is available in
two ways; these are:
Voluntary health insurance
There are two providers of voluntary health

insurance. One is a non-profit mutual
organisation established by statute in 1957
called the Voluntary Health Insurance
Board and the second is a leading
independent health care organisation, the
BUPA group. Under their schemes insured
persons and their spouses can receive care
in private and public hospitals, and
outpatient specialist clinics, together with
limited dental oral surgery and emergency
dental trauma, optical and audiological
services. Most members of the scheme
(over 90%) also choose to pay enough
contributions to cover the cost of private
medical care. Primary care through GPs
and the cost of drugs are not included.
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There is an annual predetermined budget The proportion of GDP spent on general
by the Department of Finance and the healthcare, including dentistry in 2002, was
Department of Health and Children, 6.5%. Of this expenditure, 76% was
published in the budget each December. “public” (OECD Feb 2004).
Oral healthcare
Public health insurance endodontics, (limited to 6 anterior teeth),
and preventive treatment.
Dental health care for almost all adults is
provided by approximately 1,300 general Whereas the dental care benefits from the
practitioners, who are mostly self-employed Department of Social and Family Affairs are
and working in their own premises. There available on demand, dental care provided
is also a public dental service for children under the scheme is budget-limited by
up to the age of sixteen, and others who each Health Board. The scheme was
cannot afford private care or have introduced in 1994, as part of the national
restricted access to dental services. For Dental Health Action Plan 1994-98, and
general practitioners care is mostly covers about 30% of adults. Under the
charged on a fee per item basis, but there scheme, to provide a course of treatment
are two ways in which patients are eligible for one of the regional health boards, a
for state subsidised treatment and the total dentist is required to check that the
cost of treatment is calculated differently medical card is still valid.
under each. These are:
Department of Social and Family Affairs

dental benefits scheme
All employees who make Pay Related Social

Insurance (PSRI) contributions, and their
spouses, may receive subsidised dental
treatment. This scheme is run centrally by
the Department of Social and Family Affairs
and (in 2003) 44% of adults were entitled
to receive care within it. The scheme is
distinct from the voluntary health insurance
scheme described in Government and
healthcare in Ireland and insured
employees and their spouses may receive
wholly or partly subsidised dental care for a
limited range of treatments.
Prior approval for treatment is not required

under this scheme.
Department of Health and Children means-

tested scheme
Since November 1994, the regional health

boards have been funded by the
Department of Health and Children to
provide free dental services to lower paid
and unemployed adults. The 10 Regional
Health Boards have contracts with about
78% of general practitioners to provide
services to them. People who have been
means-tested and are eligible to receive
care hold a medical card which has to be
presented to the dentist. After this,
services are free at the point of delivery for
examination and diagnosis, X-ray
investigations, fillings, some oral surgery,
removable prosthodontics, periodontology,
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the quality and quantity of dentists’ work.
However, in practice prior approval for These visits are done at random or in
treatment is only required from the response to particular complaints, but the
regional health boards for protracted dentist has to be contacted beforehand and
endodontic, prosthodontic or periodontal the visit arranged by mutual agreement.
treatment. Such visits aim
Virtually all dentists who have a contract

with the Department of Health and Children
are also panel dentists under the
Department of Social and Family Affairs
scheme and those who do not represent
less than 10% of all general practitioners.
There is no difficulty for patients to access

“NHS” care, although if there is a shortfall
in the budget allocation, practitioners may
be asked to prioritise treatment needs of
patients.
About 69% of the population regularly

receive dental care and patients would
normally attend annually for their oral
examinations. There is limited domiciliary
(home) care, provided mainly by the public
service.
Private Care
There are approximately 100 fully private
dentists. In Ireland there are very few
private insurance schemes to cover dental
care costs. Those that do exist tend to be
employer based, for example those for the
police service. Under these schemes the
patient pays for treatment and then claims
a partial subsidy.
There are currently no free-standing

private dental care plans in Ireland -
schemes where the dentist or a group of
dentists bear most of the risk.
The cost of paying privately for a limited

number of items of dental care or via
insurance premiums is tax-deductible
under current taxation law.
Dentists in general practice receive fees for

treatments (Item of service).
The Quality of Care

For treatments where some or all of the
cost is shared with the government, the
standards of dental care are mainly
monitored by the funding body. The
central payments board of the Department
of Social and Family Affairs and the
Regional Health Boards do this in two ways.
Firstly, the pattern of claims of dentists is
examined to see if they differ significantly
from existing practice norms. Secondly,
and also (in the future) the Regional Health
Boards employ examining dentists to check
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to monitor the quality of each panel the complaint or misunderstanding cannot
Ireland
dentist’s work at least once in a 5 to 7 year be resolved, the Department of Social and
period. Family Affairs or the Regional Health Board
have grievance procedures. The Irish
The only other control on the quality of Dental Association often acts as an
care is through patient complaints, advisory body when complaints arise.
particularly for dentists who do not accept Ultimately, the Irish Dental Council has a
any government-subsidised patients. In statutory responsibility to promote high
the first instance complaints are addressed standards of professional education and to
to the dentist directly. If ensure high standards of professional
conduct amongst dentists.

Undergraduate Training Health and Children scheme need to
register with one of the 10 Regional Health
To enter dental school students must Boards.
obtain the required number of points in the
Leaving Certificate Examination. No other There are no formal linguistic tests or other
vocational entry is possible. There are two tests in order to practise dentistry in
dental schools (both state funded) Ireland.
producing 75 graduates each year. A small
number of Irish students study dentistry in
the UK. Quality Assurance of the 5-year
curriculum is monitored and checked by
the Dental Council.
The title on qualification is Bachelor of

Dental Science (B Dent Sc) from the
University of Dublin (Trinity College); and
Bachelor of Dental Surgery (BDS) from
University College, Cork.
There is no mandatory post-qualification

vocational training. A voluntary scheme has
been in operation for some years.
Registration
In order to register as a dentist in Ireland, a

qualified dentist must have a degree
certificate, a letter of good standing from
their current registering body, and further
evidence of identity if coming from a
foreign country. These must be submitted
to the Dental Council.
To accept patients and remuneration under

dental benefits scheme i.e. to become a
“panel dentist”, dentists must contract with
the Dental Section of the government
department. In the same way, dentists
wishing to be remunerated for providing
free treatment under the Department of
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Further Postgraduate and undergone after primary qualification, and

Specialist Training this is followed by 3 years of full-time
specialist training. To be a consultant may
involve a further 3 years of higher training.
The training takes place in university
teaching hospitals in Ireland, or other such
Participation in continuing education is not
recognised training establishments – often
mandatory, although actively encouraged,
in the UK or other EU countries.
with a credits system. Course organisers
apply for credit points for their courses and
The trainees would provide dental care
these are then allocated to course
during their training and would normally be
participants. A dentist who has
paid as appropriate.
accumulated a target number of points in a
calendar year is entitled to a CDE
On completion of training as a specialist
Certificate.
they would normally receive a certificate of
specialist dentist in orthodontics or oral
There is an extensive system for the
surgery, issued by the competent authority
delivery of continuing education, through
(the Dental Council) recognised for this
courses provided by the Postgraduate
purpose by the competent minister. They
Medical and Dental Board, the Dental
may also receive a diploma from one of the
Schools, the Royal College of Surgeons, the
Royal Colleges of Ireland or the UK, such as
Irish Dental Association, and various
a “Fellowship” or “Membership” or a
societies.
Master’s degree or PhD from a university.
Specialist Training
In 2000, on the recommendation of the
Dental Council, the Minister approved the
There are two recognised specialties in
setting up of a specialist register, which
Ireland. To become a specialist, 2 years of
initially recognised the 2 EU specialities of
general professional training must be
Oral Surgery and Orthodontics.
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Ireland
Workforce
Dentists
There are various associations and
In 2002 there were 2,134 registered societies for specialists - these are best
dentists in Ireland, of whom 33% were contacted through the Irish Dental
female. It was estimated that 1,900 were Association.
actively working. There were no reports of
unemployed dentists. The number of
registered dentists has been rising at the
rate of approximately 75 per annum over
the ten year period 1993-2003.

2,053.
Total registered 2,13

(2002) 4
Active 1,900
General Practice* 1,300
Public Service 370
Hospital 36
University (full-time)* 34
Armed Forces 8
Specialists/limited 148
practice
Others 4
(administrative etc)
* About 95 General Practitioners also work

part-time in the Universities
Specialists
In Ireland, two dental specialties are

officially recognised by the
regulatory body
• Oral Surgery
• Orthodontics
Numbers of
specialists (2002)
Orthodontists 72
Oral Surgeons 26
There are other traditional specialist areas

of dentistry such as Paediatric Dentistry,
Periodontology, and Endodontics, where
practitioners have undertaken further
training and have limited their practices to
their speciality.
Oral surgeons work mainly in hospitals and

universities. Most orthodontists work in
private practice, although some work in
hospitals, universities and the Public
Dental Service. Patients see specialists on
referral only.
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Auxiliaries Dental technicians (are also known as

Dental Craftspersons) are a recognised
form of laboratory worker. Training is
provided by a four year apprenticeship, or
(2002)
a three year course at the Dublin Dental
Hygienists 241 Hospital/Trinity College, leading to a
Oral Health Educators Not Diploma in Dental Technology. There is no
known register. All work must be done with the
Technicians approx prescription of a dentist.
275
Assistants 2,200
In Ireland, other than dental

chairside assistants (or dental
nurses), there are three main types
of dental auxiliary:
• Oral health educators
• Dental technicians
There are no legal denturists in

Ireland (there is reported illegal
practice).
Dental Hygienists
Hygienist training is undertaken at both

Dublin and Cork Dental Schools, over a
period of 2 years. To enter this training an
applicant must have an appropriate
Leaving Certificate result and be
successful in an interview. Qualification is
by way of a diploma, which is a
registerable with the Dental Council before
they can practise.
Working in all situations where dentists

work, hygienists may only practise under
the supervision of a dentist. This does not
mean that a dentist must be present
throughout treatment but rather that a
dentist will have prescribed the treatment
plan and must be responsible for the
treatment.
A hygienist is usually paid either on a

percentage of income or by an hourly rate,
and remuneration would normally be in the
region of €30 to €50 per hour (2003).
Health Board hygienists are paid by salary.
Oral health educators
Oral health educators give advice to

individuals or groups on oral health care.
This takes place with or without the
supervision of a dentist. There is no
registerable qualification for oral health
educators.
Dental technicians
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Technicians normally work in commercial Dental Assistants (Nurses)
laboratories, although some work in
practices. They construct prostheses for Dental nurses assist the dentist at the
insertion and fitted by dentists and they chairside. Many first of all undergo formal
invoice the dentist for the work that is training in one of the dental schools after
done. They would normally be salaried, but leaving secondary school with an
their average earnings were unknown in appropriate Leaving Certificate result.
2003. They obtain a recognised qualification.
Others are trained ‘on the job’ and may or
Laboratories have to be registered with the may not attain formal qualification through
Irish Medicines Board. This requirement night school.
arises from the provisions of the EU
Medical Devices Directive. There is voluntary registration with the
Dental Council, since 2002.
Practice in Ireland
Working in General Practice In order to claim government subsidies
under the two schemes, dentists need to
join the schemes.
In Ireland, dentists who practise on their
General Practice. There are 1,300 dentists
who work in this way which represents 68%
of all dentists registered and practising. In
may be rented or owned, and may be in
most regions practitioners working as
shops, offices, houses or purpose built
“single-handed” account for 80 to 90
premises, subject to planning permission
percent of the total.
from the local authority. There is no state
Most dentists in general practice are self-
so generally dentists must take out
employed and earn their living partly
commercial loans or hire-purchase
through fees from patients, and partly from
agreement from banks. Alternatively, a
government subsidised treatment
substantial minority of dentists work for a
schemes.
period in the UK in order to finance the
For care carried out under the Department
of Health scheme there is a standard fee
for different types of common treatment.
The patient pays nothing and the dentist
claims the total fee.
For care carried out under the Department

of Social and Family Affairs scheme there
are four ways in which the dentist receives
payment. Firstly, for preventive and
common treatments such as examinations
and diagnoses, and scaling and polishing, a
prescribed fee is claimed by the dentist for
each item. Secondly, for some treatments
there are prescribed fees, of which the
government and the patient pay a set
proportion each; for example for dentures
50%. Thirdly, for more complex and
protracted forms of treatment such as
complex fillings, periodontology and
endodontics, the government pays a set
amount and the patient pays the remainder
as agreed with the dentist. Lastly, for
crowns and bridges, inlays and
orthodontics, the patient agrees the fee
with the dentist and pays the whole cost.
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dentists working in the public dental
establishment of their own practice on their service than in the other forms of dental
return. There is no constraint on where a practice.
new practice may be opened.
There are no standard contractual

arrangements prescribed for practitioners
working in the same practice. Dentists,
however, cannot form limited companies.

Service
In Ireland there is a public dental service
which mostly provides services to pre-
school and primary school children, but
also to others who are institutionalised,
medically compromised or otherwise
limited in their ability to access a general
dental practitioner. In total the 10 Regional
Health Boards employ about 370 dentists,
including a small number of orthodontists.
These services are generally provided in
health board clinics but in some areas
dentists in private general practice do
sessional work, often as a means of
building their practice numbers. The
service is available nationally to children up
to 16-years-old, as part of the 1994
National Health Strategy.
The public dental service employs all

dentists as Clinical Dental Surgeons Grade
1, General Dental Surgeons, or Senior
Dental Surgeons with special skills in
various specific disciplines, including
treatment of patients with special needs.
Principal Dental Surgeons also have
administrative and management
responsibilities. Working in the public
dental service requires no additional
training, but many have postgraduate
qualifications. For senior dental surgeons
however, three years experience in the
public dental service or the hospital dental
service is expected and five years for
principal dental surgeons.
Proposals for restructuring to enhance

Public Dental Services, agreed between the
Irish Dental Association and government,
were implemented during 2000-02. Arising
out of this restructuring an additional 60
Senior Dental Surgeon posts were created.
The role of Principal Dental Surgeon was
also enhanced and they took on additional
regional duties. There are now two types of
Principal Dental Surgeon – Regional, and
Planning and Evaluation.
Within the public dental service there is a

greater opportunity for job-sharing -
working on a permanent part-time basis
with the retention of pension rights. There
tend to be a higher proportion of female
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251
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Ireland
The quality of dentistry in the public dental experienced consultants. The complaints
service is assured through dentists working procedures are the same as those for
within teams which are led by experienced dentists working in other settings.
senior dentists. The complaints procedures
are the same as those for dentists working Working in Universities and
in other situations. In addition, Health
Boards have their own complaints-handling
Dental Faculties
procedures. In Ireland 28 dentists work full-time in the
two dental faculties, as employees of the
Working in Hospitals universities. A further 95 dentists work
part-time. Most full-time staff have
In Ireland about 20 dentists work in contracts which exclude the possibility of
hospitals, other than dental hospitals. They private practice.
are employed as salaried employees or on
a private fee basis by the national or The main academic titles within an Irish
regional government, or one of the private dental faculty are those of Professor,
health companies or religious orders which Senior Lecturer and Lecturer. Those above
own some hospitals. There are usually no lecturer level will usually have a fellowship
restrictions on outside practice, and public (of one of the Royal Colleges of Ireland or
health dentists and private practitioners the UK) and a PhD. There is a University
often provide some care within hospitals. Promotions Scheme, which sets standard
procedures for making appointments.
Dentists who work within hospitals may be Apart from these there are no other
employed as dental surgeons, senior house regulations or restrictions on the
officers, registrars or consultants, in the promotion.
following specialist areas, Oral and Maxillo-
Facial Surgery, Orthodontics and Paediatric A typical full-time faculty member of staff
Dentistry, Restorative Dentistry, Radiology will have as much time committed to
and Oral Pathology. These are the administration and treating patients as to
traditional hospital and academic research and teaching.
specialities that have existed for many
years. In 2000 on the recommendation of The quality of clinical care, teaching and
the Dental Council the Minister approved research in dental faculties is assured
the setting up of a Specialist Register in through dentists working within teams, and
Dentistry giving recognition to the two EU under the direction of experienced teaching
recognised specialities of Oral Surgery and and academic staff. The complaints
Orthodontics. As described earlier, to procedures are the same as those for
reach consultant level requires both basic dentists working in other situations.
specialty training (3 years), to obtain
accreditation, and higher specialty training
of 3 years, to obtain fellowship status.
The quality of dental care in hospitals is In 2003, 8 dentists served full-time in the
assured through dentists working within Armed Forces – it is not known how many
teams under the direction of were female.
Professional association and government, health boards and all other
bodies relevant bodies.
Fitness to Practise
There is a single national association, the
Irish Dental Association. It represents all Any person can apply to the Dental Council
sections of the profession, and in 2003 for an inquiry into the fitness of a
about 82% of all dentists were members. registered dentist to practise dentistry on
Its aims are to promote the science of the grounds of
dentistry, to maintain the honour and
integrity of the profession, to promote the • alleged professional misconduct
attainment of optimum oral health for Irish • alleged unfitness to practise because of
people and to represent the profession in physical or mental disability
all dealings and negotiations with
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Each application is given due consideration
and if there is a prima facie case for an physical or mental disability the Council
inquiry such inquiry will be held. If, may suspend the dentist’s registration,
following an inquiry, a charge of attach conditions to registration or erase
professional misconduct is proven or the his/her name from the Register. These
dentist is deemed unfit to practise by sanctions are subject to approval by the
reason of High Court.
Ethics
All dentists in Ireland have to work under a

code of professional behaviour and dental
ethics which is administered by the Dental
Council of Ireland. It covers relationships
and behaviour between dentists, contracts
with patients, consent and confidentiality,
continuing education, advertising and the
quality of treatment. This includes a duty
to provide emergency care for patients
outside normal surgery hours.
If a complaint by a patient regarding any

aspect of State funding services is upheld,
a financial penalty or a warning is the most
likely form of sanction. In some more
serious cases a dentist may only carry out
work after prior approval of all treatment
plans. Only for a very small minority of
complaints do the dentists get referred to
the registering body, or lose their right to
practise in the state-assisted system. At
all stages dentists have a right of appeal
within the complaints procedures, to the
Minister of Health and Children, via the
Regional Health Boards and the Minister
of Social and Family Affairs.
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As far as the relationship of the dentist Indemnity Insurance
with their employees and with other
dentists is concerned, there are no specific Liability insurance is compulsory for health
contractual requirements between board dentists and for general
practitioners working in the same practice. practitioners participating in either the
A dentist’s employees are protected by the Department of Social and Family Affairs or
national and European laws on equal the Department of Health and Children
employment opportunities and anti- Schemes. While it is not compulsory for
discrimination, maternity benefits (18 other dentists, it is strongly recommended
weeks in the public sector), occupational and is, in fact, held by virtually all of the
health, and health and safety. practising profession. It provides cover for
advice, legal costs and unlimited
Advertising indemnity. There are different prices for
different types of dentist and a general
The Dental Council is obliged under dental practitioner pays approximately
legislation to give guidance to the dental €2,200 to €2,950 annually. .
profession generally on all matters relating
to ethical conduct and behaviour. The Health and Safety at Work
Council favours only limited advertising by
members of the profession in private A known Hepatitis B carrier cannot work in
practice. a hospital or health board facility in a
clinical capacity. For other clinical workers
The Competition Authority in Ireland was an appropriate antibody titre is desirable.
undertaking a study of competition in the Hepatitis inoculation is highly
profession in 2003 and it was anticipated recommended for GP’s. Hospitals and
that where restrictions on advertising are Health Boards do their own monitoring.
in place, it will recommend that these
should be removed or greatly liberalised. Regulations for Health and Safety
There is no information regarding the For Administered by

introduction of legislation related to the EU
Directive on Electronic Commerce. Ionising radiation Radiological Protection
Institute of Ireland
Data Protection Electrical Local government, Health
installations and Safety Department
Ireland fully implemented the Directive on Waste disposal Local government, Health
Data Protection during 2003. and Safety Department
Medical devices Irish Medicines Board
Corporate Dentistry
Infection control Irish Dental Council
Dentists are not allowed to form corporate
bodies (companies).
Financial Matters
Dentists’ Incomes: Public €52,018 to €52,018 to
The income ranges dentists would have Health €56,801 €84,483
University No No information
Euros):
information
years old years old or
or 2 years 20 years
after after
qualificati qualification
on
General No No information
Practice information
Hospital No No information
information
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Ireland
Taxes
Retirement pensions and There is a national income tax (dependent

Healthcare on salary), and Pay Related Social
Insurance (PSRI). The highest rate of
income tax is 42% on earnings over about
For state-employed dentists, the dentist
€35,000 (married person), €28,000 (single).
contributes about 5% of earnings, plus
1.5% widows and orphans contribution.
VAT
In Defined Benefit Schemes the retirement
VAT/sales tax: Payable at 21% on some
pension in Ireland is typically 50% of a
goods; including dental equipment and
person’s salary on retirement, with a lump
consumables.
sum of one and a half times the final salary.
This assumes a minimum number of years
service. All other dentists can arrange
private pension schemes, contributing up
to a maximum of 30% (depending upon
age) of net relevant income to a money
purchase plan. The retirement age in
Ireland is 65. Dentists may practise
beyond 65 years of age.
The government funds approximately 85%

of health care costs with remaining costs
being paid for privately. VHI and BUPA pay
for private hospital care up to the level at
which an individual is insured. Sickness
benefit usually comes from the state in the
case of an employed person, or from
private health insurance in the case of a
self employed person.
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2004_______________________________________
2003
Zurich = 100 Dublin

Power
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__ ____EU Manual of
Main national association and Competent Authority:

information centre
Irish Dental Association, The Dental Council of Ireland

CUMANN FIACLÓIRÍ na hÉIREANN 57 Merrion Square
10 Richview Office Park, Dublin 2
Clonskeagh Road IRELAND
Dublin 14 Tel: + 353 1 676 2069
IRELAND Fax: + 353 1 676 2076
Tel: +353 1 283 0496/0499 E-mail: dentalcouncil@eircom.net
Fax: +353 1 283 0515 Website:
Email: info@irishdentalassoc.ie
Website: www.irishdentalassoc.ie
Postgraduate education: Publication:
The Postgraduate Medical and Dental Board Journal of the Irish Dental Association – address
of Ireland as above, for the IDA
Corrigan House, Fenian Street,
Dublin 2,
IRELAND
Tel: ++ 353 1 676 3875
Fax: ++ 353 1 676 5791
Email: info@pgmdb.ie
Web: http://www.pgmdb.ie
Dental Schools:
Dublin Cork
Name of University: Trinity College Name of University: Cork
The Dean The Dean
Dental School University Dental School and Hospital
Trinity College National University of Ireland, Cork
Lincoln Place Wilton
Dublin 2 Cork
IRELAND IRELAND
Tel: +353 1 612 7306 Tel: +353 21 454 5100
Fax: +353 1 671 1255 Fax: +353 21 434 3561
Email: info@dental.tcd.ie Email:
Website: www.tdc/ie/dentalSchool Website: www.ucc.ie/ucc/denthosp/
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2004_______________________________________
Italy
Population (2002) 57.7 million
(2002)
Currency Euros
Main language Italian
General public healthcare is funded largely through

general taxation, with small co-payments by patients
limited to specific classes of pharmaceuticals,
specialist visits and diagnostic services, with various
exemptions (medical conditions and income levels).
Oral healthcare may be limited to emergency
treatment only and most dentistry is therefore
provided through liberal, private practice. There are
about 51,000 registered dentists. Almost 41,900 are
listed in the so called “Albo odontoiatrico” (Dentists
List), while the others are dentist listed in the “Albo
dei medici” (Physicians list). There are two main
dental associations, ANDI with 14,500 members, and
AIO with 1,500 members. The use of dental
specialists is limited and the development of clinical
dental auxiliaries is limited to hygienists. There is a
Italy
Government and healthcare in Italy
Italy is a democratic republic, on the north functions including agriculture, the

side of the Mediterranean Sea. Italy is one environment, planning, the arts and
of the founder countries of the EU. In 2002 sanitation. The Regional powers are
the population was 57,715,625. The capital through ongoing revisions of the Italian
is Roma. Constitution and federalist legislation.
Italy has a central government elected by Health care is currently a constitutional

(mainly) proportional representation. The right for all citizens. The budget for health
country is divided into twenty one regions. services is decided nationally and funds
Each region has an elected parliament or are allocated via the Regions on a per
council which can raise local taxes. capita basis. At present (2003) the central
Regions are responsible for a range of government establishes health coverage,
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(namely, the typology of services provided on a private payment basis.
guaranteed under the NHS provision) Some innovations (for example, which
called LEA - Essential Levels of Assistance. specific taxes and in what percentage can
Its priorities are through the National be levied by the local authorities, regions
Health Plan and the national budget. The and municipalities) follow the
whole process is based on consultation implementation of the new Federalist
and, in reality, on the agreement with the legislation, while the entire process of
regional governments through the so- delegation of powers and responsibilities
called “Conferenza Stato/Regioni” to the regions is still ongoing.
(State/regional conference). Even if the
resources are public (taxation and state The political responsibility of the regional
budget), the NHS and the Regional budget health service is on the “Assessore alla
are produced by national and local sanità” (Health Commissioner, who is a
taxation, together with a very small member of the Regional Government.).
amount of self financing through the The institutional and organizational
application of tickets, co-payments and structure of each of the 20 regional
services services is made by “Aziende sanitarie
locali” (local health public enterprises or
firms) and “Aziende ospedaliere” (hospital
public enterprises). Each region appoints a
general manager to manage its health
local and hospital enterprises. The general
managers are supported by other technical
(medical and administrative) bodies.
Hospitals are mainly paid for the services
provided (Italian DRG’s), while the other
sectors (general practice, specialists, etc.)
are paid through services tariffs or a per
capita quota. The third component of the
NHS is the “Public Health Service”, mainly
public hygiene, prevention, etc. The
various services are provided in the
following way:
Hospital care, primary care, specialist care,

actually, all services guaranteed under the
LEA (Essential levels of services) are
provided free of charge. There are two
exceptions: tickets applied to a certain
class of drugs (all those out of class A, are
guaranteed to everybody free of
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2004_______________________________________
charge, class B 65% of the charge and The proportion of GDP spent on all
class C the full charge) and a co-payment healthcare (excluding estimated deficits),
applied to specialist services, namely visits in 2002, was 8.6% - at €103 billion -
(for example, a visit to a cardiologist, a higher than in earlier years, due to both
neurologist, etc.) and laboratory and increases in public expenditure and a very
diagnostic services. Emergency care is slow increase of GDP. The public health
free at the point of delivery but, in some share of this was 78% (source: OECD Feb
regions if the patient is not hospitalised he 2004).
has to pay for the services received,
because the emergency was deemed to be
inappropriate. Persons who are considered
“frail”, by their economic condition or
specific health conditions, those aged
under 6 and over 65, are exempt of every
ticket and co-payment.
Oral healthcare
In principle, there is a comprehensive oral buys a ‘ticket’ as a contribution to the cost.
health care system, which functions within The price of the ‘ticket’ varies according to
the National Health Service. Only implants the treatment that is necessary, but is set
are formally excluded. However, in reality, by national law for each procedure. The
the service provided depends on local amounts change from time to time and in
priorities for health and thus varies 2003 was less than €46. If the total cost of
enormously, even from town to town within a course of treatment is less than the
a region. In many areas, only emergency maximum then the patient may be required
treatment is provided. So, in practice, to pay for all the care at nationally agreed
publicly provided dental treatment fees. In most regions there are waiting
comprises mainly extractions and only lists.
occasionally restorations. Considering that
there is an extensive under-provision even There is no uniformly organised system for
in the areas where there a public duty to the oral health care of children at a
deliver dental care, dentistry is in point of national level. This is despite the fact that
fact a private sector service. In the last few there is a national law dating from 1993
years, however, there are signs of an which, subject to the payment of a small
increase of public supply both in the form fee, makes the Institute of National Health
of new models of delivery and of joint Service (NHS) responsible for the oral
public/private financing. health care of children up to the age of 14
years, and adults over the age of 65 years.
Dental care has two components. In case However, in some regions, for example,
of surgery or similar treatment which Venetia, Lombardy and Tuscany, each and
requires hospitalisation (hospital dental every child is offered a dental examination
care) it follows the rules of hospital care at defined intervals. The responsibility for
and therefore is free of charge. Cases of arranging the dental examination
ambulatory care (95% of all dental care)
follows the rules of specialist services. In
principle, it should be provided by public
dental ambulatories to everybody with the
application of tariffs related to single and
specific treatments and tickets (the tariff is
paid by the region to the providers and the
ticket is paid by the patient). Coverage,
however, is limited to the actual (medical
and dental) treatment, and not to the
“materials”, that is prostheses, etc. Thus,
dental care in its public component relies
on private resources. In addition, public
dental care is much less available than, in
principle, it should be – so there is under-
provision.
Depending on the service available,

patients who attend are examined and a
treatment plan is agreed. The patient then
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predominantly rests with the parents. structural, professional and technological
characteristics. The entire question is,
In most regions orthodontic or prosthetic however, under discussion and still awaits
treatment is not normally covered by the complete regulation.
public system. Since the amount of
treatment in the Public Health Service is
limited by local priorities and the budgets
that are available, most care is in fact
provided from Private Dental Practice.
Public expenditure on dentistry was

estimated in 2003 to be approximately
€500 million, or 0.063% of all public health
expenditure. Public dental expenditure,
however, has increased slowly in the past
few years and it is a very dynamic
component of the regional public budget,
because in the main the regions are trying
to increase supply. Private dental
expenditure is estimated to be between
€15-20 billions, between 1.15% and 1.53%
of GDP

care
There are some private healthcare
insurance plans, but largely they exclude
routine dental care. Most, however,
include hospital-based oral surgery on an
“item of care basis”. There are no private
dental care plans.
This market is changing however, because

there is a trend to develop dental plans as
a part of the coverage provided by
supplementary health insurance. The
government is trying to introduce (for the
fiscal year of 2004) new legislation which
should represent an incentive for the
establishment of various forms of
supplementary insurance, including dental
care. This will be supplementary insurance
for children and the elderly (with high fiscal
benefits), and supplementary insurance for
other population groups, with lower
incentives. The legislation is under
discussion and may be part of new rules to
be applied in 2004. Real implementation,
however, is deemed to be very problematic
and very slow.
Quality of Care
There is no formal direct monitoring in
either the public or private sector, other
than patient complaints. Both public and
private practices are nevertheless
“authorised”, which means that have to
obey to certain professional and structural
standards.
Beside mandatory authorisations, some

regions have developed and applied rules
of accreditation. In Italy, accreditation
means that practices hold higher levels of
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261
Italy
2004_______________________________________
Regional (Lombardia) and national surveys The competent authority which maintains
in the early years of this century revealed dentists’ registration and dental practice
that patients have high confidence in their accreditation (every five years) is the State
dentists and are satisfied with their Agency of Health Statistics and Medical
services, including the fees paid for Technologies, in cooperation with State
treatment. Dental Centre. Since 2001, this agency has
been working in accordance with the
Access regulations all over the state (instructions
Patients in Italy do not have problems of regarding: working – space, units, and
access to private dentists. But, patients dental technologies minimum requirements
have access problems in the public sector, standards for dental practice). A document
with under-provision (even if the treatment of evidence based methods and
is guaranteed to be available) or waiting technologies, was worked out in 2002 and
lists. was introduced from July 1st 2003, in all the
702 registered dental practices. This
Half of the population attends a dentist at document is to motivate all dental staff to
least once a year. Intensity of treatment, attend CPE courses.
that is the number of dental visits per
persons per year, is estimated however to The quality of work is evaluated by the
be low comparing to international HCQCI inspectors and experts of the dental
standards. Re-examinations for adult associations. In the framework of
patients occur usually on an annual basis. evaluation, documentation and current
clinical situation is analysed. Experts for
the Professional Certification Commission
are nominated by the associations.

Undergraduate Training The primary degrees which may be
included in the register are:
have completed secondary education (high • University degree in Dentistry and
school) and have a diploma, at the ages of Dental Prosthesis with a
approximately 18 to 19 years. There is an
entrance examination to dental school and o Degree to practice
a “numerus clausus” is applied to each dentistry and dental prosthesis.
school. However, there exceptions to this
limitation rule, following tribunal decisions or a
in those cases where applicants have
resisted legally the denial of entrance. • University degree in medicine and
surgery accompanied by the
There are 30 dental schools in Italy, all o Specialization in the dental sector
located in universities as Faculties of
with
Dentistry in Colleges of Medicine. They are
all state owned, except the University o a Degree to practise medicine and
Cattolica in Rome. The dental course is 5 surgery
years in length. In 2003, there were
approximately 900 students who entered
into dental training and 30% of the
approximately 5,000 undergraduates were
female. Students in the private dental
school were responsible for paying their
own fees. Foreign students are estimated
to be almost 50 in number.

provided by the Ministry of Education, with
some joint responsibility with the Ministry
of Health.
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262
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dentistry. The registration process is the
same for all dentists, and there are no
Italy
From January 2003, the EU Directives were regulatory or linguistic tests.
fully implemented by the Italian
Government, and only a university degree From 1998 to 2002, between 510 to 575
in Dentistry is acceptable for first dentists per year registered (for the first
registration as a dentist in Italy. time), and about 60% were female.
Until 2003 there was a confused situation in Further Postgraduate and

Italy: from 1897, by law it was mandatory to Specialist Training
have a university degree in medicine and
medical surgery (6 years) to practice dentistry.
The first (5-year) university degree in dentistry Continuing education
was introduced in 1924, but a law of 1926
confirmed that the medical university degree Since 2002 there has been a formal
was still necessary to practise dentistry.
Traditionally, therefore, dentistry was a specialty
requirement for continuing education for
of medicine, with or without formal training in dentists who work in the Public Health
dental subjects. Services (Law 229/99). They have to
undertake 150 units of CPE within a 4-year
A Presidential Decree of 1980 introduced (again) period, in courses accredited by the
the 5-year university dental degree, according to Ministry of Health.
the EC Directives but a further law in 1985
confirmed that two ways of training (through a
However, the situation regarding
medical degree and a specialisation of
“Stomatology”, or a dental degree) could lead to continuing education for dentists working
registration as a dentist. In 1991 the European in private practice was not clear at the
Court ruled that the Italian law permitting time of publication of this Manual. It was
medical doctors to practise dentistry was illegal thought that accreditation procedures
and that all medical doctors already practising were being sorted out between the dental
dentistry must be enrolled in a Dental register. associations. Formal postgraduate
education for hospital and university clinic
The Stomatology specialisation was abolished by
specialties, is still at its very
a Decree in 1993 and in 1995 the European
Court ruled that physicians who practised
dentistry according to Italian laws were ultra
viraes. In 1998 the Commission’s view that
physicians had to have attended proper dental
courses was ratified in Italian law.
There is no post qualification vocational

training in Italy
Registration
To register as a dentist in Italy, an

applicant must have a degree or diploma
in dentistry recognised by the Ministry of
Health (Foreign Affairs) and by one dental
faculty, and be a citizen from an EU or
other appropriate country. The
registration list is held by the Federazione
Ordini dei Medici Chirurghi e degli
Odontoiatri - the competent authority for
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263
2004_______________________________________
beginning, following the new university
reform. Trainees are paid during the period of
training for their specialisation, when
Specialist Training specialisation follows the first degree of
Doctor of Medicine. Resources were made
In Italy two specialties, Orthodontics and available by the Ministry of Health and are
Oral Surgery, are recognised. In each case a component of the overall financing of the
formal training lasts for three years and NHS. The new University Reform has
takes place in a University. The titles upon introduced Masters and PhD degrees to
qualification are respectively: Italy, and this will be implemented shortly
(2003). During their period of study,
• Diploma di specializzazione in students may get some specific financing,
'Ortognatodonzia' similar to what used to be available in the
old system. It is not envisaged that a
• Diploma di specializzazione in specialists’ register will be introduced to
'Chirurgia Odontostomatologica' Italy.
Workforce
Dentists
In 2002, there were 50,922 practising as Total Registered 50,922
dentists in Italy (27% female) and the General (private) 44,500
numbers are increasing annually. Indeed, practice
900 new students enter into dental schools Public dental service 2,100
annually, about 30% being female. Hospital n.a.
Approximately 9,000 of registered dentists University 150/300
are graduates in medicine with dentistry as Armed Forces n.a.
a specialty (the old system) and 30-31,000
are medical graduates without formal
specialist training in dentistry. It is not clear Movement of dentists across borders
how many restrict their work to dentistry
only, and how many practise both medicine In 2003, there were approximately 500
and dentistry. A further 10,000 registered foreign dentists working in Italy. An
dentists graduated under training unknown quota comes from other European
complying with EU Directives. countries, above all, those close the Italian
borders. Another quota comes from outside
The dentist to population ratio is formally the EU, following a recent increase of
1:1,154. However, using Ministry of immigration. Additionally, it is known that
Finance measures (see Working in there is movement across the northern
General Practice) it may be that the ratio border of Italy and that this is on the
is much higher. increase. Italian graduates tend to go to
the French speaking countries when
There is some reported unemployment working abroad, but some go also to the UK
amongst dentists in Italy, because of and the US.
supply-demand imbalance, above all in
southern Italy. There is also what is called Specialists
“underemployment”, that is to say dentist
with a number of patients which is client In Italy, two specialties, Oral Surgery and
very low, or not sufficient to cover the Orthodontics are recognised. Most
expenses of keeping open the practice, to specialists work in private practice and see
earn a basic reasonable income. patients on referral from private
practitioners. The ratio
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of specialists to other dentists is estimated per month, according to the “category
to be very low (no more than 5%) contract”, but most of them work as liberal
professionals and in these cases their
incomes may vary individually.
(2000 – the latest Dental Technicians
figures)
Italy
Orthodontics 1,100 Dental technicians are trained in
Oral Surgeons 20 independent professional (technical)
schools over 4 or 5 years, to
diploma/certificate standard. The
There are many regional associations and qualification has to be registered with the
societies for specialists. These are best Camera di Commercio of each Province.
contacted via one of the national dental
associations. Technicians cannot work at the chairside,
or treat patients, and are only legally
Auxiliaries allowed to manufacture prostheses from a
dentist’s prescription. There is also a
considerable amount of illegal practice in
Other than chairside assistants, there are
Italy, some of which is thought to be
two kinds of recognised auxiliaries. They
condoned by medical practitioners, who
are:
cover for the technicians concerned.
• Dental Hygienists
• Dental Technicians They are salaried or professionals who own
their private laboratories, deriving their
income from the provision of services to
dentists. The majority of them are
(2002)
associated in a syndicate.
Hygienists 2,000
Technicians 70,000 Their gross income may vary, between
€1,000-4,000 per month, depending on the
type of occupation (salaried or free
Dental Hygienists professionals) and the laboratory location
(big cities, north vs. south).
Education and training is provided for this
group by universities and lasts for three Chairside Assistants
years, leading to a diploma which must be
obtained before a dental hygienist may Dental chairside assistants’ education and
legally practise. There is no register. training is normally provided by individual
dental practitioners, but they may receive a
Hygienists can only work under the Certificate of a Regional School, if they
prescription of a dentist who must be have attended for a 1-2 years training
present in the same practice at all times. course (in Lombardy and Trentino Alto
Their duties (defined by Decree in 1999) Adige Universities and Hospitals, and
include oral hygiene instruction, scaling sometimes by the dental associations).
and dietary advice. Hygienists are unable
to administer local anaesthesia. Their duties are restricted to assisting the
dentist at the chairside, including (for
Hygienists in Italy are normally salaried; example) sterilising instruments, mixing
their average gross salary for a full time job filling materials and undertaking
in 2003 was approximately €2,000 administrative duties. The dental
associations estimate that there were
about 60,000 chairside assistants in 2003
Practice in Italy
Working in General Practice general treatments are said to be in
“Private Practice”.
In Italy, most dentists who practise on their They are self-employed and charge fees
own or as small groups, outside hospitals or almost exclusively as ‘items of service’, the
schools, and provide a broad range of levels of which are controlled by market
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forces. There are thought to be up to
44,000 dentists who work in private
The Ministry of Finance lists as dentists
practice, but this includes many medical
those who have a specific fiscal dentistry
physicians and general practitioners who
code and the numbers of these dentists is
have some dental equipment in their office.
less than three quarters of those
registered.
As employers, private dentists contract
with their staff on terms that are
negotiated centrally. This contract includes
pay, hours of work, sickness, holidays,
maternity leave, pensions and social
security payments. It is part of a national
social agreement, is not exclusive to dental
practice and is very strictly applied.
Benefits other than pay are funded by
workers’ and employers’ contributions.
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The structure of practice is changing, They are all salaried and earn about
although slowly. Some dentists join and €30,000 (gross) per year.
Italy
build big practices, and multi-specialty

dental practices. The public sector is very Working in Hospitals
active in this transformation, even if
change is driven by private professionals. Some dentists are employed in hospitals,
either full or part-time, to treat emergency
Joining or establishing a practice cases or perform general treatments on
There are no controls on the establishment hospitalised patients. Each hospital has a
of dental practices other than opposition Director (Primario), an Aide (Aiuti) and
through local planning regulations, but Assistant Dentists or Volunteers who work
premises must be inspected by a Public without salary in order to gain experience.
Health Official before use. Most of these staff have no specialist
training, and promotion is obtained by
Newly qualified dentists usually work as national competition, when curriculum
assistants or in the Public Dental Service. A vitae are considered by local committees.
few of these then become partners but
most (60%) buy an established practice They are salaried and earn about per year
and the rest (30%) start new practices. No €40-50,000 (gross).
central funding is available for the
purchase of practices and loans must be Working in Universities and
obtained from banks or other commercial Dental Faculties
institutions.
Dental school staff are all salaried, and
Working in the Public Dental either work full-time, or 30 hours per week
Service supplemented by private practice. The
number of staff in each of the 30 schools is
The Public Dental Service exists to a prescribed by the Ministry of Health and
varying extent in most regions as an Education, as is the proportion in each
alternative to private practice. It thus grade. Progression through the grades is
provides the only government funded by national competition, as in hospitals.
primary care. Every region has a number of
clinics each of which is managed by a The hierarchy is: full professor, associate
Clinical Officer who directs a number of professor, researcher (lecturer)
Heads of Departments, at least one of
They earn about €60-70,000 (gross) per
whom will be a dentist if dental services are
year, according to seniority and position.
provided. This individual will then be
responsible for the staff within the
department. Apart from medical and Working in the Armed Forces
dental care, social services and
How many dentists serve full time in the
environmental health support is provided,
Armed Forces is not available information,
and unusually, veterinary care. There is no
but it is known that there are some. Some
formal structure below Head of Department
military hospitals have dental beds and
and no titles, but there are salary
ambulatories. It is also unknown what
differences largely dependent on length of
proportion is female.
service.
Theoretically, all groups in society are
eligible to attend the service, but in reality
it is largely used by the lower middle class,
who cannot afford private care. In a few
regions, school screening programmes
have been introduced, together with some
prevention and oral health promotion. In
general, these activities are exceptional
and not standard.
Professional association and There are two main national dental
bodies associations, the Associazione Nazionale
Dentisti Italiani (ANDI) and the
Associazione Italiana Odontoiatri (AIO).
The origins of ANDI lie in the historical right
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of doctors to practise dentistry with or
without with or without specialisation. This
right was removed after the
implementation of the Dental Directives in The AIO and AISO (Italian Dental Student
1985. When new dentists started Federation) are founding members of the
graduating according to the EC directives, FOI (Italian Dental Confederation).
AMDI (of which ANDI was then a part)
changed its constitution to allow them to Ethics
become members. In the 2002/03 FDI Italian law defines the care a dentist may
Report, ANDI was reported to have 14,500 provide as: “All acts for prevention,
members. diagnosis and treatment of defects and
In 1984, AIO was formed to provide diseases of the mouth, teeth, jaws and
separate representation for this new class adjoining tissues, congenital or acquired.”
of university trained dentists, if they Ethical Code
wished. IAIO were reported to have 3,500
members in 2003 (FDI). Italian dentists have an ethical code which
is identical to the medical code. The code
Both organisations represent all the is administered in each Province by a
different bodies within the dental committee of dentists who are elected
profession - private practitioners, state every three years. By law there are five
employed dentists, university teachers and members in each provincial committee.
dental specialists. There is no consumer or other
representation, but legal advice may be
available. In each triennium, the
Presidents of the Provincial Committees
meet to elect five members to a National
Committee for ethics, which then appoints
its own President.
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Each ethical body has disciplinary powers There is no specific Italian position relating
and patients can complain to them about to the Advertising, Electronic Commerce
the care that they have received. Both the and Data Protection Directives. The
patient and the dentist can be legally question was still under discussion in the
represented during any hearings. If found competent bodies in 2003.
guilty of a breach of the code, a dentist can
be warned or admonished, temporarily
suspended up to a maximum of six months Liability insurance is not compulsory for
or permanently suspended for bringing the dentists but insurance is provided by
profession into disrepute. Warnings can be private general insurance companies
given for failure to provide an estimate of (addresses available from the dental
the cost of treatment. Dentists can appeal associations), or the dentists themselves.
to a central appeals committee which has a Exact cover and the cost of the insurance
state judge as a member. Patients can depends on the contract and the type of
appeal to the National Ethical Committee practitioner.
and/or take civil action against the dentist.
If such an action is successful then the case Corporate Dentistry
is referred back to the disciplinary process. Dentists can join together and for
The above system applies to both the professional companies, namely companies
private and the public sector. In practice where the only partners are dentists. Non
some dentists have been temporarily dentists cannot be members of these
suspended, but very few permanently. professional companies, although changes
to this rule have started to manifest since
Standards 2002.
There is no formal monitoring in either Health and Safety at Work
sector other than patient complaints. In
private practice these would be directed to In the case of accidental inoculation or
the appropriate ethical committee but in wound from patients at risk, public health
the Public Service they are first services are available for the private
investigated by a clinical officer who practitioners, single dentists or Dental
theoretically has the power to suspend or Associations and are linked to private
fire the dentist concerned. In practice this insurances for professional diseases, which
never happens and cases are instead are not compulsory, but the proper
considered by a Regional Board of protocols in this matter (of the Public
Specialists who in extreme cases may refer Health Service) must be followed.
them to the Ethical Committee. Regulations for Health and Safety
Data Protection
For Administered by
Italy has complied with the Data Protection Ionising radiation Regional government
Directive and personal data are protected Assessorato Sanità
under the new rules of the privacy code.
Patients have to sign a release form, in Electrical Government Ministero
order to make available data for installations Industria)
professional and scientific reasons. Infection control Government (Ministero
Salute)
Advertising
Medical devices Government (Ministero
Dental services cannot be advertised and Salute)
dentists can only inform the general public Waste disposal Regional regulation
of their title and area of practice. However
this is in the process of being revised.
Financial Matters
Dentists’ Incomes: sector may undertake private practice,
also. Consequently, their total income may
be higher than that of full-time private
Dentists working as free professionals may
professionals.
have higher gross incomes than those
working in the public sector (universities,
hospitals and public dental service).
expected to earn in 2002 (in Euros):
However, dentists working in the public
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pay 8.89% which is increased to 32.7% by
Dentist 25 Dentist 45 the employer. The right to join the ‘private
providence institution’ (called ENPAM) has
Italy
years years
old or old or been recognised. The contribution is 12.5%
2 20 and this provides cover for sickness,
years years maternity leave, pensions and social
after after security.
qualifi qualific
cation ation
Retirement pensions in the public sector
Private or General 0 to 30,000 30-100,000 are typically 80% of a person’s salary on
Practice
retirement. Retirement ages are 63
Public 30,000 40,000 (women) and 65 (men).
Hospital 30,000 60,000
Academic 30,000 70,000 In the public sector dentists can practise
until the age of 70. In private practice the
decision when to work and retire depends
upon an individual dentist.
Healthcare
Taxes
Pension premiums are paid at between
12.5% and 20% of gross earnings for self-
employed people. Those employed The highest rate of income tax is 45% on
earnings over about €75,000. Currently
self-employed people pay 5% extra tax on
their gross annual income, as a
contribution to the public health system.
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VAT/sales tax
Zurich = 100 Rome
VAT is payable at various rates depending
on the type of goods. Dentists pay 19% on Prices (excluding rent) 73.4
most materials and equipment, but VAT is Prices (including rent) 79.7
not payable on treatment. Wage levels (net) 33.4
Other taxes are also payable for the Power
creation of waste, advertising and the use
of X-rays.
2003
Main national associations Information Centre:
ANDI Federazione Ordini dei Medici Chirurghi e

Associazione Nazionale Dentisti Italiani degli Odontoiatri,
Via Savoia 43 Piazza Cola di Rienzo 80/A
I - 00187 Roma Roma
Tel: +39 6 420 11 536 Tel: +39 06 362 031
Fax: +39 6 420 20 243 Fax:
Email: esteri@andi.it Email: webmaster@fnomceo.it
Website: www.andi.it Website: www.fnomceo.it
AIO
Associazione Italiana Odontoiatri
Via Cavalli 30
I-10138 Torino
Tel: +39 11 4336917
Fax: +39 11 4337168
Email: aioto@tiscalinet.it
Website: www.aio.it
Ministero della Salute ANDI and the AIO both have national journals:
Divisione Ospedaliera
Ufficio No 6
Via Dell' Industria 20
•AIO: AIO Notizie in Doctor OS
I -00144 Roma •ANDI: Fronte Stomatologico
Lungotevere Ripa 1
Roma
Tel: +39 06 59941 There are also numerous scientific journals
Fax: +39 06 59942 417
Email: ecmsupporto@sanita.it
Website: www.ministerosalute.it
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271
2004_______________________________________
Italy
Dental Schools:
Ancona Bari
The Dean The Dean
Università di Ancona Clinica Odontoiatrica E Stomatologica
Clinica Odontostomatologiche Facolta' Di Medicina E Chirurgia Universita
Ospedale Generale Regionale Degli Studi di Bari c/o Policlinico
Via Enrico Toti N 4 I-70124 Bari
I-60123 Ancona Tel: +39 80 278727 or 278845 or 225501
Tel: +39 71 58931 Fax: +39 80 278743
Fax: +39 71 35357
Bologna Brescia
The Dean Dental School
Corso Di Laurea In Odontoiatria E Protesi Università di Brescia
Dentaria Via Valsabbina
Facolta' Di Medicina E Chirurgia I-25124 Brescia
Università Degli Studi di Bologna Tel: +39 030 398261
Via San Vitale 59 Fax: +39 030 303194
I-40125 Bologna Email: sapelli@master.cci.unibs.it or
Tel: +39 51 232394 or 229966 or 264784 paganell@master.cci.unibs.it
Fax: +39 51 236757 Website: www.med.unibs.it/didattica/cl/cl_prin.html
Cagliari Catania
The Dean The Dean
Instituto di Stomatologia di Cagliari Clinica Odontoiatrica I
Viale Regina Margherita 45 Ospedale Civico Vittorio Emanuele II
I-09124 Cagliari Università di Catania
Tel: +39 70 666617 or 663070 Via Plebiscito 628
I-95124 Catania
Tel: +39 95 457131
Fax: +39 95 457269
Chieti Ferrara
The Dean The Dean
Università "G. D'Annunzio Clinica Odontoiatrica
Via: Arniense 208 Università di Ferrara
I-66100 Chieti Via della Giovecca 203
Tel: +39 871 348735 or 65291 I-44100 Ferrara
Fax: +39 871 348735 Tel: +39 532 26408
Firenze Genova
The Dean The Dean
Clinica Odontoiatrica Policlinic Careggi Clinica Odontoiatrica
Università di Firenze Policlinic San Martino
viale Morgazni Università di Genova
I-50134 Firenze Viale Benedetto XV,
Tel: +39 55 415598 I-16132 Genova
Tel: +39 10 510223
L’Aquila Messina
Prof Mario Giannoni The Dean
Clinica Odontostomatologica Clinica Odontoiatrica
Dipartimento Scinze Chirurgiche Policlinico Universitario "Gazzi"
Via Vetoio Università di Messina
Localita Coppito Via Consolare Valeria
I-67100 L'Aquila I-98125 Messina
Tel: +39 862 433 822 or 433 821 or 646 348 Tel: +39 90 293 7060
Fax: +39 862 433 826
Email: giannonimario@virgilio.it
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Italy
Milano Modena
The Dean The Dean
Clinica Odontoiatrica Clinica Odontoiatrica Policlinica
Università di Milano Università di Modena
C/o Istituti Clinici di Perfezionamento Via del Pozzo 71
Via Commenda 10 I-41100 Modena
I-20122 Milano Tel: +39 59 361181
Tel: +39 2 584741
Napoli Napoli
The Dean The Dean
Il Facoltà II Facoltà
Clinica Odontoiatrica Università di Napoli Clinica Odontoiatrica Università di Napoli
Via S Andrea delle Dame 6 Via Pandini
I-80138 Napoli I-80138 Napoli
Tel: +39 81 459 889 Tel: +39 81 253 458
Padova Palermo
The Dean The Dean
Clinica Odontoiatrica Policlinica Clinica Odontoiatrica Policlinica
Università di Padova Università di Palermo
Via Giustiniani 2 Via Feliciuzza
I-35128 Padova I-90127 Palermo
Tel: +39 49 821 2041 Tel: +39 91 651 4444
Parma Pavia
The Dean The Dean
Clinica Odontoiatrica Ospedale Riuniti Clinica Odontoiatrica Universitaria
Università di Parma Policlinico San Matteo
Via Gramsci 14 Piazza Golgi n°2
I-43100 Parma I-27100 Pavia
Tel: +39 52 196 722 Tel: +39 38 221 136
Perugia Pisa
The Dean The Dean
Clinica Odontoiatrica Policlinica Monteluce Clinica Odontoiatrica Policlinica Santa Chiara
Università di Perugia Università di Pisa
Via Brunamonti Bonacci Via Roma 67
I-06100 Perugia I-56100 Pisa
Tel: +39 75 61985 Tel: +39 50 435 80
Roma Roma
The Dean The Dean
II° Universita degli Studi di Roma "Tor Vergata" Clinica Odontoiatrica
Odontoiatriae Protesi Dentoria I° Università di Roma "La Sapienza"
Ospedale Fatebenefratelli Viale Regina Elena 287/a
Piazzale Fatebenefratelli 2 I-00161 Roma
I-00188 Roma Tel: +39 6 8830811
Tel: +39 6 5873232
Roma (PRIVATE) Sassari

The Dean The Dean
Clinica Odontoiatrica Clinica Odontoiatrica
Università Cattolica del Sacro Cuore Università di Sassari
Largo A Gemelli 8 Viale Mancini
I-00168 Roma I-07100 Sassari
Tel: +39 6 3305 4286 Tel: +39 79 237161 or 231047
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273
2004_______________________________________
Italy
Siena Torino
The Dean The Dean
Clinica Odontoiatrica dell' Universita di Siena Clinica Odontoiatrica
Ospedale "Le Scotte" Corso Polonia 14
c/o Uuovo Policlinico Università di Torino
Via Bracci I-10126 Torino
I-53100 Siena Tel: +39 11 632 563
Tel: +39 577 42383/290771
Trieste Verona
The Dean The Dean
Clinica Odontoiatrica Clinica Odontoiatrica Dell' Universita di Verona
Ospedale Maggiore Policlinico di Borgo Roma
Università di Trieste Borga Roma
piazza Ospedale n°1 I-37134 Verona
I-34129 Trieste Tel: +39 45 933 251 or 581 212
Tel: +39 40 733 075 or 776 2263
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275
2004_______________________________________
Latvia

(2002)
Latvia
Currency Latvian Lat
(LVL)
0.6 = 1€ (2002)
Main language Latvian
In Latvia, oral healthcare for adults is funded

through private practice. State funded healthcare
is largely limited to the treatment of children and
persons, who are called up for military service.
There were 1,602 active dentists in 2002 (94.6%
are members of the Latvian Dental Association).
The use of dental specialists is well developed and
Government and healthcare in Latvia
The Republic of Latvia, lies on the eastern

shores of the Baltic Sea. With the Baltic Sea
in the west, Latvia shares land borders with The capital, Riga, is on the Northern shore,
Estonia in the north, Russia and Belarus to on the Gulf of Riga. About one third of the
the east and Lithuania to the south. Latvia total population resides in Riga.
comprises an area of 64,589 sq. km.
The Ministry of Health is responsible for
In 1991 Latvia regained its independence health care by making a public
as a state. There was a brief period of procurement of medical services. The
independence between 1918 and 1940. budget for healthcare is built on taxes and
The new Constitution of 1991 established state investment. Parliament decides
the principles of the State, setting Latvia as annually the amount of public funds to be
a democratic parliamentary republic – with spent on healthcare. The sums are divided
a unicameral 100 member Parliament among medical institutions by the Health
(Saeima), President (elected by Compulsory Insurance State Agency
Parliament), Prime Minister and Council of (HCISA), and its regional branches, which
Ministers. Parliamentary members have a conclude contracts with them under the
4-year term of office, elected on a general, supervision of the Ministry of Health.
direct and proportional basis. Latvia has Medical services thus provided are free for
four administrative regions – Kurzeme, patients, while all the other medical
Zemgale, Vidzeme and Latgale. There are services are receivable for a fee paid by an
26 rural districts and 496 local insurance company or the patient himself/
municipalities and parishes. The herself. Children under the age of 18 and
population in 2002 was 2,366,515 (about those who are called up for military service,
70% reside in urban, and 30% in rural are exempt from charges.
areas).
In 2003, about 3.5% of GDP was spent on
health.
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Latvia
Oral healthcare
In 1991, with independence, new assure high quality control in the insurance
knowledge and experience became system in the future. Recently (2003) the
available after 50 years of isolation, even range of private insurance companies has
in dentistry. Before independence, dental grown significantly.
care in Latvia was provided free of charge
to the whole population – state provision.
Subsequently, care for adults is privately
financed and public finance through the
Sickness Funds is for children up to the
age of 18 (with the exception of
orthodontic treatment). In 2003, the
average cost per child was 12.4 LVL (€20)
per year and covered approximately 50%
of all children in Latvia. Orthodontic
diagnostic and treatment planning is
financed through the Sickness Funds, but
treatment must be paid for by the patient
(the child’s parents).
Regional sickness insurance institutions,

according to contracts, finance this service
upon a mixed principle: Oral Health
promotion and education according to the
number of children (the capitation
principle); Dental care, including
professional dental hygiene is paid for
according to the work done – the principle
of “the estimation of manipulation”, which
is item of service fees.
Dental care is also state financed for the
18 to 27 year old persons who are called
up for military service, and for adults who
are victims of the Chernobyl nuclear
catastrophe (by government resolution
“Health care strategies in Latvia 1996”).
The oral health care system for the Latvian
population is administered under the
Ministry of Health and State Dental Centre,
which plan, direct and monitor the oral
health sector.
The State has set a common amount of
services to be provided, which do not
overlap with programs provided for by
insurance companies. The State Dental
Center has developed a common method
of calculation of the full price for a service
complying with the commonly approved
medicinal technologies in dentistry. Taking
into account available state financial
resources and the limits of what the state
can afford to pay, future necessary
financial resources are calculated.
Direct patient payment forms a major part

of the oral health care finance for the adult
population. Private insurance is becoming
more popular, but such policies are usually
obtained by higher social classes. There is
an agreement with the private insurance
companies to follow criteria in accordance
with recent technologies. This should
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In recognition of high caries levels, in 1994
a National Preventive Programme in In 2002 the proportion of total
Dentistry was created in the Oral Health governmental spending on healthcare
Centre and Fund (Institute of which was spent on dentistry was 1.54%
Stomatology), in close cooperation with
the State Dental Centre and WHO Quality of Care
Collaborating Centre in Continuing Dental
Education, in the Latvian Institute of
Stomatology. During the period from 1994 The competent authority which maintains
to 1999, in cooperation with the Sickness dentists’ registration and dental practice
Funds, local governments, school councils, accreditation (every five years) is the State
dental and general medical staff, 22 local Agency of Health Statistics and Medical
district Oral Health centres were Technologies, in cooperation with State
established in Latvia. Assessment of Dental Centre. Since 2001, this agency has
effectiveness for preventive and curative been working in accordance with the
work is based on regular accounting of oral regulations all over the state (instructions
health data in definite age groups, these regarding: working – space, units, and
are worked out “Evaluation criteria” and dental technologies minimum
were introduced in 1998. Prevention in requirements standards for dental
Latvian dentistry is based on the principles practice). A document of evidence based
of health promotion and education, methods and technologies, was worked
developing whole population strategy. out in 2002 and was introduced from July
1st 2003, in all the 702 registered dental
Oral examinations would normally be practices. This document is to motivate all
undertaken every 12 months. It is not dental staff to attend CPE courses.
known what percentage of the population
receive oral healthcare regularly (in a two- The quality of work is evaluated by the
year period) but 56% of under-18s are HCQCI inspectors and experts of the dental
known to visit a dentist at least once a associations. In the framework of
year. As Latvia is a small but densely evaluation, documentation and current
populated country, there is no reported clinical situation is analysed. Experts for
problem with access to oral healthcare for the Professional Certification Commission
patients. are nominated by the associations.
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Undergraduate Training subject to all the same rules as Latvian
graduates, and the extra requirement of
knowledge of the state language, which is
To enter dental school there are certain
tested according to an opinion of the
requirements:
Municipal Language Commission.
1) the candidate must be a high school
graduate, At the time of publication it was unclear
whether post May 2004 it would still be
2) gain a high school diploma with an valid, as it seems to conflict with EU rules.
examination grade in physics,
3) pass an entrance examination (with tests
in chemistry, biology, and composition in
Latvian),
4) there is competition among applicants.
There is one dental faculty, which is located

in the Riga Stradins University and publicly
funded. The length of the undergraduate
curriculum is 5 years. Student intake is
usually 35 to 45 trainee dentists and 24
trainee hygienists. In 2003, there were
208 undergraduates, 83% being female.
Commencing from 1993 there was a new
dental education programme for students
and dental hygienists, which were worked
out and introduced to comply with EU
requirements. In 2001, 32 students
graduated, 87% of them being female.
Quality assurance for the dental school is

provided by Faculty Council, chaired by the
Dean (there is no external verification,
although the school has been assessed
within the EU’s Dent-Ed Project).
The primary degree which may be included

in the register is: zobārsts (dentist)
Graduates can only register in Latvia when

they have completed 24 months’ salaried,
supervised training, working full-time as a
dentist under the supervision of an
experienced dentist (part-time working
takes longer). Following this the applicants
must pass the test of professional
certification.
Trainees are known as “Stagier”.

Remuneration depends on the place of
training, but it may not be less than the
minimum wage set in the labour
legislation.

recognised, but foreign graduates are
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The Latvian Dental Association, working in
collaboration with the Faculty and Institute
Registration of Stomatology at Riga Stradins University,
the State Dental Centre, the Latvian
To register in Latvia, a dentist must have a Physicians’ Society and the Latvian Dental
recognised degree or diploma and have Hygienists’ Association, and
completed the 24 months supervised representatives from industry are
training. The register is administered by organising professional education for all the
the State Dental Centre. For the address, dental team members in Latvia. This good
click here. cooperation is promoting exchange of
information in dental professional
There is a formal requirement to have development politics to improve
knowledge of Latvian at the highest level, technologies, dental care and dental
in order to register. Non-Latvian dentists education.
with an EU Diploma are recognised, but the
knowledge of the Latvian state language is Specialist Training
also required.
Dentists have the right to apply for
In 1992 a mandatory requirement was doctorate studies (by competition), which
introduced for all dentists and auxiliaries are completed by a successful defence of
who had been registered in Latvia to have one’s doctoral dissertation.
a new certification exam. During the period
(1992 – 2003) 1,707 dentists (including 99 Training is provided within the Riga
dental therapists) had passed this re- Stradin’s University’s Faculty in the
certification. Institute of Stomatology. In 2003 there
were 13 dentists undertaking specialist
Further Postgraduate and training, 9 of whom were female. Trainee
Specialist Training specialists are paid during training. Indeed,
Oral Maxillo-facial surgeons work both in
hospitals and private practice.
Only orthodontics and prosthodontics is
In January 2001 a mandatory requirement formally recognised, besides Oral Maxillo-
was introduced for all dentists who had facial Surgery (for which a medical
been registered in Latvia to complete a qualification is also required). Other
minimum of 250 hours of CPE every 5 years training included Paedodontics,
whilst they practise. Auxiliary personnel Endodontics and Periodontics were in the
have the same requirements only the process of receiving subspecialty
number of credit hours may be different. certification recognition in 2003.
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Workforce
Dentists
For auxiliaries working in the state system,
In 2002, there were 1,602 active dentists in the medium wage set for medical
Latvia - 85% female. Many dentists personnel is €230 per month, from
practise in more than one sphere of
practice. The number of dentists
graduating each year varies from 30 to 60.

1,477 (2002).
There is no reported unemployment

amongst dentists in Latvia.
Total Registered (2002) 1,692

General (private) practice 1,150
Community/Public dental 452
health
University 30
Hospital 37
Armed Forces 5
Specialists
In Latvia 2 dental specialities are

recognised, besides Oral Maxillo-facial
Surgery. There were 22 specialists actively
working in 2002.
Patients normally only attend specialists on
referral from a primary practitioner.
Numbers (2000)
Orthodontists 16
Prosthodontists 6
Oral-Maxillo-facial 37
surgeons
Auxiliaries

relatively well developed in Latvia and
much oral health care is carried out by
them.
Numbers (2002)
Hygienists 153
(131 active)
Therapists 99
Laboratory 567
technicians
Salaries are paid on the basis of contracts

concluded with the employers. It is against
the law to receive remuneration without a
valid contract.
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November 2003. There are no set amounts There are no legally practising denturists
for limits set for private practice, subject in Latvia
only to the law on minimum wages.
Dental Chairside Assistants (Nurses)
Dental Hygienists
Training as a dental assistant also takes
Training as a dental hygienist in Latvia place at Riga 1st Medical School, under the
takes place at a special school at the Riga supervision of Ministry of Education and
Stradin University (plans are in hand to Science. There is a qualification and they
reform this as a college at the University). may register with the State Dental Centre.
There is a competitive examination to gain
entrance. Graduates of the school receive In 2002 there were 1,023 Dental
a diploma. The title is legally protected Assistants.
and there is a registerable qualification
which dental hygienists must obtain before
they can practise. The register is held by
the State Dental Centre.
Dental hygienists work in all services only

under the prescribed instructions of a
dentist. They work usually as part of the
team although they cannot work
independently. They may not undertake
local anaesthesia. They take legal
responsibility for their work and they may
accept payment from patients, if they have
a practice of their own.
They are normally salaried, but there is no

available information about their earnings.
Dental Therapists
Dental therapists in Latvia were educated

in the 1960s, with the aim of providing oral
healthcare to children in the schools and
kindergartens. They work under the
supervision a dentist, and undertake the
same postgraduate training as dentists. A
register is held by the State Dental Centre.
Dental Technicians
Training as a dental technician takes place

at Riga 1st Medical School under the
supervision of Ministry of Education and
Science. There is a competitive
examination to gain entrance. On
qualification they receive a diploma.

registerable qualification which dental
technicians must obtain before they can
practise. A register is held by the State
Dental Centre. Their duties are to prepare
dental prosthetic and orthodontic
appliances to the prescription of a dentist
and they may not work independently.
Individual technicians are normally

salaried and work in commercial
laboratories which bill the dentist for work
done, but there is no available information
about their earnings.
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Latvia
Practice in Latvia
A dental practice may be included in the The State Dental Center sets the fees in the
structure in medical practices, hospitals state system. Adult pay a pre-determined
and other institutions. charge, which is 15% of the set treatment
fee for the dentist, but persons in need of
Working in General Practice emergency care (especially when there is
danger to life) are exempt from these
charges.
In Latvia there were approximately 1,150
privately practising dentists in 2003. They Joining or establishing a practice
practise in individual dental practices – by
registering with the Latvian Doctors There are no rules which limit the area of
Society, as well as in limited liability establishment or size of a dental practice,
companies, by registering with the State or the number of associated dentists or
Enterprise Registry. other staff working there. The state offers
no assistance for establishing a new
Dentists can choose to work in the state practice, and generally dentists must take
system, fully liberal private dentistry or out commercial loans from a bank. When
both systems. The amount of work within starting a new practice private dentists
the state system depends on the desires of have to comply with
the patient. If the treatment is carried out
in the state system the dentist is paid fixed
item of service fees.
During a first visit patient receives a full

diagnosis and explanation on further
potentially necessary treatment modalities
and expenses. If the patient agrees to all or
chooses one of the variants recommended,
a full treatment plan is signed by both
parties during the same or the next visit.
There is no regulation of private fees, which

are set on the basis of demand. All
dentists, including privately practising,
have to obtain professional’s certificate. All
equipment has to be tested to be in
accordance with the compulsory
requirements. 40% of general dentists work
only with private patients.
Privately practising dentists set their

remuneration in their practices themselves.
But, in limited liability enterprises, or other
organisations it is set by the employer,
taking into account labour legislation on
the minimum wage. Financial rules and the
quality of work for all dentists, including
privately practising dentists, are controlled
by state institutions. The requirements are
the same for all.
Offers of private insurance companies,

along with state health insurance, are
applicable to adults. The amount of
accessible care depends on respective
programs. There is no insurance applicable
only to dentistry.
Fee scales
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regulations which provide for compulsory
(minimum) rules on design, construction
Dental practice in hospitals also enhances
and equipment, including the number and
accessibility for in-patients, but the amount
size of rooms. The dentist is then
of work and the payment rules are the
responsible for attracting new patients to
same as for other dental practices.
the practice.
Dentists may purchase an existing practice, Hospital dentists are salaried and earn
together with its “list” of patients. General about €450 per month. In 2003 there were
practices are usually sited in apartments 37 hospital dentists.
and ex-government clinics.

Service
State financed dentistry services in state

owned facilities are provided for in two
institutions – the State Dental Centre and
Riga Stradin’s University’s Institute of
Stomatology. Whilst they are accessible to
everybody, the service is mainly available
to children, including children with
pathologies, oral-maxillofacial surgery
treatments and for any person who needs
emergency health care. There are no
treatment charges.
There is a lack of quality equipment for

providing full domiciliary services in homes,
so dentists offer pain relief at home and
solves the matter on the level of regional
social services by the patient to social or
medical institutions, for dental treatment.
There are 22 regional oral health centers

established and working. Their basic aims
include extensive information, motivation
in the mass media, school and kindergarten
programmes, including practical
instructions for teeth cleaning. Also, they
work out strategy for support and
promotion of oral health in regions;
organise preventive activities and analyse
their effectiveness; and they analyse the
fulfilment of municipally based
programmes.
In 2003, 452 salaried dentists were

employed in public health clinics. Their
salaries were approximately €450 per
month
In Latvia out of 180 hospitals only one is

private. The State Dental Center contains
an oral-maxillofacial clinic, the
professionals of which undertake the
consultations and medical help for all of the
State, and carry out the necessary
treatment in the hospital. Regionally these
specialists work in the two largest cities –
Liepāja and Daugavpils.
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Working in the University

Dental Faculty person with at least 10 years’ practical
work experience in the corresponding
branch. A Professor and Assoc. professor
In 2003, 30 dentists worked in the dental are elected by the Board of the Professors.
school, as salaried employees of the
university. They are allowed to combine Assistants are elected by the Board of the
their work in the faculty with part-time Faculty. They can be elected persons with a
employment or private practice elsewhere. Doctoral degree or a Masters degree, with
6 years’ experience. Assistants without a
The main academic title within the dental postgraduate degree can be elected twice
faculty is that of Professor. Other titles in the time following their primary degree.
include Associate professor Assistant
professor (Docents) and Assistants (clinical The quality of clinical care, teaching and
instructors). There are no formal research in dental faculties is assured
requirements for postgraduate training but through dentists working in teams under
senior teachers and professors will have the direction of experienced teaching and
completed a PhD, and most will also have academic staff. The complaints
received specialist clinical training. procedures are the same as those for
dentists working in other settings.
Apart from these there are other
regulations or restrictions for promotion. A
Professor, as a salaried employee, would be Working in the Armed Forces
an elected person with a Doctoral degree
and not less than 3 years’ work experience In 2003, there were 5 dentists working full
in the position of associate professor. An time for the Armed Forces, 2 being female.
Assoc. professor, as a salaried employee
could be an elected person with a Doctoral
degree or a
Professional association and • setting of medicinal technologies,
bodies criteria of manipulations and
economical prognosis for a more
efficient distribution of resources
There is a single main national association, allocated for dental care,
the Latvian Dental Association. The
• setting of the amount of public
organisation is representative of dentists
procurement.
(only) and has an elected board and
President. In 2003, 94.6% of dentists were
The Minister of Health appoints the director
members. The Dental Association, as well
of the Centre and the Latvian Dental
as other professional associations (for oral-
Association has no role within it.
maxillofacial surgeons, dental nurses,
dental hygienists and dental technicians)
undertakes the duties of:
• control and improvement of

qualification of specialists,
• setting of professional criteria and
certification,
• approval of the classification of criteria
for service manipulations.
For more information about the Latvian

Dental Association click here
The State Dental Center, which is

appointed by the state, has the duties of:
• enforcement of dental care strategy,
• drafting of various legal acts and norms
in dentistry,
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right to appeal to the Latvian Doctors’
Ethics Society’s Certification Commission.
Ethical Code In accordance with legislation, a dentist has

the right to refuse to treat a particular
The relationship between patients and patient, except in cases where the patient’s
dentists is based on a business relationship life is in danger.
in the circumstances of competition.
Although the dentist is liable for the Data Protection
method of treatment used and the result,
the most important factor is the mutual There are both Personal Data Protection
trust between the patient and the dentist. and Medical Treatment Laws.
In cases of complaints, tests are performed Advertising

by Health Care Quality Control inspection
(HCQCI) through the involvement of Advertising is permitted, but comparison of
experts from the professional associations. skills against other dentists is not allowed.
Tests are conducted mainly in cases of Dentists are permitted to use the post,
complaints, which most of the time are press or telephone directories, without
connected with the collection of financial obtaining prior approval.
compensation. There is a certain procedure
for protection of the rights of patients. Dentists are allowed to promote their
practices through websites but they are
A person can turn to the HCQCI as an required to respect the usual rules of
independent state institution, with claims “legal, decent, honest and fair”.
according to the procedure for the review
of claims. According to the procedure, Insurance and professional
documents are reviewed by both parties, indemnity
involving patients’ representatives and
experts from the professional associations,
The law provides for compulsory civil
who evaluate the factual situation. The
liability insurance for practising dentists.
claims are analysed on the basis of medical
Private commercial insurance companies
indications. In cases where the claim is
provide this insurance, and guarantees
unsound, the commission provides a
compensation for an aggrieved patient.
detailed explanation of the situation at
hand and provides a justification for its
decision. In cases when claim is sound, the
commission issues a conclusion on the
violation, providing for a chance of
settlement and elimination of faults. Claims
are submitted to a court if no solution has
been reached, or a court judgment is
needed for financial compensation for the
aggrieved party.
The professional organisation may assign

the dentist to extra, after-diploma training
or, in special cases, may decide on
revoking the professional’s certificate.
Dentists have the
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Corporate Dentistry
Dentists in Latvia are permitted to
incorporate their practices into limited For Administered by
liability companies. Non-dentists can fully
or part own these companies. Ionising radiation The State Radiation Security
Center
Health and Safety at Work Electrical The head of the practice
installations
Requirements are set by Ministry of Health. Infection control State Environmental Health
Dentists and their assistants must be Centre
vaccinated against Hepatitis B. Compliance Medical devices Health Statistics and
with the requirements is controlled by the Medicinal Technologies
State Sanitary Inspections. There is Agency
compulsory use of means of protection at
work such as facial masks, protective Waste disposal State Environmental Health
glasses and gloves, which are provided for Centre
by the state under regulation of the
Cabinet of Ministers.
Financial Matters
The income dentists would have expected

VAT/sales tax
to earn in 2003 (in Euros):
As of January 1, 2004 VAT of 18% is applied
Liberal or General €5,400 for all medical equipment, instruments and
Practice materials included - which had not been
Hospital €5,400 levied previously.
Public Health €5,400
Academic €5,400
2003
Retirement pensions and Zurich = 100 Riga

Healthcare
The age for retirement is set at 62 year for Wage levels (net) 12.2
women and 65 year for men. The system
of pensions in the country is the same for Domestic Purchasing 28.5
everybody and those working in the Power
sphere of dentistry are no exception. There
is no special age limit in dentistry. The Source: UBS August 2003
amount of pension depends on social taxes
paid and social funds accrued.
Taxes
Income tax is set at 24% from any and all

types of income.
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Latvia

Information Centre:
Latvian Dental Association Name: State Dental Center
20 Dzirciema Str Tel: +3717455584
LV-1007 Riga Fax: +3717459948
Tel: +371 2 455058 E-mail: vzc@latnet.lv
Fax: +371 2 455320 or +371 88 Website:
20113
Email: gzigurs@acad.latnet.lv
Website:
Major Specialist Association: Main Professional Journal:
Latvian Medical Association Journal”Zobārstniecības raksti”
Tel: +371 722 0661 Tel/Fax: +371 745 5058

Fax: +371 722 0657 E-mail: gzigurs@acad.latnet.lv
E-mail: lab@parks.lv
Dental Schools:
For dentists: For hygienists:
Ilze Akota Riga Stradins University School of Dental

Riga Stradins University Hygienists
Faculty of Stomatology
20 Dzirciema Street Tel: +371 781 5320
LV-1007 Riga Fax: +371 781 5323
Tel: + 371 745 1814 E-mail: esenakola@latnet.lv
Fax: + 371 781 5323 Website: www.st-inst.lv
E-mail: iurtane@latnet.lv
Website: www.st-inst.lv For technicians and assistants:
Dentists graduating each year: 30-40 Riga 1st Medical School

Number of undergraduates: 208
Tel: +371 737 1147
E-mail: medskola@dtc.lv
Website: www.medskola.biz.lv
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Lithuania
Population 3.5
million (2002)
Currency Litas
(LTL)
3.45 LTL = €1
Main language Lithuanian
The system of the State Social Insurance in

Lithuania covers nearly all residents: either, as
the insurers, or the insured, or the beneficiaries.
The system is based on the principle of solidarity
of generations. Some patients (children, the
elderly and the disabled) may receive some or all
of their oral healthcare free, but adult patients
must pay part or all of the cost of their
treatment. Most of this dental care is undertaken
in general practice. There are just over 3,000
dentists (2003) and just over half are members
of the Lithuanian Dental Association (Lietuvos
Lithuan
ia
Government and healthcare in Lithuania

The Republic of Lithuania lies on the The State of Lithuania gained its
eastern shores of the Baltic Sea, as one of independence in 1990 (having also been
the “Baltic States”. With the Gulf of Finland independent from 1918 to 1939) and is a
in the north, and the Baltic Sea in the west, democratic republic. The powers of the
Lithuania shares land borders with several State are exercised by the Parliament
countries – Latvia, Russia, Belarus and (Seimas), the President of the Republic and
Poland. The Lithuania Republic is a small Government, and the Judiciary. The Seimas
country in terms of population (3,458,200 is unicameral, with 141 seats (71 members
in 2002) and land area coverage (65.3 sq are directly elected by popular vote and 70
km). The capital is Vilnius. by proportional representation). Members
serve for four-year terms. The President is
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elected by popular vote, for five-year terms
of office.
whereas the rate of contributions relies on

The country is administered by 10 counties
the general economic capacity of the state,
(apskritys).
the number of working people, the amount
of the work income, and finally – on the
In 2003, average earnings were about €326 honesty of those who pay the contributions.
a month, and unemployment was about
9.4% of the workforce.
In Lithuania, there is a distinction in the
social security system between social
The system of the State Social Insurance in insurance (covering working people), social
Lithuania covers nearly all residents: either, assistance (for all residents) and special
as the insurers, or the insured, or the state schemes (covering privileged groups
beneficiaries. The system is based on the such as servicemen and some scientists).
principle of solidarity of generations. The The two main principles of social policy in
employed population supports pensioners, Lithuania are universality and solidarity.
the disabled and unemployed persons by Universality means that all residents are
paying social insurance contributions. entitled to services/benefits provided by
Hence, the budget of the State Social social security. Solidarity is a principle
Insurance Fund depends on contributions based on solidarity between workers and
pensioners, and between workers and
those individuals who are unable to work
because of illness, disability or other
reasons. There are approximately 495,000
inhabitants over 65 years of age, 14% of
the population.
In 2002 the proportion of GNP spent on

general healthcare was 5.7%, including
dentistry.
The social insurance system is
administered by a number of organisations:
The Ministry of Social Security and Labour

The main function of MSSL is in the area of social
policy, including social insurance, employment
and labour relations, and consists of analysing
the current social situation, drafting laws and
governmental decrees, presentation of these to
the Seimas and the Government and the
maintenance of international and public
relations.
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The State Social Insurance Fund Council The State Social Insurance Fund Board
(SoDra)
The State Social Insurance Fund Council
supervises the State Social Insurance Fund The State Social Insurance Fund Board is the
(SSIF). The Council (established by agreement in central institution that administers the State
1995) is a tripartite governing board chaired by Social Insurance Fund and whose main task is to
the Minster of Social Security and Labour. manage the funds and accounts of the State
Social Insurance Fund, ensure the collection of
The responsibilities of the Council include contributions and allocation of benefits and their
monitoring of legislation, advice and delivery to beneficiaries.
recommendations to the government, annual
reviews and advice on operational issues. SoDra, which employs over 3,300 people, is
responsible for the administration of the SSIF
through its central office in Vilnius and 52
territorial offices.
Voluntary social insurance
There is also voluntary social insurance which

includes pension and sickness/maternity
allowances.
Oral healthcare
Oral health care is coordinated by the
Lithuanian Health Ministry.
• General dental practice - 64.3 million Lt
(€18.6 million)
Public compulsory health • Dental specialists’ service – 12.2 million
insurance Lt (€3.5m)
o Orthodontics – 1.2 million Lt (€0.35
Dental care expenses may be reimbursed million)
from state or municipal funds, mandatory o Prosthetics - 3 million Lt (€0.87
health insurance funds, supplemental million)
health insurance funds and from o Hospital care – 5.4 million Lt (€1.57
(voluntary) contributions by patients. Only million)
the essential dental care services are • Programme of children’s caries
provided free of charge. prevention – 186,000 Lt (€54,000)
The national health insurance system There is also a national caries prevention
scheme offers reimbursement of the cost of programme through the state and the
some dental treatment. About 5.3% (76.7 municipalities. In 2003, it was
million Litas - €22m) from the compulsory
health insurance fund (SSIF) were allocated
to dentistry, in 2001.
Patients have the right to a free choice of

dentist. Public oral health care is free of
charge, for children and teenagers under
the age of 18 years, and prosthodontic care
for pensioners and the disabled. For adults
between 18 and 65 dental care in the
public dental service, if the dental office is
contracted with the SSIF, is partly financed
by the fund and partly (for expenditure on
dental materials) by co-payments by
patients. In 2001, the fund allocated 3
million Litas (€870,000) for dental
prosthetic appliances. Due to the lack of
financial recourses “free of charge”
prosthetic treatment is very limited.
In 2001, the 76.7 million Litas spent on

dentistry was allocated:
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mostly an oral health educational
programme. The proportion of children with
good oral hygiene (with OHI-S below 1.5)
was almost double in 2001 compared to
1993. Improved dental health has been
associated with improved living conditions
and education, better oral hygiene, regular
use of fluoride and implementation of
public health policies.
There is no regular period for oral health

checks in Lithuania, although there is a
recommendation to visit a dentist every 6
months. Approximately one third of adults
follow this recommendation. The majority
of children under 18 years are included in
Caries Prevention Program and so they are
checked regularly, every 6 months.
A full-time dentist would normally have

approximately 1,200 patients regularly
attending. In some special cases, there is
domiciliary care. Dentist who are working in
municipal policlinics are responsible for
that treatment.

care
Private dental insurance companies were

only just starting their activity in Lithuania
in 2003.
The Quality of Care
The State Inspectorate of Medical Audit

(SIMA) is the institution of health care
services inspection. SIMA's main functions
are to represent and defend patients' rights
to effective, accessible and safe health
care, and to implement state inspection
and examination of accessibility, usability
and efficiency of health care services in
health care institutions independently of
their subordination and property. SIMA
receives its regulatory authority from state
laws and is a government agency under the
Ministry of Health. Information about
disciplinary actions should be sent to the
attention of the Administrator. The
Lithuanian Dental Association becomes
involved when a patient complains about
the quality of care (see below).
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practical part (participant has to fulfil a list
Undergraduate Training of prophylactic, diagnostic and treatment
items) and a theoretical part (compulsory
attendance on recommended courses and
The original title for dentistry, stomatology,
lectures). Graduates of primary residency
was changed to odontology in 2003.
obtain the qualification of Odontologist of
General Practice, and are granted a licence
For admission to an odontology course the
to practise.
completion of a General Certificate of
Secondary Education is the minimum
Theoretical training is provided in a number
required. All persons having secondary,
of different ways and establishments; in
higher or high education and able to prove
particular in specialised training courses
it with documents recognised in the
organised mainly by the universities, dental
Republic of Lithuania have right to be
associations, and on daily basis in
admitted to the first year of basic and
approved training posts. Theoretical
continuous studies. Admission to the study
training is also given, during the course of
program is carried out according to joint
practical training.
regulations of the Faculties of Odontology
in the the two Universities of Lithuania:
Vilnius University and Kaunas Medical
University. Admission takes place by
competition, and priority is given to those
who have higher ranking in competition
queue. There are no entrance
examinations, students are selected
according to the grades of the secondary
education final examinations, and annual
marks averages. Each year admission
system is updated and upgraded. There are
about 100 graduates a year, 80% female.
The undergraduate training programme is

for 5 academic years. Teaching is
undertaken by academic staff full or part
time university teachers who hold contracts
with the university and the National Health
Service (usually it is a contract with the
university hospital).
The new program of basic training of

odontologists was developed according to
the best practices of Western universities
in 1991-1994, after Lithuania became
independent. The responsibility for quality
assurance in the faculties is by the Ministry
of Education, the Chancellor of the
University and the Dean of the Faculty.
The professional title is odontologist, which

is written down in the graduation Diploma.
Graduates of the Faculties of Odontology

are required to complete one-year training,
primary residency, in order to be registered
for the independent practice. During the
training, the dentist is a salaried employee.
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Health is the official unit, responsible for
The criteria for recognition of training organizing and giving Licences to
establishments cover the service facilities professionals.
available, the degree of supervision, the
range of experience offered and the Specialist Training
availability of time and facilities to study.
The method of specialist training is There are 3-year postgraduate specialist
apprenticeship, (occupation of a general training courses (Residency), to obtain the
practice odontologist post (dental unit) at a specialist diploma - Licence of Odontologist
State Health Service hospital or a private Specialist (endodontologist, orthodontist,
dental clinic). pedodontist, periodontologist
prosthodontist, oral surgeon). For the
The teachers are normally experienced maxillofacial surgeon specialty, there is 5-
odontologists in General Practice. They are year postgraduate training for - Licence of
employed by the University; and therefore Maxillofacial Surgeon.
belong to the public service; very few are Postgraduate specialist training courses are
employed in private dental clinics. The undertaken at the Kaunas University of
majority are part-time teachers. Medicine or the University of Vilnius. The
trainees are paid during training.
The University appointed teachers in the
State Health Service hospitals and private
clinics are responsible for the theoretical
and practical training. At the end of the
primary residency, the theoretical
knowledge and practical skills are
evaluated during the State Exam.
Registration

Health and the Regional Authority. To
register, a dentist must have a recognised
Lithuanian/EU qualification, permission for
permanent residence in the Lithuanian
Republic, a work permit, and knowledge of
the Lithuanian language, by test. For EU
citizens it is assumed that the residency
and work permit requirements disappeared
from May 2004.
Access to the profession is regulated by the

statute and restricted to the holders of the
Licence to practise - odontologist of
General Practice or odontologist specialist
(endodontologist, orthodontist,
paedodontist, periodontologist,
prosthodontist, Oral surgeon, Maxillofacial
surgeon).
The Ministry of Health maintains a register

containing the dentists´ data, including
qualifications and professional performance
data.

Specialist Training
The Licence must be renewed every five

years, based on certificates for 200 hours
of continuing education (courses, seminars,
lectures, conferences, etc). The Licensing
Committee at the Lithuanian Ministry of
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Lithuania Dental Practice 2004
Workforce
Dentists
In 2003 there were 3051 registered There are two ways for patients to access
odontologists in the Lithuania Republic, of specialists in Lithuania. The first is to ask
whom 82% were female. for referral, from a general odontologist. All
expenses in these cases will be covered by
The population per active dentist (including the insurance system. However, if patient
orthodontics and oral-maxillo-facial wishes to go directly for a specialist
surgery) was 1,133. consultation, this is acceptable, but he
would then have to pay the fees himself.
The active dental workforce is stable, but
increasing slowly. There is no reported real
unemployment among dentists, although
individuals may not be working for short
periods.
There has been little movement of dentists

away from Lithuania during the ten years
before 2003.
Numbers in 2002 3,051

General Practice* 2,441
Public Health 610
Hospitals 40
Academics 80
Armed Forces 18
* Some general
practitioners also work
part-time in the other
the other four spheres of
practice
Specialists
There are 7 kinds of specialists in Lithuania:
• Orthodontics,
• Endodontics,
• Paedodontics,
• Periodontics,
• Prosthodontics,
• Oral Surgery and
• Oral-Maxillo facial Surgery.
Numbers of
specialists (2002)
Orthodontists 22
Surgeons
Endodontists 67
Prosthodontists 304
Oral Surgeons 81
Periodontists 32
Paedodontists 77
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Auxiliaries Dental Assistants (Nurses)
There are two kinds of clinical auxiliaries in Dental assistants (nurses) are permitted to
the Lithuania Republic, as well as dental work in the Lithuania Republic, provided
assistants - Dental Hygienists and Dental they have a diploma. They train for 4 years
Technicians. in a special higher school specifically for
dental
(2001)
Hygienists 277
Technicians 584
Assistants 1201
Dental Hygienists
Hygienists are permitted to work in the

Lithuania Republic, provided they have a
diploma. Hygienists train at one of two
higher schools: Kaunas University of
Medicine (for 4 years) or the Collegiums of
Kaunas (3 years). Graduates of Kaunas
University of Medicine receive a bachelor
degree and the qualification of oral
hygienist. The completion of studies at the
Collegiums of Kaunas leads only to the
qualification of oral hygienist. Additionally it
was reported that the oral hygienists were
trained at the Collegiums of Panevėžys and
the Collegiums of Šiauliai. However, the
preparing of these auxiliaries was
suspended in 2003.
Hygienists work under the supervision of a

dentist, only, and their duties include
scaling, cleaning and polishing, removal of
excess filling material, local application of
fluoride agents, the insertion of preventive
sealants and Oral Health Education.
They need to have licence to work, but

they do not need to be registered if they
work as an employee of the dentist.
A hygienist would normally be salaried and

earn on average €300 to €400 per month
Dental Technicians
Dental technicians train for 4 years in a

high school for dental technicians. After
studies, they receive a diploma.
Technicians normally work in commercial

laboratories, only a few are employees of
dentists or of clinics. They construct
prostheses for insertion by dentists.
A hygienist would normally earn on

average about €700 per month
There are no reports of any (illegal)

denturism in Lithuania.
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hygienists. If a dental nurse has a general
Lithuania
nurse qualification and has worked for Besides assisting the dentist, they are
more than 3 years, they can receive a permitted to undertake oral health
dental assistant (nurse) qualification after education.
graduating with special additional training
at a Nursing Qualification Centre.
Practice in Lithuania
Working in Liberal (General) are higher than in general practitioners’
Practice clinics.
The Ministry of Health establishes the cost Working in Public Clinics

of dental care services provided by state,
district and municipal institutions. The cost Approximately 20% of dentists work in
of dental care services at private municipal ambulatory dental departments.
institutions is established by their owners, These municipal ambulatory dental
but charges must not exceed 60% of the departments are contracted with the SSIF
costs of state dental care services. For and adults’ treatment is partly financed by
dentists working within the SSIF it is the SSIF and partly (for expenditure on
obligatory (by law) that they undertake the dental materials) by co-payments by
treatment from a price list of items fully or patients. As mentioned earlier, some
partially covered by the insurance system - public oral health care is free of charge for
even for items which are fully paid for by children and teenagers, pensioners and
the patient (see below for private practice). the disabled. Many public clinic dentists
work part-time in private practice, also.
There are no stated regulations, which
dental practices. There are also no other
factors which effectively restrict where
dentists may locate. Any type of building
(a house, apartment, shop or clinic) may
be used which fulfils the legislative claims
to dental practice. However, rules exist
which define, for example, the minimum
size of rooms for dental practice. There is
no limit to the maximum number of
partners etc.
The state offers no assistance for

establishing a new practice, and generally,
dentists must take out commercial loans
from a bank. To establish a new practice
private dentists have to gain the approval
of the health officer and the registration of
local health state authorities. The new
practice has no claim for the contract with
any health insurance company – it
depends on the will and demand of the
health insurance companies.
Dentists in general practice would

normally earn from about €700 to €1,500 a
month.
Fully Private Practice

Dentists working outside the SSIF, in fully
private practice, are not bound by any
method of price calculation used in the
SSIF. In the same way, private specialists
may themselves make decisions about
treatment prices. However, normally prices
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Specialists receive higher fees for their Dental Faculties
work in municipal polyclinics, because
there is special index. The Insurance There are 2 dental schools, in which
system also pays more to cover a larger about 80 dentists work. They normally
proportion of the treatment price. are full-time employees of the University,
and their salary range is €300 to €700
Dentists in public clinics would normally per month. Only a few of them are
earn from about €350 to €900 a month, allowed the combination of part-time
full-time. teaching employment and private
practice (with permission of the
Working in Hospitals university).
The social status and guarantees for Staff members are graded as professors
odontologists from General Practice, and (20%), associate professors (30%),
Specialists, working in public hospitals and lecturers (5%) and assistants (45%). From
private service is the same according to 60 to 70 % of staff members are full-time
the Lithuanian Law of Labour. It is based teachers. The teacher/student ratio differs:
on a labour contract between the minimum ratio is 1:5, maximum ratio 1:7.
employee and employer, and the The qualified academic dental staff
contractual requirements. The social members provide supervision during
guarantees of the employee do not differ clinical training. The titles of university
whether the employer is a public or private teachers are: assistant (title As.), docent
institution. (title Doc.), professor (Prof.). For the
positions of docent and professor it is
Dentists who work in hospitals (university necessary to pass “habilitation” - this
or big regional hospitals) are normally involves a further degree (publication
salaried employees. Hospitals usually are activities and a record of original research)
publicly owned, and the dental services and a public lecture in front of the
provided are normally oral and Scientific Council of University. The study
maxillofacial surgery. These dentists will for a PhD is also required.
also assist in the education and training of
dental undergraduates. Working in the Armed Forces
Dentists in hospitals would normally earn In 2003, 18 dentists served full-time in the
from about €350 to €900 a month, full- Armed Forces, of whom 33% were female.
time.
Professional associations Ethical Code
Lithuania
There is an ethical code, which is

Odontologists are members of the
administered by the Lithuanian Health
Lithuanian Dental Association (Lietuvos
Ministry.
Stomatologu Sajunga), which in 2003
onwards functions as a trade union,
A complaint may be made by a patient.
officially registered in the Ministry of
This may be to:
Justice. However, the participation in the
Association is not compulsory, so not all
Odontologists are members – in 2003 just • the health insurance company
over half (1,489) were members. • the Dental Chamber (to the
Association, until the Chamber is set
A law to establish a Dental Chamber was up)
before Parliament in 2003, and this would • the State Inspectorate of Medical
regulate membership. Audit (SIMA)
By law, a representative of the Lithuanian Final complaints are processed by the

Dental Association is included in the special regional State Inspectorate of Medical
commission, which examines complaints Audit. The next possible step is a Special
filed against dentists. Commission of Medical Audit in the Health
Ministry.
Ethics
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In case of violation of professional ethics or
rules of dental practice, or causing damage Advertising
to a patient, there is a range of penalties,
which is normally administered by special Advertising is permitted under the
working groups existing at the Ministry of framework of the general advertising
Health (i.e. Ethical Committee, Medical regulation of the Lithuanian Republic.
audit, etc.). These groups include experts Additionally, dentists are permitted the use
from different areas of society, such as of websites, with no specific requirements
lawyers, doctors, ministry workers, etc. covering their use.
The penalties may include a reprimand, a Data Protection

penalty or even the loss of the licence to
All odontologists must follow the
practise (the dentist cannot be suspended
requirement to protect patients’ health
immediately). Any serious break of the law
data, according to the regulations on
can be referred to court and even result in
Odontologists’ Competence.
imprisonment.
Indemnity Insurance
Liability insurance is optional and usually
organised by the Lithuanian Dental
Association. If a statutorily based Dental
Chamber is established in Lithuania,
liability insurance is likely to become
compulsory.
Corporate Dentistry
Anyone can own a dental practice but a
director of a company which is responsible
for clinical treatment organisation must be
a dentist.

Dentists and those who work for them are
recommended to be inoculated against
Hepatitis B and later be checked regularly
for sero-conversion.
For Administered by
Ionising radiation State Centre for Nuclear
Security
Electrical The State accredits
installations electrical technicians
Waste disposal Local government
Infection control Ministry of Health and local
authorities
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Lithuania
Financial Matters

years old or 2 old or 20 years
years after after
Liberal or General 8,000 -12,000 12,000–18,000 a

Practice year
Public Health 4,000 – 5,000 5,000 – 10,000 a

year
Hospital 4,000 – 5,000 5,000 – 10,000 a

year
University 4,000 – 5,000 5,000 – 10,000 a

year
The normal age for retirement for women is 62 and for men 65 years, although dentists and
their staff can work past then.
There is a state-funded system of pensions, of which dentists and their staff are a normal part.
The pension would be about 50% of last declared income. This is the same for employed and
self-employed dentists. Any additional insurance pension depends on the individual contract
and the amount insured.
Taxes
There is a national income tax of 30% of income.
VAT
In the Lithuanian Republic the VAT rate is 18%.
The main dental materials (filling materials, impression materials, instruments) have no VAT
applied, but disinfection solutions, examination gloves and auxiliary materials, such as
radiographic materials are charged at 18% VAT. The cost of dental health care (and other
health care too) is VAT free.
Zurich = 100 Vilnius

Prices (excluding 48.8
rent)
Prices (including 46.1
rent)
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Lithuania
Details of information centre: Main national association:
Statistics Lithuania Lithuanian Dental Association

Gedimino av. 29, Tel: +370 6 995 65 40
LT-2600 Vilnius Fax: +370 3 732 31 53
Tel: +370 5 236 48 22, Email: lss@kaunas.omnitel.net
Fax: +370 5 236 48 45, Website: www.stomatologija.lt
E-mail: statistika@std.lt
Website: www.std.lt
The Government of the Republic of Ministry of Health of the Republic of

Lithuania Lithuania
Tel: +370 5 2663 876 Vilniaus g. 33,
Fax: +370 5 2663 877 LT-2001 Vilnius
E-mail a.petrauskaite@lrvk.lt Tel: +370 5 2661400
Website: www.lrv.lt FaX: +370 5 2661402
E-mail kanceliarija@sam.lt
Website: www.sam.lt
Dental Schools:
Kaunas University of Medicine Vilnius University Faculty of Medicine

A. Mickevičiaus 9, M.K.Ciurlionio street 21,
LT-3000 Kaunas LT- 2009 Vilnius
Tel: +370 37 32 72 60, Tel: +370 5 233 02 43
Fax. +370 37 22 07 33, Fax: +370 5 216 31 67
E-mail: medfak@kmu.lt E-mail: mf@mf.vu.lt
Website: www.kmu.lt Website: www.mf.vu.lt
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Luxembourg
Population 448,300
(2003)
Currency Euros
Main official language Luxembourgish,
Other official languages French & German
Luxembo
urg General health care is funded by contributions from
employers, employees and the government (37%). The
employee pays 2.72% of salary, the worker pays
4.95%, and the employer pays for an employee 2.72%
and for a worker 4.95%. Dentists work for fixed fees,
with the patient obtaining (variable) reimbursement,
using their social security number as proof of
entitlement. There are 288 (2003) practising dentists
and 99% of care is provided in general practice. About
90% are members of the Association des Médecins-
Dentistes. Specialists are not recognised. Dentists do
Government and healthcare in Luxembourg

Luxembourg is a Western European country Community (CEE). In 1957, Luxembourg became one of
the six founding countries of the CEE (later the
sandwiched between Belgium, France and European Union), and in 1999 it joined the euro
Germany. It is one of the smallest European currency area.
countries in terms of both population
(448,169 in 2002) and land area (2,586 sq The capital is Luxembourg City, in which
km). several EU/EC departments are situated,
(such as the European Court of Justice, the
The year 963 is the starting point of the history of European Bank of Investment, the
Luxembourg. The count Sigefroid made an exchange European “cour des comptes” etc).
with the abbey of Treves and got the rock of “the Bock”.
He constructed on the ancient Roman castle called
Lucilinburhuc (= small castle) a new castle. Around this Despite a relative lack of natural resources
castle a town fortress was developed during the Luxembourg has the highest level of wealth
centuries, which explains that the history of
Luxembourg is dominated by foreign sovereignties,
per capita in Europe and has a Purchasing
which wanted to control this important strategic point. Power Standard per capita Gross National
After the Counts of Luxembourg arrived the Habsbourg
from Spain, then the Bourgogne state, then the
Netherlands. Following this, Luxembourg became an
intermediate between the kingdom of France and the
German empire, and finally came the Habsbourgs from
Austria.
The real creation of the Grand-duchy of Luxembourg

was in 1815. The Vienna Act created two separate and
independent entities: the Netherlands Kingdom and the
Dukedom of Luxembourg. Since Guillaume I was the
King of the Netherlands and Grand-duke of
Luxembourg, this separation was not totally achieved.
Guillaume considered Luxembourg as the 18th province
of Netherlands rather than an independent state. But
the subsequent period was characterised by gradual
independence of Luxembourg. The Belgian revolution in
1830 caused a lot of problems and ended with the
London treaty in 1839. Luxembourg lost more than half
of its territory to Belgium at that time, but the treaty
confirmed the statute of independence of the Grand-
duchy of Luxembourg. Once more in 1867, the Treaty of
London confirmed the perpetual independence of
Luxembourg.
In 1921 the Grand-duchy created, together with

Belgium, the “Union économique belgo-
luxembourgeoise”. In 1944 the governments of
Belgium, Netherlands and Luxembourg commenced the
foundation of the Benelux Customs Union. Luxembourg
became the first European capital by hosting the siege
of the CECA (communuaté européenne du charbon et
de l’acier) the starting point of the European Economic
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Product more than 60% greater than the functionary sent by the government, so if
average for EEA countries (2001). the representatives of employees and
employers do not find an agreement, the
There is a unicameral Chamber of Deputies President with his one vote can
or Chambre des Députés (60 seats; determinate the outcome. The evolution of
members are elected by direct, popular the budget of the “caisses” is determined
vote to serve five-year terms) by law.
In Luxembourg general health care is The sick funds provide membership for
funded by contributions from employers, different occupational groups, for example,
employees and the government. About civil servants, private employees and
37% is funded by the government, the rest workers. There are no differential
half and half by the employers and contributions between funds.
employees. Manual workers (“employees”)
pay 2.72% of salary, non-manual workers Everyone in Luxembourg has a social
(“workers”) pay 4.95%, and the employer security number which is required for
pays for an employee 2.72% and for a access to health care. This number is used
worker 4.95%. The government for reclaiming charges. For visits to the
contribution is set by law. doctor or dentist the patient pays the fee
and then reclaims it.
There is one healthcare scheme, the Union
des Caisses de Maladie, which is made up Proportion of GDP spent on general
of several sick funds. In the board of the healthcare, including dentistry, reported by
Union the representatives of employees OECD (2000): 5.6% (88% public).
and employers have the same number of
votes. The President of the “caisses” is a
Oral healthcare
The provision of dental care is covered by a Private insurance for dental
Luxembourg
detailed Act of Parliament. Everybody in care

Luxembourg is entitled to dental care
partly paid for by the Union, and all dentists
It is possible to buy complementary private
must work within it (so there are no
health insurance, for example to obtain
dentists who practise independently of the
health care abroad, including in some cases
state system). Every dentist has an
dental care. In the policies presently
identification number, must use stationery
available, the insurance company takes the
from the sickness scheme and must charge
risk. The patient needs good oral health
the fees specified by the fund, unless a fee
before cover can begin, and the premiums
is not stated.
are linked to age. Premiums are paid
directly to the company and the dentist has
The Union des Caisses de Maladie and the
no role in promoting the policies. There is
different sick funds are responsible for
great variation in the cover they offer and
reimbursements to the patient and is also
the ways in which premiums are charged.
responsible for negotiating the fees with
the Association des Médecins-Dentistes.
Some patients, because of the low The Quality of Care
reimbursements, subscribe to
complementary private health insurances. The standards of dental care are monitored
by an independent body called the
The Contrôle Médical gives prior approval Contrôle Médical which employs three
for some treatments, and monitors care. dentists who check the standard of care
Domiciliary care, when needed, is given. provided. Dentists whose pattern and cost
of care is significantly different from the
There are a few private patients. Dental average may be investigated. An adverse
care is provided in general practice and report can lead to disciplinary processes for
there was no reported difficulty for access the dentist.
to care for patients in 2003.
An independent body, the Commission de
Surveillance investigates eventual
In the year 2001, oral health services
complaints.
comprised about 3% of the total
expenditure on health.
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Undergraduate and Vocational
Training Further Postgraduate and
Specialist Training
There are no dental schools in Luxembourg
and students must train outside the Continuing education
country. Likewise, there is no post-
qualification vocational training. Currently, no minimum amount of
continuing education is required, but a new
Registration law is being enacted for a minimum
amount of this.
To register as a dentist in Luxembourg, a
qualified dentist must have a recognised The negotiations between the government
degree from an EU university or the and the AMMD were being finalised in
“Diplôme d’Etat en médecine dentaire” of 2003, to fix an amount. Historically,
the Grand Duchy. Applications must be dentists either undertake their continuing
made to the Ministry of Health, and dentists education in Luxembourg (where AMMD
must be registered before they can legally organises continuing education) or they
practise. Currently, there is no fee for can return to the dental school where they
inclusion in the register. have been trained previously. They also
can choose another dental school or
There is a legal language requirement to courses.
ensure that the dentist understands
patients. If a medical mistake occurs and it Specialist Training
is due to not understanding the language
the dentist engages a civil responsibility. In Luxembourg no specialists are
recognised and specialist training is not
available.
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Luxembourg
Workforce
Dentists
Auxiliaries
In 2003 there were 288 dentists working in
Luxembourg of whom 27.8% were female In Luxembourg no dental auxiliaries are
and 72.2% male. permitted to work with patients, except as
chairside assistants to dentists.
Each year the total number of dentists
increases by about 10 persons. The dentist Dental Technicians
to population ratio (in 2003) was 1:1,556,
and has reduced, especially because of Dental technicians normally train in dental
immigration, despite the population laboratories, with theoretical education and
increasing. Or, this population growth is training taking place in a special course for
increasing much less than in the former technicians in a technical school. There is a
years. special qualification and dental technicians
need to be qualified or registered to work,
The dental association believe that the as such. Only a qualified technician may
number of practitioners had almost own a dental laboratory.
reached saturation point in 2003, and that
Luxembourg was heading towards an Most technicians are salaried and work in
excess of dentists over need. There is commercial laboratories. Fees are charged
evidence that some relatively newly to dentists for the services. A small number
installed dentists leave the country again, of technicians work as salaried employees
sometimes after only one or two years in practices.
practice.
There are no available figures for salary
In 2003, the proportion of EU dentists levels.
working in Luxembourg who are not
citizens of the country was the highest in In 2000, FDI reported that there were 20
EU, and also the demands for immigration dental laboratories in Luxembourg.
of non EU-dentists was increasing. But
almost 95% of those demands are refused Chairside assistants
because of low qualifications.
There is no formal training or qualification
Specialists for dental chairside assistants in
Luxembourg. The dentist is responsible for
No specialists are recognised as such in
the training qualification of his chair-side
Luxembourg practice as a specialist is not
assistant.
allowed. It is also not permitted to describe
a practice as, for example, “limited to
In 2000, FDI reported that there were 250
orthodontics” on practice name plates or
dental chairside assistants in Luxembourg.
stationery.
Practice in Luxembourg
Working in General Practice Union des Caisses Maladie. For most items
listed the fee stated must be charged.
However for some items the dentist may,
In Luxembourg, dentists are said to be in
with prior approval from the Contrôle
“general practice” (about 99% of dentists
Médical, charge a higher fee. The list
practise this way). Practitioners work on
indicates whether prior approval is required
their own or as small groups, outside
for particular treatments, or not. The
hospitals or schools, and provide a broad
Contrôle Médical is the body responsible for
range of care. They are nearly all are self-
prior approval. Any items of dental care
which are not listed in the Nomenclature
charging the prescribed fees for
may be charged at a reasonable rate. The
treatments.
patient pays the whole fee to the dentist
and then reclaims the fee, or part of the fee
A scale of fees, the Nomenclature des
from their sick fund.
actes et services des médecins et
médecins-dentistes, is published by the
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2004_______________________________________
must be owned by dentists and a few
The sick fund's reimbursement for fixed dentists sometimes join together to share
Luxembourg
and removable items covers a small part of facilities. The equipment and premises of a
the cost. The patient who wants to receive dental practice can be bought and sold but
100% of this sick fund reimbursement (and there is no provision for selling the right to
that is only a small part of the cost) must the patients' records.
have attended a dentist at least once a
year, the two years before treatment. There is no state assistance for establishing
Those who cannot satisfy this condition a new practice, so dentists usually take out
may only claim a smaller reimbursement. commercial loans from a bank. Dental
There are some items of care practices are normally in houses or
(prosthodontic) which will only be replaced apartments and may not be located in
under sick fund rules after a specific time commercial buildings, for example, in
period, for example a crown or bridge shopping malls or within the same building
every 15 years. as another dental practice.
The Contrôle Médical keeps a database There are specific contractual requirements
with records from the early 1980s to check between practitioners working in the same
this. The percentage of the population who practice. Employees (chairside assistants,
attend at least once every two years is not but not the dentists) are protected by the
published. Likewise, the number of patients national and European laws on issues such
a dentist normally sees is not known. as minimum wages, maternity benefits,
Joining or establishing a practice and health and safety.
There are no rules which limit the size of a Working in Public Clinics
associate dentists or other staff. However,
There is no public dental service in
most dentists work as single practitioners
Luxembourg although the Ministry of
and almost all own the practice in which
Health employs a few dentists who do not
they work. Practices
themselves provide care. At a local level,
in some towns basic dental inspections and
health education in schools are done by
dentists in general practice. Children
identified as
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needing dental treatment will then have to needs access to the hospital. Therefore,
a visit the family dentist of their choice. generally a dentist will ask a colleague who
has the access to the hospital to do the
Working in Hospitals sessions and to treat the patient.
In Luxembourg, hospitals are private and Working in Universities and

dental offices too. No dentist is working full Dental Faculties
time in a hospital. Some dentists practise
occasionally special treatments - for There are no dental faculties in
instance treatments not possible under Luxembourg.
local anaesthesia (surgery, traumatology,
disabled/handicapped people etc).
The dentist and the hospital then charge
the patient separately the fees for the care No dentists serve full-time in the
provided. To work in a hospital a dentist Armed Forces.
the contract with the patient, consent and
The “Association des Médecins et confidentiality, and advertising. This code
Médecins-Dentistes” du Grand-Duché de is administered by the Collège Médical.
Luxembourg (AMMD) is the single main Members of the board include doctors,
national medical and dental association. It dentists and pharmacists. The Collège
was founded in 1904 and is a politically Médical will also arbitrate between dentists,
independent trade union regrouping all the if there is a relationship or behavioural
doctors and dentists practising in the problem.
country. Even though membership is
voluntary, it represents most Luxembourg Outside the sick fund system a patient may
doctors and dentists. The Association is complain to the Collège Médical, but only
administered by a board of 15 members, about matters of professional behaviour
amongst which there have to be at least rather than the quality or quantity of care.
three specialists, three GPs and three Within the sick fund a patient may
dentists. The mandates come out of complain to a Commission de surveillance
general elections held in the general which may transmit the complaint to a
assembly. The mandate covers a 4-year board headed by a judge
period. It is a more than 30-year-old
tradition that the President is a specialist, For other problems, the Court of Justice is
the first of the two Vice-Presidents is a available for the complainant. Likewise, a
dentist, and the Secretary-General a GP. dentist who has a complaint against upheld
Inside AMMD, dentists have a special is may be referred to the Court. Ultimately,
association for dentists, the” Association the right to practise can be removed.
des Médecins-Dentistes”. There is also an appeal mechanism.
The Association is the main negotiating Advertising

body with the government and with the
Union des Caisses de Maladie, for the scale Advertising is not allowed. The Collège
of fees. Médical and the AMMD are analysing the
situation, with a view to permitting in the
In 2003, FDI reported 182 dentists as future standardised websites.
members of the Association (about 60% of
all dentists). Data Protection
Ethics Luxembourg has enacted the Directive on

Data Protection and during
Ethical Code 2003 the Association was
discussing with the
Dentists in Luxembourg have to work government how the
within an ethical code which covers: regulations will be operated
relationships and behaviour between within medical and dental
dentists, practice.
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307
Luxembourg
2004_______________________________________
Indemnity Insurance
For Administered by
Indemnity insurance is compulsory for all Ionising radiation under the authority of
dentists working in Luxembourg. the Health
Administration,
Health and Safety at Work controlled by Private
Company.
There is no requirement on dentists to
ensure that inoculations, for such as Electrical No information
Hepatitis B are completed by their staff, but installations available
this is recommended. Waste disposal “Sharps” must be
given to a pharmacy
for disposal, clinical
waste is to be
incinerated.
Medical devices under the authority of
the Health
Administration,
controlled by a Private
Company.
Infection control The Health
Administration
Financial Matters
There is no available information about the Taxes
income dentists would have expected to
earn in 2003. The highest rate of income tax is about
Retirement pensions and Healthcare 50%
The retirement age in Luxembourg is 65 VAT/sales tax - 15% (TVA)

years. Contributions are at a rate of 8%
from the employee and 8% from the Various Financial Comparators @ July
employer. Dentists belong to a sickness 2003
fund doctors and lawyers etc., a sickness
fund for private employees.
Zurich = 100 Luxembour
To collect a full pension, the amount of g
which depends on how much has been paid Prices (excluding rent) 78.2
in, the professional must have worked for Prices (including rent) 75.3
at least 40 years. For any benefit, Wage levels (net) 75.4
payments for at least 15 years must have
been made. A dentist may retire and collect Domestic Purchasing 88.6
a pension from the age of 60, provided at Power
least 35 years contributions have been
made. Source: UBS August 2003
Dentists may continue working beyond the

age of 65.
Main national association & Competent Authority:

information centre:
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308
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Association des
Médecins-Dentistes Médecin-Dentiste auprès de la
Association des Médecins et Direction de la Santé
Médecins-Dentistes (AMMD) Villa Louvigny
29 rue de Vianden Allée Marconi
L-2680 Luxembourg L-2120 Luxembourg
Tel: +352 444 033 Tel: +352 478 1
Fax: +352 458 349 Fax: +352 467 962
Email: secretariat@ammd.lu Email:
Website : www.ammd.lu Website
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Malta
Population 397,500
(2002)
Currency Lira (MTL)
2.5 = €1 (2003)
Main languages Maltese
English, Italian
The State provides a free medical service to

every citizen who lives in Malta. Those suffering
from chronic diseases are entitled to free
medicines. Policlinics provide free
comprehensive healthcare to all patients. Some
(free) oral healthcare is provided in these clinics
Malta but most dentistry is performed in wholly private
practice. There are 164 dentists (50% are
members of the Malta Dental Association). About
140 are practising. There is a use of (overseas
trained) specialists in both the public and private
Government and healthcare in Malta
The tiny island Republic of Malta, lies to the The capital of Malta is Valletta. The
South of Sicily (Italy), in the Mediterranean
population in 2002 was 397,500. About
Sea. Its total land area, spread over two
main islands, is 316 sq km. The terrain of 98% of the population follows the Catholic
the islands is mostly low, rocky, flat to religion.
dissected plains, with many coastal cliffs.
The State provides free medical service,
In 1964 Malta gained its independence as a including hospitalisation, to every Maltese
state within the British Commonwealth, and citizen who lives in Malta. Anybody who is
became a republic in 1974. There is a suffering from chronic diseases, such
unicameral House of Representatives (of hypertension, diabetes mellitus, asthma
usually 65 seats, but additional seats are etc., is entitled to free medicines. A new
given to the party with the largest popular central teaching hospital was being built in
vote to ensure a legislative majority; 2003 to replace the existing one.
members are elected by popular vote on Policlinics spread around the islands
the basis of proportional representation to provide comprehensive healthcare to non-
serve five-year terms). paying patients, without distinction on
income and wealth. Private hospitals exist
and are providing treatment to paying
The Executive branch includes a President
patients who usually have medical
and Prime Minister, together with a cabinet
insurance.
appointed by the President, on the advice
of the Prime Minister. The President is
elected by the House of Representatives for In 2001 the proportion of GNP spent on
a five-year term, following legislative general healthcare was 7.5%, including
elections. The leader of the majority party dentistry. No figures exist on the
or leader of a majority coalition is usually expenditure of dental treatment in state
appointed Prime Minister by the president clinics, as this treatment is included in
for a five-year term. figures for medical treatment.
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Malta
Oral healthcare
In Malta, the responsibility for planning oral nature and they are determined in
healthcare lies with the Ministry of Health. agreements between dentists and their
Dentistry, like the other medical patients.
professions, is governed by the Health Care
The normal frequency for routine oral
Professions Act of 2002. The dental register
examinations is, on average, 6 monthly.
is held by the Medical Council of Malta.
The Dental Department within the Ministry The Quality of Care
of Health looks after all the services
provided in the main Dental clinic at St. An annual check by health inspectors
Luke’s Hospital and other Government ensures that all dental clinics are set up
institutions and Hospitals. There is no and functioning according to requisite
payment for any treatment carried out by regulations.
the public dental service and school
children are provided all their dental Complaints Procedures
treatment at the school dental clinic
In the Public sector a patient lodges a
Private practice provides the bulk of all complaint with Customer Care of the Health
dental treatment and patients pay directly Department. In the Private sector it is the
for most of the dental treatment. Private Medical Council of Malta which deals with
medical insurance only covers certain such issues.
procedures, such as surgical procedures.
Private fees are fully “free market” in

Undergraduate Training 55% of clinical time is devoted to clinical
training.
There is one dental school in Malta, which
is in the Faculty of Dental Surgery of the Quality assurance for the dental school is
University of Malta. The school is publicly provided by the Medical Council.
funded. The dental school derives the
legislative framework under which it In 2003, 50% of the 30 undergraduates
educates dental students from the were female. The number graduating each
Education Act (CAP 327). These regulations year is usually also 6.
follow very closely the recommendations
for the five-year dental course in the United Primary dental qualification
Kingdom and so Malta has complied with
the EU Directives from before admission of The primary degree, which must be
the country into the EU. The legal included in the register of the Medical
framework is a legal notice within the Act Council, is: Bachelor of Dental Surgery
that prescribes curriculum and structure. (BChD)

have completed secondary school (usually
at the age of 18) and attained results
(minimal grade C) in 2 advanced
examinations (which must be Chemistry
and Biology), and 3 subjects at
intermediate level (with physics and a
language subject being compulsory). There
is a numerus clausus and those applying
with the highest grades are accepted. The
course opens on a yearly basis and is
currently (2003) accepting 6 Maltese
students and 2 non-Maltese students per
year. The 2 overseas places are not
necessarily filled. The University
Admissions Board controls the applications.
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Qualification and Vocational Training lectures and courses which award CPE
points to the participants.
Registration
There are firm proposals for a new
Dentists are automatically registered with legislation to make CPE compulsory for
the Medical Council of Malta after renewal of a licence to work as a dentist.
graduation. Dentists are given a warrant to
Specialist Training
work by the Medical Council, which by law
has a quasi-judicial board, as it has the There is no specialist training program in
power to erase dentists from the Register. Malta. However there are two training
It has never done so since it was formed in posts as part of the MFDS (UK). These are
1940. subject to the regulation of the FDS of the
Royal College of Surgeons in London. The
Diplomas from other EU countries will be
specialists who work in both private and
automatically be recognised after 1st May
public sector would have attained their
2004, when Malta becomes a full member
specialist training overseas.
of the Union. However, there is a 7 year
interim period, during which work permits
are at the discretion of the Maltese
Government. Maltese is needed as a
requirement for a foreign dentist to work in
Malta
There is a form of specific vocational

training (VT), which is not compulsory. It is
a two year rotational programme at the
Dental department St Luke’s Hospital and
peripheral Public Services Health Centres
Dental Clinic including the School Dental
Clinic. As far as possible students on
qualification are encouraged to join the
scheme but it is not compulsory and
therefore a graduate dentist has a licence
to practise after 5 years training course.
Because most general practice is single
handed a VT scheme based in practice
would be difficult to implement.

Specialist Training
Continuing education is not mandatory

under Maltese legislation, but the Dental
Association of Malta, together with the
Faculty of Dental Surgery, has been
organising regular
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Following enactment of the Health Care
Professions Act, the Medical Council Malta The Act recognises two dental specialties,
must, in consultation with the medical (oral surgery and orthodontics) that are
profession, create a Specialist Accreditation also recognised by the EU. The University
Committee. This will be needed to of Malta has recommended that a further 3
formulate policy on specialist lists for future specialities be recognised - restorative
Malta trained specialists and those entering dentistry, child dental health and Dental
Malta with overseas diplomas. Public Health.
Workforce
Dentists
In 2003 there were 143 active dentists in Numbers of specialists
Malta - 25% female. Many dentists practise (2003)
in more than one sphere of practice. In
Orthodontists 3
2003, 65% of dentists were below 40 and
25 dentists over 50; it has been suggested Oral Surgeons 5
that Malta is training more dentists than Prosthodontists 4
will retire in the first years of the Periodontist 1
millennium.
The (active) dentist to population ratio was Community dentistry 1
2,780 (2003). Endodontist 1
There were two dentists from EU countries Oral Radiology 1
working in Malta in 2003. They are both Others 6
married to Maltese nationals, which gives
Oro-Maxillo-facial surgeons 0
them an automatic right to a working
permit.
There is no reported unemployment of Auxiliaries
dentists in Malta.
The system of use of clinical dental
auxiliaries is limited to hygienists in Malta.
Total Registered (2002) 164
In active practice* 143
General (private) practice 140
University 20 (2001)
Hospital 17 Hygienists 22
* Dentists may work in more Active hygienists 16
than one sphere of practice
Laboratory technicians 20
Specialists
Dental Hygienists
In Malta dental specialities are not yet
formally recognised (2003), but will be The title is legally protected and there is a
when the Health Professions Act of 2002 is registerable qualification which dental
fully implemented. Initially, orthodontics hygienists must obtain before they can
and oral surgery will be recognised. practise. Training is for 3 years in the
government hospital. The Board for
However, a number of dentists have Professions Supplementary to Medicine
additional qualifications in specific areas of holds the registration of dental hygienists.
dentistry and patients may be referred to
them from other dentists.
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Dental hygienists work under the technicians who work solely in private
Malta
prescribed instructions of a dentist, in a practice. Those who work in the public

clinic or private practice. Their work sector also work in private practice.
includes scaling and normal dental
hygiene, and Oral Health Instruction. Like hygienists, dental technicians are
normally salaried and typically would earn
In 2003, there were 22 registered dental about €850 to €1,500 per month when
hygienists – 7 in the main hospital, 3 in working in the public sector. It has proved
Gozo General Hospital and 8 in health difficult to judge how much Dental
centres. The remainder worked privately on Technicians earn in private practice, as this
a part-time basis. depends on payment for each piece of
work.
They are normally salaried and typically
would earn about €850 to €1,500 per Denturists
month when working in the public sector.
Private earnings are not available. Denturism is illegal in Malta, but there are
known to be some denturists practising.
Dental Technicians
Dental Chairside Assistants (DSAs)
The title is also legally protected as Dental
Technologist and there is a registerable Up to the present time, DSAs are not
qualification which they must obtain before officially qualified and are trained by the
they can work independently. Training is dentists themselves. Those working in the
also for 3 years in the government hospital. public sector are usually trained general
The register is held by the Board for nurses but those working in the private
Professions Supplementary to Medicine. sector usually have no qualifications and
are trained by the dentist who employs
Dental Technicians work in commercial them.
dental laboratories, to construct
prosthodontic and orthodontic appliances, In 2003, there were 11 dental nurses
to the prescription of a dentist, and they working at a school dental clinic and 8
are not able to deal directly with the public. dental nurses working in the main Dental
Although, legally, dental technicians must Department of St Luke’s Hospital. The
not have direct contact with the public, it is health centres usually have a general nurse
widely reported that people have their assigned to the dental clinic (8) and there
dentures repaired directly by them. are 3 dental nurses in the dental
department at Gozo General Hospital. So,
In 2003, there were 20 dental technicians. there are 30 nurses working as DSAs in the
Of these, 7 work In the dental department public sector.
in the main hospital, 3 work at a school
dental clinic (mainly constructing It is estimated that 70% of dentists in
orthodontic appliances), 1 is in Gozo private practice have an assistant working
General Hospital and 2 are at a dental clinic with them.
in a retirement home (SVPR). There are 7
Practice in Malta
Oral health services are provided in both
the public and private sectors with 95% of About 80% of private practitioners work in
the dentists working in the public sector single dentist practices. There are some
also working in private practice dentists who own a practice and have a
dentist who also works in the practice and
Working in General Practice earns 50% of the amount that the patient
pays for the treatment. This dentist does
In Malta, dentists who practise on their own not contribute to the overheads and
or as small groups, outside the hospital or running of the practice. There are about 5
policlinic, and who provide a broad range of group practices where the overall expenses
general treatments are said to be in are shared between the partners but the
general practice. In 2003 there were 140 income from the patient fees is on a
dentists who worked in this way (many also separate basis.
work in the public dental service until the
early afternoon each day).
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Most dentists in private practice are self- no official fee scales and pricing is
employed and earn their living through unregulated in Malta. The patient pays the
charging fees for treatments. There are dentist in full and some then reclaim partial
reimbursement from their private insurance
if possible.
Any dentist holding a valid warrant issued
by the Medical Council may open a dental
surgery anywhere he or she decides. A
permit from the Health Department and
another one from the Malta Environment
and Planning Authority are needed.
Dentists in Malta are the only professionals
who are taxed (€230 Euros a year) to be
able to practise in their place of work.
Practices are normally sited in apartments

or small houses converted into clinics.
dental practice in terms of number of
may be rented or owned. There is no state
so usually dentists take out commercial
loans from a bank
A general dental practitioner would

normally earn from about €3,000 to €5,000
per month
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315
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Working in the Public Dental for Maltese citizens. The provision of

Service and Hospitals domiciliary (home) care is not very
common in Malta, and is usually provided
In 2003 there were 40 dentists working for
by public health dentists.
the Dental Department - 7 have
postgraduate training in a specialised field. The quality of dental care is assured
through dentists working in teams under
(1) In the main dental clinic at St. the direction of experienced specialists.
Luke’s Hospital emergency consultation, The complaints procedures are the same as
major oral surgery under local anaesthesia those for dentists working in other settings
or general anaesthesia, and normal
consultations are provided for free to all Persons employed in the public service
patients. Some services, such as receive fixed remuneration (by salary),
Restorative Dentistry and Prosthetics very often divided into several components
(mainly acrylic dentures) are provided only
to patients in low income brackets.
such as seniority, specialisation, premium
Extractions for all patients are free, when etc. They earn from just under €1,000 to
carried out under general anaesthesia. In about €1,700 per month.
2003 there were 14 dentists working at the
Working in University and
Malta
main Dental clinic at St Luke’s Hospital.
Dental Faculty
(2) There is a dental clinic in the sister
island of Malta, Gozo in the Gozo General
Hospital and in 2003 there were 3 dentists In 2003, 20 dentists worked in the dental
working there. school, on a part time basis as salaried
employees of the university. This number
(3) There is 1 dentist working in a does not include the medical staff who
dental clinic in a retirement home (SVPR) lecture to the dental students in their pre-
providing free prosthetics and restorative clinical year. They are allowed to combine
treatment to those patients who are their work in the faculty with full-time
entitled to it.
employment or private practice elsewhere.
The salary range is not available.
(4) There are 8 Regional Health
Centres which have a Dental Clinic which The main academic title within the Maltese
provides emergency dental care, dental faculty is that of university
restorative dental treatment to those who professor. Other titles include lecturer,
are entitled to it (patients in low income
brackets and children below the age of 16)
assistant lecturer and clinical
and preventive care. In 2003 there were 14 demonstrators. Senior teachers and
dentists working in these health centres. professors will have completed a PhD, and
most will also have received a specialist
(5) There is a School Dental Clinic clinical training. Apart from these, there
which offers free treatment to all children are no other regulations or restrictions on
below the age of 16 (child dental health and promotion.
orthodontics). Referrals to the School
Dental Clinic are via the regional health The quality of clinical care, teaching and
centres and the main dental department in research in dental faculties is assured
the main hospital. Children who have a high through dentists working in teams under
caries rate, require orthodontic treatment the direction of experienced teaching and
and specialist paediatric care are referred academic staff. The complaints procedures
to the school dental clinic. Orthodontic
are the same as those for dentists working
treatment which includes any form of
removable appliance therapy is provided in other settings.
for free to all patients. Fixed appliance
therapy is provided for free to those Working in the Armed Forces
children who are considered as high There are no full-time dentists in the Armed
priority, such as cleft lip and palate
patients, patients with hypodontia, and
Forces. Members have all their treatment
those patients about to undergo provided free by the state dental services.
orthognathic surgery. There were 8 dentists
working at School Dental Clinic.
Funding for all the above departments is

from government funds allocated to the
health department. Treatment is free
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There is a single main national association,
Ethics
the Malta Dental Association (DAM). In
2003 about 80 dentists were members
(about 50%). The Association represents The Medical Council
private and public health dentists and
combines this role by trying to emphasise The Medical Council of Malta consists of a
to common, professional matters. It is not a legal practitioner, medical practitioners,
trade union, but the Government of Malta dental practitioners and lay people. Some
recognises DAM as the valid representative are nominated and some are elected.
of all Maltese dentists, for example for EU Dentistry is incorporated under the Medical
accession talks, a new health care Council with appropriate representation of
profession act, etc. the dental profession on the body. The
Council meets as a single body and
For more information about the Malta dentistry is not subservient to Medicine.
Dental Association click here For more information about the Medical
Council click here
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317
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Malta
Ethical Code Insurance and professional indemnity

Dentists are subject to the same ethical Indemnity insurance is not mandatory.
code as their medical colleagues. For There are a few dentists who are insured
example, they must only use proven with the Medical Protection Society (UK) at
techniques and must constantly update an annual cost of about €325 per annum.
their clinical skills. There is also a special The premium is more if the dentist does
law to protect patients’ rights, consent and implants and oral surgery. A patient is
confidentiality. The Medical Council judges entitled to lodge a complaint and demand
infringements of malpractice. There are no compensation before a medical court or a
specific contractual requirements for common court.
dentists working together in the same
Corporate Dentistry
practice. The national and European laws
on equal employment opportunities, There is no corporate dentistry in Malta.
maternity benefits, occupational health,
minimum vacations and health and safety Health and Safety at Work
however protect a dentist’s employees. There is legislation in the field of employee
Data Protection protection. Hep B vaccinations are
mandatory in Malta and are provided free
In 2002, a law, covering data protection by the Health Department.
came into force. In July 2003 a document
was set up which defines the guidelines to Regulations for Health and Safety
be followed by a Data Controller within the
Public Service, for the notification of an For Administered by
organisation’s process – both computer as Ionising radiation Private company
well as manual, existing as well as new. Electrical Private company
The document also provides instructions on installations
filling in the Notification form. This
Infection control Department of Infection
notification form is to be sent to the Data
control of the Ministry of
Protection Commissioner.
Health
See Medical devices Private
http://mohweb/healthweb/dataprotection.ht Waste disposal Private (All private companies
m for more details. are licensed by the Health
Advertising Department).
Advertising by dental surgeons is not

allowed, although notification of a change
of address or working hours is permitted.
Post graduate qualifications may be
announced, but without a photo. The
Medical Council regulates and monitors
this. There are no regulations relating to
the use of websites.
Financial Matters
Dentists’ Incomes: Public €10,500 €22,500
Health
expected to earn in 2002 (in Euros), per Academic No data No data
annum: available available
Dentist 25 Dentist 45 Retirement pensions and

years old or years old or Healthcare
2 years after 20 years after
qualification qualification The national insurance premiums (4.6% of
Liberal or No data No data earnings) include a contribution to the
General available available national pension scheme. Retirement
Practice
Hospital €10,500 €22,500
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318
__ ____EU Manual of
National Insurance premiums are an
additional 8.3% of salary or income.
pensions in Malta are typically 60% of a
person’s salary on retirement. The official VAT/sales tax
retirement age in Malta is 60, although the
There is a value added tax, payable at a
average age of retirement is 59. Dentists
rate of 15% on purchases. Medicinals and
practise, on average, to little over 60 years,
certain dental equipment and filling
although they can practise past this age.
materials are exempt from VAT.
Taxes Approximately 70% of dental materials and
equipment needed are VAT free. Patients
For the majority of the Maltese population do not pay any VAT on treatment, and
general health care is paid for mainly dentists do not get refunds on purchases.
through income tax.
on salary or income). The maximum
Malta
amount of tax that can be paid is 35%.
Malta
Information Centre:
Dental Association of Malta, The Director General,
The Professional Centre, Department of Health,
Sliema Road, Gzira GZR 06 Palazzo Castellana,
MALTA Merchants Street ,
Tel: +356 2131 2888 Valletta
Fax: +356 2131 2004 MALTA
Email: mfpb@maltanet.net Tel:
Website: Fax:
Email:
Website:
The Medical Council of Malta: Board for Professions Supplementary
to Medicine:
181 Melita Street 181 Melita Street
Valletta Valletta
MALTA MALTA
Tel: +356 212 26349 Tel: +356 212 26349
Fax: +356 212 55540 Fax: +356 212 55540
Email: Email:
Website Website
Publications: f
The Probe
4 times a year newsletter, by the Dental Association of Malta.
Editor: Dr. Kenneth Spiteri.
E-mail: kenspit@maltanet.net
Dental School:
The Dean
Faculty of Dental Surgery
University of Malta
Medical School
Gwardamangia MSD 08
MALTA
Tel: +356 221019 or 225464
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319
2004_______________________________________
Fax: +356 235638

Email:
Website:
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320
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The Netherlands
Population (2002) 16.15
million
The GDP per capita (2001) €23,124
Netherlands Currency Euros
Main language Netherlands
(
Dutch)
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. About 80% of active
dentists are members of the Nederlandse
Maatschappij tot bevordering der
Tandheelkunde (NMT) - the Dutch Dental
Government and healthcare in the Netherlands

The Netherlands is a small but densely also based on the employee’s salary.
populated country on the southern edge of These contributions are 1.7% of salary from
the North Sea. The estimated population the employee and 6.75% from the
(July 2003) was 16,150,511. It is both a employer and the percentage levels are set
constitutional monarchy and a by the government. Unemployed people
parliamentary democracy. There are 12 have to pay the nominal
provinces and 572 (1997) municipalities
and there is substantial decentralisation of
government responsibility, especially in
education, transport and health.
The Parliament consists of two chambers;
the lower, the Second House, has 150
members elected in direct elections by
universal suffrage; the 75 members of the
upper chamber, the First House, are
elected by the members of the Provincial
Councils. The capital is The Hague.
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, €31,750 per year
or less. Those in the public scheme pay a
nominal premium, which varies per
insurance company, from €240 to €400 per
year, set by the sick funds, and an
additional percentage of their income.
Employers also pay a contribution, which is
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321
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premium, but the government pays the their age, health condition and the financial
employer’s contribution. risk they are prepared to carry. Once again
there is a nominal premium, which varies
In the past the choice of insurance scheme, between €1,000 and €3,000 per year.
or sick fund, used to be limited by the Cover may only be for hospital and general
geographical area where an individual practitioner care or may include many
lived, but a change in the law a few years extras. Some employers pay part of the
ago allows all schemes to operate premium for their employees. Within the
nationally. The public insurance companies total system private and public patients are
may compete for customers and every year treated in the same way, and in the same
the individual can choose which scheme to facilities.
belong to. They may also compete for
business in the private sector. The proportion of GDP spent on general
healthcare is rising slowly, and including
The private schemes are for people who do dentistry in 2002, was 8.9%. Of this
not qualify for the public, lower-income expenditure, 63.3% was “public” (OECD
system. The premiums paid vary according Feb 2004). There is a predetermined
to the care the person wishes to insure for, budget set by the government.
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Oral healthcare
The
Public Healthcare Private Care

Almost all dentistry is provided by dentists Most people who have basic dental health
working in general practice. cover under the public scheme have an
Approximately 69% of the population is additional private insurance (86%).
registered in the public system. Adults (18 However, this insurance does not cover
years or more) who are part of public 100% of the total costs.
insurance schemes are entitled to
preventive treatments, examinations, Only approximately 33% of adults in the
plaque removal and oral hygiene wholly private sector pay for all their
instruction and the dentist’s annual claim dental care through insurance schemes.,
for this standard package of treatment is although about 62% of those outside the
called the ‘cluster charge’. To claim this public scheme have some form of dental
entitlement to preventive care a patient insurance.
must visit the dentist at least once a year.
Other treatments are either covered by
supplementary insurance or patients must
pay for each item separately.
The service also provides comprehensive

care to those aged under 18 years,
including restorative work, endodontics,
prevention and extractions. Crowns,
bridges and orthodontics are not included,
except for patients with clefts or other oral
conditions of comparable severity.
Children are issued with a card at each
examination which is valid for one year. If,
at the age of 13 years, they do not have a
valid card they may be required to make a
contribution of their own. If parents take
out private dental insurance their children
are automatically covered. The remainder
of the population must make their own
arrangements for dental care.
Although the majority of dental treatment

is provided under the private system,
there is a national scale of maximum fees.
The principle is contained in the Health
Care Charges Act and amounts are set
each year by a government appointed
body, the Central Body for Health Care
Charges.
Patients will normally attend for their re-

examinations about every 9 months. There
is no formal system for domiciliary care.
People who are handicapped (as measured

by medical examination within social
security system) are seen under the public
scheme, but before their treatment can be
undertaken approval has to be obtained.
There is a system of advisory dentists to
assist the national insurance companies.
The proportion of total healthcare costs

spent on dentistry is 3.5% (2002).
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All such schemes are personal schemes, The quality of dental care is monitored by
where individuals insure themselves and the profession in different ways and
their children by paying premiums directly emphasis is placed on improvement and
to an insurance company. Private assurance rather than control. Quality
insurance companies are self-regulating improvement is achieved through
and bear all the financial risks of continuing education, peer review and the
treatment. Often the level of the development of standards and
premiums will be linked to the age of the certification. The Individual Health Care
patient, and the insurance company may Professions Act (BIG Act) was introduced
refuse to provide cover. However, there is for the whole of health care and dentistry
a ‘safety net’ standard policy for which the on December 1st 1997. Its purpose was to
premium and level of cover is set by the promote and monitor the quality of
government, and which must be offered by professional practice across the whole of
all insurance companies in the market. health care and to protect the patient
The dentist does not sell or promote the against inexpert and negligent treatment
scheme, and there is no formal relation by professional practitioners. The act has
between the dentist and the insurance four significant consequences for dentistry,
company. There are many competing a change in the revised regulation of
insurance companies and most patients qualification, new registration by law,
take out dental health insurance as a part quality assurance and a revised
of their general health insurance with the disciplinary code. The act replaced a
same company. number of existing and out of date laws.
There are some private practitioners who A Dutch Health Inspectorate makes
completely work outside the public occasional visits to practices. Their
scheme. There are no data about how checklist for screening dental practices
many. covers:
The Quality of Care • clinical practice,

• infection control,
The quantity of dental care provided within • waste disposal,
the public system is monitored by • radiation practice.
comparing the amount of completed
treatments with the available budget. They are able to issue warnings and
Under the public system, an insurance initiate disciplinary procedures (see
fund will have to give prior approval for below).
any major restorative or orthodontic care.
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Undergraduate Training Dentists who have graduated outside the
The
Netherlands can apply for recognition of
To enter dental school a student needs their degree and ask for a declaration of
diploma VWO (secondary education) with professional quality, which may allow them
physics, chemistry and biology and no to be registered in the national register. It
entry examination. There is no vocational should be noted that a reasonable
entry, such as from being a qualified dental command of the Dutch language is
auxiliary. essential in order to practise in the
Netherlands (although there is no absolute
Dental schools are parts of measure of this).
Colleges/Faculties of Medicine in the
universities. There are three dental
schools, all of which are state-funded. The
students have to pay to go to university. In
2002, student intake was 300 and approx.
50% of the students were female. Training
lasts for 5 years. In 2001, 190 students
graduated and approx. 50% were female.
For a list of schools, see Dental Schools
The Ministry of Education and Science

monitors the quality of the training, and the
Council of the Faculty is directly
responsible.
Upon qualification, the graduates receive

the title “drs” after 4 years, then after the
fifth year graduates receive a certificate. In
full the title is: 'Universitair getuigschrift
van een met goed gevolg afgelegd
tandartsexamen'.
The title dentist is reserved to those who

are registered in the “BIG” register (see
below, “Registration”).
At some in the future it is planned that

after 3 years a Bachelor of Science (BSc)
degree will be awarded, then after 2 further
years, Master of Science (MSc).
No post-qualification vocational training is

necessary for entering into full,
unsupervised practice.
Registration
In order to register as a dentist in the

Netherlands, an applicant must hold a
diploma from a Dutch dental school. A
formal application with appropriate dental
certificates must be made to the Ministry of
Public Health Welfare and Sport (or het
ministerie van VWS).
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specialists to the Specialist Registration
After the introduction of the Individual Board 'Specialisten-Registratiecommissie
Health Care Professions Act, people are (SRC)'. However, any changes to the
able to call themselves dentists if they, on registration procedure have to be approved
presentation of the required documents – by the Ministry.
including the full the title 'Universitair
getuigschrift van een met goed gevolg Orthodontic training lasts four years and
afgelegd tandartsexamen' (ie recognition takes place at two dental schools:
and declaration of professional quality), Nijmegen and Amsterdam (ACTA). Trainees
have had themselves registered as such by are paid by the university.
the National Health Inspectorate (BIG-
register). The title is legally protected. Its The title on completion of training is
use without registration is punishable by 'Getuigschrift van erkenning en inschrijving
law. als orthodontist in het Specialistenregister'
(a certificate showing that the person
Further Postgraduate and concerned is officially recognised and that
their name is entered as an orthodontist in
Specialist Training the specialists' register), issued by the
Specialists Registration Board.
Oral and Maxillo-facial Surgery requires
Continuing postgraduate education is not four years at one of five training facilities in
compulsory for dentists. This is normally university hospitals. To undertake this
provided by universities and private training a student requires a medical and
organisations. dental qualification. Students are paid by
the hospital.
Specialist Training
On completion of training the title given is
'Getuigschrift van erkenning en inschrijving
In the Netherlands two dental specialties
als kaakchirurg in het Specialistenregister'
are recognised:
(a certificate showing that the person
concerned is officially recognised and that
• Oral and Maxillo Facial Surgery
his name is entered as an oral surgeon in
• Orthodontics the specialists' register), issued by the
Specialists Registration Board.
The Ministry of Health has delegated the
responsibility for registration of all
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Workforce
The
Dentists Auxiliaries
The total number of dentists registered is
7,623 of whom 5,848 (76.7%) are male and In the Netherlands there are dental
1,775 (23.3%) are female. About 300 assistants, dental technicians and two
qualified outside of the Netherlands. The other groups who provide clinical oral
Dutch Dental Association (NMT) has health care, dental hygienists and
reported that the active workforce is denturists.
decreasing and there is a growing shortage
of dentists.
The population per active dentist

was 2,118
It is reported that about 37% of dentists are

over 50 years of age.
Total (2002) 9,60

0
General practice (owners) 5,900
General practice 1,100
(employees/locums etc)
Public dental service (Child care, 120
health care, advising etc.)
University 300
Education (non-university) 60
Armed Forces 97
Specialists
There are 2 classes of specialists in

the Netherlands:
• Orthodontics
• Oral Maxillo-Facial Surgery
(2002)
Orthodontists 283
surgeons
The ratio of dental specialists to dentists is

about 1:16. Numbers under the age of 64
years who are registered to work are in the
table alongside.
Patients may attend specialists directly, but

usually they go by referral from a primary
dentist. Specialists can apply a different
scale of fees from general practitioners.
Oral and maxillofacial surgeons work
mainly in hospital and universities. Most
orthodontists work in private practice,
although some work in universities.
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There is no available data about how much
a full-time dental technician would expect
Numbers of auxiliaries to earn.
(2002)
Denturists
Hygienists 2,200
Technicians 1,000 Qualified denturists train for 3 years part-
Denturists 250 time, after completion of training as a
dental technician. Training is provided by
the Dutch Denturist Federation. On
Dental Hygienists completion of training they receive a
further diploma. “Denturist” is a
In the Netherlands dental hygienists are
paramedicals with independent status. As
such, they form an official profession who
are required to be qualified and have a
diploma. They train in special hygienist
schools (not associated with dental
schools), for 4 years full time. On
completion of training they receive a
diploma.
Most are employees in dental practices,

some work in hospitals and centres for
paediatric dentistry. However, hygienists
may practise in a dental hygiene clinic,
independently from a dentist, but all the
treatment undertaken must have been
referred by a qualified dental practitioner.
Approximately 10% do this and there is
pressure from the hygienists to acquire the
right to work without interference from a
dentist. Some hygienists with extra skills
work as orthodontic auxiliaries.
There is a course where dental hygienists

are taught how to provide routine dental
treatment e.g. fillings, extractions for
children. When the course is completed, a
hygienist may practise paediatric dentistry,
but again, only after referral from the
dentist.
The NMT has developed a working protocol

for the above relationships and advises
dentists and hygienists to comply with it.
There is no available data about how much

a full-time dental hygienist would expect to
earn.
Dental Technicians
Dental technicians train in special schools,

for 2-4 years, part time. On completion of
training they receive a diploma, but are not
required to register. Most dental
technicians work in dental laboratories.
They are permitted to produce dental
technical work to the prescription of the
dentist, but cannot work in the mouth.
There are about 1,000 dental laboratories,

employing about 3,500 technicians.
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protected title, with an ethical/disciplinary training schools and a postal course, most
system administered by the Denturist assistants are trained by individual dentists
Netherlands
Federation. in their practices.
Denturists are only allowed to provide full Assistants have a wide range of duties but
dentures and may work in independent can only carry out ‘reserved procedures’
The
practice when authorised by a dentist who is
satisfied that he/she is competent to do so.
There is no available data about how much In all cases, the responsibility for the care
a full-time denturist would expect to earn. provided remains with the dentist.
Because of a shortage of dental hygienists,
Dental Assistants some assistants also carry out scalings but
not root planning - this is permitted under
There is a ‘certified training’ available for the Individual Health Care Professions Act
dental assistants in the Netherlands but (BIG).
although there are approximately 30
There were 11,809 dental assistants in
2000.
Practice in the Netherlands
Working in General Practice There are no rules which limit the size of a
In the Netherlands, dentists who practise associate dentists or other staff. Premises
on their own or as small groups, outside may be rented or owned. There is no state
hospitals or schools, and who provide a assistance for establishing a new practice,
broad range of general treatments are said so usually dentists take out commercial
to be in General Practice. loans from a bank. The NMT has a special
service for introducing young dentists as
Dentists in general practice are mainly self- locums to established practices and
employed and obtain income from patients’ recommends that new dentists work in
fees, with a small proportion (an average of several practices to gain experience before
approximately 25%) from reimbursement choosing which to buy.
from the government system.
Approximately 5,900 of the 7,623 dentists

(77%) work in their own general practice
and about 61% (2001) of which are “single-
handed” practices. The remainder work in
practices of two or three dentists, with a
few larger groups. About 1,100 dentists
work as assistants or locums. Within group
practices responsibilities are shared, work
is discussed and some dentists concentrate
on different types of care. The average
number of patients per single-handed
practice is approximately 2,700 (2001).
There is a fee scale of maximum charges,
and dentists bill every treatment. To claim
reimbursements from the sick funds a
dentist must hold a contract with at least
one of the twenty main health insurers in
the Netherlands. It is increasingly common
for patients to be asked to pay in cash.
Bank card payments are also being used,
but there is a cost to the dentist of
investing in the system.
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Netherlands
In 2003, very few dentists were employed
in these public health clinics, and average
Anyone can own a dental practice, and earnings for them were unknown.
there is also provision for them to be run as
The
companies, although no reliable data exist Working in Hospitals
on this. NMT has a service to help in the
selling and buying of dental practices. It
There are no organised hospital dental
puts buyers and sellers in contact and also
services in the Netherlands, except for oral
has business advisers. It is possible to sell
maxillo-facial surgery. In patients receive
the goodwill of a practice and often the
their general care from their regular
equipment is sold, as well as the building.
dentist.
The only restrictions on setting up practice
are planning laws and it is not possible to Working in Universities and
open premises in residential areas. Dental Faculties
However the local councils often allow
dentists to establish themselves in new There are 3 dental schools, as part of
estates and also designate areas as universities and dental faculties, in which
suitable for the dentist. There are no about 300 dentists work as full-time or
access problems for patients living in rural part-time employees of the university.
areas but there are some shortages of They are free to combine their work in the
dentists working in inner city areas and faculty with part-time work elsewhere, for
some specific social groups are having example in private practice.
trouble accessing dental care.
Private practices are mostly housed in

separate practice buildings (about 60%) or
in/next to the private house of the dentist
(35%)

have incomes in the range of €91,000 per
year (2002)

Apart from the extension of coverage of the
public sick funds, to provide dental care for
card-holding children and handicapped
people, there is no separate public dental
service in the Netherlands. There is,
however, a small dental service for schools
which is run as a private business. A public
medical service provides some information
on prevention, statistics and advises the
Ministry of Health.
The Ivory Cross, which specialises in

dentistry, is an organisation which is
subsidised by the Ministry of Health and the
NMT. It produces leaflets with general
information on dental care, and also more
specific information for the public, for
example “amalgam in dentistry”.
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The main title within a Dutch Dental is spent teaching. In general salaries are
Faculty is that of university professor. lower than for dentists who are in practice,
Other titles include university assistants, and in 2003 there were recruitment
university lecturer and university head problems for full-time positions at
lecturer. There are no formal requirements universities.
for postgraduate training but professors
and university head lecturers must have a Working in the Armed Forces
doctorate. Professors are appointed on the
basis of their publications and teaching.
Approximately 70% of an academic’s time
Armed Forces.
Professional associations regular care from that dentist) face
financial difficulties a dentist must
continue to treat them. The dentist must
Main national association is the
make considerable efforts to obtain the
Nederlandse Maatschappij tot bevordering
der Tandheelkunde (NMT) or Dutch Dental
Association. The NMT is an association
according to private law. A dentist is free
to become a member or not. About 80% of
the dentists are members of the NMT. The
NMT is governed by a board of four
dentists who are appointed by the General
Assembly. The GA exists of
representatives of the Regional Boards.
The NMT has as its objectives the
promotion of dentistry in general and the
advancement of the intents of the dental
profession.
The Association publishes an advice

booklet on ‘Practising Dentistry in the
Netherlands’.
In 2003 80% of the 7,623 dentists were

members of the NMT.
There are several associations and

societies for dentists with special interests.
These are best contacted via the NMT.
Ethics
Ethical Code
Dentists in the Netherlands have to work

within an ethical code which covers
relationships and behaviour between
dentists, contracts with patients, consent
and confidentiality, continuing education
and advertising. This code is administered
by the NMT. Also, if a patient visits a
dentist with a problem such as pain, then
under Dutch law the dentist is obliged to
see him. However, the dentist is not
required to accept the patient on a regular
basis.
The ethical code also states that when

established patients (those who receive
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In co-operating or engaging in publicity,
money and to finish complicated the dentist shall ensure that such publicity
treatment, for example endodontics, is not in conflict with the law, the truth or
before discontinuing treatment, although good taste, is in accordance with the due
this is not a formal part of the ethical care that befits a dentist, and does not
code. infringe on the goal of a mutual
relationship between colleagues that is
There are no specific contractual based on courtesy and trust. Publicity
requirements between practitioners may not be intended to attract clients.
working in the same practice but a
dentist’s employees are protected by the A dentist may publish a website, but must
national and European laws on equal ensure that this is according to the rules
employment opportunities, maternity on advertising.
benefits, occupational health, minimum
vacations and health and safety. Data Protection
Complaints Regulations are in place in the Netherlands

which enact the Data Protection Directive.
Patient complaints may be handled in The CBP (College Bescherming
three ways. There is a general disciplinary Persoonsgegevens) is responsible for the
law for the health care professions. Under administration.
this law patients’ complaints are
considered by one of five regional medical Indemnity Insurance
disciplinary boards. Board membership is 2
lawyers (including the chairman) and 3 Indemnity insurance is not compulsory for
dentists. Sanctions may be a warning, a dentists and is provided by general
reprimand, a fine or suspension/removal insurance companies. The NMT has an
from the register. Any appeal will be heard arrangement with a company to provide
by a board of 3 lawyers (including the more favourable premiums for its
chairman) and 2 dentists. members. General insurance covers
damage to persons, property, capital
The NMT also has a system, which liability (as the owner of dental premises)
conforms to legislation, where patients and and employer liability. Prices are the same
colleagues can register a complaint for all dentists who pay approximately €90
against a member of the Association. annually.
Dentists who are not NMT members must
set up their own complaints procedures.
As a last resort, the patient has the option

of starting a civil lawsuit against the
dentist.
Advertising
Dentists working in the Netherlands must

follow rules of conduct which control
advertising. After changes in the law in
1997 a rule (31) was adopted for the
advertising code established by the NMT,
which reads as follows:
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The
Corporate Dentistry
Dentists in the Netherlands may form

limited liability companies and non-
dentists may be members of the boards of
such companies.
A practice needs a permit for using

radiation equipment. The Health and
Safety inspectorate of the Department of
Social Affairs may also visit employers, but
this rarely happens. They carry out
surveys of risks but dentists are
encouraged to undertake their own
evaluation and the NMT has forms
available for this.
For Administered by
ionising radiation Dutch Health Inspectorate
Electrical No available information
installations
Waste disposal Dutch Health Inspectorate
Medical devices No specific organisation.
To a certain extent, the
Dutch Health Inspectorate
is involved.
Infection control Dutch Health Inspectorate
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Financial Matters
There is no available data on the income Taxes
ranges for dentists. The Central Bureau of
Statistics investigates dentists’ annual The top rate of tax is 25% and is charged
incomes, but the information is very on net incomes above €5,000 per year.
general about net income and personnel.
VAT
Healthcare VAT is 6% (for dental materials) or 19% (for
instruments and equipment).
In the Netherlands there is a general law
which provides all Dutch people over the
age of 65 years with a monthly benefit. To Various Financial Comparators @ July
supplement this most people take out a 2003
private pension. In general, a pension will
be approximately 70% of final earnings. Zurich = 100 Amsterda
m
Self-employed professionals are not
covered by the public health system, and Prices (excluding rent) 77.3
therefore have to take out private health Prices (including rent) 81.0
insurance policies. The annual premium for Wage levels (net) 57.0
such private insurance will be a standard Domestic Purchasing 67.6
(or ‘nominal’) amount - €1,000 to €3,000 Power
per year,
Normal retirement age is 65, but dentists Source: UBS August 2003
may practise beyond that, in private
practice.
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The
Competent Authority: Dental Association (including

Specialist Training Board and main
information centre)
Ministerie van Volksgezondheid Welzijn en NMT (Dutch Dental Association)
Sport Postbus 2000
Postbox 20350 3430 CA Nieuwegein
2500 EJ ’s-Gravenhage The Netherlands
The Netherlands Tel: +31 30 60 76 276
Tel: +31 70 34 07 911 Fax: +31 30 60 48 994
Fax: +31 70 34 07 834 Email: nmt@nmt.nl (NMT general)
Email: e.ledoux@nmt.nl (for Specialists
Website: www.minvws.nl Board)
Website: www.nmt.nl
National Health Inspectorate: Other information centre:
Staatstoezicht op de Volksgezondheid Ministerie van VolksgezondheidWelzijn en
Inspectie voor de gezondheidszorg Sport
Address Postbus 16 119 Afdeling Buitenlandse Diplomahouders
2500 BC ‘s-Gravenhage Postbus 16 114
The Netherlands 2500 BC ‘s-Gravenhage
Tel: +31 70 34 07 911 The Netherlands
Fax: +31 70 34 05 140 Tel: +31 70 34 062 00
Email: hi.higz@igz.nl Fax: +31 70 34 05 966
Website: www.igz.nl Email: info@verwijspunt.nl
Website: www.verwijspunt.nl
Dental Schools:
Amsterdam Nijmegen
Academisch Centrum Tandheelkunde Katholieke Universiteit Nijmegen (KUN)
Amsterdam (ACTA) Philips van Leydenlaan 25
Louwesweg 1 Postbus 9101
1066 EA Amsterdam 6500 HB Nijmegen
Tel: +31 20 51 88 888 Tel: +31 24 361 88 24
Fax: +31 20 51 88 333 Fax: +31 24 361 88 04
Email: Email: m.hermsen@dent.kun.nl
Website: www.acta.nl Website: www.kun.nl
Dentists graduating each year: Dentists graduating each year:
Number of students: Number of students:
Groningen
Rijksuniversiteit Groningen
Faculteit Tandheelkunde/afd. Mondhygiëne
Antonius Deusinglaan 1
9713 AV Groningen
Tel: +31 50 36 33 092
Fax: +31 50 36 32 696
Email:
Website: www.rug.nl
Number of students:
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Norway
Member of the European Economic Area
Norwa (2003)
y GDP per capita (2001) €42,690
Currency Kroner
(7.88 = €1)
Main language Norwegian
General health services are funded through a form

of national insurance, the Folketrygden, which is
administered by the Rikstrygdeverket or RTV.
Benefits include pensions, full salary for one year
for long term sickness, unemployment benefit and
health care. However, only priority groups (mainly
children, mentally handicapped and elderly in
care) receive dental health care free of charge
from the Public Dental Health Service. Adults must
pay the full cost for dental care (there are some
exemptions). There are 4,140 active dentists (95%
Government and healthcare in Norway
Norway is a Nordic country with a population of 4,525,116 in 2002. It is mountainous and

virtually all of the centres of population are located on the coast. Norway is a constitutional
monarchy, with a parliamentary democratic system.
The Storting (Norway’s Parliament) has the legislative and budgetary power. In addition the
Parliament also authorizes plans and guidelines for the activities of the State through
discussions of political issues of a more general nature. The parliament has 165
representatives and has a two chamber system for passing laws.
General health services are funded through a form of national insurance, the Folketrygden
which is administered by the Rikstrygdeverket or RTV. Benefits include pensions, full salary for
one year for long term sickness, unemployment benefit and health care. Hospital care is free
at the point of delivery, but patients are required to pay one third of the cost of a visit to their
general practitioner for primary care.
The proportion of GDP spent on general healthcare, including dentistry in 2002, was 8%. Of
this expenditure, 85.5% was “public” (OECD Feb 2004). The national budget is predetermined
for one year at a time.
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Oral healthcare
Oral Health Services
Oral healthcare in Norway is divided into easier to understand for dentists and the
the public and the private sectors. Annually general public, and making it easier for
approximately NOK 2.8 billion (€355m) is patients to be reimbursed. All rates were
spent on Public Dental Care. regulated, both the general rates and the
reimbursement rates. After review, the
Public Dental Health Service reimbursement rates were regulated once
more from March 1st.
The Dental Health Services Act of 1983
established the county as the prime From January 1st 2003, three changes
authority responsible for oral health applied to the NIS. A “high cost protection”
services, and each county has a chief was introduced. The maximum payment,
dental officer. It also defined the counties’ the "roof', in this system is NOK 4500
accountability for the Public Dental Health (€550), referring to the specified amount
Service, and the coordination of this service that is defined as "own risk" payment. In
with private dental practices. addition to some dental treatment, mostly
surgical operations, periodontal treatment
The Public Dental Health Service is country- and treatment of
wide and is organised and funded by the
counties. Approximately 30% of all active
dentists work full-time in the public sector,
the remainder working also in private
practice. The Public Service provides
dental care to priority groups, and in
geographic areas with few private
practitioners, to non-priority adults. The
five groups, in order of priority, are:
• children under 18 years

• the mentally handicapped
• people who due to long term illness are
under care in institutions or at home
for longer than 3 months (these
groups can also receive domiciliary
care)
• young people under 21 years of age
• the elderly, the disabled and adults
with no access to dental care
Annually between 60% and 76% of the

population in the priority groups (this varies
between the different groups) receive
screening and/or treatment, and about 10%
of the non-priority group adults also receive
their care from the PDHS.
The Public Dental Service is free of charge,

except for orthodontic treatment. However
youths under 21 years must pay 25% of the
costs. The elderly/disabled group pay
reduced fees. Adults pay in full for oral
health care, except for the exemptions
mentioned above.
National Insurance System (NIS)
Several changes were made in the national

insurance system for dentistry in 2003. The
entire system was updated and upgraded
from January 1st 2003, making it both
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conditions of the oral soft tissues, the This state social assistance is provided at a
maximum "own risk" amount could cover municipal level, and there is considerable
expenses for physiotherapy, therapy in variation between municipalities in the way
specified training institutions and at certain this is managed.
overseas treatment clinics. This does not
mean, however, that whenever a patient Private insurance for dental care
has paid NOK 4500 for dental treatment,
any amount exceeding this will be covered Most of the dentists practise outside the
by the NIS. Only specified treatment as state system most of the time. They are
mentioned is included in the high cost responsible for screening and treatment for
protection system, and only the reimbursed adults. The national insurance system
amount is counted into the "own risk" benefits certain treatments but it is the
amount. patient who has to claim a refund. Only in a
few cases does the dentist receive
The second change was a family reduction,
for families with more than one child in
need of orthodontic treatment.
Also changed was the method of

reimbursement. Dentists can now receive
the reimbursement amounts directly from
the NIS, instead of charging the entire
amount to the patient, who then had to
obtain reimbursement from the NIS. For the
time being, this is a voluntary system.
From May 1st 2002 reimbursement for

periodontal treatment was raised
considerably. The long time planned
reimbursement for rehabilitation was
introduced from October 1st 2003. Any
tooth lost from marginal periodontitis after
this date gives the patient a right to
reimbursement for rehabilitation. The rates
differ according to the treatment that is
chosen. Reimbursement is given only once
for each tooth lost, and as a general rule
reimbursement is not given if the lost tooth
is a molar.
All in all, the NIS does not cover dental

expenses for more than a small part of the
Norwegian population. Most adults still
have to pay their dental treatment
themselves, without any government
funded financial support system.
Private Care
Oral healthcare for most adults is provided

by private dentists. Approximately 70% of
dentists work as private practitioners.
About 75% of the adult population see the

dentist on a regular basis, even though
they may have to pay the full cost of the
treatment. Patients normally attend once a
year, on average. The majority of these
‘regular’ attenders (90%) obtain their care
from general practitioners in private
practice. In some circumstances the social
security system may pay for those who
cannot afford care (see above) and give
reimbursements to others.
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payment directly from the national supervise and assess the dental medical
insurance system. standards, quality assurance programmes
Norway
etc.
Dental insurance plays a very small (tiny)
role in the whole picture. Only about 0.25 A Competition Authority is responsible for
% of the population has such insurance. ensuring that prices are displayed and that
quotations are given to patients and the
The Quality of Care Labour Inspectorate is responsible for
monitoring employees’ conditions,
Standards in dental practice are governed radiation protection, and waste disposal.
by three different types of supervision. The
National Board of Health is responsible for Guidelines for the use of dental materials
monitoring in the field of dental care. The were introduced by the Directorate for
monitoring is carried out by the Chief Health and Social Welfare in July 2003,
Medical Officer in the counties. They recommending a reduction in the use of
normally use designated dentists to amalgam, but amalgam will still be
accepted as a dental material if preferred
by the patient.

To enter dental school in Norway, suspended for other reasons such as
applicants must have a general serious mental illness, being away from
matriculation standard - this means practice for a long period of time, or for
completed higher secondary school, with “unworthy behaviour”.
advanced courses in mathematics, physics
and chemistry Norway is part of the EEA Agreement. Thus
dentists qualified in other EEA states may
The Universities in Oslo and Bergen each practise in Norway. Although there are no
have a Faculty for Odontology. There are formal linguistic or other tests for EEA-
no private dental schools. In 2003 there dentists there is an ethical requirement to
was a student intake of 113 and be able to communicate effectively with
approximately 110 dentists graduate each patients.
year (approximately 50% each male and
female). There are about 560 For the address of the competent authority
undergraduates in total, for the 5-year click here
course. After graduation the candidates
may be authorised as dentists. To contact
these schools click here.
In 2004 a new dental school will open in

Tromso. Initially there will be an intake of
10 students, but this will rise to up to 40 in
2007.
The title upon qualification is: Master of

Dentistry
Registration
Graduates must register with the

Norwegian Registration Authority for Health
Personnel. After the age of 75 years a
dentist's registration can only be renewed
if the practitioner is considered fit to
continue practising. Registration can be
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Vocational Training (VT) Should the dentist give treatment with
outdated methods it may result in a
There is no post-qualification vocational number of consequences - private lawsuits,
training in Norway as well as investigations and possible
actions by the supervising authorities and
Further Postgraduate and the dental association.
Specialist Training
Specialist Training
There is an organised three year full-time
postgraduate training period for specialists
In order to maintain a certain level of
in universities, in four recognised dental
professional standard the Norwegian
specialities: orthodontics, oral surgery,
Dental Association (NDA) – click here for
paediatric dentistry and periodontics.
address - offers postgraduate courses as
“brush up” lessons for dentists in practice.
The faculties of Odontology in Oslo and
However these courses are not mandatory.
Bergen run the programmes for graduate
But, dentists have an obligation to treat the
dentists who want to achieve authorisation
patients in accordance with the
as a specialist. The trainees are not paid.
professional standard (based on the current
To register they must produce a written
knowledge and common accepted
record of their training to the Specialist
procedures at the time). This requires that
Registration Committee of the NDA, which
the dentist adopts new knowledge.
maintains the register of specialists on
However there are no specific requirements
behalf of the government.
concerning how.
To contact these schools click here.
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Workforce
Dentists
In 2003 there were 5,802 registered Health Service (PDHS). Most paediatric
dentists in Norway – 36% female. dentists work in the PDHS and most
periodontists in private practice. There are
4,140 were reported as being “active”, associations and societies for specialists
(65% of these in private practice). 898 and for special interest groups: these are
dentists had qualified outside Norway, best contacted via the Norwegian Dental
elsewhere in the EU/EEA, especially from Association.
Germany.
Patients may go directly to specialists,
without referral from a primary dentist.
Total registered 5,802
Private (general) practice 2,698
Public dental service 1,107
University 186
Others (including armed 149
forces)*
* The 149 dentists work in the armed forces,

public administration, private firms, hospitals
etc.

1,100. The dental workforce is decreasing,
so there is no relevant unemployment
amongst dentists. The workforce is
decreasing for many reasons. The main
reason is that the number of new dentists
is not enough to replace the large number
of older dentists retiring.
However, it is to address this problem that

the new dental school in Tromsø is being
established in 2004.
Specialists
In Norway four dental specialities are

recognised:
• Oral Surgery
• Orthodontics
• Paediatric Dentistry
• Periodontics
Year: 2002
Oral Surgeons 43
Orthodontics 182
Periodontics 84
Oral surgeons work mainly in public

hospitals and universities. Most are
employed full time in hospitals but some
work part-time in private practice. Most
orthodontists work in private practice,
although some work in the Public Dental
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Auxiliaries
In Norway there are 3 types of dental Dental assistants have to undertake 3
auxiliary: years education and training in high school.
In the last year of high school dental
• Dental hygienists chairside assistants have a special
• Dental technicians curriculum. However, authorisation for
registration can be given on the basis of
• Chairside assistants (secretary)
education or training for a given number of
years (less than 3 is possible), until 2008.
Year: 2002 Since January
From then, only persons with a full
1st 2003, all
Hygienists 700 education and training will be awarded the
dental
Technicians 830 title.
auxiliaries
Assistants 3,500 must be
registered with
the Norwegian Registration Authority for
Health Personnel.
Dental Hygienists
To be admitted to training as a hygienist

the applicant must have completed higher
secondary school. Dental hygienists
undertake 2 years’ education and training
at a Hygienist School, which are located in
Oslo, Bergen and Tromsø. They are part of
the University and are located in
connection to the faculties of Odontology -
in Tromsø as part of a University college. It
has been decided by the Universities in
Oslo and Bergen that the education will be
3 years, and will apply to students who are
admitted from 2003, so does not to affect
those starting or completing before then.
In Tromsø the education and training will
still be two years, with the possibility of an
additional third year.
Dental hygienists normally work together

with dentists, as salaried employees.
However they may have their own private
practice. They may diagnose as well as
treat, and can undertake local infiltration
anaesthesia if they have had special
training.
There is no available information about

earnings (2003)
Dental Technicians
Technicians undertake 3 years education

and training at the University College in
Oslo. They provide fixed and removable
prosthetic work for insertion by dentists.
They may not deal directly with the public,
although they do take legal responsibility
for their work. They normally work in
commercial laboratories and charge the
dentists for their services. Some work as
employees in dental clinics.
There is no available information about

earnings (2003)
Dental Chairside Assistants (Secretaries)
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Norway
Practice in Norway
In Norway, dentists who practise on their The government provides no assistance in
own or as small groups, outside hospitals or funding the establishment of new practices
schools, and who provide a broad range of and there are no restrictions on the
general treatments are said to be in private location or the size. The practice has to be
practice. In 2003 there were approximately owned by a dentist, but a widow or
2,698 dentists in private practice. This widower may continue ownership for one
represented approximately 70% of active year after the death of their spouse.
dentists in Norway.
There are no specific requirements for the
Most dentists in private practice are self- type of premises in which a surgery can be
employed and earn their living through housed, so these may be in shops, offices
charging fees for items of treatment. There or houses and even in rented clinics (see
is no prescribed fee scale, but price cartels below) - as long as the clinic meets the
are forbidden. Every dentist must display necessary standards concerning hygiene,
the cost of twelve specified items of radiation protection and confidentiality for
treatment on the wall in his/her waiting patients etc.
room, and must provide a complete list of
prices. If the cost of treatment exceeds
NOK 2,000 (€250) the dentist must provide
the patient with a written quotation. If the
treatment plan is then changed, the
quotation may be changed and the patient
informed. When the treatment is finished
the dentist must give the patient a written
description of what care has been provided.
There are no figures for how many patients

a dentist would normally have on his
regular “list”, nor about the intervals at
which re-examinations would normally be
carried out for most adult patients.
Reimbursement for dental treatment by the

National Insurance Scheme is slowly
increasing in Norway. Treatment of
periodontal diseases and surgical
treatment that are refunded by the
Scheme, received a big increase on 1st
March 2003. Rehabilitation by bridges and
implants is not yet included because the
Government first wished to survey the
need and costs of such treatment. It was
then decided by the Government that
patients losing teeth because of
periodontal diseases would get
reimbursement for prosthodontics, from
October 1st 2003.
Orthodontics is paid for in a different way.

Orthodontists normally work in private
practice, and for children the cost is paid
directly to the orthodontist by the parents,
who then reclaim a part of it from the
Rikstrygdeverket. There is an index of four
grades of severity for orthodontic need.
The level of fees is based on the index, with
full reimbursement for correction of the
most severe anomalies, and none for
treatment of less severe malocclusions.
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no formal structure of staff grades for
Standardised contracts, prepared by the dentists.
NDA, are available for dentists working
together in the same practice. Contractual There is no fixed salary for such positions.
arrangements include partnerships, limited Thus the salary varies a lot and we can only
companies and working totally indicate the lowest level. A hospital dentist
independently but sharing some facilities would earn from about €4,150 a month
such as waiting rooms. However, limited (2002)
companies may only be owned by dentists
and there may be tax advantages to Working in Universities and
practising in this way. Dental Faculties
Working in the Public Dental Dentists working in full time positions are
Service employees of the University, but are free to
combine their duties in the faculty
The Public Dental Health Service (Den
Offentlige Tannhelsetjenesten or DOT) is
organised on a county basis. It began as a
school dental service based in clinics built
in school grounds. Five groups are eligible
for treatment and the counties are obliged
to prioritise the provision of dental care for
the groups in the order identified above, in
the oral healthcare section.
Dentists working within the public dental

service have the following titles and
functions, District Dental Officer
(performing general dentistry), Special
Dental Officer (specialist treatments),
Regional Chief Dental Officer (both general
dentistry and administration) and County
Chief Dental Officer (administration). These
dentists are all salaried.
Only a few counties employ specialists and

most orthodontics is delivered in private
practice.
A limited number of adults are treated by

the Service. Some counties allow public
dental service dentists to rent a clinic to
provide dentistry to adults as private
patients. However, the PDHS currently has
a large number of vacancies and the
government is addressing the problem of
recruitment, to overcome geographical
variation of supply.
Their income varies from county to county.

The salary is from 300,000 to 420,000 NOK
(€38,000 to €53,000), depending on
experience etc. For dentists with a position
as head of clinic etc. the salary may be
even higher.
Oral surgeons normally work in hospitals as

salaried employees, either full- or part-time
with other duties elsewhere. To practise as
an oral surgeon in a hospital it is necessary
to have a specialist competency. There is
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with part-time work elsewhere, usually up There is no fixed salary for such positions.
to a maximum of six hours per week. Thus the salary varies a lot and we can only
Typical academic titles within a Norwegian indicate the lowest level. An academic
Norway
dental faculty are Professor, Associate dentist would earn from about €3,400 a
Professor II), PhD Research Fellow. A month (2002)
typical faculty staff member is supposed to
spend 45% of their time on teaching, 45%
on research and 10% on administration. Working in the Armed Forces
PhD students on the other hand have light
teaching responsibilities and no In 2003, 25 dentists worked full time in the
administrative duties. Armed Forces, of whom 5 were female
Most academic posts require a minimum of

a PhD together with further training in a
particular speciality, and progression to
higher grades is also based upon academic
achievements. Clinical instructors, who
work part-time, only need specialist
training if they are instructing in a
specialist discipline.
Professional associations are also responsible for the publication of
the Norwegian Dental Journal. They
There is a single main national association, maintain contact with governmental bodies
the Norwegian Dental Association, with and authorities on questions concerning
3,948 dentists as members. So, dentists and dentistry. The secretariat is
approximately 95% of active dentists are led by a secretary general. For the address
members of the NDA (2003) and it of the NDA, click here.
represents both private and public service
dentists. The national association consists Ethics
of 21 local associations - primarily, there
one association for each county. All Ethical Code
members of the NDA are also members of a
local association. Dentists in Norway work under an ethical
code which covers relationships and
The NDA is a democratic organization and behaviour between dentists, the contract
every year there is an assembly were with the patient, consent, and
representatives from all the local confidentiality. This code is administered
associations take part. The assembly is the by the Norwegian Dental Association.
highest authority in the Association and Much of the guidance on ethical behaviour
during the annual assembly they the is also codified in the Health Personnel Act.
guidelines to be followed in all matters of
importance are decided. Every second
year the assembly elects a board of 9 NDA
members (President, Vice-president and 7
other members). The President is the chief
executive of the NDA.
The NDA has a secretariat with 22

employees (2003). They carry out a
number of tasks, such as legal services for
members, salary negotiations for the public
dental service, organisation of insurance
for members, organisation of post-
graduate (“brush up”) courses for dentists,
organisation of a pension system for
members etc. Their other important tasks
include the distribution of information to
members, as well as to the public,
Government and other authorities. They
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For non-members the insurance costs
Cases concerning breaks of the ethical approximately 1,500 NOK (€190). Under
code are discussed by a designated Board. Norwegian law they may have their
The consequence of a violation can be an registration suspended if they do not have
action in the following forms: a formal insurance.
notice of disapproval, a decision that the
dentist in question, for a period of two Health and Safety at Work
years, cannot be elected as a
representative within the NDA. They may There are a number of regulations
also advise the NDA Board to fine the concerning Health and Safety at work, for
member (to a maximum of 110,000 NOK - instance concerning radiation protection,
€14,100) or to exclude him/her from handling of toxic substances etc. However,
membership of the NDA. The decision inoculations such as for Hepatitis B are not
cannot be appealed, but the member has compulsory.
the right to make a statement to the Board
which handles the case.
Patients’ claims are not handled. Liability

is regarded as a separate question, and is
not part of the Board’s jurisdiction.
Advertising
Dentists are allowed to advertise and may

use websites. They may not give
information which is misleading or
incorrect, and may not give information
about special treatments etc. in a way that
may mislead patients. At 2003 Norway was
not following the EU DLC guidelines for
websites.
Data Protection
In accordance to national laws all dentists

have an obligation to secure all patient
records, including confidential patient data.
Corporate Dentistry
Dentists are allowed to form companies,

but only dentists may be on the board of
such a company.
Indemnity Insurance

dentists. Since January 2000 the cost has
been included in the annual membership
fee of the NDA, to ensure compliance. The
insurance itself is with a private company
and provides cover for damages related to
dental treatment. Non-members must
organize their own Insurance Agreement
themselves.
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__ ____EU Manual of
for administered by
Ionising radiation Norwegian Radiation
Protection Authority
Electrical Directorate for Fire and
installations Electrical Safety
Waste disposal Norwegian Pollution
Control Authority/local
government
Amalgam Directorate for Health
and Social Affairs
Medical Devices Directorate for Health
and Social Affairs
Infection control Institute for Public
Health
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Financial Matters
There is no information available about the Taxes
range of incomes earned by dentists in
private practice in Norway.
Healthcare
on salary). The lowest rate is 28% and the
maximum is 55.3% .The rate of taxation is
General health care is mostly paid for by based on the income level. The rate
the National Health Insurance Scheme. increases in a step by step system
This covers hospital services which are free depending on the income level.
at the point of delivery, and partially
subsidises other services such as general VAT/sales tax
practitioner visits. Contributions for
national health insurance are deducted VAT is also payable on certain goods and
from salary and paid to the RTV by the tax services at 23%. Dental treatment is
authorities. Employees pay 7.8% of excluded from VAT. However, costs related
income, owners of companies or to purchase of dental equipment,
practitioners pay 10.1% and employers pay instruments and materials are subject to
14.1% of employees' salaries. VAT and will be reflected in prices.
Retirement pensions are paid by the RTV Many dentists in Norway have assistant
on the basis of a dentist’s income. The dentists working in their office. The
retirement age is 67 for RTV purposes. Directorate of taxes/Tax Inspectorate are
Dentists who work in the private sector considering whether they are going to
receive the basic RTV pension of NOK charge VAT on equipment and goodwill.
54,000 per year (€4,000) and a supplement The NDA is trying to avoid VAT being levied
based on the individual earnings from on the transactions between practice owner
those years in which they have been dentists and assistant dentists.
member in the RTV. In addition the dentists
may have private pension schemes. Various Financial Comparators @ July
Dentists employed by the Public Dental 2003
Health Service receive a pension of 66% of
their final salary. This is based on 30 years
of work in the PDHS. Zurich = 100 Oslo
Dentists may work beyond 67 if they wish. Prices (including rent) 111.3
In public service they may work until they Wage levels (net) 87.0
are 70. Private practitioners can actually
work until they lose their licence. Few work Domestic Purchasing 68.6
beyond 70. Power
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Main national association Competent Authority:

and Information Centre:
Norwegian Dental Association Directorate for Health and Social Affairs
POB 3063 Elisenberg PO Box 8054 DEP
N-0207 Oslo N-0031 Oslo
Tel: +47 22 54 74 00 Tel: + 47 22 163 000
Fax: +47 22 55 11 09 Fax: + 47 22 163 001
Email: Email:
Website: Website: www.shdir.no
www.tannlegeforeningen.no
Publications:
The Norwegian Dental Journal is NDA’s main journal. The web address
is www.tannlegetidende.no
The journal publishes articles on new developments in odontology as

well as information concerning dental political issues, international
developments, interviews and a variety of useful information for
members concerning for example new laws and regulations.
Dental Schools:
Oslo Bergen
Det odontologiske fakultet Det odontologiske fakultet,

Geitmyrsveien 69/71 Fakultetssekretariatet,
Boks 1142 Blindern Årstadvn.17,
N-0317 Oslo N-5009 Bergen
Tel: +43 22 852 000 Tel: +43 55 586 560,

Fax: +43 22 852 332 Fax: +43 55 586 577
E-mail: E-mail: post@odont.uib.no
infoskranke@odont.uio.no Website: www.uib.no/odfa
Website:
Dentists graduating each
year: 62 Number of students: 240
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Poland
Population 38.7
million
Currency Zloty
(PLN)
4.41PLN = €1
Main language Polish
Poland
Poland has a system of healthcare financed by

means of a common health insurance within the
National Health Fund (Narodowy Fundusz
Zdrowia, NFZ), with16 divisions. The fund’s
budget is financed by an obligatory premium, an
8% tax charged on the income of each citizen
who is employed or conducts commercial
activity. Availability of NFZ 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. In 2003
there were 32,843 dentists registered in Poland
of whom 72% were female and 24,100 active.
Specialists are widely used, but the clinical
Government and healthcare in Poland

Poland is a northern central European authority is exercised by the President of
country, with the Baltic Sea to the north the voivodeship. The capital is Warsaw.
and 7adjacent neighbouring countries –
Belarus, the Czech Republic, Germany, Until 1998, the national healthcare system
Lithuania, Russia (Kaliningrad Oblast), was financed solely by the state’s
Slovakia and Ukraine. The land is mainly budgetary means (taxes). From 1998 to
flat plains, but with mountains to the south.
The population in 2002 was 38,662,660
and the capital is Warsaw.
Poland has a Parliamentary democracy,

with a Bicameral Parliament – the Sejm and
the Senate – as the legislative authority,
the government – as the executive
authority, and a judicial authority. The
President of the State is elected in common
election by the People. Authority is
exercised in the State by the government
administration down to the regional level
(voivodeships of which there are 16) and
self-government authorities – gminas and
poviats, and the Voivodeship Parliament
(sejmik) wherein the territorial self-
government authorities are represented at
the voivodeship level.
The government (state administration)

representatives in the regions
(voivodeships) are voivodes. At the
voivodeship level, the representational
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2003, it was financed by common health to pay for health insurance. The
insurance institutions – the 17 sick funds. unemployed and the homeless have their
premium paid by the state with its
Since 2003, the system has been financed budgetary means. A part of medical
by means of the common health insurance services are also financed by the state’s
within the National Health Fund (Narodowy budgetary means, for example the
Fundusz Zdrowia, NFZ), with its 16 comprehensive treatment of development
voivodeship divisions. The fund’s budget is clefts.
financed by an obligatory premium.
Regardless of how a citizen earns income, There is no private or state additional
including old age pensioners, they are insurance, although attempts are being
obliged to pay the premium of 8% of made aiming to introduce such forms of
income from each source. However, those insurance.
who pay the said amount entitled to 7.75%
deduction from income tax, while 0.25% is The proportion of GDP spent on general
not. Farmers are charged according to a healthcare, including dentistry in 2002, was
different rule, conditioned by the price – 6.3%. Of this expenditure, 71.9% was
they are exempt from tax, so do not have “public” (OECD Feb 2004).
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Poland
Oral healthcare
Public compulsory health health care programmes. Relating to dental
insurance care, the programme for comprehensive
treatment of development defects (cleft
palate) is one such initiative.
The act on universal health insurance
determines the scope and principles of If a dental surgeon is employed, it is the
providing dental medical services financed employer’s duty to provide a salary. If he
by means of the NFZ. Subject to the act, works on his own account, and provides
the persons insured are entitled to the services for insured patients under a
basic dental services, normally performed contract with a sick fund, the fund provides
by a dental surgeon, as well as dental the financial means for the services
materials specified by the Minister of contracted. In such a case it is the fund
Health, subsequent to the opinions of the which exercises supervision. All private
President of the Fund and the Polish practitioners are under the supervision of
Chamber of Physicians and Dentists. the physicians’ chamber. If they work
exclusively on their own account, their
Children and young people under 18 years, remuneration is included in the service
as well as women who are pregnant and in price. The price is agreed with the patient.
the post-natal period (up to 42 days after
childbirth) are entitled to additional
services by a dental surgeon, taking into
account the specific dental needs of this
section of population. These services are
provided by various entities: health care
establishments owned by gminas, or
individuals, including dental surgeons (but
not necessarily dental surgeons), and
dental surgeons in private practice,
individually or in a group.
Starting work for NFZ is decided in a tender

announced by NFZ. One of the conditions is
the lowest price. The minister determines
the kind of services and their point value
according to the ICD-9-CM, which is a
catalogue of dental work in points
(klasyfikacja procedur medycznych i
dodatkowych badań laboratoryjnych). The
availability of the services is limited by the
budget for dental health care. Persons
insured within NFZ are not entitled to
services other than those mentioned in the
list of the Minister of Health and pay for
them from their own means.
Availability is limited due to the Fund’s

insufficient financial means and very low
budgetary expenditure on dental care. An
insured person is entitled to a dental
examination or periodical examination once
a year. Children and young people are
entitled to an additional periodical
examination and a wider range of services.
The NFZ budget is established on the

amounts deducted from the income tax
and its size may vary - amongst other
criteria it is conditioned by the level of
citizens’ incomes. Besides these, within the
state’s budgetary means, the Minister of
Health sometimes finances additional
highly-specialist medical procedures and
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employment” in 2003 amounted to 2,040
hours per year, ie 170 hours per month, 40
Not all practitioners can work in the state hours per week, 7 hours 35 minutes per
system, since its financial means are day, 5 days a week. From 2004, this has
limited. Approximately 30 per cent of all been adjusted to 5 hours a week, 5 days a
registered dental surgeons (about 9,000 week for a contract.
dentists in 2002) are “employed” under
this system. So, some dentists have Private Fees
contracts directly with NFZ but work in
their own (private) offices and other
dentists work in health centres and clinics Private fees are fully free market in nature.
which have contracts with NFZ. Specialist They are determined in agreements
treatment is paid at a higher rate of points. between dentists and their
There is a difference between private
practices under the NFZ and clinics
because in private practices the patient
pays all costs of treatment, whilst in NFZ
clinics the patient does not pay for some
treatments which are under the insurance,
although some procedures are also
payable.
The remaining dentists operate on the free

market. Private fees are fully free market in
nature. They are determined in agreements
between dentists and their patients. The
majority of dental surgeons see private
patients in their own surgeries, regardless
of whether they are in employment
contract with some other employer.
A dentist under contract to provide full time

NFZ services would look after 3,500 – 4,000
insured persons, including children and
young people under 18 years.
Patients would normally attend their dentist

for an oral re-examination 6 monthly.
Availability of NFZ care is limited by the low

financial expenditures (and limits) on
dental care in the NFZ, everywhere in the
country. There are no difficulties in
obtaining dental services within private
dental practice.
Home services are provided if there is a

need to give an aid to a sick person. The
service is performed by a dentist asked to
do so. In the event such a service is not
possible at home, the sick person is
referred to hospital in order to undergo the
appropriate procedure.
Public expenditure on dentistry is 3.16% of

the National Public Health Fund (NFZ) –
about €6 per citizen per year.
Working time
Working time is determined in a contract

with an insurance institution. In the case of
employment, the working time is regulated
under the labour code. “Full-time
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patients. Attempts have been made at The complaint is taken over by a screener
founding private insurance systems. for professional liability, in a regional
However, they are still only attempts and physician’s chamber. He may abandon the
thus cannot be considered an organized proceedings or bring the case to a regional
system. medical court. Appeal can be made to the
Supreme Screener. The rules are
determined in the Act on the Profession of
The Quality of Care Physician and Dental Practitioner. A
complaint may also be brought by a
There are regular inspections, as well as complainant to common courts and if error
ones following a complaint. In most cases is suspected, the case may be taken over
they are from a complaint made by a by the prosecutor and, subsequently,
patient. decided by the common court under
criminal proceedings.
In the event of a case being in the common

court, the rules of appeal are determined
under a separate act.

Undergraduate Training of the dental training at the University is 5
years (10 semesters). The overall number
There are 10 universities educating dental of class hours is 5,000 hours among these
students across Poland: Medical Academies 4,540 stated in educational standards.
in Warsaw, Poznan, Wroclaw, Bialystok, Subjects are divided into 3 groups:
Szczecin, Gdansk, Lublin and
Zabrze/Katowice; Collegium Medicum of • Basic subjects - 505 hours;
the Jagiellonian University in Krakow and • General medical subjects – 1,575
Medical University in Lodz. The Dental hours
schools are known as Wydział Lekarski Dental subjects – 2,460 hours,
(Faculty of Medicine), Oddział including 1,450 hours of practical clinical
Stomatologiczny (Division of Stomatology) training.
or Wydział Stomatologii. All are publicly
funded. The responsibility for quality assurance in
To enter a dental school a student has to the Chancellor of the University and the
have to graduated from high school, Dean of the Faculty.
passed a maturity exam and an entrance
exam for the university with a very good
result, because each year there are 4 to 5
candidates for every place. The entrance
exam is in the form of a test in physics,
chemistry, biology and one foreign
language from English, German or Russian.
The number of students is regulated by the
Minister of Health. In 2003 the number of
first-year students was assigned as 760.
The Dental Committee of Polish Chamber of
Physicians and Dentists believes this
number is about 10% too large for future
oral healthcare requirements in Poland.
80% of undergraduates are female. There
is no available data about the number of
graduates and the gender mix in 2003.
In 2002, the undergraduate training

curriculum was changed to bring it into line
with the requirements of the EU. The length
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Poland
The post-qualification training does not
have a theoretical part. There are no
Primary dental qualification recommended courses. The official final
state exam does not exist yet, but the
The titles awarded on qualification are: project of this exam has existed since
1993.
• Dental doctor (until 1996)
• Stomatologist (1996 to 2004) At the end of the vocational training the
• Dental Doctor (lekarz dentysta) – Resident has to sit a national (medical)
from 2004 exam (Iekarski egzamin panstwo\vy - LEP).
There is a debate going on whether or not
Qualification and Vocational Training this exam should be moved to the end of
the undergraduate studies. It is suggested
that the final exam is “medical” because of
Registration a test to check medical knowledge,
including elements of medical law. But the
In Poland, a Diploma of graduation from main part of post qualification training is
studies does not allow a graduate to begin the practical part.
practising of as a dentist. To practise the
profession, it is necessary to obtain a From 2004, Polish vocational training is not
“Right to practise the profession” licence. compulsory for graduates of other EU
All graduates who want to practise a countries’ dental schools.
profession, are obliged to register
according to the place of residence, with
the Regional Chamber of Physicians and Further Postgraduate and
Dentists (Okręgowa Izba Lekarska). The Specialist Training
Chamber is the competent authority, given
by the state, and maintains the registers of There are 3 elements to postgraduate
dentists and of dental specialists. education and training:
The legal requirements concerning dental • Continuing education for all dentists
surgeons who are citizens of EU are that • Specialist Training
their qualifications are certified • Academic Training
automatically on the basis of a document
(diploma) specified in Article 1 of Directive
78/686 EEC.
Vocational Training (VT) Dental surgeons have an ethical and legal

obligation to permanent education and are
Each graduate - a stomatologist, and from under a statutory obligation to partake in
2004, a dental doctor - receives after continuing education. This is determined by
registration (see below) a temporal right to the Act on the Professions of Physician and
practise the profession (a licence) as a Dental Surgeon. The tasks specified therein
“Resident”. The diploma and licence are fulfilled by physicians’ chambers in
provide him/her with a right to go through accordance with the resolution of the
the one-year vocational training, which is Supreme Council. A credit-point system is
about improving the practical skills, while applied, over a 3-year period. Such
being supervised by experienced dental education is conducted in various forms
practitioners. This is a prerequisite for and in accordance with a grading scale.
obtaining the licence (the right to practise
the profession of dental surgeon). Whilst by 2003 non-compliance was not a
Residents receive their salary from the serious issue, the consequences of such
national budget. would include a period of pressure by the
authorities and, ultimately, could be a loss
of the licence to practise.
Many kinds of courses and training

sessions, as well as routine monthly
training are organised by the Polish Dental
Association (PDA).
Specialist Training
Dental surgeons are also entitled to

specialist education and training. For
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specialist training a dentist has to graduate training starts s/he has to undergo a
from his/her studies (and obtain his/her qualification procedure in the form of a test
primary diploma) and complete the one- and an interview. Education is conducted in
year postgraduate traineeship. Before the the form of the so-called Residence – after
qualification a physician obtains
remuneration from the state and is
employed at an eligible entity entitled
(accredited) to conduct specialist training
in a given field. The employment of the
dentist may also be in other forms,
whereby s/he obtains no remuneration but
is still employed at the eligible entity. The
list of eligible entities is drawn up by the
Minister of Health. The vast majority of
them are universities and educating dental
surgeons.
Specialist training is conducted according

to a given specialization programme,
determined by the Minister of Health, at
the request of Centrum Medyczne
Kształcenia Podyplomowego (Medical
Centre for Postgraduate Training). The
education is supervised by the Medical
Centre for Postgraduate Training in
Warsaw, as well as regional centres
managed by voivodes, through the so-
called national and voivodeship consultants
in a given field, appointed by the Minister
of Health and the voivodes. The co-
ordinating role in continuing education is
played by the Regional Chambers.
Registration of specialists is by State

entities - the Medical Centre for
Postgraduate Training and voivodeship
centres for postgraduate training.
Poland has 7 main specialties:
• oral surgery
• orthodontics
• paediatric dentistry
• dental prosthetics
• periodontology with oral medicine
• conservative dentistry and
endodontics
• maxillofacial surgery
Besides, dentists may take up the following

types of specialization:
• hygiene and epidemiology

• organization of health care
The titles follow the specialty, eg dental

doctor specialist II° of periodontology (or
periodontologist).
Academic training
Academic training is usually connected with

obtaining a PhD or publishing a work. There
are a number of degrees and diplomas
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associated with specialist qualifications, universities (such as PhD, Doctorates,
and these may be awarded by the university professorships).
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Poland
Workforce
Dentists practice. Patients do not have to be seen
on referral from primary dentists.
In November 2003 there were 32,843
Most oral surgeons work in private
registered dentists in the Poland, of whom
practices or practices with contract with
23,700 (72%) were female. It was
NFZ, also, apart from oral maxilo-facialists
estimated that about 24,100 of all dentists
who work mainly in hospitals.
were actively working (72% female). Just
under 5,000 registered dentists were over
65 years old.
It was reported that there were no

permanently unemployed dentists.
However, as young dentists cannot
establish their own practice for at least two
years after graduation, they may have
short periods of unemployment.

1,605.
The Polish Chamber reports that about one

third of all dentists are over 50 years old,
and it is presumed that most of these
dentists will retire in within the next 20
years (dentists normally retire at 70 or
younger).
Nevertheless, the Chamber believes that

there are too many active dentists in
Poland. To counter this problem they have
concluded that admission to dental studies
should be restricted, as they suggest that
during recent years the quota of students
was too high.
Total (2003) 32,843

General (private) 20,233
practice*
Hospitals (2002) 147
University (2002) 400
Armed Forces (2000) 400
Public dental service About
7,000
*Only about 2,500 are in
totally private practice:
most work in both public
and liberal practice.
Specialists
Orthodontic and other specialists work in

both private and NZF practices. In the NZF,
as specialists their “points” are higher, but
it is not known how many still practise in
the clinics and how many in fully liberal
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There were 2,500 hygienists in 2000 (the
Numbers of last available data).
specialists (2003)
Hygienists would normally earn €200 -
Orthodontists 310
€300 per month (2003).
Oral Surgeons 414
Prosthodontists 625
Periodontists 86
Conservative and 898
endodontists
surgeons
Auxiliaries
There are two kinds of clinical auxiliaries in

Poland – Dental Hygienists and Dental
Technicians. Additionally, there are dental
nurses and receptionists.
(2000)
Hygienists 2,500
Technicians 7,000
Nurses (Assistants) 9,725
If auxiliaries are employed at public

establishments they are full-time
employees; in private establishments and
in the case of private practice it may either
be a full-time or other forms of employment
provided for by the law. The provisions of
the labour code are binding.
In non-public establishments various forms

of employment envisaged by the law occur.
Dental Hygienists
The training for dental hygienists is

conducted at medical schools and
universities, for 2 years, after a high school
diploma has been obtained. Dental
hygienist is a professional title conferred
upon the completion of the training, when a
diploma is granted. These are granted by
the Minister of Education acting in
agreement with the Minister of Health.
Registration is not compulsory, unless the
hygienist is working commercially.
Their duties include preparation,

registration, prophylactic care and
promotion of health. They may not
diagnose or give local anaesthesia and
cannot work without the presence of a
dentist. They cannot accept fees from
patients, except on behalf of the dentist.
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Poland
Dental Technicians There were about 7,000 technicians in

2000 (the last available data).
The training for dental technicians is
conducted at medical schools and There is no reported problem in the Poland
universities (technical colleges), and lasts 2 with illegal denturists/clinical dental
years. Dental technician is a professional technicians.
title conferred upon the completion of the
training, when a diploma is granted. They Dental Nurses (Assistants)
register with their own association to
conduct commercial activity. Dental nurses are assistants, with training
by the dentist. There is no formal education
Technicians normally work in commercial available, except for a one-month course,
laboratories, only a few are employees of BHP in Public Service.
dentists or of clinics. They may work in
clinics on salaried contract or by tender for Besides assisting the dentist they are not
fees. permitted to undertake other duties.
Technicians who work in a public health There were 9,725 dental nurses in 2000
care establishment would normally earn (the last available data).
€300 - €400 per month (2003)
Practice in Poland
Working in Liberal (General) The state subsidizes only those dentists
Practice who give up their jobs at public
establishments and want to start their
individual practice or establishment. Others
Not all the physicians willing to work within have to resort to bank credits, but only
the NFZ system can be employed, due to those who decided to give up the job at a
the limited amounts of financial means public health care establishment after 1
allocated to medical care. Only January 2000 are eligible for a loan, which
approximately 9,000 dental surgeons is curtailed by the state. This was so that
worked for Sick Funds in 2002. Others work unemployed dentists transferring from
exclusively outside NFZ, practising in their public service can open their own office.
own private practice, as owners of
establishments, who employ their They must register their surgeries with the
colleagues or co-owners in partnerships or Regional Chamber of Physicians and
exclusively in their own private practice. Dentists. They have to possess premises
The state has not set the legal framework which meet the requirements of the law,
for the principles of practising, which would have the right to practise the profession
allow only one of the aforementioned forms and be registered members
of practice.
The rules of entering into the list of

physician and dental practice are specified
by the Act, as well as by the regulation of
the Minister of Health. One has to fulfil
specific requirements concerning the
premises, the sanitary and epidemiological
arrangements, requirements concerning
ionising radiation, sterilization, storage and
disposal of waste materials.
There are no limitations as to the building

type. There is also no limitation as to the
area size, or the number of partners
(employees) or the number of patients.
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of the regional chamber. They may join a
company or register their own Hospitals are public property. There are a
establishment (clinic). They may not start small number of private hospitals run, for
their own practice until two years have example by the Church or individuals.
passed from the moment of completion of Procedures tend to be maxillofacial
their postgraduate traineeship and surgery, undertaken by maxillofacial
obtaining the right to practise the surgical specialists.
profession, 3 years after first qualification.
Dentists are employed at clinics and
Remuneration is decided by a given university hospitals and at certain hospitals
establishment’s remuneration regulations. in larger cities.
In private practice, it is the profit gained
after payment of liabilities. Supervision of Their remuneration for full-time work, or a
individual and group private practice is part-time equivalent would be about €250 -
exercised by a regional chamber through €400 a month.
dental surgeons. The quality of services
provided by NFZ is controlled by NFZ
through its consultants, i.e. dental
surgeons.
There is no available data about the

earnings of dentists in general (private)
practice.
There are public clinics in Poland. Everyone

insured to the extent of the services
provided by NFZ may benefit from them.
Besides, services paid directly by the
patient are also available. They do not bear
any costs of services to which they are
entitled free of charge if they are insured,
pursuant to the Act.
The quality of services provided at health

care establishments is supervised by a
voivode, through the voivodeship
consultants, who are dental surgeons,
although most often academic workers.
Persons employed at public establishments

receive fixed remuneration (salary), very
often divided into several components such
as seniority, specialization, premium etc.
Their income would be in the range of €250

to €400 per month.
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Dental Faculties Their remuneration for full-time work, or a
part-time equivalent would be about €300 -
There are 10 dental schools, in which about €450 a month.
400 dentists work. Whilst they are normally
full-time employees of the University, in Working in the Armed Forces
practice many of them also work part-time
in private practice . In 2000, 400 dentists served full-time in
the Armed Forces – the gender mix is not
The titles of university teachers are: dental available.
doctor or professor. They may need to have
a further degree such as PhD.
Professional associations governing, autonomous bodies of
physicians and dentists, subject only to
regulations of the legal act and possessing
The Polish Chamber of Physicians and
legal status.
Dentists includes, with equal status both
physicians and dental practitioners, and is
The highest authority of the Polish
divided into 23 regional chambers, with a
Chamber of Physicians
separate chamber of military physicians
and dentists, that has legal status of the
regional chamber, although it is active in
entire country. Chambers of physicians and
dentists deal with all kinds of problems of
practising medicine and dentistry in Poland.
The jurisdiction of individual regional

chambers of physicians and dentists and
their headquarters are determined by the
Polish Chamber of Physicians and Dentists,
in consideration of the basic territorial
division of the state.
Democratically elected representatives

(delegates) meet at the Regional Medical
Assembly. The Assembly, in a secret ballot,
elects the president of the regional medical
council and members of some statutory
offices (the medical court, the screener for
professional liability), members of the
regional medical council and
representatives to the General Medical
Assembly.
The General Medical Assembly ballots for

the President of the Supreme Medical
Council, the Supreme Screener and Deputy
Screeners for Professional Liability,
members of the Supreme Medical Court
and the Supreme Audit Committee. One
Vice President will usually be a dentist. The
term of office for authorities of medical
chambers is 4 years. The Polish Chamber of
Physicians and Dentists (consisting of
elected representatives) and regional
chambers (encompassing representatives
and all members in the region) are self
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Ethics
and Dentists is the General Medical
Assembly, and, in regional chambers - Ethical Code
regional medical assemblies. In the period
between assemblies - the Supreme Medical Dental surgeons are bound by the ethical
Council and regional medical councils code. The ethical code was adopted by the
respectively carry out day to day business. 3rd General Assembly, in 1993. The
The Supreme Medical Council represents sanctions against a dentist found guilty of
the medical profession at the state level, breaching the ethical code by a Medical
and regional councils at regional levels. Court include an admonishment,
suspension of the licence (for up to 3 years)
Membership in the Chamber is mandatory. or full deprivation of the licence. Any
All the physicians and dental practitioners appeal is to the Supreme Medical Court.
who intend to practise medicine or
dentistry in Poland have to belong to the The Medical and Supreme Medical Courts
Chamber, as these are the chambers that comprise dentists (dental
award the right to practise medicine or doctors/stomatologists) and physicians.
dentistry. However, cases rigidly connected with
dental practice would be conducted by
The Polish Dental Association - the Polish dentists only. Other problems about the
Stomatological Association- or PDA, is the ethical code may be undertaken by
main scientific dental association to which physicians. Screeners for Professional
practising dental practitioners generally Liability and for the Regional Courts, at
belong. This Association takes part in each of the 24 regional chambers, and one
helping dental practitioners undertake their Supreme Court screener, supervise
obligation to take part in continuing compliance with the rules of the ethical
education. It strives to advance the science code. Dental practitioners are active in the
of dentistry. Membership of this association work of the Supreme and Regional
is not mandatory. Screeners, for Professional Liability and the
Medical Courts, as they deal with all the
The PDA is currently divided into regional matters of dental practitioners, but they
divisions which are co-terminous with may also be involved with work in cases
governmental administrative divisions at a about physicians. The Polish Chamber also
regional level. Each division organises area employs lay people for advice and
meetings in which papers, lectures and assistance to dentists and physicians.
scientific research are delivered. The
functions are carried out in cooperation Advertising
with the regional Polish Chambers. There
are many other scientific dental According to the Act on Healthcare
associations in Poland, but the Polish Establishments, public announcements
Dental Association is the biggest. All dental have to be exempt from commercial
practitioners with specialisations must advertisement features. According to the
belong to one of them. Act on the Professions of Physician and
Dental Surgeon, dental surgeons may
Other registered and acting scientific and inform the public of the medical service
specialist societies are: the Polish they provide and the content and form of
Orthodontic Society, the Polish Society of such information must also be exempt from
Oral Cavity and Maxillo-Facial Surgery, and the features typical of commercial
the Polish Society of Stomatological advertising. The rules according to which
Implantology. physicians and dentists announce their
services are determined by the Chamber of
Physicians and Dentists. The following
adjectives are banned from the
information: “cheapest, best, painless etc.”
According to the ethical code, a dental

surgeon must not impose a service, or gain
patients, in a manner inconsistent with
ethical and deontological principles, and
the rules of loyalty to fellow practitioners.
Information, such as address, practice
hours and specialisation may be placed in
the press, but adverts are not permissible.
The following adjectives are banned from
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information: “cheapest, best, painless
etc.” and his/her background is confidential. The
death of the patient does not release the
Every dentist may run his/her own website. dentist from the duty of confidentiality.
At present, the ethical code does not Whilst information may be stored in
contain a chapter on the regulations electronic form, dentists must also carry
following from the Electronic Commerce paper records.
Directive, but amendments to the code are
being discussed and should take place in
September 2003. Indemnity Insurance
Data Protection A patient is entitled to lodge a complaint

and demand compensation before a
By general statute, the dentist is bound to medical court or a common court. Every
observe patient confidentiality. Information dentist has to be insured against civil
acquired by the dentist in the course of liability for the practice of the profession.
his/her professional duties, concerning the
patient Insurance is concluded with insurance
companies active on the insurance market.
Chambers conclude collective contracts of
insurance covering members of the
chambers. Very often they are insurance
packages including other types of
insurance as well (surgery, flat, house, car,
etc.). The insurance rate is not conditioned
by the form of practice, whether it is under
employment contract or private. Polish
dentists combine both forms and work both
under employment contract and pursue
private practice. If there are claims on the
part of the patient and a public
establishment is involved, the
establishment is liable. Nevertheless, if a
dentist’s fault is proven, the establishment
may claim return of the incurred costs.
Corporate Dentistry
Dentists in Poland may form companies -

Grupowa Praktyka Lekarska, Spółka
Partnerska, Niepubliczny Zakład Opieki
Zdrowotnej. A non-dentist can be a
shareholder, on the board, or the owner of
the company, but he should register a
company in the City’s Office (Urząd Miasta)
and Public Health (Zdrowie Publiczne) but
not at the Chamber.
The types of obligatory vaccination are

determined by the state and supervised by
the State Sanitary Inspector. Each
employee must undergo periodic medical
examination (Health Book). There is no
obligation for hepatitis B vaccination.
However this vaccination is recommended
and may be required by the employers.
Students undertaking dental studies are
usually inoculated against Hepatitis B, as
are all Public Health dentists.
Regulations for Health and Safety:
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For Administered by
Ionising radiation SANEPID (Sanitary
Inspection, the state)
Electrical Inspekcja Pracy – BHP (The
installations state)
Waste disposal Incineration only
Medical devices The Medical Chamber
Infection control SANEPID (Sanitary
Inspection, the state)
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Poland
Financial Matters
The income ranges dentists would have expected to earn in 2002 (in Euros) was:
years old or years old or
2 years 20 years after
after qualification
qualificatio
n
Liberal or General No data No data
Practice available available
Hospital 3,000 – 4,200 – 4,800 a
4,200 year
Public Health 3,000 - 4,200 4,200 – 4,800 a
year
University 3,600 – 4,200 – 5,400 a
(Higher education 4,200 year
schools)
Women of 60 years and men of 65 years are entitled to retirement at those ages (this had
previously been that dental surgeons could retire at the age of 55 and 60 years, respectively).
However, in private practice there is no age limit. In fact, dental surgeons normally end their
practice before they are 70 years old.
The profession was included among professions who practised under special conditions, with
pensions of €250 - €400 a month received by dental surgeons who retired under the old
system. But, currently the reception of retirement pensions is conditioned by income. In the
new pension system young dentists will retire under the new scheme, whereby they have to
make their own personal contributions to their pension funds. A minimum of 60% of average
income in the country is the basis of retirement schemes.
Taxes
There is a national income tax: the highest rate is 40%, which is charged on net incomes above
PLN 74,048 (€16,800).
VAT
In Poland there are three VAT rates: 0% on dental services, 7% on materials and drugs, 22% on
instruments and equipment
Zurich = 100 Warsaw

Power
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Poland
Details of information centres:

Misterstwo Zdrowia ( Ministry of Health) Narodowy Fundusz Zdrowia (National Health
Tel: Fund)
Fax: Tel:
E-mail: Fax:
Website: www.mz.gov.pl E-mail:
Website: www.nfz.gov.pl
Main national association and the Other national association
competent authority
Polish Chamber of Physicians and Dentists Polish Dental Association
Sobiesko,110 ul. Kuźnicza 43/45
00-764 Warsaw 50-138 Wrocław
Tel: +48 22 851 71 34 Tel: +48 71 342 42 16
Fax: +48 22 851 71 36 Fax: +48 71 342 42 16
Email: stomatologia1@hipokrates.org Email: paradont@stom.am.wroc.pl
Website: www.nil.org.pl Website:
Other useful contacts:
Centrum Medyczne Kształcenia Główny Inspektorat Sanitarny SANEPID
Podyplomowego (Medical Centre for (The Main Sanitary Control / Inspection)
Postgraduate Training) Tel:
Tel: Fax:
Fax: E-mail: inspektorat@gis.mz.gov.pl
E-mail: Website: www.gis.mz.gov.pl
Website: www.cmkp.edu.pl
There are two scientific periodicals: "Journal of Dentistry" and the "Journal of Prosthodontics",
which are issued by the Polish Dental Association. These journals are for scientific research
articles and advertisements about courses and other assemblies of dental practitioners in
Poland.
There are also other magazines/scientific periodicals:
Dental Magazine (Magazyn Stomatologiczny), Your Review Stomatologic (Twój Przegląd

Stomatologiczny), New Dentistry (Nowa Stomatologia), Modern Dentistry (Stomatologia
Współczesna), Guide for Dentistry (Poradnik Stomatologiczny), Ace of Dentistry (As
Stomatologii) and many others.
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Poland
Dental Schools:
Białystok Gdansk
The Dean Academia Medica Gadanesis
Oddzial Stomatologiczny The Dean
1 Wydzialu Lekarskiego Akademii Medycznej Oddzial Stomatologiczny
ul. Kilinskiego 1 Wydzialu Lekarskiego Akademii Medycznej
15-230 Białystok ul. M Sklodowskiej-Curie 3a
Tel: +48 85 420707 80-210 Gdansk
Website: www.amb.ac.bialystok.pl Tel: +48 58 32 49 28
Website: www.amg.gda.pl
Krakow Lublin
The Dean The Dean
Oddizial Stomatologiczny Oddizial Stomatologiczny
Wydzialu Lekarskiego Wydzialu Lekarskiego Akademii Medyczenej
Collegium Medicum Aleje Raclawickie 1
Uniwersytet Jagiellonski 20-059 Lublin
ul.Sw. Anny 12 Tel: +48 81 532 46 34
31-008 Krakow Website: www.am.lublin.pl
Tel: +48 12 422 54 44
Website: www.cm-uj.krakow.pl
Łodz Zabrze / Katowice/
The Associate Dean Medical University of Silesia (Katowice)
Faculty of Medecine and Dentistry The Dean
Medical University of Łodz Oddzial Stomatologiczny
ul. Pomorska 251 Wydzialu Lekarskiego Slaskiej Akademii
92-213 Łodz Medycznej
Tel: +48 42 675 74 18 Pl. Traugutta 1
Fax: +48 42 678 93 68 41-800 Katowice
Website: www.umed.lodz.pl Tel: +48 322 71 26 41
Website: http:// infomed.slam.katowice.pl
Dentists graduating each year: 100 and www.slam.katowice.pl
Warsaw Szczecin
The Dean The Dean
Oddzial Stomatologiczny Wydzial Stomatologiczny
1 Wydzialu Lekarskiego Akademii Medycznej Pomorskiej akademii Medycznej
ul. Filtrowa 30 ul. Rybacka 1
02-032 Warszawa 70-204 Szczecin
Tel: +48 22 25 53 66 Tel: +48 91 34 75 24
Fax: +48 22 25 73 00 Website: www.pam.szczecin.pl
Website: www.amwaw.edu
Wrocław Poznań
The Dean
Oddzial Stomatologiczny www.am.poznań.pl
I Wydzialu Lekarskiego Akademii Medycznej
ul. Mikulicza Radeckiego 5
50-368 Wrocław
Tel: +48 71 209 761 Łodz
Fax: +48 71 215 729
Websites: www.am.wroc.pl and Wojskowa Akademia Medyczna
www.zagr.am.wroc.pl www.wam.lodz.pl
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Portugal
(2002)
Currency Euros
Main language Portuguese
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 of whom 2,227 (49%) were
male and 2,273 (51%) were female. Specialists are
new to Portugal and there were only 41 (37
orthodontists and 4 oral surgeons). Continuing
education for dentists is mandatory, and is
Portuga
l
Government and healthcare in Portugal

Portugal is a democracy with a population
of 10,102,022 in 2003. The capital is There is currently no regional tier and
Lisbon. major functions such as health and
education are managed nationally through
There is a centralist government elected by ministerial departments. A local
proportional representation. The government network also exists, which
Portuguese Parliament (called the Republic collects some taxes, but only limited
Assembly) is the representative assembly authority is given to this system, for
of all Portuguese citizens, with 230 example, motor vehicles and commerce.
deputies, as stipulated in the electoral law.
The deputies are elected by electoral Healthcare is controlled by a Minister of
circles geographically determined in the Health who delegates powers to Districts
law, so that the proportional representation (cities and towns). Each District has a
system is assured. The legislature has an politically appointed President who is often
electoral period of four years. The a lawyer, but can be someone else, such as
Portuguese Parliament has the legislative a physician or a dentist. There is no
competence, as well as political and fiscal committee or board at this level; instead
power above the government. there is a Regional Administration that is
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responsible for large Hospitals and Health
Centres, which provide primary and All treatment is free for the poor and
secondary care, and Clinics which only unemployed, but the working population
have primary care facilities. The Health pays a social security tax to a Sick Fund
Service employs doctors, nurses and other (employees pay premiums of 11% of
supporting staff, but only a very small earnings, with employers contributing
number of stomatologists and no dentists. 23.75% of earnings). There are a large
number of these funds which provide cover
for individual professions, for example for
doctors, lawyers and dentists, banks,
industry, the military and civil servants.
Each fund has its own administrative
structure and each pays a different level of
benefit as a contribution towards the cost
of care. Payments to each fund vary and
the system is progressive with higher paid
personnel contributing more than those
with lower salaries. Payments are collected
by employers from salaried personnel and
the self-employed pay a quarterly amount
based on the previous year’s income. The
level of contributions is calculated annually
according to expenditure and deficits are
not allowed.
Entitlement to care is not affected by the

differential payments from individuals and
any additional benefits are provided
through private insurance. Funds cover
employees and their dependants.

9.2%. Of this expenditure, 69% was
“public” (OECD Feb 2004). About 4% of this
was spent on dentistry.
The Parliament decides the level of health

expenditure each year.
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Portug
Oral healthcare
al
The Structure of the Profession
As in several other EU countries, dentists They certainly do not have “Acquired

did not exist as an identifiable independent Rights” to enable them to work elsewhere
profession until Portugal became a member in the EU.
of the European Community (in 1986).
Before then, oral health care was provided
by Stomatologists, who undertook 3 years
of dental training after obtaining their
medical degree. Stomatologists work in
hospitals and in private practice. None
were being trained in 2003. Portuguese
Stomatologists, as well as dentists, can
work in other countries of the EU under
“acquired rights” legislation.
To complement the two groups identified

there are also Odontologists, a professional
category introduced by the government
many years ago to meet the problem of a The European Commission, following pressure from the
shortage of dentists. None are being Portuguese Dental Association (OMD), decided in early
2003 to take a recommendation before the European
trained now, but there is still pressure on
Court of Justice, in connection with Portuguese
the government from these unrecognised legislation on the profession of "odontologista", which
practitioners, to recognise them regularizes, with this professional title, certain groups
individually within the Laws which govern that practise dentistry in Portugal with no legal basis.
the dental discipline. It is reported by the The Commission considered this legislation to be
Ordem dos Médicos Dentistas (OMD), the contrary to Directives 78/686/EEC and 78/687/EEC on
Portuguese Dental Association, that some the mutual recognition of qualifications of practitioners
of them are practising illegally in Portugal. of dentistry and the coordination of training for that
profession respectively, since the profession of
"odontologista” as defined in the legislation in
question, operates in virtually the same area as that of
dentists holding the Portuguese qualification referred to
in Directive 78/686/EEC, which respects the training
Publicly funded oral healthcare conditions laid down in Directive 78/687/EEC.
The Commission deemed that the profession of

The publicly funded oral health care system "odontologista" would therefore seem to be alternative
in Portugal is complex and not very to and to compete with that of dentist.
comprehensive for dentistry. For example, "Odontologistas" do not, however, have the
dentists may contract to one or more Sick qualifications provided for in Directive 78/686/EEC and
Fund schemes. Each scheme has its own so they stated that that their training is in no way
list of eligible treatments and scale of fees comparable to that laid down in Directive 78/687/EEC.
and most include emergency care. Few
provide cover for advanced prosthodontics
and those that do usually have a prior
approval system. The Social Security
system is not controlled by any single care
national law and each Fund is self
regulating within its own rules. There is a small Private Healthcare
insurance market in Portugal which is
Most oral healthcare is provided in private growing quickly. A few companies include
(liberal) practices although a few hospitals dental care and dedicated dental care
and Health Centres from the National plans were starting to appear in 2003.
Health Service have dentists. Where oral health cover is available, the
patient pays the total cost of treatment to
Domiciliary care is not offered and patient the dentist and then reclaims, as
oral examinations would normally be appropriate from the company. Prior
carried out 6-monthly. approval applies through reports from the
dentist and sometimes, contributions may
be made to advanced prosthodontics. The
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OMD believes that up to 40% of dental care Neither the quantity nor the quality of the
may be being provided privately (2003). care provided is monitored in any formal
way and only in exceptional cases is fraud
The Quality of Care identified and pursued. Complaints from
patients are dealt with in two different
ways (see below).
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Portug
al
To enter dental school a student must Registration

finish secondary school with an average
that has been requested, then undertake To obtain registration an applicant must
national tests, to get into the university. hold a degree or Diploma in Dental
Medicine or meet the requirements for
There are 7 dental schools in Portugal, 3 European Union freedom of movement.
publicly owned and run, and 2 private ones. Applications are to the Ordem dos Médicos
The three state dental schools are located Dentistas (OMD), which also holds the
in university faculties of Medicine register. The Statute of the OMD (Law nº
(Coimbra) or in faculties of Dental Medicine 44/2003) defines the acts that a dentist
(Porto and Lisbon). The private schools are may perform as “the study, prevention,
in Institutes of Health Science (North and diagnosis and treatment of dental and oral
South), in the Fernando Pessoa University diseases, jaws and annexed structures”.
and in the Católica University. There is no Portuguese language
requirement to register.
Some students in private schools receive
help towards their tuition fees, but not all. Further Postgraduate and
Since entry to the EU, the number of
dentists whose education meets the
Specialist Training
requirements of the Dental Directives had
been 7 times more annually than Continuing education
stomatologists, but stomatologists are not
being trained anyway, now. Continuing education is compulsory in
Portugal, and is regulated by the OMD.
Study as a dentist is for 6 years, which Non-compliance may ultimately lead to the
includes theoretical education and practical loss of the licence to practise. However, by
training. 2004 the terms and conditions had not yet
been determined by the OMD.
In 2003 the total student intake was 585
and the total number of undergraduates The OMD arranges an annual continuing
was 2,100. There were 336 graduates (138 education programme, and there is an
male and 198 female). annual scientific congress. Courses are
usually one-day in length, on a range of
Primary dental qualification subjects. Dentists who attend receive a
Certificate of Attendance.
the register is the Carta de curso de Specialist Training
licenciatura em medicina dentaria (diploma
conferring official recognition of completion
Specialist training in Portugal, in the
of studies in dentistry).
recognised specialties of orthodontics and
oral surgery, is at least 3 years in length,
Qualification and Vocational Training and takes place in universities and public
health institutions, and is followed by a
Vocational Training (VT) written examination by the OMD. Students
receive no particular remuneration during
There is no requirement for post- training.
qualification vocational training in Portugal
The titles awarded for specialist
qualification are:
• especialista em ortodontia
(orthodontics)
• especialista em cirurgia oral (oral
surgery).
Specialists must register as such in a

register administered by OMD.
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Portug
Workforce
al
Dentists
Auxiliaries
In 2003 there were 4,500 dentists
registered in Portugal, of whom 2,227
Other than Dental Assistants, for whom
(49%) were male and 2,273 (51%) were
there is no organised formal education, or
female. The number is increasing as there
training requirements, there are two other
are almost 350 new graduates every year.
recognised grades in Portugal. They are:
Despite the low dentist to patient ratio Numbers (2003)
(2,245) the Portuguese Dental Association
Hygienists 150
believes that there are too many dentists in
Portugal. Technicians (est) 5,500
There is insignificant cross border

movement.
Total (2003) 4,500

General 4,432
practice
Hospitals Not
known
University* 200
Armed Forces 35
Public service None
Stomatologists 635
Odontologists 550
* also work in General Practice
Until the late 1990s Brazilian-trained

dentists were allowed to practise in
Portugal under a bi-lateral agreement with
Brazil. However, since the implementation
of the EU Directives immigrants from Brazil
are recognised no differently to those who
enter from other non-EU/EEA countries.
This means that they need to gain
recognition of their diplomas through the
public universities.
Specialists
Numbers (2002)
Orthodontists 36
Oral Surgeons 4
The specialties of Oral Surgery and

Orthodontics were introduced in 1999.
All specialists work in private practice, only,

and see patients on referral.
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They can be paid either by fees or salary:
• Dental hygienists there is no available information about the
• Dental technicians level of their earnings.
In 2003, there were approximately 150

hygienists on the register.
Dental technicians
Training for dental technicians is at the

(public) dental schools and lasts 3 years, at
the end of which the student has a
certificate (a registerable qualification) for
Dental hygienists dental technicians. Legally, they can only
prepare prostheses. They must register
Dental hygienists must train at the dental with the Ministry of Health. Students may
school in Lisbon and gain the recognisable study for one more year and obtain a
qualification before they can work. Their degree (4 years).
training course is 3 years, at the end of
which the student has a bachelor In Portugal, they may also register with the
certificate. Dental Technicians’ Association, but this is
not compulsory. So, there are about 1,500
To work they have to be registered. The Dental Technicians legally registered and
register is administered by the Ministry of the Dental Technicians’ Association
Health. Hygienists must work under the estimates that there are about 4,000 non-
direction and prescription of a dentist, who registered.
must be present in the building when they
are working. The permitted acts for Technicians work in dental laboratories and
hygienists are oral hygiene education and earn fees for the work they do. There is no
screening, examination, history taking and available information about the level of
prophylaxis (scaling), the application of their earnings
topical medicaments and sealants, clinical
assistance to the dentist and care of dental Dental Assistants
equipment. They are not permitted to give
local anaesthetics. There is no available information about
dental assistants in Portugal. There is no
register for them.
Portug
Portug
Practice in Portugal
al
al
Working in Private Practice Stomatologists work within a similar system
but Odontologists do not (they are limited
to a certain number of types of treatment,
If a dentist is contracted to a Sick Fund, he
as they do not have appropriate training).
claims his fees directly from the scheme
and there is in most no patient charge,
There are no formal controls on the quality
except for care that is not covered. The
and quantity of care provided in private
fees paid are very low and payment is
practice, other than those described in the
reported to be slow. Dentists who are not
ethical code.
contracted may still accept patients from
Sick Funds but the patient then pays the
In 1998 a law was introduced which allows
fee and reclaims it from the scheme.
patients who receive private care from a
doctor or a dentist to produce receipts and
Most dentists in Portugal also work in
gain 100% income tax relief. Tax
totally private practice, where patients pay
avoidance by professionals is now therefore
100% of fees, which the dentist can
very difficult.
determine within a maximum and minimum
set by OMD. This arrangement has no legal
standing but is part of the ethical code and
thus the disciplinary process. They are the
There are no restrictions on the
same nationally, and specialists receive the
establishment of dental practices.
same fees.
However, Law 233/2001 regulates the
operation of dental clinics and consulting
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379
2004_______________________________________
rooms as health units which, regardless of
their name and legal structure, carry out
activities related to the prevention, Dentists can be employed as assistants,
diagnosis and treatment of disorders and with legal responsibility for their own work,
diseases of the teeth, mouth, jaws and and are then usually paid a percentage of
adjacent tissues. their gross income. Only rarely do
assistants progress to partnerships. No
In order to promote quality and safety, by government funding is available for the
adopting a similar system to that purchase of practices.
established regarding already regulated
health centres, this law defines the A dentist would normally have a list of
requirements which concern facilities and about 2,000 regular patients.
equipment, as well as the rules regarding
organisation and operation, regulates the Working in the Public Clinics
licensing process and establishes the
supervising bodies, and the tools for the
practice of dentistry at national and There are about 400 Public Health Centres:
regional levels. in 2003 no dentists were working in health
centres or clinics, although there were
Most dentists work in single-handed dental surgeries in some. OMD was trying
practice but occasionally mixed practices to negotiate some salaried posts to provide
are established, with a dentist, a care for children and other priority groups –
stomatologist (or, in some cases, a legally progress had already been made with the
registered Brazilian dentist). The premises Dental Health Promotion Program on
may be shops, special buildings, or children and teenagers. This program is
converted houses. being executed in every health
establishment of the Health Ministry and it
relates to a whole range of activities of
primary and secondary tooth decay
prevention. This was at the discussion
stage only and the government is resisting
the introduction of a career structure.
Only Stomatologists are allowed to work in

the approximately 80 hospitals in Portugal,
and there are very few dental posts. There
are a small number of private hospitals and
some dentists work in them, but no
information is available about the dental
access to these premises.

Dental Faculties
Approximately 200 dentists work in the

schools and are salaried, although all also
maintain commitments in private practice.
Their duties are mainly teaching. The
quality of this is monitored by the Ministry
of Education, but currently only in the
private and public dental schools.
To teach in universities, a dentist would not

only need the degree of a licentiate (6
years of study) but also hold a Master’s
degree, or Doctorate (the highest degree of
a faculty or university).
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There are 35 dentists working in the Armed • Army: 13 dentists
Forces (including 35 females) as: • Navy: 13 dentists
• Air Force: 9 dentists
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Portug
al
Advertising
The national dental association in Portugal
is the Ordem dos Médicos Dentistas (OMD), Advertising is not allowed in Portugal.
which also administers the dental register. Websites may be used, but only according
All 4,500 dentists are members; it is to the Ethical Code of the OMD.
obligatory to be a member to practise.
(Stomatologists are regulated by their own Indemnity Insurance
Ethical Code).
There is no specific body to register dentists. However, professional insurance is
odontologists, although they do need to provided by private general insurance
register as such with the Ministry of Health. companies. Cover depends on the dentist’s
It is reported that an Ethical Code will be individual requirements and premiums will
formed in due course. vary to reflect this. There is no minimum
mandatory rate.
Ethics
Corporate dentistry
Ethical Code
According to the 26th article of the
In Portugal, there are laws and codes which Deontological Code of the Portuguese
control professional conduct and ethical Dental Association, dentists may form into
behaviour. They include fitness to practise, companies. The number of them is
advertising and continuing education. unknown. Non-dentists can own a
company, but according to the
Complaints from patients are dealt with in Deontological Code, companies must have
two different ways. If the issue involved is a clinical director, who must be a dentist.
solely one of contract then it is considered
by a legal assessor. If the quality of care is Health and Safety at Work
challenged then the patient is examined by
the Clinical Director in a Sick Fund and/or Inoculations, such as Hep B are not
by an independent dentist, if the patient compulsory for the workforce. A co-
has been treated by private contract. If payment of 40% for the cost of them is
prima facia evidence is found to support guaranteed by the National Health Service.
any complaint, it may be referred to the
Ethical Council of OMD for investigation. Regulations for Health and Safety
Only dentists serve on the Council.
For Administered by
The Council has the power to reprimand,
suspend for up to five years or remove Ionising Departamento de
from the register. No dentists had been radiation Protecção e Segurança
suspended by 2003, which may reflect the Radiológica, and
maturity of the Portuguese Dentists, which Laboratório Nacional de
is a relatively new class of profession. Any Energia e Tecnologia
appeal against a decision of the Council Industrial
made to the administrative courts. Electrical Local city authorities, and
installations (forthcoming)
None of the above prevents civil action by regulation by the Ministry
patients in the courts. All in all, the of Health
procedure is very slow and each case may Waste disposal Ministry of Health
take two to three years to conclude. Medical devices Ministry of Health
Dentists may also appeal to the courts.
Criminal offences are included in the court Infection Ministry of Health
process. control
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Portug
Portug
Financial Matters
al
al
Taxes
No accurate data is available on average
incomes, but there is evidence that the
Income Tax
large number of new graduates has
affected the market, and remuneration
levels have reduced.
on salary) with rates up to 40% of gross
salary (at incomes above €52,300).
VAT/sales tax
Employees pay premiums of about 11% of
earnings (with employers contributing VAT is payable at various rates (19%
23.75% of earnings), which, in addition to normally and 5% for anaesthetics). It is
the retirement pension also provides social payable on all dental equipment and
security protection against unemployment, consumables.
and includes the sick fund contribution.
The scheme for self-employed people is 2003
different - they pay a quarterly amount
based on the previous year’s income.
Zurich = 100 Lisbon
Retirement pensions in Portugal are
typically 80% of a person’s salary on Prices (excluding 65.1
retirement (for 36 years’ work). Normal rent)
retirement age is 65 years. Dentists can Prices (including rent) 68.5
practise beyond the normal retirement, as Wage levels (net) 25.1
there is no age limitation.
Power
Competent Authority: Main National Association and

Information Centre
Ministério da Saúde Ordem dos Médicos Dentistas (OMD)
Departamento de Recursos Av. Dr Antunes Guimarães, 463
Humanos da Saúde 4100-080 Porto
Avenida Miguel Bombarda, 6 Tel: + 351 22 619 7690
1000-208 Lisboa Fax: + 351 22 619 7699
Tel: + 351 21 7984200 Email: ordem@omd.pt
Fax: + 351 21 7984220 Website: www.omd.pt
E-mail: drhs@drhs.min-saude.pt
Website: http://www.min-saude.pt Delegação
Publications: Campo Grande, 30-50-C
1700-093 Lisboa
Boletim Informativo
Tel: + 351 21 794 1344
Av. Dr Antunes Guimarães, 463
Fax + 351 21 799 3551
4100-080 Porto
Email: delegacao@omd.pt
Tel.: + 351 22 619 7690
Website: www.omd.pt
Fax: + 351 22 619 7699
Email: ordem@omd.pt
Website: www.omd.pt
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Portug
Dental Schools:
al
Public Faculties:
Faculdade de Medicina Dentária do Porto Faculdade de Medicina Dentária de Lisboa

Rua Dr Manuel Pereira da Silva Cidade Universitária
4200 Porto 1600 Lisboa
Tel: + 351 22 5093938 Tel: + 351 21 7922600
Fax: + 351 22 5507375 Fax: + 351 21 7957905
Faculdade de Medicina da Universidade

de Coimbra
Licenciatura de Medicina Dentária
Av. Bissaya Barreto
3049 Coimbra Codex
Tel: + 351 23 9400 578
Fax: + 351 23 9402 910
Private Faculties:
Instituto Superior de Ciências da Saúde Instituto Superior de Ciências da Saúde do

do Norte Sul
Rua Central da Gandra 1317 Quinta da Granja
4580 Paredes Travessa da Granja
Tel: + 351 22 4157142 2825 Monte da Caparica
Fax: + 351 22 4155954 Tel: + 351 21 2946700
Website: Fax: + 351 21 2946768
http://www.cespu.pt/cespu/universitario/i Website: http://egasmoniz.edu.pt/iscss/
scsn/meddent.asp
Universidade Fernando Pessoa Universidade Católica Portuguesa
Rua Carlos da Maia, 296 Centro Regional das Beiras
4200-150 Porto Estrada da Circunvalação,
Tel: + 351 22 5074630 3504-505 Viseu
Fax: + 351 22 5074637 Tel: + 351 23 2430200
Website: http://www.ufp.pt Fax: + 351 23 2428344
Website:
http://www1.crb.ucp.pt/index.php?
pag=esct/meddent/apresentacao
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Romania
Candidate for the EU in 2007
GDP per capita (2002) € 2,400
Currency Romanian
LEU
41,000 LEU = €1
Main language Romanian.
Romania has a healthcare system which depends

on the compulsory membership of each insured
citizen in the Social Health Insurance System. It
provides a legally prescribed standard package of
general and oral healthcare. Most dental care is
provided under private arrangements. In 2003
there were 8,694 dentists registered in Romania of
whom 66% were female. Specialists are widely
used, but there are no clinical auxiliaries.
Continuing education for dentists is mandatory,
and is administered by the Romanian Collegiums of
Physicians (RCP), to which all dentists must belong.
There is also the Romanian Dental Association of
Private Practitioners (RDAPP, a non-governmental
Romani
a
Government and healthcare in Romania
Romania is a medium country in terms of is governed as a constitutional republic

its population size (22,272,839 in 2003) with an elected parliament with two
and land area coverage (237,500 sq km). It chambers. The country is administered as
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40 counties and 1 municipality, the capital Government ended the right of the RCP to
Bucharest. be a negotiating organisation, and
established that the Ministry of Health and
The statutory health insurance system was Family together with NSHIH undertook all
established in 1998. General and oral the activities of social health insurance
health care depends on the compulsory system.
membership of each insured citizen in the
Social Health Insurance System. The The funds for NSHIH are met by a 13.5%
National Social Health Insurance House levy on salaries (employers contribute 7%
(NSHIH) at national level and County Social of salaries and employees 6.5%). The
Health Insurance House (CSHIH) at county different level of contribution to NSHIH
and capital level administrate the system. generated by the different levels of salaries
The whole population is insured and pays does not affect the level of quantity or
monthly a fixed amount of their salaries to quality of the health care. The allocation of
the CSHIH, situated in the county where monies and resources is managed by the
they live. The system of social health NSHIH and CSHIH, which are the legal
insurance provides a legally prescribed financing institutions. The main functions of
standard package of general and oral NSHIH and CSHIH are to pay the providers
healthcare. of medical and dental services and to
control the quantity and quality of the
Financial sources from general taxation services.
(from the national Budget) are only for the
general prevention programmes, managed They represent the interests of the general
by the Ministry of Health and Family. In community of the insured persons. In the
Romania the budget for NSHIH is directly original text of the law the Board of the
proportional to the level of the salaries of NSHIH and CSHIH must be democratically
the population. In every year the budget of elected by a general assembly of the
NSHIH is estimated according the last year insured persons but in practice this does
budget, adjusted with the inflation index for not happen, because they are under
the new year. Government control and designated by the
Government. The legal framework of NSHIH
The administration of the NSHIH and CSHIH restrict their activities only to
establishes at every year-end, by social health care.
negotiating with the Romanian Collegiums
of Physicians (RCP), the expenditure for the From the beginning of the social health
different medical specialties (hospitals, insurance system, the Romanian Dental
family medicine, specialties, emergencies, Association of Private Practitioners (RDAPP)
drugs, and dentistry). At the end of 2002 had many proposals to improve the laws
the and regulations and to introduce more
rights for the dentist who work in the
NSHIH. A number of proposals (44) for the
improvement of the law of NSHI were made
by RDAPP to the Senate and the Deputies’
Chambers, when the law was
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being reviewed by the Parliament. In the political prisoners and1989
Romania
new Law 150/2002, about Social Health revolutionaries

Insurance, 18 of the proposals of the disabled persons
RDAPP were accepted (40%).
The special institutions of the Government
The followings groups are exempt from (Treasury, Ministry of Work and Social
paying monthly contributions for NSHIH: Solidarity, the Secretariat of Government
for Disabilities Persons, etc.) are
• children and young people until 18 responsible for these special groups.
years old,
• unemployed persons, pregnant The proportion of GNP spent on general
healthcare, including dentistry, as reported
(retired) women and after-pregnancy
by the FDI in 2002 was 3.5%.
(retired) women
• persons who undertake military
service, war veterans and seriously war-
wounded,
Oral healthcare
Almost 90% of Romanian dentists are
private; they have fiscal code and all kinds In some parts of Romania, it is reported
of legal authorisations for free practice, that some dentists use old types of dental
with full responsibilities. 42% of Romanian treatment and prosthetic restorations, due
dentists are owners of their dental offices. to the level of dental education of different
48% of dentists are not owners, but work in generations of dentists.
old buildings offered temporarily, free of
rent, by the Government, which is the real Insured patients would normally receive
owner. Since 1994, when healthcare reform annual prevention control.
began, there have been many proposals by
the Government to sell their medical and Public Compulsory Health
dental offices to their occupants, but these Insurance
have never been finalised - maybe for
political and social reasons. 10% of
The social health insurance provides cover
Romanian dentists work as employees in
for all prevention and treatments for
primary schools and dental faculties.
children and young people, until they are
18 years old. For adults, the NSHIH initially
Almost half of Romanian dentists, owners
covers 40% of
or non-owners of their dental offices, work
within the CSHIH. The other half of the
dentists work in a completely liberal
system, with direct payments from
patients. The number of CSHIH dentists is
limited by the Social Health Insurance
Houses at county level.
In Romania only 1% of the medical funds of

the CSHIH are spent on dental treatments -
the greatest part of the funds is spent in
hospitals (75%), or for family medicine
(10%), etc. It is estimated that patients
directly pay at least 90% of the costs of
dental treatments.
They are major differences between access

to medical and dental care in the
population: at rural level only 25% of the
population access dental treatment; at
urban level, 75% of population access it.
However, there are some shortages of
dentists working in inner city areas and
some specific social groups (children,
farmers, retired persons) are having trouble
accessing dental care at rural level.
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the costs of the list of dental treatments. Private dental care
Patients directly pay the difference of 60%.
The RDAPP created and proposed to the A large number of dentists have completely
NSHIH and RCP the concepts of basic private patients, who pay the all cost of
(social) dental care for adults and optional care. Private fees are regulated by the
(free) dental care for adults. In the first internal rules of every dental office and
years (1998-2000) the concepts were generally they are established after a direct
respected, the NSHIH covered only 25% negotiation between the dentist and his
from the entire list of dental treatments patient. A real free dental market was
and 75% of treatments were optional (ie, established between 1990 to1998, with
basic dental care: 25%, optional dental prices regulated by the principles of the
care: 75%). Since 2001 the package of market economy. Without any financial
social dental care increased to over 55% help 42% of Romanian dentists created a
and the optional treatments were only private dental workforce and private dental
45%. In the same last period the proportion offices.
allocated to dentistry was decreased from
3.5% to a nominal 2% (but actually to 1%). Approximately 30% of dentists have only
So, the 1% allocated to dentistry by NSHIH private patients.
was not enough for all dental treatments,
and the NSHIH covers children’s prevention Private health insurance companies are not
and adults’ emergency care only. yet functioning in Romania.
The proposals of RDAPP, which had been

invited by the Ministry of Health to a
“Partnership for Health”, whose goal is to
find the ways to improve the dental social
health insurances, were accepted at the
end of 2003. From the beginning of 2004 in
Norms of Application of the Frame Contract
between dentists and NSHIH, the following
treatments are supported by the social
health insurance:
• Preventive care for children and

adolescents – 100%
• Dental treatments of children and
adolescents (up to 18 years) – 100%
• Pain relief and emergency treatments –
60%
• Basic surgical care (with emergency
treatments) – 60%
• Risk-diagnostics and preventive
consultation – 100%
• Mobile social acrylic dentures for adults
– 100%
For dentists who are employees in primary

schools, dental faculties, maxillo-facial
surgery hospitals, payment for their income
is by salary. The fees for dentists in the
NSHIH system were negotiated in the
period 1998-2002 between NSHIH and RCP.
From the end of 2002 the fees are not
negotiated but established by NSHIH itself.
The quantity of dental treatments provided

by dentists is monitored only in social
health insurance, at county level, by the
CSHIH. The quality of work claimed by
dentists from the remuneration bodies is
monitored in the social health insurance
system, at county level, by the Romanian
Collegiums of Physicians.
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The Quality of Care a contract with them, through an inspection

commission composed of employees of the
Romania
A mixed commission (CSHIH and the CSHIH, which may or may not have dentist
Romanian Collegiums of Physicians), only members.
following a complaint of a patient, can
judge the quality of work in the NSHIH For further information see Ethical Code
system. Outside the NSHIH, in the liberal
system, the quality of dental work can be A full-time dentist working either in the
judged only by the RCP. From the quality NSHIH or in a private system would have
point of view, the County Social Health about 2,500 patients who he would count
Insurance House has the right to control as his “list”. There is no form of domiciliary
regularly the activities of dentists who have dental care.
Education and Training
Undergraduate Training 2002-03 graduate year. The title “dentist”

was substituted from the start of the 2003-
4 dental school year.
To enter dental school a student needs to
be a secondary school graduate (including
school leaving examination) and an entry
examination. There is no need for
vocational entry.
Dental schools were known as Faculties of

Stomatology, as a part of a University of
Medicine and Pharmacy, until 2003. From
the 2003-04 academic year they became
Faculties of Dental Medicine. For a list of
schools, see Dental Schools
There are 9 state-funded dental faculties

and 3 wholly privately funded. In 2002,
student intake was 1,191 and more than
half of the students (640) were female. The
same year, there were 1,180 graduates
and 635 were female. The students have to
pay a small contribution for the state-
funded faculties and the full costs for the
privately funded faculties. Every state
funded faculty has the right to manage 10-
20% private places for students in every
year of study. The students who follow this
course of entry are obliged to pay the
complete costs.
Undergraduate training has been for 6

years, since 1991. It was modified in 2003,
by the Ministries of Health and Education,
to bring this training into line with EU
requirements.
The Ministry of Education monitors the

quality of the training and the Council of
the Faculty is directly responsible.
Upon qualification, the graduates received

the title “Physician stomatologist” until the
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At the licence examination, there is a

clinical test and it is followed by 1-year
probation (in public dental office) before
the young dentist can work on his own. The
dentist becomes a “Probation physician
stomatologist (1 year)/stagier”. The
Ministry of Health and Family pay the
“Probation physician stomatologist/stagier”
a salary of around €720 for the year. The
post-qualification training has a practical
part (participant has to fulfil a list of
prophylactic, diagnostic and treatment
items) and a theoretical part of training
(compulsory attendance on recommended
courses and lectures).
Romanian dentists will not be covered by

the “Acquired Rights” provisions of the EU
Directives until after the accession to full
membership of the EU, in 2007.
Before Romania accedes to the EU, the

vocational training scheme is to change to
become more in line with general EU
standards. So, there will be European
curricula, a decrease of medical disciplines,
an increase of dental disciplines, a greater
number of practical hours, a holistic
approach of the patient, the introduction of
behavioural sciences, new dental units and
devices and a unique system of final
evaluation of the graduates.

recognised without the need for vocational
training.
Registration
The Romanian Collegiums of Physicians

registers all the physicians and dentists. It
is absolutely necessary to know the
Romanian language - before studies,
foreign citizens must follow one year of
study of Romanian language.
Further Postgraduate and Every physician and dentist must undergo
Specialist Training 200 hours of continuing education in every
5 year period. If they do not collect in 5
years the 200 hours of continuing
Continuing education education, the RCP has the legal obligation
to end the right of the dentist or doctor to
Continuing education is compulsory for all practise.
dentists. The Romanian Dental Association
of Private Practitioners and the specialist Specialist Training
dental associations organise continuing
education (courses, seminars, symposiums,
Congresses), under the supervision of
Romanian Collegiums of Physicians and the
Minister of Health and Family.
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Before entering into specialist training
dentists must have completed their 1 year
post-qualification training. The specialist The general stomatology specialities are a
training is undertaken in the Dental 3 years specialisation which (in practice)
Faculties and the Board of the Faculties repeats the items studied in the faculties.
monitors and are responsible for the quality
assurance of the training. Any dentist can undertake specialist
training, but the Ministry of Health limits
There is training in 3 specialties: the number of orthodontists and oral-
maxillo surgeons. The trainees are paid
• Orthodontics: 3 years training during their training by a fixed budgetary
• Oral-maxillofacial surgery: 5 years salary supported by the Ministry of Health.
training In this period it is forbidden to work in
• General stomatology: 3 years training private dental practice. At the end they
receive a specialist degree and the
diploma:
• physician specialist orthodontist;
• physician specialist maxillo-facial
surgery
From the former communist system,
Romania has the inheritance of two
professional degrees: “specialist
physicians” and “primary physicians”,
obtained after a period of home training
followed by a final examination. These two
professional degrees were in possession of
a large number of generations of dentists.
The first of these “specialist physicians” is
at the origin of the “general stomatology”
specialisation. The second one is a matter
of higher fees in the NSHIH system.
The Romanian Collegiums of Physicians is
responsible for the registration of the
specialists.
Workforce
Dentists
In Romania, there are 8,694 dentists (2002) The population per active dentist was
– 66% being female. 3,650 private dentists 2,562.
work as independent professionals,
although most are self-employed or in
partnership. There is no information about
whether there are unemployed dentists.
There are an unknown number of emigrant
young dentists in the EU, the USA and
Canada.
Total 8,694
General practice (liberal) 3,650
Hospitals 200
University 950
Armed Forces 80
Public dental service 3,827
(CSHIH)
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The active dental work force is increasing.
More then 40% of dentists are older than
50 years.
Specialists
Specialists practice in dental faculties,

hospitals, private dental offices, and they
receive higher fees regularly from the
CSHIH or optionally directly from the
patients.
Patients being seen by a specialist within

the social health system must be referred
by a generalist. However, in liberal practice
they may access a specialist directly,
without the need for a referral.
Number of specialists
(2002)
Orthodontists 153
surgeons
General Stomatologists 4,938
Auxiliaries A full-time dental technician would expect

to earn €5,000 a year, which is twice as
much as public health dentists. In 2003
There are no clinical dental auxiliaries in
there were approximately 3,000
Romania. There are Dental Technicians and
technicians.
additionally, there are dental assistants.
There is some illegal dental practice
Dental Technicians practising by non-specialized technicians,
without a higher degree qualification, but
Dental technicians are trained in dental the RCP and RDAPP fight against these and
technician colleges, organised in frame of the number of cases is decreasing every
the dental faculties. The training is for 3 year.
years, with a final examination and a
diploma. They must be registered with the Dental Assistants (Nurses)
Order of Romanian Medical Assistants.
Dental assistants train in secondary
Dental technicians normally work in
medical schools, with 3 years of study and
separate dental laboratories and invoice
a final examination and diploma. They
the dentist (or directly the patient) for
must be registered in Order of Romanian
completed prosthetic works. A small
Medical Assistants. The duties of dental
number of technicians are employees of
assistants are: assisting dentists,
dental offices and they are paid with a
maintaining records, sterilisation, infection
percentage of the fees for the prosthetics
control, and office work. Dental assistants
work.
are paid a salary.
There are 7,245 Dental Assistants (Nurses).
Practice in Romania
Working in Liberal (General) Every dentist chooses himself whether to
Practice work only with NSHIH or in an independent
way, or both. Of course, the financial
position of the patient also determines the
Patients pay the dentists, who work in choice of possibilities. There are two
private sector, directly and completely. systems of payments, one is Item of
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Treatment Fees, for NSHIH dentists and the
other direct patient full payment. Joining or establishing a practice
There is no prior approval for treatment The only restrictions are for the dentists
necessary - only the consent of the patient, who work with the NSHIH on setting up
established freely and directly together dental practice in big cities, which are full
with the dentist. of dental offices. Here, the CSHIH
Fee scales establishes the number of new dental
offices which are able to work with the
The fees for dentists in the NSHIH system CSHIH. However the local RCP councils
were negotiated in the period 1998-2002 often allow dentists to establish themselves
between NSHIH and RCP. From the end of in liberal dental offices.
2002 the fees were not negotiated, but
established by the NSHIH itself. There are no rules regarding the type of a
dental practice, in terms of building: house,
The dentists who work within social health apartment, and clinic. There is no state
insurance are paid partially (40%) by the assistance for establishing a new practice,
CSHIH (through banks) and partially so some dentists take out commercial
directly by the patients (60%). This type of loans from a bank. There are no limits
payment is identical for prosthetic works regarding the maximum number of
too. Every CSHIH dentist reports monthly to partners or associates or a
CSHIH the list of completed dental maximum/minimum number of patients.
treatments. The CSHIH pays for the work of
the dentist each month, and at the end of Any dentist can own a dental practice, and
the quarter they undertake a final audit there is also provision for them to be run as
and pay any balance. The CSHIH never limited companies. See Corporate Dentistry
pays for adults the full cost of dental
treatments. It is possible to sell the equipment, as well
as the building. The patients of a dentist
See Public Compulsory Health Insurance. who stops his activities may choose freely
another dentist, including of course, the
new owner, of an old dental office.
However, the list of patients is not for sale
and a newly opened dental office must
create its own list of patients.
When starting new practice, private

dentists have to inform the local health
authorities, and to obtain all the necessary
authorisations and visas.
Dentists in general practice (liberal) would

normally have incomes in the range of
€12,000 to €36,000 per year
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Armed Forces - 4% of these were females.
The number of dentists who work only in

the public service in not exactly known,
because they also work in their dental
offices, which are in the property of
Government. The main sector is public
schools, but the number is decreasing
every year.
The service is not limited. The patients

(children) do not pay for their treatment.
General prevention programmes of Ministry
of Health and Family support the costs. All
the dentists from schools are salaried and
paid for by the County Health Board. The
dentists who work in the public service
earn about €2,400 per year and they may
only treat patients inside the public dental
service (CSHIH system).
The quality of dentistry in the public dental

service is assured through the controls of
County Health Board.
In 2003, about 3,827 salaried dentists were

employed in public health clinics (CSHIH
system).
In Romania, about 200 dentists work in

maxillo-facial surgery in hospitals. All of
these dentists are employees of the
hospitals, which are owned and run by
regional government.
They are salaried and earn about €2,400

per year.

Dental Faculties
There are 13 dental faculties, in which

about 950 dentists work. They normally are
employees of the Faculty of Stomatology,
and their salary range is €150 to €300 per
month, (€3,600 per year). They are allowed
a combination of part-time teaching
employment and private practice (with the
permission of the faculty).

professors. This involves a further degree
(publication activities, a record of original
researches and the study for a PhD is also
required).
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and confidentiality, continuing education
and advertising. The ethical code is
administered by the Romanian Collegiums
Professional Matters of Physicians.
Professional associations A complaint by a patient is first screened

by a professional expertise commission of
The Romanian Collegiums of Physicians the RCP (the County Dental Commission of
oversees and administers ethical issues. It the RCP).
is a legally based, non-governmental
organization and serves the whole of Complaints, which proceed, are presented
Romania at national level. In each of 40 to the County Dental Commission of the
counties a regional body exists, which RCP, which then creates a committee of
administrates ethical issues. dental experts, nominated from the
members or non-members of RDAPP from
The body of the Romanian Collegiums of the region.
Physicians includes all physicians in
Romania - from hospitals, family medicine The RCP Committee of Dental Experts
and dentistry, etc. A specific dental section analyse the case and establish if the
of the RCP exists (the National Dental complaint is well founded. If this is
Commission of the RCP) but it is not confirmed, the consequences for the
autonomous within the RCP (without dentist are proportional to the gravity of
negotiating power, only being a consulting the facts (medical problems and
commission). complaints,
The Romanian Dental Association of Private

Practitioners (RDAPP, established in 1990)
represents and defends the liberal dental
profession. RDAPP obtained from the
Ministry of Justice, the quality mark of a
“national representative association legally
certified”, which is very important for
negotiation with the NSHIH. In the 2002/03
Annual Report of FDI it was reported that
1,450 dentists were members (about 45%
of private practitioners).
The EU Commission recommended the

establishment of a new Law relating to the
dental profession, “the Law for establishing
the Romanian Dental Collegiums”. A
brochure containing 87 proposals of the
RDAPP was realised and distributed to all
senators, deputies, and members of
Government and to all of Romanian
dentists. Following these proposals, the
RDAPP was invited to the official hearings
in the Romanian Parliament, where all the
proposals were appreciated. After these
hearings 60 (70%) of the proposals of the
RDAPP were included in the Draft Law
about Romanian Dental Collegiums.
The specialists (orthodontists, oral-maxillo-
facial surgeons, dental academicians) have
their own professional associations.
Ethics
Ethical Code
Dentists work under a general physician

ethical code, which covers relationships
and behaviour between physicians,
dentists, contracts with patients, consent,
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financial problems and complaints, or
both). The dentist is not suspended All practising dentists and dental assistants
immediately because the RCP has gradual are required to be inoculated against
sanctions. A complaint may be referred to Hepatitis B - the County Health Board
the justice system only if the Committee of monitors these activities.
Dental Experts considers that there has
been very great injury, a loss of a function,
or the patient’s life was put in danger.
The final sanctions are established by the

Romanian Collegiums of Physicians at
county level - justice decisions are very
rare.
The dentist can appeal to the RCP at

national level or to the superior court in
those instances. If the official commission
of the RCP establishes that the dentist is
guilty he must repeat the treatment,
supporting all the costs.
Advertising
Usually, advertising is not permitted,

except for the first announcement of the
opening of the new dental or medical
office. However, many physicians do not
respect this rule and use different ways of
advertising (newspapers, flyers, radio, TV
and the internet).
Dentists may use websites to inform and
advertise their services, subject to the
usual rules of advertising and commerce.
The RCP Code of Ethics does not include
specific regulations regarding electronic
commerce.
Indemnity Insurance
Indemnity insurance is compulsory in

Romania only for dentists who work within
the NSHIH. Other dentists are free to
choose to have indemnity insurance for
treatment, or not. There are many
insurance companies, which advise and
defend dentists against complaints and
accusations of malpractice. The RDAPP
studies and recommends to the members
the best companies.
Corporate Dentistry
From 1990 a large number of new private

dental offices have been organised as
limited companies by non-medical
investors, with their tax advantages. But
from the beginning of 1998 the new law of
medical offices introduced the right of
every investor to open dental practices as
Limited Companies, but this is limited by
the regulation that only 1/3 of the
associates can be non-dentists.
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Regulations for Health and Safety The set age for retirement is the same for
all citizens, 60 years old for females and 65
years old for males. Dentists and dental
For Administered by
auxiliaries can work after the retirement
Ionising CNCAN (National Council only in the private liberal system.
radiation for the Control of the
Nuclear Activities). At There are both compulsory general social
county level, the County pensions and optional private pensions. In
Health Board. compulsory general social pensions the
Electrical County Fire Brigade level of pensions is about €1,200 per year,
installations but in optional private pensions the level
Waste disposal The County Inspectorate depends upon the contributions made.
of Environmental
Protection
Medical The Ministry of Health and
devices Family, at national level,
through its specialized
department SVIAM,
administrate the rules
relating to Medical
Devices.
Infection The Ministry of Health and
control Family, at national level,
and the County Health
Board, at regional level,
through the County
Inspectorate for
Transmissible Diseases.
Financial Matters

or 2 years 20 years
after after
qualificati qualificatio
on n
General €12,000 €36,000

Practice
(liberal)
Hospital €1,200 €2,400
Public €1,200 €2,400

Health
(CSHIH)
University €1,800 €3,600

Healthcare
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Taxes Various Financial Comparators @ July

2003
The top rate of tax is 40%, which is applied
to salaries (for employed dentists), or to Zurich = 100 Bucharest
benefits (for self employed dentists). It is Prices (excluding rent) 33.2
charged on net incomes above about €300 Prices (including rent) 29.9
per month (€3,500 per year).
VAT Domestic Purchasing 31.4
Power
For dental materials, instruments and
equipment, VAT is the same as for general Source: UBS August 2003
goods, 19%.
Competent and Legal Authority: Dental Associations:

Romanian Collegiums of Physicians Romanian Dental Association of Private
Timişoara Blvd., 15, Sector 6, Practitioners
061303 Bucharest 3, Voronet street, Bl.D4, Sc. 1, Ap. 1 (Floor
Tel: +40 21-413.88.00 1)
Fax: +40 21-413.77.50 Sector 3
E-mail: office@cmr.ro 031551 Bucharest
Website: Tel: +40 21-327.41.19
Fax: +40 21-323.99.69
E-mail: amsppr@dental.ro
Website: www.dental.ro
Main Specialist Associations:
Romanian Society of Oral and Maxillo- Romanian National Association Of
Facial Surgery Orthodontists
Mircea Vulcănescu street, 88, Sector 1, Tel: +40 232-211.683
010816 Bucharest Fax:
Tel: +40 21-212.63.65 E-mail:
Fax: +40 21-212.63.65 Website
E-mail:
Website:
Romanian Society of Stomatology
(Academic Association)
Ionel Perlea street, 12, Sector 1,
010209 Bucharest
Tel.: +40 21-614.10.62
Fax: +40 21-314.20.80
E-mail:
Website:
Main Professional Journals
Name: “Viaţa Stomatologică” (Dental Name: “Stomatologia” (The Stomatology) -
Life) - RDAPP RSS
Tel: +40 21-327.41.19 Tel.: +40 21-614.10.62
Fax: +40 21-323.99.69 Fax: +40 21-314.20.80
E-mail: amsppr@dental.ro E-mail:
Website: www.dental.ro Website
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Romania
Dental Schools:
Iaşi Timişoara
University of Medicine and Pharmacy University of Medicine and Pharmacy
“G.T. Popa”– Faculty of Dental Medicine « Victor Babeş » Faculty of Dental Medicine
Tel: +40 232-267686 Tel: +40 256-220480
Fax: +40 232-211820 Fax: +40 256-220480
Email: Email : stoma@umft.ro
Website: www.umft.ro
Tîrgu- Mureş Cluj-Napoca

University of Medicine and Pharmacy University of Medicine and Pharmacy
Faculty of Dental Medicine « I. Haţieganu » Faculty of Dental Medicine
Tel: +40 265-212813 Tel: +40 264 597256
Fax: Fax: +40 264 597257
Email: rectorat@umftgm.ro Email:
Constanţa Craiova
University “Ovidius” University of Medicine and Pharmacy
Faculty of Dental Medicine Faculty of Dental Medicine
Tel: +40 241 545697 Tel: +40 251 124443
Fax: +40 241 545697 Fax: +40 251 593077
Email: amariei@stomato-univ.ro Email: dentistry@umfcv.ro
Bucureşti Sibiu
University of Medicine and Pharmacy University of Sibiu
« Carol Davila » Faculty of Dental Medicine Faculty of Dental Medicine
Tel: +40 21 3155217 Tel: +40 269 436777
Fax: +40 21 3126765 Fax: +40 269 212320
Dentists graduating each year: 250 Email: medicina@ulbsibiu.ro
Oradea
Faculty of Medicine And Pharmacy
Tel: +40 259-412834
Fax: +40 259-418266
Email: medas@rdsor.ro
PRIVATE FACULTY PRIVATE FACULTY
Bucureşti Iaşi
University of Medicine and Pharmacy University « Apollonia »
« Titu Maiorescu » Faculty of Dental Medicine Faculty of Dental Medicine
Tel: +40 21 3251416 Tel: +40 232 215922
Fax: +40 21 3251415 Fax: +40 232 215900
PRIVATE FACULTY
Arad
Western University « Vasile Goldiş »
Faculty of Dental Medicine
Tel: +40 257 228081
Fax: +40 257 228081
Email: rectoratuvg@inext.ro
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Slovakia

(2002)
Currency Crown
SK42 = €1
Slovaki
a Main language Slovakian
Slovakia has a system of compulsory health

insurance and the constitution guarantees
healthcare free of charge for all the citizens.
However, in reality this has led to very low fees for
oral healthcare. Private care whilst freely available
is heavily regulated, however. In 2003 there were
just over 3,000 dentists registered of whom 61%
were female. Specialists are widely used, and the
use of clinical auxiliaries was also widespread.
Government and healthcare in Slovakia

Slovakia is a small republic, established on The currency used in 2004 is the Slovak
January 1st 1993, in the geographical centre Crown (Sk), which is estimated at Sk 42 =
of Europe. The population at the beginning €1
of 2003 was 5,379,161 (females comprising
51.4%) and the land area is 49,035 km2. All citizens of the Slovak Republic are
The capital is Bratislava (with a population compulsorily insured. The insurance
of about 400,000). The national language is benefits do not depend on the level of
Slovak. income or salary. The state and the
constitution guarantee healthcare free of
The ethnicity of the population is Slovak charge for all the citizens, to a very wide
(85.8%), Hungarian (9.7%), Romany extent, but the state may not have
(1.7%), Czech (0.8%), Rusyn, Ukrainian, sufficient resources for this care.
Russian, German, Polish and others (2%).
Two thirds of the population follow the There are 5 insurance companies. The
catholic religion. premiums are 14% of income or salary (the
self employed pay the whole amount, an
Slovakia has been independent – as part of employee pays only 4% and the remaining
the Republic of Czechoslovakia – since 10% is paid by the employer). The
1918, but separation into the current insurance is called “zdravotné poistenie”.
statehood occurred in 1993. Slovakia is a
Parliamentary democracy with unicameral The proportion of GDP spent on general
parliament, the National Council of the healthcare, including dentistry in 2002, was
Slovak Republic (Narodna Rada Slovenskej 5.7%. Of this expenditure, 89.3% was
Republiky) as a 150 seat legislative “public” (OECD Feb 2004).
authority elected by proportional
representation to serve for 4-year terms Despite an increase in incomes over the
and the government as the executive period, Slovakia saw a drop in spending on
authority. The President of the State is publicly funded healthcare (as a share of all
elected for 5 years, in a direct election by healthcare spending) from over 91.7% in
the people. 1997.
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Slovakia
Oral healthcare
Public compulsory health insurance
The principle of unlimited “solidarity” sometimes also the dental equipment.

(compulsory insurance cover) for all They are paid from the health insurance
persons does not motivate patients to take according to their output, paid fully or
care of their teeth. This means that the partly by the insurance company
state insures also non-insurable damages, (depending upon the patient’s co-
which are paid by all, also by the patients payment). The insurance company does
who take care for their teeth. not pay for the treatment, if there is no
agreement between the dentist and the
The Slovak Chamber of Dentists (see patient.
below) has attempted to harmonise the
catalogue of dental services in the Payments from insurance companies are
compulsory healthcare system, with the up to the limit of a budget. After depletion
requirements of the European Union, as of the limit, the insurance company does
defined by the European Law on Social not pay anything. In other words, the free
Security. But this has caused financial choice of dentist is circumscribed by the
difficulties, and has led to reductions in agreement between the patient and the
public expenditure. So, for example, from dentist. The patient has to have an
July 1st 2000, the share of payments for agreement with a dentist. He can then
prosthetic dentures changed to 60% paid change dentist after 6 months.
by the patient and 40% by the insurance
company. As fees paid by the insurance companies
are low, but these may not cover the
From 1st February 2000 an amendment of expenses of the practice in providing the
the Law no. 98/1995 of the Medical order prosthesis. Treatments that are not in the
came into effect. This amendment set the Medical Order must be paid for in full by
extent of the provision of dental care and the patient. This (supplementary)
the payments for dental care. The
amendment set also that the patient must
pay a part of the payment for dental
services. The Law also set the basic group
of dental services and prosthetic products
(“Part A” of the Catalogue), in which the
patient does not contribute to the payment.
The goal is to implement a model of multi-

source financing, through the system of
basic health insurance and complementary
health insurance, with the contribution of
the patient and direct payments. This is to
develop the existing model of financing,
which allows the utilisation of all sources of
accessible finances. The regulation of
prices is statutorily possible in the Slovak
Republic.
Following the appointment of the new

Minister of Health in 2002 another
reduction of public resources for the Health
Service was expected, also at the expense
of dentistry, which has never been in deficit
in the health service.
About 73% of private dentists have an

agreement with an insurance company.
The insurance company and the district are
assigned by a public dentist. These dentists
work mostly in former public institutions,
where they rent the premises, and
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payment is calculated in a free market, but attending dentists who do not have this
according to the operating costs of the agreement, they voluntarily repudiate the
practice. “advantages” of the compulsory health
insurance. Their motivation is the
In 2003, the expenditure on dentistry was accessibility and quality of the treatment.
about 2,100 million Sk (approximately The prices in private practices are different,
€51.2) and the share of the healthcare dependent on the place and region of the
budget was 3.4% provider and depend also on the overheads
of the provider. The advantage is
Private Practice particularly the visit in an exact time, which
means certain savings of time spent by
waiting in an overcrowded waiting room.
There is a relatively low percentage (9%) of Before treatment, an informed approval of
private dentists without an agreement with the choice and way of treatment is
an insurance company in the Slovak obtained.
Republic. They rent the premises or work in
private premises with their own equipment.
They are paid directly by the patient (cash)
according to their treatment tariffs. The
insurance company does not pay for
diagnosis or treatment.
Dentists in private practice, without an

agreement with an insurance company
take a free decision to work like this, but
with an authorisation of a state authority
(see below). They are not assigned any
levy, and are not bound by any agreement
with an insurance company. They work on
the basis of licence, as independent
entrepreneurs, who take free decisions on
the placement, way and extent of their
work – as part of a liberal profession.
Nevertheless, this type of practice is within

Slovakia’s disadvantageous legislative,
economical and social environment – which
includes relatively low average wages
(€4,000 per annum), and 17%
unemployment in 2002.
This original situation was caused also by

the obligation to conclude this agreement
with dentists who were in the “chain of
institutions” assessed by the Ministry of
Health. Some dentists remained in the
private sector, without an agreement first,
after the Ministry of Health assessed this
chain.
Dentists without the agreement are able to

take free decisions on the placement of
their practice and the modality of
treatment, according to the newest
knowledge and therapeutic procedures. In
this way they also are responsible for the
costs of the practice and on the level of the
income.
The system of compulsory health insurance

that does not depend on the level of the
salary is thought by the Slovak Chamber of
Dentists to discriminate against patients of
private dentists who have no agreement
with an insurance company. When
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The Quality of Care they control, for example, the invoices that
dentists send to the insurance company,
from a professional (clinical) point of view.
Patients expect a high-quality and long-
Slovakia
However, in most cases dentists are
lasting functional treatment, but this
controlled by complaints made by patients.
depends of course, as well as in the case of
A patient can present the complaint to the
dentists with an agreement, on the
revisory dentist, to the Higher Territorial
personal responsibility, skills and
Unit, to the Control Committee of each
professional knowledge of the dentist. The
regional Chamber of Dentists, to the
high standard of the equipment of the
Section of state supervision and control of
practice and the newest materials are not
the Ministry of health or directly to a court.
necessarily a guarantee of a high-quality
treatment.
On average a Slovakian dentist will see
regularly 1,870 patients, who attend every
Dental practitioners may be controlled by
1 – 2 years for their oral examinations.
revisory dentists. These are dentists
employed by an insurance company;

To enter dental school students have to certificate. Only then may a dentist lead his
pass a state school-leaving examination own dental practice, as a fully licensed
(GCE) and pass a dental studies entrance dentist. During this training the dentist is a
examination. The undergraduate course salaried employee.
lasts 6 years.
There are 3 medical faculties of medical part - the participant has to work in
universities, all state owned and financed. a hospital. The dentist works 2 months in
“Dental schools” are known as lekárska anaesthesiology and intensive medicine, 2
fakulta, and are parts of the Faculties of months in surgery, 2 months in internal
Medicine of two of the universities, in medicine, 1 month in
Bratislava and Košice .
In 2002, student intake was 47. The same

year, there were about 330 students and
52 graduated - 32 (62%) were female.

the faculties is by an accreditation
commission of the Ministry of Health.
Upon qualification, until 2003, the title was

MUDr – Medicinae Universae Doctor. A new
title MDDr was introduced for graduates
from 2004.
Following qualification, there is a

programme of vocational postgraduate
training for 36 months, under the guidance
of skilled dentists, which is a prerequisite
for obtaining a licence (the right to practise
the profession of dental surgeon). After the
training the dentist has to pass
an interview in front of a Commission which
has three members, to obtain a practice
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hygiene and epidemiology and 1 month of with an authenticated copy of the
optional specialisation. There is a diploma, an official translation and a copy
theoretical part of training (compulsory of the syllabus studied, to the Chancellor
attendance at recommended courses and of the Comenius University
lectures). It is not clear what will happen to
this essentially medical training after 2. Pass a linguistic examination of
harmonisation of education and training of knowledge of the Slovak language,
dentists with EU regulations. controlled by the Slovak Chamber of
Dentists
Registration
3. For working in private practice, an
All dentists in the private sector work under authorisation to work is necessary, from
a licence issued by the state authority, the Ministry of Health, under Law
after completing the “1st grade 277/1994 §54 ods. 9 – then a licence is
attestation”, (3-years preparation after necessary, also from the Ministry, under
graduation). The dentist has to be 277/1994 §32. Finally, contact with Vyšší
registered in the register of the Slovak územný celok (Higher Territorial Unit),
Chamber of Dentists and he has to Trnavská cesta 8/A is necessary.
substantiate to the state authority the
confirmation of his professional and ethical Employees – graduates of the Medical
eligibility, issued by the Slovak Chamber of faculty, clinical employees, who work in
Dentists. this field also have to be registered in the
register of the Slovak Chamber of Dentists,
The steps are as follows: but they do not need the licence issued by
the state authority.
1. Recognition of the diploma – this must
be done by sending a request, together
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Slovakia
Further Postgraduate and Specialist Training
Orthodontics, Maxillo-facial surgery,
Dental surgeons are under a statutory Paedodontics and lasts for 3 years.
obligation to take part in continuing
education under Law 219/2002. Control Specialist training is conducted according
over continuing education is responsibility to a given specialisation programme,
of the Slovak Chamber of dentists which determined by the Slovak Medical
supervises and provides the Quality University of the Ministry of Health. This
Assurance. institution also determines the form, length
and course of the studies. The education is
They must undertake 5 days a year, in a also supervised by this institution. The
mixture of theoretical and practical dentist’s participation in study is recorded
training. The schemes are provided by by the Slovak Medical University in the
universities, the Slovak Chamber of cooperation with the Chamber. The co-
Dentists and the dental industry. A dentist ordinating role in continuing education is
who does not complete the continuing undertaken by the Slovak Chamber of
education requirement breaks the rules Dentists together with the educational
and the duties of a member of the Slovak institutions and associations of specialists.
Chamber of Dentists, which will lead to Training takes place at dental clinics, or at
disciplinary processes. the Slovak Medical University, or in dental
practice under supervision of a specialist.
Specialist Training
The titles upon completion of the courses
Slovakia has 5 main specialties: are:
• Orthodontics
• Periodontology • Specialist in dentofacial orthopaedics
(čeľustný ortopéd)
• Prosthodontics
• Paediatric Dentistry • Maxillofacial surgeon (maxilofaciálny
• Oral Maxillo-facial Surgery chirurg)
Dental surgeons are also entitled to

• Specialist in paedodontics
(Pedostomatológ)
specialist education and training. For
specialist training a dentist has to graduate
Since 2003 training for periodontics and
from his studies (and obtain his primary
prosthodontics has ceased (it was 3 years),
diploma) and then complete the one-year
but those who have already qualified in
postgraduate traineeship. Study in the
these specialisms and those entering
Slovak Republic can be taken in three
Slovakia from abroad are recognised as
specialisations -
such.
Registration of specialists, like all dentists,

is by the Slovak Chamber of Dentists.
Workforce
Dentists

dentists in Slovakia, of whom 61% were The population per active dentist was 1,812
female. It was estimated that 2,968 were
actively working (61% female). 82% of Total (2003) 3,084
active dentists work in private practice
(73% with an agreement, and 9% with no In active practice 2,968
agreement with insurance companies). Private practice 2,433
Salaried private 287
It is reported by the Chamber that in 2003 practitioners
there were unemployed dentists
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Public dental service 249 The Chamber expects that the active
dental workforce will decrease. Almost half
Academic dentistry 93
of all active dentists are over 50 years and
Armed Forces 13 it is presumed that during the early years
of the century more dentists will leave their
practices due to reaching retirement than
will join the profession.
Specialists
In 2002, there were 5 specialties in

Slovakia:
• Orthodontics
• Periodontology
• Prosthodontics
• Oral Maxillo-facial Surgery
There is a specialist register held by the

Chamber.
Patients do not go directly to specialists

and are always referred.
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They cannot work on their own, without a
Numbers of specialists dentist. They must be employed by a
(2002) dentist. They can diagnose, but only to the
Orthodontists 150 extent of the nature of their work. So, they
Periodontists 87 can diagnose the periodontal diseases, by
Prosthodontists 59 assessing PBI, CPITN, the status of loose
teeth, the level of inflammation of the
Slovakia
Paediatric dentists 69 gingivae and so on, but they cannot assess
Oral Maxillo-facial 29 whether the extraction of a tooth should be
surgeons made (and other such cases) that only a
dentist would assess.
They cannot give local anaesthetics, nor

can they accept monies from patients,
Auxiliaries although they may sell oral healthcare
products such as toothbrushes.
There are three kinds of clinical auxiliaries
in Slovakia – Dental Hygienists, Dental Hygienists would normally earn €200 -
Technicians and Clinical Dental €300 per month (2003). Whilst there were
Technicians. Additionally, there are dental 270 hygienists, it was not possible to
nurses and receptionists. estimate how many were actively working.
Dental Technicians
Numbers (2002)
Hygienists 270 Training for dental technicians is conducted
Technicians 1,989 at secondary schools. The length of the
course is 4 years and the student gains the
Chairside assistants 2,500 title Dental Technician. Without this title
they cannot open their own laboratory.
If auxiliaries are employed at public For opening their own laboratory a
establishments they are full-time technician has to pass 2 years of super-
employees; in private establishments and structural study and obtain the title
in the case of private practice they may Diploma’d Dental Technician. He or she
either be a full-time or part-time or in other then has to register at the Slovak Chamber
forms of employment provided for by the of Dental Technicians.
law. The provisions of the labour code are
binding. Technicians can work in commercial
laboratories, or be an employee of a dentist
In non-public establishments various forms or of a clinic. Technicians who work in a
of employment envisaged by the law occur. public health care establishment would
This means that whether work is full-time normally earn €500 per month (2003). In
or part-time, there must be prior 2003, the total number of dental
agreement on the execution of a work and technicians was 1,989. It was reported that
the working activity. 1,547 were actively working - of these,
1,051 were registered dental technicians,
and 496 employed by the public dental
Dental Hygienists service.
The training for dental hygienists is There is a report from the Chamber that
conducted at state medical schools. There there is some illegal practice of dentistry by
are two schools in Slovak Republic, in denturists in Slovakia.
Bratislava and in Prešov. The training is 2
years in the form of superstructural study. Dental Assistants (Nurses)
Then the dental hygienist obtains a
professional title, Diploma of Dental They are educated at secondary schools for
Hygienist. They are registered at the 4 years, with a leaving examination -
Association of Dental Hygienists. baccalaureat. They work at the chairside,
as employees of dentists. A dentist may not
undertake treatment without the presence
of a dental assistant.
It is estimated that there were 2,500

chairside assistants in 2003.
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Slovakia
Practice in Slovakia
Working in Liberal (General) Dentists in general practice would normally
Practice have incomes in the range of €400 to €650
per month.
In 2003 there were 2,433 dentists

Working in the Public Clinics
practising in their own private practice, as
owners of establishments, or co-owners in
partnerships, or exclusively in their own There are public polyclinics in the Slovak
private practice. There were an additional Republic. These are clinics which include a
287 who were employed by their number of health professionals
colleagues.
Fee scales
“Liberal” practitioners calculate their own

prices (a price list must be displayed on the
wall of the practice). Net profit can be a
maximum of 30% (according to Law No. 18/
1996 about prices). This is checked by the
fiscal bureau/ office. A dentist whose profit
is more than 30% breaks the law on prices,
which may lead to a fine or other sanctions.
Every dentist has to be a member of the

Chamber according to the Law No.
219/2002. When establishing a practice
s/he has to obtain permission - for this he
or she has to present a statement to the
Slovak Chamber of Dentists, on the
professional and ethical eligibility and on
the equipment of the practice -
requirements according to Regulation No.
40/1997).
There are no limitations as to the building

type, but there is a limitation as to the
minimum size of the floor area. There is no
regulation relating to the number of
partners (employees) or the number of
patients.
The state does not subsidise the costs of

opening an individual practice or
establishment.
Once established, the dentist must be

registered in the regional chamber. They
may form a company or register their own
establishment or clinic. They may not start
their own practice until 3 years have
passed from the moment of completion of
their postgraduate traineeship and obtain
the right to practise in the profession.
Patient lists must be kept - this means that

the dentist has to have a written
agreement with all patients and must
retain the documentation for all the
patients.
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(including dentists) supply health services

in the same venue. They do not supply Working in Universities and
hospital-type services. They may be owned
by the municipality or even private
Dental Faculties
individuals.
There are 3 medical faculties in the Slovak
Every insured person may benefit from Republic, but only 2 include the
attending them, but they may also provide specialisation of “dentistry” as part of their
services paid directly by the patient. All teaching. About 93 dentists work in these
clinical controls are the same, but the two “dental schools”. They normally are
responsibility for the facilities lie with the full-time employees of the University, and
owner of it. their salary range would be up to €400 per
month. They may be allowed the
Persons employed at public establishments combination of part-time teaching
receive a fixed remuneration (salary). Their employment and private practice (with the
income would be in the range of €250 to permission of university).
€400 per month.
Working in Hospitals • Academic (for teachers): Doc. (Docent),

Prof. (Professor)
Hospitals are public property. They tend to • Scientific: CSc. (Candidate of Science),
be clinics and university hospitals and DrSc. (Doctor of Science), PhD
certain hospitals in larger cities. There are
a small number of private hospitals run, for This involves a further degree (publication
example by the Church or individuals. activities and a record of original research).
Procedures tend to be maxillofacial
surgery, undertaken by maxillofacial
surgical specialists. Working in the Armed Forces
Hospital dentists are paid for full-time work
There are 13 dentists working in the armed
about €400 - 500 a month, or a part-time
forces. Four are professional soldiers and 9
equivalent.
are employees in army institutions.
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The main dental association is the Slovak Dentists, which means that the dentist may
Chamber of Dentists. The endeavour of the not continue to practise.
Chamber is to reach an independent,
equitable and serious evaluation of the Advertising
work of dentists, and to create an
environment and conditions for a high- Dentists may inform the public of the
quality provision of dental services for dental service they provide but the content
patients on an international level, in all the and form of such information must also be
dental practices in Slovakia, and to move exempt from the features typical of
the development of Slovak dentistry commercial advertising.
towards a modern Europe. Membership of
the Chamber is compulsory. According to the ethical code, a dental
surgeon must not impose his/her service,
The Slovak Chamber of Dentists has 8 or gain patients, in a manner inconsistent
Regional Chambers. The chambers are with ethical and deontological principles,
self-governing organisations, which and the rules of loyalty to fellow
associate dental practitioners. They were practitioners. Information may be placed in
brought into existence under the Act No. the press. S/he can present medical
219/2002 and the compulsory membership themes in front
is by virtue of this Act. The important
constituent parts are:
Statutory body: The President
Bodies of the Chamber:
• Assembly (highest body, meetings are

held minimum once a year, usually twice a
year)
• Council (meets 4 times a year)
• Presidium (once a month)
• Control Committee
• Honourable Council
Ethics
Ethical Code
Dental surgeons are bound by the ethical

code. The ethical code is a part of the Act
No. 219/ 2002. This act defines the duties
regarding membership of the Chamber and
the duties concerning the provision of
services. The sanctions against dentists
who break the ethical code are defined in
the § 42 of the Act No. 219/ 2002. This may
lead to an admonishment. If s/he
repeatedly fails to respect the
admonishment, then a fine of up to Sk
10,000Sk (€240) may result, from breaking
the obligations of a member of the Slovak
Chamber of Dentists. This may double, to
Sk 20,000 (€480) when breaking the duties
that he/she has in the context of the
performance of the profession. The
ultimate sanction is to be excluded from
membership of the Slovak Chamber of
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of the public, in TV, radio, or press. S/he
cannot act unworthily to augment the Dentists, and those who work for them, do
number of his/her patients. not have to be inoculated against Hepatitis
B and later be checked regularly for sero-
Every dentist may run his/her own website. conversion, but the risk-holder is then the
However, in 2003, the ethical code did not employer.
contain a chapter on the regulations
following from the Electronic Commerce
Directive.
Data Protection
Act No. 428/2002 on the Protection of

Personal Data regulates the use of
information. This act is based on the EU
Directive.
Indemnity Insurance
It is compulsory for dentists to have

malpractice insurance. Insurance is
concluded with insurance companies active
on the insurance market. The amount
covered is for claims up to 1,000,000 Sk,
(€24,000). When the dentist provides
surgical services also, it can be over
1,000,000 Sk. A patient is entitled to lodge
a complaint and demand compensation
before court. Every dentist has to be
insured against civil liability for the practice
of his/her profession.
Insurance is concluded with insurance

companies active on the insurance market.
The Chamber has a collective contract of
insurance covering members of the
Chamber, and also the secretariat of the
Chamber, with the insurance company
Allianz. Very often the insurance packages
include other types of insurance as well
(such as surgery, flat, house, car, etc.). The
insurance rate is not conditioned by the
form of practice, whether it is under
employment contract or private. But it does
depend on the value of the equipment.
Slovak dentists combine both forms and
work both under employment contract and
pursue private practice. If there are claims
on the part of the patient and a public
establishment is involved, the
establishment is liable. Nevertheless, if a
dentist’s fault is proven, the establishment
may claim return of the incurred costs. The
cost of cover up to Sk 1,000,000 for a non-
specialist would be about Sk 6,000 (€140).
Corporate Dentistry
Dentists in Slovakia may form companies.

A non-dentist can be a shareholder,
member of the board, or even the owner of
the company, but when s/he is an owner he
has to have a professional guarantor.
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For Administered by
Ionising radiation State Medical Institute
Electrical Revisory technicians authorized
installations and by the
Electrical devices State testing institution
Waste disposal Ministry of environment
Medical devices State Medical Institute
Infection control State Medical Institute
Financial Matters
The income ranges dentists would have expected to earn in 2002 (annually):
Dentist 25 years old or Dentist 45 years old or

2 years after 20 years after
Liberal or General cca. €4,500 – 6,000 cca. €6,000 – 7,500
Practice
Hospital cca.€3,900 cca. €4,800 – 6,000
Public Health cca.€3,000 cca. €4,800
Academic cca. €4,500
The normal retirement age is 60 for a man and variable (according to the following
table) for a woman:
man woman
Number of Always 60 0 1 2-3 4-5 More
children
Retirement age 57 56 55 54 53
A dentist may work beyond normal In 2003 the rate for dental materials and
retirement age. The pension depends on equipment was 14%.
the number of years that the dentist has
worked, and also on the salary or profit
through his/her life.
Taxes
There is a national income tax: the highest

rate is 38%, which is charged on net
incomes above 564,000Sk (€13,430).
VAT
The rate of VAT in Slovakia is 14% and 20%

but this going to be unified in due course.
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2003
Zurich = 100 Bratislava

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418
Slovakia
Competent authority:
For authorisation & licence: For recognition of a diploma:
Ministry of Health Chancellor of the Comenius University

Sekcia zdravotníckej starostlivosti Šafárikovo nám. 6
Limbová 2, 818 06 Bratislava 16
PO Box 25, Tel.: +421 2 52 92 15 94
Bratislava 37 or +421 2 59 24 41 41
Tel: +421 2 59 37 33 81 Fax: +421 2 52 96 38 36
E-mail: kr@rec.uniba.sk
Professional Association: Main information centre:
Slovak Chamber of Dentists Ministry of health

Fibichova 14 Tel: +421 2 59 37 31 61
821 05 Bratislava 2 Fax: +421 2 54 77 76 59
Tel: +421 2 43 29 31 22 E-mail: ozv@health.gov.sk
Fax: +421 2 43 41 31 98 Website: www.health.gov.sk
Email: dent@skzl.sk
Website: www.skzl.sk
Major Specialist Associations: Details of indemnity
organisations:
Name: Slovenská ortodontická Name: Všeobecná zdravotná
spoločnosť poisťovňa
Tel: +421 2 65 42 23 05 Tel: +421 2 67 27 71 11
Fax: none Fax: +421 2 62 41 26 31
E-mail: alex1@netax.sk E-mail:
Website: none Website: www.vszp.sk
President/ contact person: Dr.
Gabriela Alexandrová
Name: Slovenská stomatologická

spoločnosť Sekcia Maxillo-faciálnej
chirurgie
Tel:
Fax:
E-mail:
Main Professional Journals:
Name: Zubný lekár Name: Stomatológ
Tel: +421 2 43 29 31 22 Tel./Fax: +421 2 84 24 13 50 60
Fax: +421 2 43 41 31 98 E-mail: redakcia@vydosveta.sk
E-mail: zubnylekar@skzl.sk Website:
Website:
EU Manual of Dental Practice 2004
_______________________________________
Slovakia
Dental Schools:
Medical Faculty with specialisation Medical Faculty with specialisation in

in dentistry dentistry
Bratislava Košice
Univerzita Komenského Univerzita Pavla Jozefa Šafárika
Lekárska fakulta Univerzity Komenského Univerzita P. J. Šafárika v Košiciach
Špitálska 24 Lekárska fakulta
813 72 Bratislava Trieda SNP č.1
Tel: +421 25 9357 466 or 52 961 040 11 Košice
736 Tel: +421 55 6428 141
Fax: +421 25 9357 201 or 52 925 Fax: +421 55 6428 151 or 6420 253
574 e-mail: gdovin@central.medic.upjs.sk
e-mail: sd@fmed.uniba.sk Website: www.medic.upjs.sk
Website: www.fmed.uniba.sk
The medical faculty in this university

does not have any
specialisation in dentistry
Martin
Name of University: Univerzita
Komenského,
Jesseniova lekárska fakulta
Jesseniova lekrska fakulta Univerzity
Komenského
Záborského 2
PO Box 34
036 45 Martin
Tel: +421 43 4133305
Fax: +421 43 4136332
e-mail: sd@jfmed.uniba.sk
Website: www.jfmed.uniba.sk
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Slovenia
Population 1.97
million
Currency Tolar
(SIT)
238 SIT = €1
Main language Slovene
Slovenia has a healthcare system which

depends on the compulsory membership of
citizen through a national social insurance
system (HIIS). About half of dental care is
Sloveni provided in general practice and half in
a municipal clinics, in the HIIS. There is some
fully liberal private practice. In 2004 there
were 1,533 dentists registered in Slovenia of
whom 61% were female. Specialists are
widely used, but there are no clinical
Government and healthcare in Slovenia
The Republic of Slovenia lies at the heart of

Europe, bordering the Alps and the Adriatic Healthcare is a constitutional right for all
Sea. There are four neighbouring adjacent citizens. In Slovenia most healthcare is
countries: Austria, Italy, Croatia and provided through a national social
Hungary. The country has a land area of insurance system. There are three levels in
20,273 sq km. the healthcare
Slovenia was formerly part of the Republic

of Yugoslavia (until June 1991), and
proclaimed its independent constitution in
December 1991. The constitutional system
is a parliamentary democracy. Slovenia had
a population of 1,965,986 in 2003 of whom
87.9% were Slovenes, 0.16% Italian, 0.37%
Hungarian and 11.57% others. The capital
city is Ljubljana.
The official Language of Slovenia is

Slovene. The majority of Slovenes are
Roman Catholic.
The President of the Republic is elected

directly by the people, and the Prime
Minister by the National Assembly. The
unicameral National Assembly or Drzavni
Zbor has 90 seats - 40 are directly elected
and 50 are selected on a proportional basis
(the numbers of directly elected and
proportionally elected seats varies with
each election; members are elected by
popular vote to serve four-year terms).
There are some selected seats based on
minorities, so that there is one seat each
for Italian and Hungarian minorities.
__________________________________________________________________
421
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system. The first level is the responsibility
of the local government. For secondary and There are also two more health insurances,
third levels (hospitals and clinics), these for non-compulsory health insurance. Their
are the responsibility of the state titles are the Mutual Health Insurance
government. (Vzajemna zdravstvena zavarovalnica) and
the Adriatic Insurance Company (Adriatic
There are three organisations providing zavarovalna družba). In 2003 another
health insurance. The first one, the Health insurance company started: Triglav
Insurance Institute of Slovenia - ,Zavod za insurance company (Triglav zavarovalna
zdravstveno zavarovanje Slovenij - (HIIS), is družba).
for compulsory health insurance. Every
resident in Slovenia must be registered in Public health care is budgeted for by
this health insurance institute and the Parliament after proposals by Health
majority outlay for healthcare is paid from Insurance Institute of Slovenia. The
this insurance. The members are proportion of GNP spent on general
democratically elected, but the executive healthcare, including dentistry in 2002 was
director must have the agreement of 8.8%
parliament. The main function of the HIIS is
to conclude agreements with public oral
health institutes and private dentists.
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Oral healthcare
Public compulsory health
insurance
There are also 1.6% employed dentists in
The majority of the oral health services are the private practice of other dentists. Of
organised in same way as the general the remaining 49.6% of dentists, who work
healthcare system. The dental services are in the State system, some will also work
delivered through the system of public privately, part-time.
clinics, municipal health centres or by
private dentists.
Private care
Public compulsory health insurance
provides dental cover for all patients of 0 to There are 139 fully private (liberal)
18 years of age, all removable and fixed dentists, almost all working full-time, who
appliances, and for adults, surgical items, work as independent professionals,
some basic prosthodontic treatments, although most are self-employed or in
periodontal and conservative treatment partnership. In fully liberal practice,
such as fillings and endodontics. Some patients must pay the full cost of their
cover for this treatment is borne by the dental care, at a price directly negotiated
non-compulsory health insurance. Some with the dentist.
treatments – such as for cosmetic
treatments, porcelain crown and bridge and
implants have to be paid for in full by the Private health insurance does not exist in
patient. There is no annual limit of Slovenia.
treatment range for an individual patient.
The Quality of Care
A full-time working dentist would normally
have a list of 1,800 patients attending For dentists who have agreements with the
regularly. Oral re-examinations would HIIS, the quantity of work is monitored by
normally be carried out for most adult them.
patients every 9 months. It is estimated
that about 40% of the whole population For private dentists, work is monitored by
access dentistry in a 2-year period. The Medical Chamber of Slovenia for
minimal price and government market
In Slovenia about 7.6% of the public inspection (see below, Working in General
healthcare budget is spent on dentistry (ie Practice).
0.7% of all governmental spending),
although it is estimated that about 1.9 % is For all dentists, the quality of work is
paid directly by patients for non-obligatory monitored by the Chamber. There are
insurance, for dentistry, in addition. routine checks and also if someone has
made a complaint (patient, other
48.8% of dentists are in private (general) colleagues, insurance companies or the
practice. Of these, 38% dentists have a Ministry of Health). The Professional
contract with the HIIS and 10.8% are fully Medical Committee of the Chamber carries
private. out the investigations (see Ethics)

There is one dental school, which is state-
funded. The school is known as Medicinska
To enter the dental school a student needs
fakulteta, Odsek za stomatologijo, (Faculty
to be a secondary school graduate
of Medicine, Department of Oral Medicine)
(including a school leaving examination,
of the university. For details of the school,
known as matura exam, with a good score).
see Dental School
There is no entry examination and no
vocational entry, such as from being a
qualified dental auxiliary.
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423
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In 2002, student intake was 55 and 60% of
the students (33) were female. The same
year, there were 40 graduates and 60%
were female. Dental undergraduate The Ministry of Education, Science and
training is for 6 years. Sport monitors the quality of the training
and the Council of the Faculty is directly
responsible.
Upon qualification, the graduates receive

the title "Doktor dentalne medicine”
(dr.dent.med.).
Registration
The Medical Chamber of Slovenia registers

all the physicians and dentists. It is
necessary to know the Slovenian language.
Slovenia
Vocational Training (VT) the examination leads to a loss of licence
to practise.
Slovenia
There is a 12-months’ period of vocational Specialist Training
training necessary following graduation.
The Ministry of Education is responsible for Before entering into specialist training
the supervision of this. The trainees are dentists must have completed their 1 year
paid a salary of €700 per month, from the post-qualification training. The specialist
Ministry. training is undertaken in Stomatology
clinics, private and public health institutes
This post-qualification training has a which are licensed to provide this.
practical part (the participant has to fulfil a
list of prophylactic, diagnostic and • Oral Surgery
treatment items) and a theoretical part • Orthodontics
(compulsory attendance on recommended • Conservative Dentistry & Endodontics*
courses and lectures). There is a final • Prosthetic Dentistry
examination, which must be passed to work • Preventive and Paediatric Dentistry
as a dentist.
• Oral Medicine and Periodontology
* this was a new
Diplomas from other EU countries have specialisation in 2002
been recognised without the need for
vocational training since May 2004. In 2003 there were 29 dentists undertaking
specialist training – 13 males and 16
females. There are limited numbers who
Further Postgraduate and may undertake training, all of which is for 3
Specialist Training years, except Oral Surgery, which is for 4
years. A specialists’ degree is received on
completion of training. The title given is
Specialist for Orthodontics, Specialist for
Continuing education is compulsory for all Oral Surgery etc.
dentists. Every physician and dentist must
undergo 75 points (about 10 courses) of The Medical Chamber of Slovenia is
continuing education in every 7 year responsible for the registration of
period, provided by the Chamber. The specialists.
responsibility for the supervision of this lies
with the Chamber. If the dentist does not
fulfil this 75 points obligation, then he must
undertake an examination. Failure to pass
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424
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Workforce
Dentists
Specialists
In Slovenia, there are 1,533 dentists (2004)
There are 6 classes of specialists in
– 61% being female. The number of
Slovenia:
“active” dentists was reported by the
dental association as 1,285, in 2004 (67%
female). The 139 private dentists (almost • Oral Surgery
all working full-time) work as independent • Orthodontics
professionals, although most are self- • Conservative Dentistry & Endodontics
employed or in partnership. • Prosthetic Dentistry
• Preventive and Paediatric Dentistry
The dental workforce is decreasing as 573 • Oral Medicine and Periodontology
(ie nearly half of) practising dentists in
2003 were over 50 years of age. All specialists see patients on referral from
a primary dentist, only.
1,530. Numbers of
specialists (2002)
Total (2004) 1,533 Oral Surgeons 29
General practice (HIIS and 648 Orthodontists 79
private*)
Periodontists/Endodontis 37
Public clinics 592 ts
Hospitals 3 Prosthodontists 34
University 42 Paediatric dentists 34
Armed Forces 0 Oral Maxillo-facial 15
* The 648 in General Practice included 139 surgeons
in fully liberal (private) practice
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425
_______________________________________
Slovenia
Auxiliaries
There are no legal clinical dental auxiliaries A full-time dental technician would expect
in Slovenia. However, the first special to earn €9,000 (a laboratory owner would
training school for dental hygienists started earn double this, on average).
in 2003. The school is privately financed,
and training will be for 2 years, so there will In 2000 (latest figures), there were 464
be hygienists in Slovenia from 2005 technicians.
onwards. They will receive the diploma of
Dental Hygienist, which will not be Dental Nurses (Assistants)
registerable initially.
Dental nurses are paid a salary. They assist
There are Dental Technicians and the dentist.
additionally, dental assistants.
There are no special schools for dental
Dental Technicians assistants and it is necessary to be a
trained nurse to be a dental assistant.
Dental technicians are trained in dental However, they are often first medical
technician secondary schools, for 4 years nurses after which they are trained by the
and then may go to colleges, organised in dentists where they work.
frame of the dental faculties. To work, they
must register with the Economy Chamber. In 2002 there were about 1,376 nurses. The
majority of dental assistants are nurses,
Dental technicians normally work in but several are dental technicians and from
separate dental laboratories and invoice other professions. They have their own
the dentist for the work done. A small representative organisation, but
number of technicians are employees of membership is not obligatory
dental offices and they are paid with a
percentage of the fees for the prosthetics
work.
Practice in Slovenia
In 2003, there were 1,285 active dentists patient payments for other (fully private)
working in the Slovenia: work.
139in (fully private) non-salaried general Each year new prices are scheduled as a
practice result of negotiations between the HIIS,
20 employed in the private practice of delegates of the Chamber and the Ministry
another dentist of Health. The prices of items fully covered
489in salaried general practice (they may by the insurance system are the same
also treat fully private patients) across the country. For dentists working
42in the clinic in Ljubljana (Stomatološka within the system of the HIIS (contractual)
klinika v Ljubljani) these prices are obligatory.
3 in hospitals
592in municipal health centres For payment, the contracted dentist sends
an invoice with the list of patients and the
So, 46% of dentists work in public provided dental care, to the health
municipal health centers, 38% dentists insurance company, monthly (by e-mail).
work in a general practice (salaried) and The payment by
10.8% general practice (non-salaried).
In Slovenia general practitioners may work

in the HIIS and in fully liberal practice, or as
has been stated above may be in fully
liberal private practice only. There is only
one system of payment, which is Item of
Treatment Fees, for HIIS work, and direct
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426
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the insurance company is also monthly (by Working in Public Clinics
lump sum) and at the end of the year, a
final payment. Dentists who work in the Public Service are
salaried and work in public clinics. As
There is no prior approval for treatment stated above, nearly half of Slovenia’s
necessary - only the consent of the patient, dentists work there. These municipal
established freely and directly together ambulatory dental departments offer
with the dentist. common dental care for any citizen, also
paid by HIIS care. All other conditions are
For fully private dentists, the contract is the same - the difference is only of the
between the dentist and the patient, who ownership.
must pay the full cost of the dental care,
directly negotiated with the dentist. But They earn about €900 to €1,600 a month.
compliance with minimum prices is They may treat patients outside the public
monitored by the Chamber (see above, dental service, for example after normal
Oral Healthcare). work in an afternoon, if they have the
permission of the Director of the Clinic.
Joining or establishing a practice The quality of dentistry in the public dental

service is assured through the Medical
There are no stated regulations which Chamber.
dental practices. There are also no other Working in Hospitals
factors which effectively restrict where
dentists may locate. Any type of building
In Slovenia, only 3 dentists work in
may be used if this fulfils the legislative
hospitals. All of these dentists are
claims to be a dental practice. But rules do
employees of the hospitals, which are
exist which define, for example, the
owned and run by the state government.
minimum size of rooms, the equipment for
They undertake oral and maxillo-facial
a dental practice, and the standards of
surgery.
hygiene.
They are salaried and earn about €1,100 to
Normally dentists practise on their own,
€1,900 a month.
without another dentist in the practice.
Rarely, they practise as two dentists
together. There are a few large practices,
with joint owners. Anyone may own a
dental practice, but non-dentists need a
dentist present during working hours.

€1,600 per month.
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427
Slovenia
_______________________________________
Working in Universities and Prof.dr ……… dr.dent.med., višji svetnik

Dental Faculties
Study for a PhD is also required for the
positions of docent and professor; it also
There is 1 dental school, in which about 22
necessary to pass an “habilitation” - this
dentists work. They normally are full-time
involves the further degree and a record of
employees of the University, and their
original research, and a public lecture in
salary range is €900 to €2,500 per month.
front of the Scientific Council of University.
They allowed a combination of part-time
teaching employment and private practice Working in the Armed Forces
(with permission of university).
In 2003, no dentists served full-time in the
Armed Forces.
Asist………….dr.dent.med.
Asist.mag.….. dr.dent.med.
Doc.dr. ………dr.dent.med.
Prof.dr. …….. dr.dent.med.
The Slovenian Medical Chamber is the
the Chamber is where democratically
national professional association. All the
elected representatives meet as delegates.
physicians and dental practitioners who
The President of the Medical Chamber is
intend to practise medicine or dentistry in
directly elected by all physicians and
Slovenia have to belong to the chamber, as
dentists. One of the two Vice Presidents of
these are the chambers that award the
the Chamber has to be a dentist. The term
right to practise medicine or dentistry.
of office for officers is 4 years.
The Slovenian Medical Association is an
Dental practitioners are represented at all
independent, professional, democratic,
organisational levels of the Medical
public body of all physicians and dentists
Chamber. The representation of dental
working in Slovenia. Its aims, objectives
practitioners is secured in the Executive
and activities are determined by statute.
board of the Medical Chamber of Slovenia.
There is equal status for both physicians
and dental practitioners. The Assembly of
The tasks of the Slovenian Medical Chamber are:
• exercising care over conscientious practice, protecting the prestige of physicians and dentists
• preparing, performing, controlling and updating of decisions concerning the quality and conditions of
medical practice, expressing its opinion on matters concerning public health and health policy of the
state with its national and provincial local bodies, in cooperation with other associations and
institutions in Slovenia and in foreign countries: Communication of the standpoints of the medical
profession on matters of health policy and medicine
• setting the principles of professional ethics. Ethical Code: regulate ethical and professional obligations
of physicians and dentists among themselves and vis-à-vis patients
• defending individual and collective interests of members, offering mutual aid and other forms of
assistance to members
• expressing its opinion on matters concerning postgraduate education of physicians and dentists,
taking part in its realisation
• Promotion of quality assurance
The Slovenian Medical Chamber performs the tasks by means of
• keeping the register of physicians and dentists
• cooperation in working out the general conditions of contracts between physicians/dentists and the
National Health Insurance Fund
• delivery of opinions on draft legislation concerning the protection of health and practising as a
physician or dentist
• making decisions with respect of inability to practise as a physician or a dentist
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Slovenia
• professional and ethical supervision of members

• negotiating conditions of work and remuneration
• defending individual and collective interests of the members
Ethics
by law, but is strongly recommended by
Ethical Code The Medical Chamber.
There is a written ethical code in Slovenia. Corporate Dentistry
The Chamber has a Professional Medical Anyone may own or invest in a dental
Committee which investigates complaints practice. The person undertaking the
against and the quality of care given by dentistry must be a dentist but there is no
Slovenian dentists. There are also Medical requirement for the investors to be
courts, which are part of the Chamber. This dentists.
executive body has the responsibility to
censure dentists, or ultimately to remove Health and Safety at Work
their licence to work, for life.
Dentist, and those who work for them,
Advertising must be inoculated against Hepatitis B. The
employer usually pays for inoculation of the
Advertising is permitted, under the dental staff.
framework of the ethical code, but this is
very limited. It is restricted to information Regulations for Health and Safety
on name, title, telephone number, address,
specialisation and consultation hours – and For Administered by
is only permitted when a dentist opens a
new practice or changes location of an Ionising radiation Institute of Occupational
existing practice. Safety
Electrical Institute of Occupational
Slovenian dentists may use websites, installations Safety
within the ethical considerations - although Waste disposal Ministry of Health
the ethical code does not include a specific There is compulsory
section on the issue. contracting with special
companies who transport
Indemnity Insurance and dispose of waste
Indemnity insurance is taken out with
commercial companies, at a cost of about Infection control Ministry of Health
€200 per year (2003) (it is possible to
choose the level of cover). It is not
compulsory
Financial Matters
Dentists’ Incomes: Practice year
Public Health €10,800 €19,200 per
year
Dentist Dentist 45 Hospital €13,200 €22,800 per

25 years years old or year
old or 2 20 years
University €10,800 €30,000 per
years after
year
after qualification
qualificati
on
General €10,800 €19,200 per
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429
_______________________________________
Retirement pensions and Various Financial Comparators @ July
Healthcare 2003
The set age for retirement is 58 years, for Zurich = 100 Ljubljana
males after at least Prices (excluding rent) 55.0
40 years of work, and for females after 38
years of work. Dentists may practise until
they are 75 years of age. Wage levels (net) 17.6
The contribution rate for state pensions is
€700 per year, and this gives a state
pension of about €1,000 year on Source: UBS August 2003
retirement. But for optional additional
private pensions the level depends upon
the contributions made.
Slovenia
Taxes
The top rate of tax is 25% and is charged

on net incomes above €5,000 per year.
VAT
For dental materials, instruments and

equipment, VAT is the same as for general
goods, 20%.
Slovenia
Competent and Legal Authority: Dental Association:
Name: Ministry of Education, Science The Medical Chamber of Slovenia
& Sport Komenskega 4
Tel: +386 1 478 4600 1000 Ljubljana
Fax: +386 1 478 4719 Tel: +386 1 307 2100
E-mail: Fax: +386 1 307 2107
Website: http://www.mszs.si E-mail: zdravniska.zbornica@zzs-mcs.si
Website:
Dental School:
Ljubljana
The Dean
Faculty of Medicine
Department of Stomatology
Hrvatski Tr g 6
1000 Ljubljana
Tel: +386 1 543 7700
Fax:
E-mail: stoma@mf.uni-lj.si
Website: http://animus.mf.uni-
lj.si/~stoma/
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431
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432
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433
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Spain
Currency Euros
Main language Spanish (also,
Catalan,
Basque,
Valencian, and
Galician are
spoken)
Spain Comprehensive health care is available to all by law.

However, Dentistry, Psychiatry and Cosmetic
services (for example, Plastic Surgery) are excluded.
Hospital and Primary Medical care is free at the point
of delivery. There is a small Public Dental Service
which operates in Primary Health Care Units
(Ambulatorios) managed by Insalud or the regions.
This only provides emergency care. Private care is
freely available, however. In 2003 there were nearly
20,000 registered dentists (41% female) of whom
about 75% were active. About 98% of dental care is
delivered in general practice. Specialist care is very
limited and clinical auxiliaries are limited to
Government and healthcare in Spain

Spain is a democratic country with a elective surgery is controlled by waiting
population of 40,077,100 in 2002. The lists.
capital is Madrid. Spain has a history of
centralist government supported by a In regions that do not yet have a health
regional structure. Currently, all the regions competency, services are provided by
have autonomous powers. Autonomy Insalud (Sistema Nacional de Salud).
operates through a system of ‘delegated Medical staff who are employed by Insalud
competencies’ e.g. health, education, are not well-paid and usually supplement
police etc., and the central government their income through private practice.
retains authority for foreign policy and When competencies are introduced, better
defence.
At present there are 17 Regions

(Autonomias), and two autonomous cities,
governed by elected local politicians. Some
of these already have delegated ‘health
competencies’ which largely operate
through programmes which complement
national laws. To manage these
programmes, each region has established a
health care institution, for example, the
Catalan Institute of Health, Andalusian
Health Service etc.
In Spain, comprehensive health care is

available to all by law. However, dentistry,
psychiatry and cosmetic services (for
example, plastic surgery) are excluded.
Hospital and primary medical care is free at
the point of delivery but there is a charge
for medicines unless the medicaments are
provided directly. The charge varies
according to the drugs prescribed but an
average is 70% of the total cost. Access to
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pay and conditions for more committed national minimum wage and the minimum
hours are often negotiated and waiting lists social security payment. This system
are usually reduced. In some regions, ensures equity and applies to all citizens
social security funds buy private services except government employees who have a
rather than creating public systems. special agency for pensions and health.
The agency operates a compulsory
Generally, healthcare provided by the insurance scheme which allows civil
government or the regions is funded by servants to choose between private or
deductions from earnings, supplemented state care. The scheme for government
by employers for their employees. These employees includes limited dental care.
payments are aggregated into a national
social security pool from which pensions Patients in Spain do not attend for dental
and unemployment and sickness benefit care on a regular (periodical) basis, but
are also funded. There is therefore an tend to go when they have dental
annual budget for health, although the problems, only. There is no form of
social security fund is often in deficit, which domiciliary (home) care.
is met from national taxation.
Individual contributions are progressive and healthcare, including dentistry in 2002, was
depend on income, with an annual 7.5%. Of this expenditure, 71.4% was
collective agreement which sets the “public” (OECD Feb 2004).
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435
_______________________________________
Spain
Oral healthcare
Almost all oral healthcare in Spain is Previasa and Sanitas offer more
provided by private practitioners and comprehensive dental care for an
patients usually pay the total cost. There is additional premium. However, only 8% of
a small Public Dental Service which the population (2003) use these private
operates in Primary Health Care Units insurance schemes to cover their dental
(Ambulatorios) managed by Insalud or the care costs.
regions. This only provides emergency
care such as extractions or the prescription All such schemes are personal plans, where
of antibiotics, although patients may be individuals insure themselves by paying
referred to an oral surgeon if necessary. premiums directly to the insurance
Care is usually offered for a limited period companies. The companies then pay fixed
each day (3 to 4 hours), and its provision is fees to the dentists for treatments which
a legal requirement. Regions which are are covered by the companies. Private
delegated health competencies may insurance companies are self-regulating
supplement this service through specific (Insurance Law and the General Insurance
programmes. At present, these Office) and act as intermediaries for the
programmes are largely confined to dentists, who in turn bear all the financial
prevention and paediatric dentistry. risks of treatment. The level of the
premiums depends on the procedures
Some capitation-based ‘incremental covered and takes no account of the risk of
programmes’ have existed since 1989, In poor health.
the Basque country and Navarre the
schemes have been extended for children Patients who subscribe to these schemes
but at present they only care for children are given a ‘chequebook’ for each
aged 6 to 15-years-old. In 2003 a procedure covered. After treatment, the
programme was introduced in Andalucia dentist submits the cheques to the
and Murcia, starting at 6-7 years. company and is paid. Cheques may be
used as a part payment for advanced
The share of expenditure for oral treatments, for example crowns and
healthcare from total healthcare spending bridges. The schemes are not very popular
is unknown. with dentists because the fees per item are
very low.
Private Practice
Apart from the scheme for government The Quality of Care
employees referred to earlier, which only
covers examinations, extractions and
prophylaxis, there are a number of private In Spain there is no formal monitoring of
health insurance plans which include these the quantity or quality of dental care.
items and X-ray diagnosis. Several
companies such as Asisa, Caja Salud,
Adeslas,

To enter dental school students have first Dental schools are part of the universities,
to pass a state school-leaving examination. and not necessarily part of medical
faculties. In 2003 there were 9 publicly
funded dental schools, with 1 additional
one being opened in 2004. These allow
entry of 550 places a year. There were also
3 private dental schools, with 1 further
being opened also in 2004. These allow 600
entrants a year. About 70% of 1,150
entrants are female. The course lasts 5
years and in 2002 about 900 graduated
(70% female). For the addresses of dental
schools, click here.
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Until 2001, it was possible to train as a
The responsibility for quality assurance in stomatologist, in Spain; this involved a
the schools is undertaken by the Ministry of period of dental training by qualified
Education. medical practitioners.
Qualification and Vocational Training Registration

The qualifications on graduation are as The law defines the specific acts a dentist
follows: may perform as: ‘The treatment of diseases
of the whole mouth’ (law 10/86, RD
• Licenciado en Odontología (1986 1594/1994).
onwards )
• Médico Especialista en Estomatología To practise as a dentist in Spain a dentist
must hold a degree awarded by a
(1948 to 2001)
recognised Spanish University, or a diploma
• and other historical categories: from a European Union country which is
Odontólogo (1901 to 1948) recognised by the Ministerio de Educacion
y Cultura. There is a register of dentists
held by the Consejo General in Madrid. The
list is revised every day and there is a fee
for inclusion which varies because each
regional Colegio charges its own fee
according to local expenses. It varies,
under a liberal system between €18 and
€50 monthly. An incoming dentist must
register regionally.
Dentists from other member states of the

EU are not subject to any linguistic tests.
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437
_______________________________________
The current system of continuing education
Spain
is organized by the Consejo General and
There is no post-qualification vocational local Colegios de Odontólogos y
training in Spain. Estomatólogos. Some companies and
particular initiatives offer programmes on
Further Postgraduate and continuing education, of different degrees
Specialist Training of quality and control
Continuing education Specialist Training
An extended system of evaluation of the

There is no specialist training in Spain (but
continuing education systems is being
see Working in Hospitals)
developed, after encouragement by the
government but it is not compulsory in
2004.
Workforce
Dentists
Since 1986 dentists could qualify with an

EU recognised degree, and since 2001 no There are no figures for the movement of
more stomatologists have been trained. In dentists out of Spain.
2003 about half the dentists practising in
Spain were stomatologists.
Specialists
dentists in Spain, of whom 41% were No specialties as defined in the 1978 EU
female. It was estimated in 2000 that about Dental Directives are formally recognised.
75% were actively working (Chief Dental There are a number of Stomatologists and
Officers’ survey). Maxillo-Facial Surgeons who are specialists
in Maxillo-facial surgery according to the
Total (2002) 19,678 EU Medical Directives.
(estimated)
Private practice* 14,600
Academic dentistry 480
Hospital dental service 320
Armed Forces 60
* Many dentists in private practice also work
part-time in other spheres, hence the
numbers add up to more than 15,000.

2,667.
The dental association believes that as

numbers are growing (1,100 graduate each
year) Spain is approaching an excess of
supply over need. There is also a tradition
of accepting dentists trained in third
countries, usually South America, but the
numbers entering Spain are reducing (the
Eurostat database lists 98 entering from
other EU/EEA countries in 1999). The entry
examinations for these dentists have
become progressively more difficult. These
dentists may not be able to work freely in
other countries in the EU.
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There are an increasing number of from 1,000 to approximately 9,000.
Spain
practitioners who are limiting their practice
to a given speciality, mainly orthodontics, Hygienists are almost exclusively employed
periodontics, endodontics and oral surgery. in private practice. The public dental
Some Spanish universities offer service has created positions for this group,
postgraduate courses in different specialist although some are employed on preventive
areas, however they lack official programmes, on temporary contracts.
professional validity.
Hygienists would normally earn on average
about €1,200 pm.
Auxiliaries
Dental Technicians
Numbers (2000
estimated) There is a qualification for Dental
Technicians which is obtained after training
Hygienists 9,000 and education at schools of Formacion
Technicians 7,000 Professional, over a 2-year period.
Dental Assistants 20,000 Voluntary registers are kept by the regional
(Nurses) associations for the craft, but there is no
national mandatory requirement and some
Other than dental chairside nurses or

receptionists, who are trained by dental
practitioners directly, there are two main
types of dental auxiliary. They are:
Dental Hygienists
In Spain hygienists must hold a registerable

qualification. Their education and training
is provided over 2 years by private or
public schools of Formacion Professional
and certificates of proficiency are granted
by the Ministry of Education and Culture.
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. The employing dentist is
responsible for their work. Until 1998 there
was an unknown number of non-titled
dental hygienists. However, in 1996 the
Government started a validation process
which finished in 1998 for dental hygienists
who had accredited a minimum number of
years of experience in dental practices, and
then passed an examination process. This
has resulted in a rapid increase in the
number of “recorded” hygienists (there is
no registration)
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439
_______________________________________
regional ‘colegios’ are being established.
However, in some regions it is compulsory Dental assistants work at the chairside.
and the numbers of such are growing. There is no formal training or qualification.
In Spain dental technicians may only work

in commercial laboratories. Average
earnings are not known.
Dental Assistants (Nurses)
Practice in Spain
Working in Private (General) for how many patients a dentist would
Practice normally look after on a regular basis.
In Spain, dentists who practise outside

hospitals, universities or the public dental
service are referred to as private
practitioners. Approximately 98% of the
profession work in this way and are largely
in single-handed practice.

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 Consejo is
studying the possibility of having
recommended fees related to quality of
care.
Newly qualified practitioners normally work

as assistants and are paid a proportion (30-
50%) of their gross earnings. A few of
these eventually become partners but
more usually they open their own practices.
Although there are no manpower
restrictions, there are agreed minimum
conditions for a new clinic. These include
sterilisation and prevention of cross
infection, radiological protection, adequate
waiting rooms and toilets, fire precautions
and emergency lighting and insurance.
Existing practices may also be purchased
together with goodwill and it is acceptable
to inform patients when this occurs. No
state assistance is available for practice
purchase, or establishing a new practice,
but some banks have special agreements
with the Colegios, for loans.
Premises may be rented or owned. They

would usually be sited in houses or offices
only.
There is no information available relating to

dentists’ earnings, in private practice, nor
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440
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with Temporo-Mandibular Joint therapy,
and Oral Medicine or Maxillo-Facial
Working in Public Clinics Surgeons. In each case these are titles and
not definitive grades.
A public dental service exists as described
above and limited care is available to all There is no formal postgraduate training
sections of the population. Approximately requirement for Odontologists and
6% of registered dentists work in the Stomatologists, but if applicants hold an
service but although the number employed oral surgery qualification they are
by Insalud is stable (290), the number of evaluated preferentially. Maxillo-Facial
those working in the regions is rising, for Surgeons must have completed a formal
example 122 in Andalusia. The titles used five-year training programme in an
are Odontólogo de área and Odontólogo de accredited hospital as set out in the EU
cupo. No formal postgraduate training is medical directives. No career structure
required for these posts but attendance for exists for these appointments but pay,
continuing education is assessed on a which is revised every three years, reflects
points basis, when evaluating applicants. experience. Posts are filled by national
As in the hospital dental service there are competition but autonomous regions can
no grades but every third year, a dentist apply their own rules.
receives a ‘Trienio’ which raises his salary.
In some regions, such as the Basque Working in Universities and

region, Navarre, Andalucia and Murcia, the Dental Faculties
regional authorities have introduced an
incremental capitation system for children, There are eleven public dental schools in
which has commenced by involving state-owned universities and four private
patients of 6 to 8 year old. Private dental schools. Standards are not
practitioners are eligible to accept patients controlled in the private sector and the
from these schemes. clinical facilities are limited. In Spain,
Dental Schools have no health service
Patients attending the public dental service responsibilities and students gain clinical
pay nothing for their care. The number of practice within Docente University Clinics.
procedures undertaken is recorded for
statistical purposes and complaints are Both full-time and part-time staff are
investigated through a medical system. employed and the latter also routinely work
Where these are upheld a warning may be in private practice. Full-time staff may also
recorded on the dentists file, but he may practise outside their school when they
only be prevented from practising in the have completed their university schedule if
service by judicial sentence following they have full ‘dedication’. However this
malpractice. group can also opt for exclusive
Dentists in clinics would normally earn ‘dedication’ which denies them outside
€1,500 to €2,100 a month. work but allows intra-mural practice.
Most hospitals are owned by the state, but
a few have been established by the large
insurance companies. In the latter private
practitioners may rent facilities and charge
patients on a fee per item basis. Normally
however, dentists are employed as
Odontologists who provide routine dentistry
and minor oral surgery, or medically
qualified Stomatologists, who supplement
the work of Odontologists
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441
Spain
_______________________________________
The following grades have been established appointed to a predetermined subject by a
for faculty staff: panel of their peers after national
competition. Appointees must also have
• Associate Professor (Profesor Asociado) had at least three years of teaching
- part-time faculty member experience.
• Assistant Professor (Profesor Ayudante)
- contracted full-time and pursuing an Teaching standards are not formally
academic career monitored but some universities have their
• Profesor Titular own evaluation systems using student
- full-time professor questionnaires. The quantity and quality of
an individual’s research is voluntarily
• Chairman (Catedratico) - highest monitored by a National Agency for
academic rank, with the same obligations Evaluation which also awards research
and duties as a full-time professor grants. The agency reviews publications
and if a candidate passes this process, a
To be eligible for a full professorship, a salary increment is awarded.
faculty member must obtain a doctorate
after a five-year training programme in Working in the Armed Forces
research methodology, a research project
and the production of a thesis which must In 2003, 60 dentists served full-time in the
be defended. Professors are usually Armed Forces - 17% of these were females.
Professional association
There is a single federal organisation, the employees however are protected by the
Consejo General de Colegios Oficiales de national and European laws on maternity
odontólogos y estomatólogos de España benefits, occupational health, the payment
which has a Council (Consejo General) of of social security benefits and health and
which the Presidents of each of the 19 safety.
regional Colegios are members. In the
2002/03 Annual Report of FDI it was If a patient wishes to complain, this may be
reported that 18,418 dentists were to either the Regional Colegio or Municipal
members, which is over 90% of all dentists. Consumer Offices in the Town Halls or
directly to the courts. Complaints to the
The regional organisations are best former are considered by a Deontologic
contacted through the national association. committee, which has only dental
members. These committees may
Ethics arbitrate, issue a private or public warning,
suspend a dentist or, in severe cases, refer
Ethical Code to the courts for removal from the Register.
Dentists have a right of appeal to the
There is an ethical code that is agreed and Consejo General and patients to the legal
administered by a committee of the system. All criminal acts against patients
Consejo General. The code covers are considered by the courts. Until
partnership agreements, disputes with recently, removal from the register was
other dentists, advertising where standards very rare but it is slowly increasing. For the
have been set for signs, plaques and same reason, the Consejo General is
newspapers and confidentiality. Written considering a procedure for dentists who
consent and patient contracts are not have health problems.
currently included.
Advertising
requirements between practitioners In 2003, there was a Codigo de publicidad
working in the same practice other than about advertising in dentistry accepted by
private contracts agreed by individual the Tribunal of Competence Defence, which
dentists. A dentist’s has applicability to all dentists.
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442
__ ____EU Manual of
Spain
Electronic commerce is not extensively Corporate Dentistry

implanted among dentists but some
companies of dental supplies operate in Dentists are permitted to form companies,
this mode. However, dentists may have in which to practise. Non-dentists can own
their own websites under the Codigo and or be on the board of such companies.
the ethical code.
Data Protection
Inoculations, such as Hepatitis B are not
There is a strict compulsory protocol of compulsory for the workforce.
clinical data collection and storage, for
patient protection and all dental offices Regulations for Health and Safety
must be adapted to conform by 2007.
For Administered by
Indemnity Insurance
Ionising radiation State Government
Liability insurance is compulsory for Electrical Regional Government
dentists and is provided by private general installations
insurance companies. It provides cover for Waste disposal Regional Government
financial liabilities of not less than Medical devices Regional Government
€300,506, up to €601,012 and premiums
Infection control Regional Government
do not vary for different types of dentists
(nb. a general dental practitioner pays
between €150 and €240 annually).
Financial Matters
Dentists’ Incomes: Social security payments (autónomos) for a
dentist in private practice are
approximately €258 a month. Many
Collective agreements for income are dentists will also take out private health
established yearly between employers and insurance plans.
trade unions in the different professions,
but salaried dentists are not included.
However, in some provinces there are
agreements between unions and employer
associations, with an agreed salary of
around €1,800 per month. In public health
institutions dentists usually earn €1,500 to
€2,100 per month. There is no data
available for dentists working in liberal
practice.
Public pensions are paid as a percentage of

up to 85% of average salary, up to a
maximum of €1,502 a month, and assume
a minimum of 15 working years. Many
supplement their public pension with
private pension plans. The compulsory
retirement age in Spain is 70 (65 for some
professions), but it can be done on a
voluntary base from 65 years onwards.
Dentists may continue to work in private
practice beyond normal retirement age.
For the majority of the Spanish population

general health care is free, paid for out of a
General State Budget - from taxation 92%,
and 8% from the Social Security
contributions of employers and employees.
__________________________________________________________________
443
_______________________________________
local authorities. The amount depends on
Taxes the size of the clinic (about €2,000 per year
for a two-dentist practice).
There is a national income tax: the highest Various Financial Comparators @ July
rate is 49%, which is charged on net 2003
incomes above €9,000.
VAT Zurich = 100 Madrid

No medical procedures, including Prices (including rent) 67.5
laboratory prostheses attract VAT. The VAT Wage levels (net) 39.2
rates are 7% on dental equipment and 16% Domestic Purchasing 55.4
on materials. Power
There is also an Economic Activities Tax

paid by businesses and professionals to Source: UBS August 2003
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444
__ ____EU Manual of
Spain
Details of competent authority: Main Professional Journals:
Direccion General de Recursos Humanos y RCOE (Revista del Ilustre Consejo General de
Servicios Económicos Presupuestarios. Colegios de Odontólogos y Estomatólogos de
Ministerio de Sanidad y Consumo. España)
Paseo del Prado 18- 20. BOCGOE (Boletin Oficial del Consejo General
28014 Madrid. de Colegios Oficiales de Odontólogos y
Tel: +34 91 596 44 26 Estomatólogos de España)
Fax: +34 91 596 40 36 Calle Alcala 79-2
Email : dgresep@msc.es 28009 Madrid
Website: www.msc.es Tel: +34 91 426 44 13
Fax: +34 91 577 06 39
Email: rcoe@infomed.es
Website: www.consejodentistas.org/rcoe.html
Professional Association: Main information centre:
Consejo General de Colegios de Odontologos y Ministerio de Educación y Cultura
Estomatologos de España Secretaria General Tecnica
Calle Alcala 79-2 Subdireccion General de Cooperacion
28009 Madrid Internacional
Tel: +34 91 426 44 10/1 Paseo del Prado 28 (planta 2)
Fax: +34 91 577 06 39 28014 Madrid
Email: consejo@infomed.es Tel: +34 91 506 56 00
Website: www.consejodentistas.org Fax: +34 91 701 86 48
Email
Website: www.mec.es/sgci/index.htm
Private Dental Schools:
Universidad Alfonso X El Universidad Europea de

Sabio Madrid
Facultad Ciencias de la Salud Facultad Ciencias de la Salud
Avda. de la Universidad, 1 C/ Tajo s/n
Villanueva de la Cañada Urb. El Bosque –
28691 Madrid 28670 Villaviciosa de Odón
Tel: +34 91.810 92 00 (Madrid)
Fax: +34 91.810 91 02 Tel: +34 91.616 82 56
Email: info@uax.es Fax: +34 91.616 82 65
Website: www.uax.es Email: uem@uem.es
Website: www.uem.es
Universidad Internacional de Universidad Cardenal Herrera

Catalunya CEU
Facultad Ciencias de la Salud Facultad Ciencias Experimentales
Campus de Sant Cugat. y de la Salud
Hospital General de Catalunya C/ Luis Vives, 2
Gomera s/n – 46115 – Alfara del Patriarca
08190 San Cugat del Vallés (Valencia)
Tel: +34 935 042 000 Tel: +34 961 369 000
Fax: +34 935 042 001 Fax: +34 961 395 270
Email: info@unica.edu Email:
Website: http://www.unica.edu/ Website:
http://www.uch.ceu.es/princip
al/inicio.asp
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445
_______________________________________
Public Dental Schools:

Spain
Madrid Barcelona
Facultad de Odontología Facultad de Barcelona
Ciudad Universitaria Ciudad Sanitaria de Bellvitge “Principe
Universidad Compultense – de España”
28040 Madrid Feixa Llarga, s/n
Tel: +34 91.394 19 15 08907 - Hospitalet de Llobregat,
Fax: +34 91.394.19.10 Barcelona
Email: infocom@ucm.es Tel: +34 93 335 88 99
Website: www.ucm.es/info/odonto/ Fax: +34 93 403 59 27
Email: sec-odon@bell.ub.es
Website: http://www.ub.es/fodont/
Valencia Granada
Facultad de Valencia Facultad de Odontologia de Granada
C/Gascó Oliag 1 - Campo Universitario de Cartuja s/n
46010 Valencia 18071 Granada
Tel: +34 96 386 41 75 Tel: +34 958 24 38 12
Fax: +34 958 24 37 95
Email odonto@ugr.es
Website: http://www.ugr.es/~odonto/
Fax: +34 96 386 41 44
Email: dise@uv.es
Website: www.uv.es
Vizcaya Santiago de Compostela

Facultad de Vizcaya Facultad de Medicina de Santiago de
Universidad del País Vasco Compostela
Facultad de Medicina y Odontología Entrerios, s/n1
Sarriena s/n 15705 Santiago de Compostela (La
48940 Lejona (Vizcaya) Coruña)
Tel: +34 94 464 77 00 Tel: +34 981 562 026
Fax: Fax: +34 981.582.642
Email: rgzadmin@lg.ehu.es Email coieinf1@usc.es
Website: www.lg.ehu.es Website: http://www.usc.es/coies/
Sevilla Murcia
Facultad de Sevilla Facultad de Medicina
Facutad de Odontología Campus de Espinardo.
C/ Avicena s/n, Hospital General Universitario Morales
41009 Sevilla Meseguer
Tel: +34 95 448.11.03 Avda. Marqués de los Vélez, s/n –
Fax: +34 95 448.11.04 30008 Murcia
Email: fodonjsec@us.es Tel: +34 968 36 43 12
Website: www.us.es Fax: +34 968.36 41 50
Email: www@um.es
Website: http://www.um.es/~medicina/
Oviedo Salamanca
Facultad de Medicina. Facultad de Medicina
Clínica Universitaria de Odontología. Campus Miguel de Unamuno
C/ Catedrático José Serrano, s/n , C/ Alfonso X El Sa bio, s/n.
33006 Oviedo 37007 Salamanca
Tel: +34 98 510 36 47 Tel: +34 923.29.45.41
Fax: +34 98.510.35.33 Fax: +34 923.29.45.10
Email: Email: medicina@usal.es
Website: www.uniovi.es Website: www.usal.es
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446
__ ____EU Manual of
Madrid
Universidad Rey Juan Carlos
C/ Tulipán s/n
28933 (Móstoles) Madrid
Tel: +34 91.665.50.60
Fax: +34 91.614.71.20
Email: info@urjc.es
Website: www.urjc.es
Sweden

Population 8.88
Sweden million (2002)
Currency Kronor
9.10 = €1 (2003)
Active dentist to population ratio
1,176
Main language Swedish
In Sweden most healthcare is provided through a

national social insurance system, which also
provides sick pay, child benefits, disability
allowances and pensions. There are 7,600 active
dentists (95% are members of the Swedish
Dental Association, which is a Federation of
Associations). The use of dental specialists is
widespread and the development of dental
Government and healthcare in Sweden

Sweden has a population of 8,876,744
(2002), with about 85% of inhabitants living Many aspects of government, including
in the southern half of the country. The healthcare, are delegated to the county or
capital is Stockholm. municipality level (289 municipalities
2001). Both the counties and
It has a constitutional monarchy with a municipalities have elected councils which
parliamentary system of government, but may levy taxes. Liberal immigration
as Head of State the King only has a policies have given Sweden a multicultural
ceremonial function. The Swedish population, with immigration accounting for
Parliament, the Riksdag, consists of 349 39% of the gross population growth.
members. These members are chosen in 29
different constituencies and therefore
represent the entire country. At present
(2003) seven political parties are
represented in the Riksdag. Together,
members belonging to the same party form
a party group.
The parties and their mandates in 2003:

The Social Democratic Party 144, The
Moderate Party 55, The Liberal Party 48,
The Christian Democrats 33, The Centre
Party 22, The Left Party 30, The Green
Party 17.
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447
_______________________________________
Social expenditure accounts for some 40% resident in Sweden is registered with a
of Sweden’s Gross Domestic Product. The social insurance office when they reach the
proportion of GDP spent on general age of 16. The expansion of healthcare in
healthcare, including dentistry in 2002, was the 1950s and 1960s concentrated
8.7%. Of this expenditure, 85.2% was especially on secondary care, so that
“public” (OECD Feb 2004). The county Sweden now has a high proportion of
government has a predetermined global specialist and hospital-based services.
budget every year. Public expectations of health services are
high. In total, around 85 % (2001) of
In Sweden most healthcare is provided healthcare costs including dentistry, are
through a national social insurance system, funded by government.
which also provides sick pay, child benefits,
disability allowances and pensions. The For the majority of the Swedish population
national insurance system operates as a general health care is paid for through
government agency (the National Social general taxation, plus a small fee (€20 in
Insurance Board or Riksförsäkringsverket), 2003) for each visit to a doctor.
through local Social Insurance Offices
(Försäkringskassan). Everyone who is
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448
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Sweden
Oral healthcare
In Sweden oral healthcare is the • limit the dental care is subsidized by a
responsibility of county government, fixed sum.
although counties are not required to
provide the services themselves. 8% of • People older than 65 have a 100%
total governmental spending on healthcare subsidy for dental prosthetic treatment,
is spent on dentistry. on costs of more than €850 (2003),
excluding the costs for the materials.
Almost all oral healthcare is provided in one
of two ways. Firstly, there is a Public Prior approval for some treatments is
Dental Service (NDS) which provides free necessary.
dental care to children up to the age of 19.
These dental services are mainly delivered In 2000 (the latest figures available) the
in local clinics which are managed by the total cost for dental care was
counties. Children and their parents can approximately €1.54 billion. Patients’ fees
choose to attend either the NDS or private were €0.9 billion of this sum, so the
practitioners. Secondly, adults and elderly taxpayers’ share was €0.6 billion. Of this,
people who are not entitled to free care €0.2 billion was provided through the
from the Public Dental Service can get national insurance scheme.
subsidised dental care from the NDS or
dentists in private practice. It is easier to access NDS-care in the big
cities than in the country. During a one-
The framework in 2003 is (this national year period (2001) 64.6% of men and
insurance scheme was introduced in 1999): 70.1% of women in the ages from 16 to 84,
accessed dentistry. In a 2-year period,
• Basic dental care, such as prevention, approximately 82% of the adult population
fillings and emergency treatment is access dentistry. A re-examination is
partially paid for by a fixed subsidy. normally carried out every one or two
For those between the ages of 20 and years.
29 this covers the initial examination as
well.
The Quality of Care
• There is free pricing with a fixed
subsidy. The dentists in private practice
settle their prices themselves. The There is a Dental Act which states that all
counties settle the prices for all the Swedish citizens are entitled to good
clinics within the county. quality dental care. The standards are
monitored by the Regional Departments of
the National Board of Health and Welfare
• There are no subsidies for amalgam
(Socialstyrelsen). The authority has issued
fillings.
a regulation imposing the dental services to
work with quality questions. The dental
• For those with long-term illness, certain
service also works using a system called
diseases or special need, get a subsidy
Lex Maria, where all incidents that have
by means of a fixed sum for dental
caused or could have caused serious injury,
care.
are to be reported.
• There are cost limits for both prosthetic

and orthodontic treatment. In 2003 the
limit was set at €600 – over this

Faculties of Medicine of the respective
universities. To enter dental school,
Undergraduate Training students must have completed secondary
education. There is no entrance
Primary dental qualification examination. The dental undergraduate
course lasts 5 years and there is an annual
There are 4 dental schools, all State owned intake of about 200 to 220 students. There
and financed. The schools are all part of the are over 800 undergraduates and about
__________________________________________________________________
449
_______________________________________
130 graduate each year (67% female). See
dental schools.
On completion of studies students are
awarded a degree, known as There is no post-qualification vocational
“Tandläkarexamen”. training in Sweden.
Quality assurance for the dental schools is Registration
provided by the National Agency for Higher
Education. In order to practise as a dentist in Sweden,
a qualified dentist must have a licence
awarded by the National Board of Health
and Welfare unit for Qualification and
Education. This body keeps a register of
dentists. For the address of the unit click
here
The main degrees which may be included
in the register are: the licence, and a
diploma of specialisation. There is a fee of
€45.60 to receive the licence.
The Social Insurance Office
(Försäkringskassan) also keeps a register of
practitioners who are affiliated to the
national social insurance scheme, and
dentists must be on this
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450
__ ____EU Manual of
register before they can claim social Orthodontics and Oral Surgery receive the
insurance subsidies. Registering for following:
affiliation with the national social insurance
scheme only requires the production of a
recognised degree certificate or diploma.
• 'bevis om specialistkompetens i
tandreglering' (certificate awarding the
There are no formal linguistic tests in order right to use the title of dental
to register, although dentists are expected practitioner specialising in
to speak and understand Swedish. orthodontics) issued by the National
However, an employer has the right to Board of Health and Welfare.
demand knowledge in Swedish – as the
“case book” must be written in Swedish
since a patient has the right to understand
• 'bevis om specialistkompetens i
tandsystemets kirurgiska sjukdomar'
what is written in it.
(certificate awarding the right to use
Further Postgraduate and the title of dental practitioner
specialising in oral surgery) issued by
Specialist Training the National Board of Health and
Welfare.
Continuing education is optional. The

Swedish Dental Association has a
continuing education program (printed and
sent to all members twice a year), but
almost all county councils (public dental
health) do as well; the dental industry gives
courses and also there are private
initiatives (for the address of the SDA, click
here).
Specialist Training
Training for the specialities lasts 3 years,

after 2 years in general practice. It takes
place in university clinics or recognised
postgraduate institutions approved by the
Swedish Board of National Health and
Welfare. The capacity of specialist training
in 2003 was about 180 places - 150 were
being used. The major part of this training
is paid for by the Counties, directly through
education on request or indirectly through
the co-ordinated County grant. Before
2009, 30% of specialists are due to retire
and it is anticipated that there will be a
shortage in some disciplines.
There is training in 8 main specialties:
• Orthodontics
• Oral and Maxillo-facial Surgery
• Endodontics
• Periodontology
• Prosthodontics
• Radiology
• Stomatognathic Physiology
The number of specialist training posts is

limited. The systems for remuneration vary.
Those who complete specialist training in

the EU recognised specialisms of
__________________________________________________________________
451
Sweden
_______________________________________
Orthodontics 430 120

Workforce Oral & MF Surgery 251 83
Dentists Endodontics 68 17
Paediatric dentistry 171 54
In 2002, 222 persons obtained a dentist’s Periodontology 202 52
licence in Sweden - 81 of these graduated Prosthodontics 198 51
as a dentist in another country than
Sweden. There were over 7,500 active Radiology 70 15
Sweden
dentists under the age of 65 (normal Stomatognathic 51 6
retirement age). 54% of those who are physiology
active are men and 46% are women. But,
the number of active dentists is decreasing.
Retirement is increasing due to the Auxiliaries

dispersion of age. In the mid 1990’s the
Government reduced undergraduate The system of use of dental auxiliaries is
numbers by 40%. Additionally, emigration well developed in Sweden and much oral
is higher than the immigration of dentists. health care is carried out by them. Apart
During the period 1993-2001 the net loss of from (chairside) dental nurses, there are
dentists was 722. Most of the emigrated three types of dental auxiliary:
Swedish dentists have moved to the United
Kingdom and Norway. The trend of a • Dental hygienists
greater movement in and out of Sweden is • Dental technicians
predicted to last. • Orthodontic Auxiliaries
For the moment (in 2003), the loss of
retired dentists is balanced by the newly-
qualified, so the reduction of the active Numbers of auxiliaries Total
workforce is only from this emigration. (2003)
There is no information about any Hygienists 2,900
unemployment amongst Swedish dentists. Technicians 1,348
Orthodontic Auxiliaries Unknown
General (private) 3,313
Dental Hygienists
practice
Public dental service 3,761 To train as a hygienist requires an
University 300 academic entry of 2 “A” levels, and then 2-
Hospital 220 3 years of undergraduate academic
education, in oral health science, at one of
Armed Forces 2
several University Colleges in Sweden. Oral
health science is multidisciplinary and
Specialists composed of medical/odontological and
behavioural sciences.
In 2003 there were approximately 1,450
dentists in the eight recognised dental After qualification all hygienists are
specialties (this works out as a ratio of 1/8 licensed by the National Board of Health
specialists to generalists). 1,080 were and Welfare. They have to have a
under the age of 65. registerable qualification and may work
independently. Their duties may include
Patients are referred by a dentist to the diagnosis of caries and periodontal disease,
specialist. Most specialists work in the and they may provide temporary fillings
Public Dental Service or the universities. A and local anaesthesia (mandibular and
small number work in private practice, but infiltration).
many of these are approaching retirement
age. There are many associations and Most dental hygienists work in locations
societies for specialists - a list of these is where dentists work, with 600 employed in
available from the Swedish Dental private practice and 2,100 in the public
Association. dental health sector and 200 are private
practitioners. They take legal responsibility
Numbers of Total Over for their work and charge fees to patients,
specialists (2003) 65 which may vary from what dentists charge.
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__ ____EU Manual of
They are required to obtain professional
indemnity insurance. than 60% since 1990. In the period 2000 to
2003 an average of 45 dental technicians
Their earnings would be about €24,000 have been qualified each year.
per year (in 2000).
Typically they would earn about €21,000
per year (in 2000)
Dental Technicians
There are no reports of (illegal)
To train as a dental technician requires an
academic entry of 2 “A” levels, and then 3 denturists in Sweden.
years of lectures and practical training at a
dental school. After qualification
technicians are licensed by the National Orthodontic Auxiliaries
Board of Health and Welfare, but they do
not have to have a registerable Orthodontic operating auxiliaries’ training
qualification to work. Their duties include lasts one year and takes place where
the production of fixed and removable orthodontists are trained. This enables
prosthetic and orthodontic appliances. They them to carry out specified procedures, but
may not deal directly with the public. they must work under the direction of an
orthodontist.
The number of active dental technicians
amounted to 1,348 in 2001. Of these, 226 There is no available data on numbers for
were employed by the Counties and 1,122 this group.
worked in private practice. This is a
decrease of more
Dental Nurses
More than 8,000 dental nurses are

employed by the Counties. The total
number of dental nurses is estimated as
14,000 in 2003. About 3,100 will reach
retirement age within a period of ten years.
An addition of newly-qualified dental nurses
is not expected as formal education for
dental nurses did not exist in 2003.
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453
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__ ____EU Manual of
Sweden
Sweden
Practice in Sweden
Service is funded by the Counties. It
broadly provides the same types of
Working in General Practice treatment for which national insurance
subsidies are available. For adults the
In Sweden, dentists who practise on their same system of national insurance
own or as small groups, outside hospitals or reimbursements and fee-scales apply as in
schools, and who provide a broad range of private practice.
general treatments are said to be in private
practice. There are about 3,300 dentists The service employs about 4,000 dentists,
who work in this way. This represents 45% approximately 700 as specialists. (The
of all dentists registered and practising. In specialists receive patients from dentists in
Sweden, the term ‘general practice’ refers private practice, as well as from dentists in
to dental practitioners who are not the Public Dental Service.)
specialists and who work outside hospitals.
Dentists in private practice are self-

employed and are remunerated mainly by
charging fees for treatments,
supplemented by social security subsidies.
The most common way of remunerating a
dentist is to pay a fee for each treatment
(item of service). If the treatment is one
included in the NDS the dentist gets
reimbursed by the dental insurance. Very
few dentists (less than 1%) accept only
private fee-paying patients.
In Sweden, dentists who practise on their

general treatments are said to be in private
practice. There are about 3,300 dentists
who work in this way. This represents 45%
of all dentists registered and practising. In
Sweden, the term ‘general practice’ refers
to dental practitioners who are not
specialists and who work outside hospitals.
Dentists in private practice are self-
employed and are remunerated mainly by
charging fees for treatments,
supplemented by social security subsidies.
The most common way of remunerating a
dentist is to pay a fee for each treatment
(item of service). If the treatment is one
included in the NDS the dentist gets
reimbursed by the dental insurance. Very
few dentists (less than 1%) accept only
private fee-paying patients.

Service
There is a public dental service with

responsibility for free services to children
up to 19 years of age. Apart from children,
the service also provides dental care for
adults as stated earlier. The Public Dental
__________________________________________________________________
455
_______________________________________
15% on their own patients, 25%
administration and 10% research. The
Besides the dental degree, the only formal complaints procedures are as described
qualification required to work in the public above.
dental service is for specialists, who should
have received recognised additional Working in the Armed Forces
training.
The monitoring of dentists in the Public It has been reported that 2 dentists work
Dental Service is the same as that for full-time in the Armed Forces.
dentists in private practice, except where
services are provided free of charge.
The provision of domiciliary (home) care is

not very common in Sweden, and is
usually provided by public health dentists.
In Sweden dentists work in hospitals as

salaried employees of the counties. There
are usually no restrictions on seeing
patients outside the hospital. Dentists
working in hospitals are employed as
hospital dentists who provide conventional
dental treatment to disabled or medically
compromised patients. Dental treatment
under general sedation and/or nitrous
oxygen is also available but the
sedation/anaesthesia cannot be performed
by a dentist. For this, formal postgraduate
training is required.
Any complaints are handled by the Public

Dental Service or the Medical Responsibility
Board (HSAN).
Hospital dentists earn about €43 000

per year.

Dental Faculties
In Sweden about 300 dentists work in

universities and dental faculties, as
employees of the university. They are
allowed to combine their work in the dental
faculty with part-time employment
elsewhere and, with the permission of the
university, may work in private practice
outside the faculty. Academic titles within a
Swedish dental faculty are: professor
(responsible for education and research),
associate professor (teaching), and
assistant professor (teaching). There are
no formal age or training requirements, but
most promotions are made on the basis of
scientific research experience.
The time of a typical full-time faculty

member of staff is spent 50% on teaching,
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__ ____EU Manual of
Sweden
Professional associations In the Medical Responsibility Board
membership may comprise politicians and
The Swedish Dental Association (SDA) has jurists. The person who submits the report
four member associations: concerning dental matters is always a
dentist. The Medical Responsibility Board
• the Swedish Association of Private (HSAN) is the only authority that can apply
Dental Practitioners, sanctions. There are 4 alternative sanctions:
• the Swedish Association of Public Dental an admonition, a caution, to keep the
Officers, licence for a trial period or the licence is
• the Swedish Association of Dental suspended. The most common reason why a
Teachers and dentist loses his licence is illness - less
• the Swedish Association of Dental common is crime and lack of skill.
Students.
An appeal against a decision made by the
Through the membership in one of these Medical Responsibility Board (HSAN) can be
associations, the dentist automatically gets made to the County Court in Stockholm.
a membership in the SDA as well. More than
95 % of all active dentists in Sweden are
members of the SDA.
The SDA has, through a membership in the

Swedish Confederation of Professional
Associations (SACO), close links to other
professional organisations in Sweden.
Ethics
The SDA has formulated a number of ethical
guidelines for the members. The guidelines
are imbedded in the rules of the SDA and
are formulated by the Association’s highest
decision-making body. The Swedish
Association of Private Dental Practitioners
has formulated an ethical code for their
members.
As far as the relationship of the dentist with
their employees and with other dentists is
concerned, there are no specific contractual
requirements between practitioners working
in the same practice; however a dentist’s
employees are protected by the national
and European laws on equal employment
occupational health, minimum vacations and
health and safety.
Standards and monitoring
If a patient complains, and the dentist

cannot resolve the matter directly, there are
two processes through which the issues may
be considered. Local Boards for Private
Practice (composed of dentists) and Local
Boards for Public Dental Services (may
consist of people from another profession
than dentistry) is one way, and the Medical
Responsibility Board (HSAN), on behalf of
the National Board of Health and Welfare is
the other.
__________________________________________________________________
457
_______________________________________
Medical Medical Products Agency, P.O. Box

Advertising devices 26,
S-751 03 Uppsala
Advertising is regulated by law. A dentist Waste Swedish Environmental Protection
cannot compare him/herself with other disposal Agency, Blekholmsterassen 36,
dentists nor say he/she is better than S-106 48 Stockholm
somebody else. Only basic information
may be given in an advertisement.
Advertising should be “reliable, impartial
and accurate”.
Dentists are allowed to promote their

practices through websites but they are
required to respect the legislation on
Data Protection and Electronic
Commerce.

dentists. For dentists working in the
Public Dental Service there is a national
scheme. Insurance for private
practitioners is provided by The Swedish
Association of Private Dental Practitioners
and by the producers’ cooperative
Praktikertjänst, for the dentists joined to
Praktikertjänst. (The Praktikertjänst group
is a private provider of healthcare, schools
and welfare, with the owners themselves
healthcare practitioners). The liability
insurance for the private practitioners
provides financial support for the cost of
further medical and dental treatment,
compensation for loss of income, damages
for pain and suffering, physical disability
and injury and other inconveniences. A
private dental practitioner currently pays
in average €220 (2003) each year for this
cover.
Corporate Dentistry
Dentists are able to form limited liability

companies. Non-dentists may fully or partly
own these companies.
Inoculations are not compulsory for the

workforce, but there is a general
recommendation to undertake
inoculations, such as Hep B.
For Administered by
Ionising Swedish Radiation Protection
radiation Authority,
S-171 16 Stockholm
Electrical The county authorities
installations
Infection The National Board of Health and
control Welfare,
S-106 30 Stockholm
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__ ____EU Manual of
Sweden
Financial Matters
The income ranges dentists would have expected to earn annually in 2002 (in Euros):
2002 Dentist 25 Dentist 25 Dentist 45 Dentist 45

(in Euros) years old or 2 years old or 2 years old or years old or 20
years after years after 20 years years after
qualification qualification after qualification
(average) (Range of qualification (Range of
income) (average) income)
Generalist 35,000 33,000 – 40,500 40,000 – 45,000
37,500
Head of Clinic - - 52,000 -
Hospital dentist - - 43,500 38,000 – 49,000
Specialist (and - - 52,800 47,500 – 59,400
not Head of
Clinic)
People born before 1937 receive a supplementary payment according to the old rules, and
those born between 1938 to1953 receive part of the pension according to the new and part
according to the old system. Anyone born after 1954 will receive pensions according to the
new system only. The new pension system will base payments on lifetime income and
individuals contribute 18.5% of their pay.
The normal retirement age is between 65 and 67. A dentist is allowed to practise dentistry until
the age of 70. There is also a disability pension (again from the Försäkringskassan) for those
unable to work due to chronic illness or disability.
Taxes
National income tax: 2003
The highest rate of income tax is about 58 Zurich = 100 Stockhol

% on earnings over about €46,155 per m
year. Prices (excluding rent) 91.1
VAT/sales tax Prices (including rent) 88.1
VAT is 25% of the value of some types of Domestic Purchasing 59.9
goods, including dental equipment, Power
instruments and materials. There are also
reduced rates of 12% (on public
transportation, hotels and provisions etc.) Source: UBS August 2003
and 6% (on newspapers and cinema
tickets).
__________________________________________________________________
459
_______________________________________
Main national associations and

Information Centres:
Swedish Dental Association The Swedish Association of Private Dental
PO Box 1217 Practitioners
S-111 82 Stockholm Sveriges Privattandläkarförening
Tel: +46 8 666 1500 Tel: +46 8 555 446 00
Fax: +46 8 662 5842 Fax: +46 8 555 446 66
Email: kansli@tandlakarforbundet.se E-mail: info@ptl.se
Website: www.tandlakarforbundet.se Website: www.ptl.se
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Association of Public Health Dentists In Sweden

Tjänstetandläkarföreningen
Tel: +46 8 545 159 80
Fax: +46 8 660 3434
E-mail: kansliet@stf-tt.org
Website: www.stf-tt.org
The Swedish Association of Dental Teachers, The Swedish Association of Dental Students
Karolinska Institutet, Anders Bolin Tel: +46 8 666 1500
Tel: +46 8 728 8154 E-mail: info@tandlakarforbundet.se
Publications:
Tandläkartidningen Competent Authority:
(Journal of the Swedish Dental
Association) The National Board of Health and Welfare
and Swedish Dental Journal Rålambsvägen 3
(the scientific journal of the SDA), both at: S-106 30 Stockholm
PO Box 1217 Tel: +46 8 555 53000
S-111 82 Stockholm Fax: +46 8 555 53252
Tel: +46 8 666 1500 Email: socialstyrelsen@sos.se
Fax: +46 8 666 1595 Website: www.sos.se
E-mail:
redaktionen@tandlakarforbundet.se
Dental Schools:
Huddinge Göteborg
Karolinska Institutet Göteborg University
Odontologiska Institutionen Odontologiska fakulteten
Box 4064 Medicinaregatan 12A, vån 8
S-141 04 Huddinge Odontologen,
Tel: +46 8 728 646 0 Göteborg
Fax: +46 8 760 815 05 Tel: +46 31 773 3033
Email: Fax +46 31 773 3207
studentservice@studavd.ki.se Email: info@odontologi.gu.se
Website: www.ki.se/odont/ Website
Annual intake: 65 www.sahlgrenska.gu.se
Dentists graduating each year: Annual intake: 68-74
approx. 47 Dentists graduating each year: 29-
Number of students: approx. 250 31
Number of students: approx. 200
Malmö Umeå
Tandvårdshögskolan Tandläkarhögskolan
S-205 06 Malmö S-901 87 Umeå
Tel: +46 40 665 8461 Tel: +46 90 785 6000
Fax: +46 40 925 359 Fax: +46 90 770 580
Email: Email: refekt@odont.umu.se
odont.studentexp@od.mah.se Website
Website: www.od.mah.se www.umu.se/odont
Annual intake: 48-56 Annual intake: 48-49
Dentists graduating each year: 29- Dentists graduating each year: 23-
32 30
Number of students: 213 Number of students: approx. 200
__________________________________________________________________
461
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462
__ ____EU Manual of
Switzerland
Member of the European Economic Area
Population 7.3
million (2002)
Currency Swiss
Franc (CHF)
€1 =
1.54CHF
Main lan Main languages
G
Switzerla e
nd r
m
a
n,
Fr
e
n
c
h,
Italia
Government and healthcare in Switzerland

Switzerland is a completely landlocked Although the largest insurance companies
country with a population of 7,310,994 have members nationwide, subscribers in
(2002). The capital is Bern. different Cantons pay different
contributions to reflect the varying demand
In Switzerland most public policy is and cost of healthcare in each area. The
organised at the cantonal level of regional Kassen are not subsidised by Cantonal and
government. Central government Federal taxes. They are not allowed to
legislates in a Federal Parliament whose make profits from the basic statutory
members are elected by proportional insurance, but can benefit from any
representation. If supported by substantial additional coverage, such as dental care.
numbers in a petition, some laws must be In addition to the main programmes for
approved by referendum. medical insurance and accident insurance,
The main form of healthcare provision is there are smaller health schemes of
mandatory insurance against the effects of disability insurance and military insurance.
diseases including accidents. This The insurance covers the cost of hospital
insurance is provided by private insurance care, drugs, specialist and general
companies (Kassen), which are recognised practitioner services. For primary medical
by Federal Office for Social Insurance. The care and some dental services a payment
system is established by Federal Law, and mechanism, the “franchise” system
is compulsory for everyone living in operates. Under this arrangement
Switzerland, who pay a basic annual fee of everyone pays up to 300 CHF (€195) per
approximately CHF 3,000 (€1,950). For year towards their bills, and 10% of the
those on low incomes the fee is reduced by cost of any treatments covered by the
up to 100%. The reduction is subsidised by Health Insurance System, up to an upper
Cantonal and Federal taxes and maximum, CHF 700 (€455) in 2003.
approximately 30% of the Swiss population
are eligible. The government also The proportion of GDP spent on general
reimburses the cost of treatment for healthcare, including dentistry in 2002, was
patients on extremely low incomes by 11.1%. Of this expenditure, 57.1% was
providing Welfare cover through local “public” (OECD Feb 2004).
authorities.
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463
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__ ____EU Manual of
Switzerlan
Oral healthcare
Oral Health Services

d
In Switzerland, apart from a minority of The proportion of total governmental

dentists employed by hospitals or the spending on healthcare spent on dentistry
school dental service, most oral healthcare is about 1%.
is provided by independent private
practitioners and paid for directly by Private insurance for dental
individual patients. Unless dental
treatment is necessary because of an
care
accident, the medical insurance system
only subsidises the cost when a patient has In Switzerland, about 10% of the population
a prescribed disease and only 10-15% of are members of private insurance schemes
care is eligible. Disability insurance entitles which cover some dental care costs,
children and young adults aged up to 20 especially orthodontics. All such schemes
years, to any necessary treatment for a are personal and premiums are paid
defined set of facial congenital directly to the insurance companies which
abnormalities. Over the age of 20, the are self-regulating and bear all the financial
general medical insurance system provides risks. The level of the premiums is linked
cover for this group. to the cover required, and the insurance
company determines whether an entrant’s
There is a dental service dedicated to oral health is good enough to join the
children in Switzerland, provided by private scheme.
practitioners and a small public service.
The practitioners or the service receive The Quality of Care
government subsidies, and parents pay set
fees for each item of treatment according
The standards of dental care are monitored
to their income.
by the insurance agencies and by dental
councils within each Kasse. By law all
There is no reported any difficulty for
treatment has to be appropriate,
patients to access the limited public health
economical and ‘evidence based’.
care.
However, there are no statistical checks on
dentists whose treatment patterns exceed
It is estimated that regular patients
the average.
normally visit their dentist for re-
examinations every 6 to 12 months. About The only other control on the quality of
90% of the population access dentistry in a care is through patient complaints (see
2-year period, and a dentist would normally below).
have a “list” of between 2,000 and 3,000
regular patients.
Undergraduate Training years - 2 years at the university learning

the theory without any chairside work and
3 years combined university and practice.
In 2002, 35 of the 100 graduates were
female.
There are four dental schools in
Switzerland, all publicly funded. They are
part of the Faculties of Medicine within the
the register is the Swiss Federal Diploma
relevant universities.
for Dentistry. However, “fully harmonised”
EU primary qualifications are also
To enter dental school students must pass
accepted.
an examination for university ability. There
is no other vocational type entry. In 2002,
student intake was 147 and 48% of the
students were female. The course lasts 5
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465
_______________________________________
demonstrate ongoing participation in
The responsibility for quality assurance in continuing education. Applications must be
the faculties is by the University board. made to the Federal Board (of the national
government), but the registers are kept by
each of the 26 Cantonal authorities. The
Qualification and Vocational Training additional dental experience can be earned
in university clinics, public dental clinics
Registration and as a private practitioner.
To register as a dentist in Switzerland, a Vocational Training (VT)

practitioner must have a recognised
diploma with a minimum of 5 years’ study, There is no post-qualification vocational
evidence of 2 years additional training in Switzerland.
postgraduate experience and be able to

Specialist Training recognised by the SSO. Maxillo Facial
surgery is recognised as a medical
speciality, by the Swiss Medical
Switzerlan
Continuing education Association.
There is a minimum level of compulsory

participation in continuous education, 10 • Orthodontics: 4 years training and
d
days per year in 2003. If a dentist does not exam, leading to the title -
undertake this he/she may suffer a Fachzahnarzt für Kieferorthopädie
reduction of reimbursement by the social • Periodontics: 3 years training
health insurance. Every year 10% of all and exam, leading to the title -
dentists are checked; if they do not fulfil Fachzahnarzt für Parodontologie
the requested time, the social insurance
agency reimburses the dentist at a lower • Prosthetics: 3 years training and
level. exam, leading to the title -
Fachzahnarzt für Rekonstruktive
Specialist Training Zahnmedizin
• Oral surgery: 3 years training
In Switzerland there are four specialties – and exam, leading to the title -
orthodontics, periodontics, oral surgery and Fachzahnarzt für Oralchirurgie
prosthetics are officially
Training is provided in dental university
centres and at private specialists’
practice. Examinations and registration
are organised by Schweizerische
Zahnärzte-Gesellschaft, in collaboration
with the Swiss federal health office.
Workforce
Dentists
In 2002 there were 4,250 active dentists Total 4,250

registered in Switzerland of whom 20% are
women. The total number of practitioners General practice* 3,800
is stable. Public dental service 150
Hospitals 50
It was reported that there were no University 250
unemployed dentists. There is no
* this includes dentists who also work in
information relating to the movement of
the other sectors
dentists into and out of Switzerland.
The population per active dentist

was 1,717 (2002).
Specialists
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466
__ ____EU Manual of
Numbers in 2002
There are four specialties – orthodontics, Orthodontists 165
oral surgery, periodontics and prosthetics Oral Surgeons 101
are officially recognised by the SSO. Maxillo Periodontists 82
Facial surgery is recognised as a medical
speciality, by the Swiss Medical Prosthodontists 65
Association.
There is no specific system for access to
specialists and in most cases patients are
referred by another dentist.
Auxiliaries
In Switzerland, other than dental chairside

assistants, there are 4 types of dental
auxiliary:
• Dental therapists
• Denturists (only recognised in 3 of 26
cantons)
in 2002
Hygienists 1,400
Therapists 250
Technicians 1,100
Denturists 100
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467
_______________________________________
Switzerlan
Dental Hygienists
Denturists
d
Hygienist training is for 3 years, at Denturists are permitted to work in private

Hygienist School and there are four such practice, but only in the cantons of Zurich,
colleges. They must hold a dental hygienist Nidwalden and Schwyz. They are only
qualification and this has to be registered allowed to provide removable prostheses.
with the professional education department They are not accepted for the provision of
of the Swiss Red Cross. treatments covered by the health
Their duties include scaling and simple gum insurance.
treatment and Oral Health Instruction, and
the insertion of preventive sealants. In They train under postgraduate modules for
some cantons they are permitted to dental technicians and this requires an
administer local anaesthetics. additional training period of 1,500 hours.
The denturists have to register with the
Dental Hygienists are employed by private cantonal health department.
practitioners or the public dental service,
and may only work under the supervision of Dental Therapists
a dentist. In 13 cantons they may be self-
employed and accept money from patients. In Switzerland dental therapists are allowed
But the working field is restricted and the to undertake simple operative treatments
patients are assigned by a dentist. under the supervision of a dentist. In
Indemnity or insurance cover is not reality, the majority of the work they do is
compulsory. the removal of supragingival calculus, so
their role is very similar to that of a dental
Hygienists would normally earn €3,500 –
hygienist. They are SSO-trained and are
€4,000 per month (2001).
also registered with the association. Most
work with dentists in private practices,
Dental Technicians
although they are also employed in the
public dental service. Self-employment is
Technicians train for 4 years in dental
not permitted.
technicians’ laboratories. A federal
registerable qualification is required in
Therapists would normally earn €3,000 per
some cantons.
month (2001).
Dental technicians duties are the
construction of prostheses and they are not
allowed to work in the mouths of patients.
The training for a chairside assistant is 3
They normally work in commercial
years, with a final examination for
laboratories. A few work in practices, for a
qualification. This education is federally
salary.
recognised. It is estimated that there are
about 5,500 chairside assistants (2003).
Technicians would normally receive fees for
appliances and would earn €3.500 per
month (2001).
Practice in Switzerland
charging fees for treatments. Almost all
are also contracted to treat patients under
Working in General Practice the social insurance system. This contract,
is established by the santésuisse which is a
In Switzerland, dentists who practise on corporate body representing the health
their own or as small groups, outside insurance companies. The contract
hospitals or schools, and who provide a includes a scale of fees, for a limited range
broad range of general treatments are said of treatments, which must be applied for all
to be in Private Practice. There are about work carried out within the social or
3,800 dentists who work in this way. This medical insurance scheme. The dentist
represents 89% of all dentists registered charges a patient according to the special
and practising. 40 to 50 per cent of rate, the patient then sends the invoice to
dentists in private practice work in isolation the insurance company for reimbursement.
from other dentists (“single-handed”). Apart from the insurance premium, the
treatment is therefore free for the patient.
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468
__ ____EU Manual of
About 100 dentists work completely outside
However, even though the SSO signs the the santé suisse.
tariff contract on behalf of its members,
dentists retain the right to treat patients
outside the scheme where most care is
requirements between practitioners
provided.
working in the same practice. A dentist’s
employees however are protected by the
The fee-scale incorporates both a points-
national laws on equal employment
system reflecting the relative cost of
different treatments, and an established
monetary value per point. The scale is
and health and safety.
calculated using the standard income,
running expenses and level of service of a Joining or establishing a practice
“standard practice”. The “standard
income” uses the principle that a dentist in Although premises can only be rented or
private practice should earn approximately owned by dentists, they can be located
the same as one employed by the state anywhere where there is sufficient demand
and the expenses of a “standard practice” for services. For SSO members the practice
which is based upon a practice of a defined cannot be a limited company, and in
size, in terms of space and manpower. The certain Cantons dentists can only work as
standard rates of treatment are determined the sole owner of the business. There is no
by a large survey of private surgeries and state assistance for establishing a new
state-run dental clinics. practice, and dentists must take out
commercial loans from a bank. There is no
Under the health insurance agreement, restriction on the opening of new practices,
prior approval for treatment may be but recognition for health insurance is
required for more expensive forms of limited.
treatment. In contrast, for those patients
who pay the whole cost of care themselves, Dentists in general practice would normally
the level of fees is set by each individual have incomes in the range of €10,000 -
dentist. However, the SSO sets maximum €14,000 per month.
prices for its members.
In certain parts of Switzerland a small

public dental service provides care for
school children and some handicapped
people, usually free of charge.
In 2003 the service employed about 150

dentists, but the work of the public dental
service is increasingly carried out by
private practitioners. Usually the service is
provided in school clinics or another public
building. However, in some rural areas the
service is contracted to private dentists in
their own practices. Working in the public
dental service requires no additional
postgraduate training and there is no
career structure.
Their income would be in the range of

€10,000 - €14,000 per month.
In Switzerland about 50 dentists practise in

hospitals, either as salaried employees of
__________________________________________________________________
469
Switzerlan
d
_______________________________________
the cantonal governments or on a fee-per- Working in Universities and
item basis. Working as dentists or dental Dental Faculties
surgeons, they provide dental care in the
major hospitals at Bern, Basel, Geneva and
Zurich where the four dental schools are In Switzerland about 250 dentists work in
also located and in about twenty other universities and dental faculties as
hospitals. There are usually no restrictions employees of the university. If their
on seeing other patients outside the contract allows, University dentists can
hospital. Some doctors working in work in private practice outside the faculty.
hospitals also carry out oral surgery.
The main academic titles within a Swiss
Their income would be in the range of dental faculty are those of Ordinary
€12,000 - €14,000 per month. Professor, Extraordinary Professor, Lecturer
and Assistant and First Assistant to help
instruct students. Ordinary professors are
academics; hospital clinical employees and
public officials are appointed by the
Cantonal government. There are no formal
requirements for postgraduate training but
professors generally qualify by a process
called habilitation. This requires a
recognised research record and delivering
a special lecture or seminar. Dentists who
are professors through habilitation also
become faculty members, on the
permanent body of the university with
tenured positions. As public employees the
retirement age for professors is 65.
A typical full-time dental faculty member
will spend most time (50%) on teaching,
approximately 20% of their time on
research, 15-20% on administration and
the remaining 10-15% on seeing their own
patients.
Their income would be in the range of
€12,000 - €16,000 per month.
In 2003, no dentists served full-time in the

Armed Forces.
There is a single main national dental

association, the Société Suisse d’Odonto-
stomatologie - or SSO, supported by a
strong system of Cantonal Sections. The
Sections have an important role in
organising continuing education, and
working with the Cantonal government to
produce legislation. The Liechtenstein
Dental Association is also a Section of the
SSO.
About 90% of Swiss dentists are members

of the SSO (3,870 in 2003).
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Switzerlan
Standards and monitoring
Ethics
If a patient is concerned about the
Ethical Code treatment they have received they may
d
complain to an ombudsman within their
Dentists in Switzerland work within an Canton. The Canton Section of the SSO will
ethical code which covers relationships and then set up a “supervision commission” to
behaviour between dentists, contracts with determine whether the treatment was
patients, consent and confidentiality, appropriate, or the level of the cost. The
continuing education, and advertising. This sanctions which may be applied for
code is administered by the SSO and the complaints include financial penalties and
cantonal governments. Cantonal laws warnings, and on rare occasions limitation
cover some ethical aspects of practice, of the right to practise. Rules relating to
including advertising regulations and these sanctions vary from Canton to
obligations to provide emergency out-of- Canton.
hours services.
Advertising
Advertising is allowed providing it is open

and the content is not misleading. There is
no available information about rules
relating to the use of websites.
Indemnity Insurance

dentists but all have it. The insurance is
provided by private insurance companies.
A general practitioner pays approximately
2,000 CHF (€1,300) annually for this,
although the sum depends on the level of
coverage.
Corporate Dentistry

bodies (companies), if they are not
members of the SSO, in some cantons, but
it has not been reported whether non-
dentists can be part or whole owners of
these.
Dentists and those who work for them are

recommended to be inoculated against
Hepatitis B and later be checked regularly
for sero-conversion. The employer usually
pays for inoculation of the dental staff.
For Administered by
Ionising radiation Private agency (for the
national government)
Electrical There are no regulations
installations or laws concerning this
Waste disposal Cantonal government
Infection control Swiss Federal Office of
Public Health
Medical Devices Swiss Medic, a federal
__________________________________________________________________
471
_______________________________________
agency Financial Matters

expected to earn in 2002 (in Euros).
General Practice €120,000 to

€168,000
Public Health €120,000 to
€168,000
Hospital €144,000 to
€168,000
University €144,000 to
€192,000
Pension premiums are paid at about 15 -

20% of earnings for national and
professional schemes. Retirement
pensions in Switzerland are typically 50 -
80% of a person’s salary on retirement.
For the majority of the Swiss population

accident insurance is paid for at about 1 -
1.5% of annual earnings, and for disease
insurance coverage an individual would
typically pay around 2,000CHF (€1,300) per
year.
Ordinary retirement is 65; dentists are

allowed to practise beyond this age.
Taxes
There are a national income tax, social

security tax, and cantonal taxes. Social
security tax is approximately 18% of salary.
There is also a cantonal wealth and
inheritance tax which is payable on certain
types of earnings up to a level of 1%.
The top tax rate is at 40% and is levied to

on incomes above approximately CHF
200,000 (€128,000).
VAT/sales tax
VAT is 7.6 % on some goods including most

dental equipment and consumables Costs
for dental treatment are not subject to VAT.
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472
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Switzerlan
Switzerlan
Dental Associations (and competent
d
d
authority) Liechtenstein
Switzerland
Schweizerische Zahnärzte-Gesellschaft The President
Société Suisse d’Odonto-stomatologie (SSO) The Liechtenstein Dental Association (GLZ)
Società Svizzera di Odontologia e Stomatologia Dr Hansjörg Marxer
Münzgraben 2 Landsstrasse 144
CH-3000 Bern 7 FL-9494 Schaan
Tel: +41 31 311 76 28 LIECHTENSTEIN
Fax: +41 31 311 74 70 Tel. +423 232 89 07
Email: sekretariat@sso.ch Fax: +423 232 95 32
Website: www.sso.ch Email: hmarxer@adon.li
Website:
Details of information centre: Placement Service for dental professionals
Schweizerische Schweizerische Stellenvermittlung SSO
Sanitatsdirektion-Konferenz Terrassenweg 18 Münzgraben 2
CH-3012 Bern CH-3000 Bern 7,
Tel: +41 31 301 21 52 Tel: +41 31 311 67 32
Fax: +41 31 301 22 36 Fax: +41 31 311 74 70
Email: office@sdk-cds.ch Email: jobs@sso.ch
Website: www.sdk-cds.ch
Publications:
Schweizer Monatsschrift für Zahnmedizin
Postgasse 19
3000 Berne 8,
Tel: +41 31 310 20 80
Fax: +41 31 310 20 82
Website: www.sso.ch
Dental Schools:
Geneva Zürich
Université de Genève Universität Zürich
Faculté de Médecine Zentrum für Zahn-, Mund- und Kieferheilkunde
Section de Médecine Dentaire Plattenstrasse 11 Postfach,
19, rue Barthélémy-Menn, CH-8028 Zürich
CH-1211 Genève 4 Tel: +41 01 634 33 11
Tel: +41 22 382 91 61 Fax: +41 01 634 43 11
Fax: +41 22 781 12 97 e-mail: name@zzmk.unizh.ch
e-mail: firstname.name@medecine.unige.ch website: www.zzmk.unizh.ch
website: www.medicine.unige.ch Dentists graduating each year: 44
Dentists graduating each year: 23 Number of students: 132
Basel Bern
Zentrum für Zahnmedizin der Zahnmedizinische Kliniken der
Universität Basel Universität Bern, Postfach 64
Hebelstrasse 3, Freiburgstrasse 7,
CH-4056 Basel CH-3010 Bern
Tel: +41 61 267 25 80 Tel: +41 31 632 25 78
Fax: +41 61 267 25 81 Fax: +41 31 632 49 06
e-mail: firstname.name@unibas.ch e-mail: marlis.walther@zmk.unibe.ch
website: www.unibas.ch website: http://dent.unibe.ch
__________________________________________________________________
473
_______________________________________
Liechtenstei
LIECHTENSTEIN
The Principality of Liechtenstein was
established in 1719; it became a sovereign Healthcare
n
state in 1806. Since 1919 the Principality

has been in customs and monetary union The main form of healthcare provision is
with Switzerland (the Swiss franc is the mandatory insurance against the effects of
national currency). The country is diseases including accidents, similar to the
mountainous, sandwiched between Austria system in Switzerland. The system is
and Switzerland land its area is a mere 76 established by law, and is compulsory for
sq km. The population is 32,842 (2002) and everyone living in Liechtenstein, who pay a
the capital is Vaduz. The country is a basic annual fee of approximately CHF
constitutional monarchy, and there is a 2,400 (€1,625). The patient pays 50% and
unicameral Parliament (Landtag) of 25 the employer the other 50%.
seats, elected by proportional
representation for four-year terms. Workforce (active)
Despite its small size and limited natural General Practitioners 33 (in 22 offices)
resources, Liechtenstein has developed Orthodontist 1
into a prosperous, highly industrialized, Oral Surgeons 2 (in 2 offices)
free-enterprise economy with a vital
financial service sector and living standards
on a par with the urban areas of its large Periodontist 1
European neighbours. The Liechtenstein
economy is widely diversified with a large Clinical dental auxiliaries are trained in
number of small businesses, and dental dentists’ offices and go to school in
products being a major export material. Switzerland. They are registered with the
Berufsbildungsamt, another public
Liechtenstein has been a member of the authority. Hygienists are trained in
European Economic Area since May 1995. Switzerland, in the EU or the USA: the
numbers of auxiliaries and hygienists are
Training not known.
Liechtenstein's dentists are usually trained Dental technicians and chairside assistants
in Switzerland or Germany. Dentists from mainly are trained in Switzerland, and
Liechtenstein or from EU/EEA partners, with register with the Berufsbildungsamt. Their
a diploma from an EU/EEA University must numbers are also not known.
(by a new law in 2003) be registered by the
Amt für Gesundheitsdienste, a public Professional Matters
authority.
The Liechtenstein Dental Association has
22 full members. There are also guest
members, who practise outside
Liechtenstein. The Association handles
ethical issues.
For further information, please contact the

President of the Liechtenstein Dental
Association (see above).
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475
The United Kingdom
Population 59.8
million (2002)
Currency GB
United
Kingdom
Pounds £
Main language English, also
Welsh, Gaelic
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.
There are about 28,000 practising dentists and about
84% of care is provided in general practice. About two
thirds of dentists are members of the British Dental
Association (BDA). Specialists are widely used and the
__ ____EU Manual of
Government and healthcare in the UK

The UK is both a parliamentary democracy Healthcare (publicly and privately funded)
and a monarchy. The population in 2002 was takes about 7.6% of the UK’s GDP (OECD
59,778,002. Although the Queen plays a data 2002). The amount of funding to the
ceremonial part in the legislative process, NHS is decided by Parliament, as part of a 3-
the parliament is bi-cameral. The first year expenditure programme (about 83% of
chamber of locally elected members, the all healthcare spending in 2002). Policy is
House of Commons, is the main forum for implemented by the Departments of Health
debating and changing government policies. in the four home countries and local health
The second chamber, the House of Lords, is authorities based on municipalities in
a fully appointed one, a small proportion England (Primary Care Trusts – PCTs) and
whose members are hereditary peers. It “regions” in the other three countries.
plays a significant part in the revision and
passing of legislation. Politics in the UK is All forms of primary medical care services
historically polarised between three main are free at the point of delivery, for all adults
political parties: the Labour Party, and children and there is a nationwide
Conservative Party and Liberal Democrat system of patient registration with general
Party. medical practitioners. These practitioners
(GPs) also act as ‘gatekeepers’ to the rest of
The Government is led by a Prime Minister the NHS with most access to specialist and
with a cabinet of Ministers called Secretaries hospital services being via a GP referral.
of State. Most Ministries with a seat in the
Cabinet represent particular aspects of the Funding of NHS drug prescriptions, dental
economy such as Health or Trade and and optical services has gradually altered to
Industry. Some powers, in particular health, the point where many in the population now
have recently been devolved to varying pay a significant contribution to the cost of
degrees to elected Assemblies in Scotland, these services. Indeed, the effect of an
Wales and Northern Ireland. The UK’s capital increased expenditure by patients on private
is London. oral healthcare and the high proportion paid
by them as co-payments, when obtaining
The UK has had a comprehensive National treatment in the dental NHS, means that
Health Service (NHS) since 1948, which is patients are now funding directly about 60%
largely funded through general taxation and of all spending on dentistry, with only 40%
provides healthcare to all. Approximately being funded by general taxation (British
80% of NHS funds are provided by general Dental Association estimate, 2003)
taxation, with the balance coming from
charges to patients for prescriptions, dental Both in terms of funding and population
and optical care. coverage, private health insurance is a small
but growing part of medical healthcare.
__________________________________________________________________
477
______________________________________
Kingdom
Oral healthcare
United
“rolled” forwards, as ‘registered patients’
Oral healthcare in the UK is available from for continuing care, or for occasional
three distinct services. As with all other (episodic) treatment. Only a limited range
European countries, the majority of care is of treatments is available for occasional
provided by non-salaried dental treatment.
practitioners, working outside hospitals
usually in privately owned premises. These However, many dentists will not accept
General Dental Practitioners (GDPs), if they everyone who wants to receive and pay for
accept NHS patients, are part of the treatment under NHS terms. At present
General Dental Service, which is locally 95% of GDPs are registered to provide care
coordinated by health authorities. The bulk under NHS terms and about 5% only accept
of payments to these dentists are by fees private fee-paying patients. Dentists
for items of treatment, but some capitation contracted to provide care under NHS
fees, allowances and direct reimbursement terms may therefore provide as much or as
of expenses also occurs. However, in 1997 little NHS care, and as much private care as
local commissioning schemes called they wish.
Personal Dental Services were introduced
in England, and these are being extended The system of remuneration for general
during the early years of the millennium. dental practitioners and the ‘NHS fee scale’
Dentists are paid in the PDS by other are described later.
means, such as bulk or sessional payments,
as well as the traditional methods.
There is also a Community Dental Service

(CDS). This provides public health dentistry
by salaried dentists for groups who have
poor access to other dental services, for
example ‘special needs’ children and
adults, and communities where there are
few GDPs. They also provide dental public
health and epidemiological support, for
data collection.
Finally, dental care is also provided in most

large general hospitals and all dental
teaching hospitals. In the UK the majority
of specialist dental treatment, other than
orthodontics, is carried out within the
Hospital Dental Service (HDS), usually after
referral from a dentist in the general or
community dental services. However, an
increasing amount of specialist care is
being provided in ‘high street’ practices,
especially in oral surgery. Traditionally, the
bulk of orthodontic care has been
undertaken in general dental practices.
All four services - the GDS, CDS, PDS and

HDS are planned and coordinated at
regional and local geographical level by
health authorities and public “trusts”.
However, in contrast to the GDS, hospital
services and the CDS are purchased by the
health authority from local healthcare
providers (NHS Trusts), usually under
service contracts.
Access to a GDP is, in principle, available to

all. Individuals can seek treatment on a
private fee-paying basis or as ‘NHS
patients’. NHS patients may be treated
under a 15 months contract, which can be
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478
__ ____EU Manual of
(see Practice in the UK). There will also be
In reality about 50% of adults and 60% of changes to the system of co-payments by
children (aged 0 to 18 years) are patients.
registered with GDPs for continuing care.
Many patients attend six-monthly for their Private insurance for dental
routine re-examinations, but it is thought
that less than 50% adults are now keeping
care
to this timetable, because of
improvements in oral health. In the UK, approximately 3% of people use
private care plans or insurance schemes to
Most patients who receive dental pay for the cost of dental care. This can
treatment under NHS terms from a GDP either be a separate policy or an extra to
are charged a percentage co-payment of a general medical cover. Most private
set ‘NHS fee’ (currently 80%); there is also schemes are personal schemes, where
a maximum charge payable in one course individuals insure themselves by paying
of treatment (about €550 in 2003). NHS premiums directly to the company. The
fees are typically about half, or less, of largest scheme (Denplan) is a pre-payment
those that would be paid privately. plan where participating dentists receive
capitation payments and bear the financial
Specific groups may receive NHS dental risk of
care from a GDP without any patient
charge, for example children under 18
years-old, pregnant or nursing mothers,
individuals on welfare benefits, and those
under 19 years old who are also in full-
time education. Some NHS treatments,
which are often provided by GDPs, are free
of charges for all patients, such as
domiciliary care for the housebound and
repairs to dentures.
All dental services provided by hospitals

and most services provided by the CDS are
free.
Access to NHS dental care is becoming

difficult for patients in many parts of the
UK and the government has opened
“Access Centres”, staffed by salaried GDPs
and Public Health Dentists, which offer a
variable range of clinical services, at
normal NHS charge rates.
In the year 2002, oral health services

comprised about 3.5% of the total
governmental expenditure on health.
Changes to Primary Care

Dentistry in the NHS
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 (those practising in the
GDS, CDS and PDS) to more locally
negotiated contracts, and new payment
systems.
The details of these changes were not

finalised at the time of publication of this
Manual, but are referred to briefly later
__________________________________________________________________
479
Kingdom
United
______________________________________
treatments provided. During the last few Each NHS practice and clinic must have a
years general insurance companies have complaints procedure. Any complaint
also begun to enter the market for dental either by the DPB or a patient must first be
care insurance. made to the dentist. If it is not possible to
resolve the complaint through the practice
Private care plans and insurance procedure then the matter may be referred
companies are self-regulating and set their to the health authority. Whilst the system is
own levels of fees. Generally the level of under review in 2004, the authority
the premiums will be part of a standard currently has an independent review panel
scale for all members, but for personal care consisting of dentists and lay members.
plans the company will usually only provide The panel produces a written report with
cover for those with good oral health. recommendations. Serious complaints are
dealt with through an NHS Disciplinary
The Quality of Care Committee. If they find a breach of
regulations this may result in the dentist
having to repeat the treatment, a
The way in which standards of dental care withholding of fees, or removal from the list
are monitored depends on which service of dentists who may work in the NHS. They
provided the care. NHS GDPs who receive may refer the matter to the General Dental
payment through the Dental Practice Board Council (GDC), for professional conduct
(DPB) have their treatment statistics issues. The GDC may censure a dentist or
compared to national norms. A Dental remove the right to practise. There is a
Reference Officer (DRO) may investigate right of appeal against both health
the treatment of one or a number of authority and GDC decisions.
patients in a practice where the results are
outside normal limits. Health authorities, if For treatment delivered outside NHS
they receive complaints, may ask a DRO to regulations there is no official route for
examine patients. DROs also examine complaints other than through litigation but
patients randomly selected from any for treatment undertaken within the
practice participating in the General Dental hospital or community service there is a
Service. health service complaints procedure.
However in all situations complaints may
be made directly to the GDC.

Undergraduate Training 1960s most offered a diploma of Licentiate
in Dental Surgery (LDS) as an alternative.
There are 13 UK dental schools, all part of LDS diplomas, formerly awarded by the
medical faculties of state-funded Royal Colleges of England, Edinburgh and
universities. To enter dental school a Glasgow, have not been available since
student must normally have passed at least 2003.
3 “A-level” subjects studied at high school
and because of the competition for places Qualification and Vocational Training
these would normally all have to be at the
highest pass level. Students have to pay a
sum towards the costs of tuition, for which Registration
they may claim a low-interest loan from the
state – which is repayable after graduation All dentists who wish to practise dentistry
when earnings have passed a minimum in the United Kingdom have to be
threshold. Annual undergraduate intake is registered with the General Dental Council
902 (42% female) and the total number of (GDC). The GDC is the ‘competent
undergraduates is about 4,300. The authority’ and maintains the register of
number of graduates is normally about dentists as well as those on the specialist
800. In 2002, there were 791 graduates lists.
(53% female). Of these, 41 were
“overseas” students (including 25 females).
All the universities award a degree,

Bachelor of Dental Surgery (BDS or BChD),
upon graduation, although until the late
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480
__ ____EU Manual of
Kingdom
United
Specialist Training
To register as a dentist in the UK, a
qualified practitioner must present Continuing education
evidence of their recognised first
qualification, a letter of good standing from All dentists (including specialists,
their current registering body, a passport administrative and registered retired
and a statement attesting to their good dentists) must participate in continuing
health. education, of 250 hours in five years. This
requirement is subdivided into 75 hours
EU nationals are not required to pass an verifiable postgraduate education and 175
English test at registration level. However, hours of general (informal) postgraduate
there is a requirement to pass an English education. Verifiable activity would include
language test (the IELTS), at a set participation in courses, interactive
standard, for working in NHS general dental distance learning, clinical audit, peer
practice (see below). Non-EU nationals are review – all of which must have defined
generally required to acquire IELTS and learning objectives and outcomes. Dentists
then pass the GDC’s International must record and keep a record of their
Qualifying Examination (IQE) before they activity and certify compliance annually.
can register. EU nationals with non-EU The scheme is administered by the GDC.
degrees are required to pass the IQE.
NHS dentists must participate in regular
Vocational Training (VT) peer review and clinical audit, both of
which receive government funding, as part
In order to practise in the NHS in the UK a of the mandatory continuing education.
dentist must normally complete a period of NHS GDPs may claim allowances for loss of
(supervised) vocational training, in a practice income, for attending courses.
practice, public health clinic or hospital.
GDP and Community VT are based on There are two schools of postgraduate
clinical practice for 4 days a week and day dentistry (London and Edinburgh) and also
release courses for one day a week. A postgraduate institutes attached to many
certificate of completion of VT must be undergraduate schools.
obtained before independent, unsupervised
practice is possible. Specialist Training
Graduates of non-UK EU dental schools are The training for all specialties takes place
exempt from a VT requirement, although in recognised hospital, PCT or other health
they may undertake this if they wish. Also, authority training posts, is supervised by
VT can be waived and equivalence given, the Medical Royal Colleges and lasts from 3
by the Dental Vocational Training Authority to 5 years, following a period of 2-year
(DVTA), to those dentists who can show at general professional training (which
least 4 years’ experience in supervised includes the year of VT). So, depending
general practice in the UK, who have
undertaken an equivalent amount of
continuing education.
__________________________________________________________________
481
______________________________________
upon the specialty it may take 5 to 7 years In the UK the following dental specialties
to become a recognised specialist. are recognised:
The General Dental Council (GDC) • Oral Surgery

administers lists of registered dentists who • Endodontics
meet certain conditions and have been • Orthodontics
given the right by the GDC to use a • Periodontics
specialist title. Two dental specialties, Oral • Restorative dentistry
Surgery and Orthodontics, are recognised
• Prosthodontics
by the European Union but UK law allows
the GDC to recognise any specialty where • Dental Public Health
this would be justified in the interests of • Surgical dentistry
the public and the dental profession. The • Paediatric dentistry
lists indicate the registered dentists who
are entitled to use a specialist title, but do There are a number of degrees and
not restrict the right of any registered diplomas associated with specialist
dentist to practise in any particular field of qualifications, and these may be awarded
dentistry or the right of any specialist to by universities (such as Masters’ degrees
practise in other fields of dentistry. and Doctorates) and the Royal Colleges
(such as Memberships and Fellowships).
Workforce
Dentists
Despite the fact that the workforce is
slowly growing, there is a severe shortage The active dentist to patient ratio is 1:
of dental workforce in the UK. The reasons 2,105
for this are being extensively investigated,
but the gender change towards more There is no reported unemployment
females qualifying as dentists, with part- amongst dentists in the UK
time working may be a major factor. Of the
31,600 registered dentists in 2004, 30% Total (2004) 31,16
are female. The four UK governments are 0
applying varying measures to address UK graduates 25,03
workforce issues. 0
Irish 831
There was a net inflow of dentists into the
UK until 2002. The table alongside Swedish 439
demonstrates the number of dentists Other EU 296
registered in the UK at the beginning of South African 1,200
2002 Other overseas graduate 1,259
Their spheres of practice were:
Specialists
General practice* 24,000 Some Specialists are known as Consultants
Community 1,800 and work in hospitals. However,
Hospitals 2,000 Consultants in Dental Public Health are
University 400 employed by PCTs and other health
authorities and a few work in teaching
Armed Forces 300 hospitals, which are part of the universities.
Administrative (estimated) 250
* many GDPs also work in clinics, hospitals Many specialists now work in general
and the universities also practice, where they may restrict their
services to their specialty – but may also
undertake general dentistry, if they wish.
However, when
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practising as a specialist it is usual to although some schools have now extended
receive patients only by referral from the course to 3 years and a degree is
general dental practitioners, or from other awarded.
specialists. Most orthodontists now work
out of hospital for part or all of their time – Dental Hygienists may only work under the
with hospital practice being increasingly direction of a dentist, who must prepare a
reserved for exceptionally complex cases, treatment plan, but need not be on the
including those needing surgical premises during treatment. To be able to
intervention. work they must register with the GDC, and
they are subject to similar disciplinary
There are many associations and societies procedures as dentists (see below).
for specialists.
(2002)
Orthodontists 1,023
Oral Surgery 236
Periodontology 261
Endodontics 163
Prosthodontics 349
Paediatric Dentistry 222
Oral Medicine 86
Oral Radiology 21
Auxiliaries
In the UK, dental auxiliaries are known as

Professionals Complementary to Dentistry
(PCDs). Other than dental nurses (chairside
assistants), there are four types of dental
auxiliary:
• Dental Hygienists
• Dental Therapists
• Dental Technicians
• Oral Health Educators
There are no legal denturists in the United

Kingdom, although there is some illegal
practice.
(2002)
Hygienists 4,215
Therapists 451
Technicians 10,000
Dental Nurses 30,000
Dental Hygienists
Dental hygienist training is usually for 2
years at dental hygiene school, normally in
dental schools alongside dental students.
To enter hygiene school a student usually
needs to be a qualified dental nurse and
may be required to have an “A-level”. Upon
qualification a diploma is awarded,
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483
Kingdom
United
______________________________________
Their duties were subject to a proscribed
list (by the GDC) until 2003, but legislative Oral Health Educators give advice to
changes are altering this from later in the individuals or groups on oral health care.
decade, so that their permitted duties will This takes place in any setting, with or
depend upon the training they have without the supervision of a dentist. There
undergone. are diplomas available but there is no
registerable qualification for oral health
Hygienists would normally be salaried in educators. They are often general teachers
hospitals and clinics, but would be paid per who have changed careers, or dental
hour or even as a share of fees earned in nurses who have undertaken additional
general practice. Earnings for a full-time training.
hygienist would be dependent on the type
of working environment, general practice There is no available information about
offering higher sums. The range would be their numbers or earnings.
from €1,200 - €3,000 per month (2003)
Dental Therapists
Dental therapist training is usually for 27
months full-time in dental schools,
alongside dental students. They also train
as hygienists. To enter training a student
usually needs to be a qualified dental nurse
and may be required to have an “A-level”.
Upon qualification a diploma is awarded,
although some schools have now extended
the course to 3 years and a degree is
awarded. There is a qualification which
they must register with the GDC and which
Dental Therapists must hold before they
can practise. They are subject to similar
disciplinary procedures as dental
hygienists.
As with Hygienists, the dentist must

prepare a treatment plan but need not be
on the premises during treatment.
Their duties may include the following:
• Intra and extra oral assessment

• Scaling and polishing, application of
fluoride and fissure sealants
• Take dental radiographs
• Provide dental health education
• Routine restorations in both deciduous
and permanent teeth, on adults and
children, including under infiltration
analgesia
• Administration of Inferior Dental Nerve
Block analgesia, under the supervision of a
dentist.
• Pulp therapy treatment of and/or
placement of pre-formed crowns on
deciduous teeth.
• Emergency temporary replacement of
crowns and fillings.
• Impressions.
Therapists are able to work in any sphere

of practice. Their earnings are similar to
dental hygienists.
Oral Health Educators
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Dental Technicians Dental Nurses

Kingdom
United
Training as a dental technician is provided Dental nurses work at the chairside to

by Universities, Colleges, Hospitals or assist dentists. In the UK they are usually
Health Authorities, leading to a University responsible for infection control and are
or College diploma/certificate (BTEC - often called upon to write patient records.
Business and Technician Education
Councils, Scotvec in Scotland) or degree. Education and training may be undertaken
Basic training would normally be 4 years, informally by the employing dentist, but
with an additional up to 2 years for more there is an extensive range of educational
specialised work. establishment which offer off-site
education, in colleges and schools, typically
There is a voluntary register of dental as “day-release” for one day a week, or as
technicians, and this will become a evening courses.
statutory register, possibly in 2005. Until
then there is no disciplinary body. There is an established qualification,
following a final examination, under an
Dental Technicians are permitted to Examination Board (www.nebdn.org), but
produce dental technical work to the this is now changing towards a vocational
prescription of the dentist, but cannot work qualification (NVQ) accepted by a
in the mouth. Historically they worked in a national accrediting body. Qualified
laboratory alongside dental practices, as dental nurses may voluntarily register in
employees of dentists, but by 2003 this had a register administered by the British
become very rare – most now work in Association of Dental Nurses
commercial dental laboratories which (www.badn.org.uk), and legislative
charge fees to dentists, PCTs or other amendments in 2003 mean that this will
health authorities. Some work as salaried become statutorily based later in the
employees in hospitals. decade.
Technicians would normally earn €1,250 to

€3,000 per month (2003).
Practice in the United Kingdom

To be able to work in unsupervised practice without another dentist in about a third of
in the NHS all dentists need to demonstrate practices.
that they understand English. They have to
undertake an examination (IELTS) and Most dentists in general practice are self-
receive a certificate which indicates that employed and earn their living partly
they have achieved a score of at least “7” through charging fees for treatments and
in each of the four, separate modules partly by claiming government subsidies. A
(listening, speaking, academic reading and growing number of dentists in general
academic writing). practice accept only private fee-paying
patients, but this was still thought to be
Also, there are requirements to declare less than 10% of all GDPs in 2003.
that they have had no criminal convictions
anywhere in the world which has led to a There is a prescribed NHS fee scale with
prison sentence of more than 6 months. defined contributions from the government
Two clinical references must be obtained. and the patient. Prior approval for
The language requirement is less formal treatment, from the DPB, is required for
for those working in supervised practice. complex treatment which costs more than
€570,
In the UK dentists who practise on their

General Practice. There are about 24,000
dentists (GDPs) who work in this way. This
represents 84% of all dentists registered
and practising in the UK. Practitioners work
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485
______________________________________
orthodontics for adults and some other practice in terms of the number of
treatments. associate dentists or other staff. Premises
may be rented or owned. There is little
However, government proposals will amend state assistance for establishing a new
this (NHS) system from April 2005 in practice, so dentists usually negotiate
England, and a new contractual system and commercial loans from a bank.
payments will be introduced from then.
These will ensure local negotiations Dentists starting in practice usually work
between GDPs and PCTs – based on a for a general practitioner as an assistant
national framework for the first 3 years. (supervised practice) or as an associate, if
they have completed VT. They then either
For private patients who pay the whole cost buy into that practice or purchase their
of care themselves, there is no restriction own. Traditionally, dental practices were
upon the fees charged. Private insurance opened in converted private homes and
schemes are used by 3% of patients (they above shops, but increasingly practices can
are described earlier in Oral healthcare in now be found in ground floor, modern-
the UK). fronted “high street” shops, shopping malls
and purpose built clinics.
requirements between practitioners Dental practices may only be owned by
working in the same practice. Draft dentists (but see Corporate Dentistry).
contracts are available from the BDA and However, widows or widowers may
form the basis for such arrangements. A continue to own a dental practice for up to
dentist’s employees however are protected three years after their spouse’s death.
by the national and European laws on
employment rights, equal employment To participate in NHS general practice a
opportunities, maternity benefits, dentist must also have evidence of
occupational health, minimum vacations indemnity insurance, and a practice
and health and safety. address, when they apply to the local
health authority to be included in their list
Joining or establishing a practice of dentists.
There are no stated regulations in 2004 Experienced General Dental Practitioners,

which specifically aim to control the after, say, 5 years in practice and who work
location of dental practices. There are also full time in predominantly in the NHS are
no other regulations or factors which estimated to earn about €200,000 gross
effectively restrict where dentists may (2003). They would take home (after
locate – although this may change in expenses are paid) about €90,000 a year,
England from April 2005. before tax. They see on average about 160
patients a week and have about 2,500
However, for practices offering NHS care, patients on their NHS “list”. Typically they
or sedation, the PCT or local health also have a few fully private patients. The
authority has the right to inspect the level of NHS fees and allowances is set by a
premises first (before first opening) to quasi-independent committee, the Doctors’
ensure compliance with health and safety and Dentists’ Review Body (DDRB), which
regulations. Any type of building may be makes annual recommendations on pay.
used which fulfils the legislative claims to Newly qualified dentists work as salaried
dental practice. There are also no rules Vocational GDPs, and their salaries are
which limit the size of a dental fixed at €42,000 before tax (2003).
A GDP who is fully private is estimated to

take home over €100,000 a year (before
tax) and would see about 100 patients a
week. BDA figures show that an increasing
number of dentists are increasing the
proportion of their practices to provide
private-only care, independent of the NHS.
The public dental service is known as the

Community Dental Service, and mostly
provides care for children, domiciliary care,
treatment for people with disabilities and
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486
Kingdom
United
__ ____EU Manual of
for those who have problems receiving The monitoring of dentists in the public
dental care from another source. In 2003, dental service is usually within guidelines
the service employed about 1,800 dentists prescribed by the health authority. All
as clinical dental officers, senior dental dental staff are required to participate in
officers or dental service managers and the clinical audit. The complaints procedures
size is reducing. Working in the are the same as those for dentists working
Community Dental Service requires no in other settings, as already described.
formal postgraduate training but promotion
is usually given to those who have Incomes are in the range of €3,500 to
additional qualifications. A higher €7,500 per month.
proportion dentists working in the
community dental service, are female. With the changes to NHS dental services in
England, a Salaried Primary Dental Care
Increasingly public health dentistry is being Service is envisaged by 2005, incorporating
offered through the Personal Dental salaried PDS, Access Centres and the CDS.
Services (see above), where access to NHS
dentistry is perceived by the health Working in Hospitals
authorities to be problematic.
In the UK about 2,000 dentists work in
hospitals as salaried employees of NHS
Trusts. Hospital dentists may treat patients
outside the hospital with the agreement of
their employer, if they work part-time and
there are no earnings restrictions.
Dentists work as hospital consultants,

associate specialists or in staff grade
positions. There are career grade posts
and there are also junior training grade
posts – for example, house officer or
specialist registrar. In order to be
promoted to a consultant it is necessary to
follow a formal specialist training pathway,
as described above. To be offered a post in
maxillo-facial surgery normally requires a
medical qualification in addition to any
dental qualification.
Dentists in the service are monitored

through clinical audit and by the Faculties
of the Royal Surgical Colleges. All hospital
dentists are required to participate in
clinical audit.
Incomes are in the range of €2,300 to

€12,500 per month.

Dental Faculties
In the UK about 400 dentists work in
university dental faculties as employees.
Private practice is often restricted and
dentists need to negotiate this right with
their employer.
The main academic title within a UK dental

faculty is that of university professor,
supported by senior lecturer and lecturer.
Dental academics in the UK hold an
academic title but also an honorary hospital
title. For promotion a dentist must undergo
clinical specialist training as well as
__________________________________________________________________
487
______________________________________
academic training usually by obtaining a
PhD, or Master’s degree and publishing
their work. There are no other regulations
or restrictions on the promotion of dentists
within faculties. Academic dentists spend
approximately 60% of their time on clinical
duties and the remainder on teaching,
research and administration.
Incomes are in the range of €3,000 to

€11,000 per month.

Armed Forces - 33% of these were females.
Army 159
Royal Air Force 78
Royal Navy 63
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__ ____EU Manual of
Kingdom
United
Professional associations advertising material that is legal, decent,

honest, truthful and has regard for
professional propriety. All advertisements
The main dental organisation for dentists in
and printed material must include the
the UK is the British Dental Association (or
name of at least one dentist normally in
BDA). About two thirds of dentists are
attendance at the practice in question.
members. As well as being a professional
Publicity or advertising material should not
association it is also the trade union for
be of a character which could bring the
dentists, being responsible for negotiations
profession into disrepute. It should not
with the 4 UK governments on terms and
make a claim that is not capable of
conditions of service for dentists working in
substantiation nor suggest superiority over
the NHS. It is also a scientific society.
any other dentist or practice and it should
There are 4 professional branches each
not contain any reference to the efficiency,
headed by a central committee, for General
skills or knowledge of any other dentist or
Dental Practice, Hospital Dental Services,
practice.
Community and Public Dental Services and
Clinical Academic Staff. The BDA also has
an extensive structure of regional branches
and local sections.
There are also some other, smaller general

practitioner associations and scientific
interest groupings (besides the specialist
societies).
Ethics
Ethical Code
Guidance on most aspects of professional

behaviour is contained in the document
‘Maintaining Standards’, produced by the
registration body, the General Dental
Council (GDC). The guidance includes the
contracts with patients, consent and
confidentiality, continuing education and
advertising. This code is administered by
the GDC. Guidance and advice on
relationships and behaviour between
dentists, and between dentists and their
staff, is the responsibility of the BDA.
The GDC is therefore the main disciplinary

body for dentists in the UK, through a
Fitness to Practise Panel of 45 people (15
dentists, 15 PCDs and 15 non-dentists) who
form panels for Professional Conduct,
Health Matters, Re-registration and
Performance Review. Upon the
recommendation of a FTPP panel a dentist
may be admonished, put on probation,
suspended, or lose the right to practise –
depending upon the severity of the
misdemeanour.
There is a right of appeal to the Judicial

Committee of the Queen’s Privy Council.
Advertising
A dentist may only use publicity or
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489
______________________________________
Corporate Dentistry
Dentists may use websites to publicise
their practices and the BDA has advised its
Whilst normally dentists must be owners of
members about the need to follow the
dental practices, there are a few historical
guidelines set out by the EU Dental Liaison
exceptions to this, where practices are
Committee, following the enactment of the
owned by outside commercial organisations
Directive on Electronic Commerce in 2001.
(bodies corporate). There are several large
chains of bodies corporate, which trade on
Data Protection
the stock market, and own upwards of 200
The provisions of the various Data practices each.
Protection Regulations are taken seriously
in the UK and all dentists have to comply Nevertheless, in all cases the majority of
with these. Annual notification to the directors currently must be dentists. The
Information Commissioner (at €50 per government indicated in 2003 that changes
year) is compulsory for all practising to legislation relating to bodies corporate
dentists who keep records on computer. are contemplated.
Indemnity Insurance Health and Safety at Work
Liability insurance is compulsory for all Dentists and those who work for them must
dentists working in the NHS. Professional be inoculated against Hepatitis B and later
indemnity insurance is provided by Dental be checked regularly for sero-conversion.
Protection Ltd, the Dental Defence Union, The employer usually pays for inoculation
and the Medical and Dental Defence Union of the dental staff, although in many parts
of Scotland. They provide cover for advice, of the UK this is now provided free of
legal costs and unlimited indemnity. There charge by the Occupational Health Services
are different prices for different types of of the local health authorities.
dentists, but a full-time general dental
practitioner pays approximately €1,500 Regulations for Health and Safety
annually.
Kingdom
United
For Administered by
Ionising radiation
Health and Safety
Executive at local level
Electrical Health and Safety
__________________________________________________________________
installations Executive at local level
Waste disposal Health and Safety
490 Executive at local level
Medical devices Medical Devices Agency
Infection control Local health authorities
__ ____EU Manual of
Financial Matters
Kingdom
United
The normal retirement age in the UK is 65,
although NHS general practitioners can
carry on as practice owners until they are
70. Dentists working as assistants in the
NHS and/or in private practice have no
Dentist 25 Dentist 45 fixed retirement age.
or 2 years 20 years Taxes
after after
qualificati qualification
on
on salary), and a local council tax
General €75,000 €100,000 a
Practice year The highest rate of tax is 40%, on income
Public Health €42,000 €90,000 a above approximately €50,000. National
year Insurance payments are also made (at a
Hospital €28,000 €150,000 a further 10% of income to about €50,000
year and 1% on all income thereafter).
University €36,000 €130,000 a
year VAT/sales tax is 17.5%, which is payable on
all equipment, instruments and materials.
Healthcare
2003 (Source: UBS August 2003)
Dentists who work in the NHS are usually
members of the NHS superannuation
scheme, a retirement pension scheme. The Zurich = 100 London
dentist contributes approximately 6% of Prices (excluding rent) 97.6
net income (after practice expenses) and Prices (including rent) 111.4
the NHS about 7%, to produce a retirement Wage levels (net) 63.9
fund (which is uprated each year, for
inflation). After 40 years they can take a Domestic Purchasing Power 63.6
pension based on 1/80th of the fund (if
they have been in practice) or a proportion
of their final salary. They can retire earlier
than this, from the age of 50, at a reduced
pension. There is a similar but independent
arrangement for University staff.
Dentists working outside the NHS are

responsible for their own pension and
contribute to private pension schemes
where the final payment is dependent upon
the amount of money saved.
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491
______________________________________
Main national association: Competent Authority and official

information centre:
British Dental Association
64 Wimpole Street General Dental Council
London 37 Wimpole Street
W1G 8YS London
Tel: +44 20 7563 4563 W1M 8DQ
Fax: +44 20 7487 5232 Tel: +44 20 7887 3800
E-mail: enquiries@bda.org Fax: +44 20 7224 3294
Website: www.bda.org Email: Information@gdc-uk.org
Website: www.gdc-uk.org
British Dental Hygienists Association British Association of Dental Nurses
Email: bdhasecretary@dental- Email: admin@badn.org.uk
design.co.uk Website: www.badn.org.uk
Website: www.bdha.org.uk
The Dental Technicians’ Association
British Association of Dental Email: info@dta-uk.org
Therapists Website: www.dta-uk.org
Email: secretary@badt.org.uk
Website: www.badt.org.uk
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__ ____EU Manual of
The BDA produces a wide range of Advice Sheets on aspects of practice management, health
Kingdom
and safety, finance, ethical and legal matters and employing staff. The BDA also has a
United
comprehensive list of specialist societies and other useful addresses.
Publications: For advertising:

British Dental Journal
BDJ Classified Advertising Department
Editorial Office
Porters South
64 Wimpole Street
4 Crinan Street
London W1G 8YS
London N1 9WX
Tel: +44 20 7535 5830
Tel: +44 20 7843 4729
Fax: +44 20 7535 5843
Fax: +44 20 7843 4725
Email: bdj@bda.org
Email: bdj@nature.com
Website: www.bdj.co.uk
Website: www.bdjjobs.co.uk
Dental Schools:
Belfast Birmingham
Queen’s University of Belfast University of Birmingham
School of Clinical Dentistry School of Dentistry
Grosvenor Road St Chad’s Queensway
Belfast BT12 6BP Birmingham B4 6NN
Tel: +44 28 90 263122 Tel: +44 121 237 2763
Fax: +44 28 90 438861 Fax: +44 121 625 8815
www.qub.ac.uk/cd/ www.dentistry.bham.ac.uk/
Bristol Cardiff
University of Bristol University of Wales College of Medicine
Dental School Dental School
Lower Maudlin Street Heath Park
Bristol BS1 2LY Cardiff, CF14 4XN
Tel: +44 117 923 0050 Tel: +44 29 2074 7747
Fax: +44 117 928 4994 Fax: +44 29 2076 6343
www.dentalschool.bris.ac.uk/ www.uwcm.ac.uk/
Number of therapists in training: 6
Glasgow Dundee
Glasgow Dental Hospital & School University of Dundee Dental School
378 Sauchiehall Street Park Place
Glasgow G2 3JZ Dundee DD1 4HN
Tel: +44 141 211 9703 Tel: +44 1382 635976/7
Fax: +44 141 331 2798 Fax: +44 1382 225 163
www.gla.ac.uk/schools/dental/ www.dundee.ac.uk/dentalschool/
London London
Barts and The London Guy’s, King’s and St Thomas’ Dental
Queen Mary's School of Medicine and Institute
Dentistry Hodgkin Building
Turner Street Guy's Campus St Thomas's Street
London E1 2AD London SE1 1UL
Tel: +44 20 377 7000 Tel: +44 20 7848 6963
Fax: +44 20 377 7612 Fax: +44 20 7848 6982
www.mds.qmw.ac.uk/dental/ www.kcl.ac.uk/depsta/dentistry/
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493
______________________________________
Kingdom
Leeds Liverpool
United
Leeds Dental Institute University of Liverpool
Clarendon Way Liverpool University Dental Hospital
Leeds LS2 9LU Pembroke Place
Tel: +44 113 343 6172 Liverpool L3 5PS
Fax: +44 113 343 6165 Tel: +44 151 706 5203
www.leeds.ac.uk/dental Fax: +44 151 706 5652
Dentists graduating each year: 52 www.liv.ac.uk/luds/index.htm
Number of students: 272 Dentists graduating each year: 43
Number of therapists in training: 8 Number of students: 266
Number of therapists in training: 8 (must be
hygienists first)
Manchester
Turner Dental School Newcastle upon Tyne
Higher Cambridge Street Dental School
Manchester M15 6FH Framlington Place
Tel: +44 161 275 6601 Newcastle upon Tyne NE2 4BW
Fax: +44 161 275 6604 Tel: +44 191 222 8347
www.den.man.ac.uk/ Fax +44 191 222 6137
Dentists graduating each year: 65 www.ncl.ac.uk/dental/
Number of students: 354 Dentists graduating each year: 70
Number of therapists in training: 8 (3-year Number of students: 350
course)
Sheffield
University of Sheffield
School of Clinical Dentistry
Claremont Crescent
Sheffield S10 2TA
Tel: +44 114 271 7801
Fax: +44 114 279 7050
www.shef.ac.uk/dentalschool/
Dentists graduating each year: 50 to 55
Edinburgh (postgraduate only) London (postgraduate only)

Postgraduate Dental Institute Eastman Dental Institute for Oral Health
Centre for Dental Education Care Sciences (postgraduate only)
Lauriston Building University of London
Lauriston Place 256 Gray’s Inn Road
Edinburgh EH3 9YW London WC1X 8LD
Tel: +44 131 536 4961 Tel: +44 20 7915 1038
Fax: +44 131 536 4962 Fax: +44 20 7915 1039
www.eastman.ucl.ac.uk/
Annual Number of
Graduates Undergrads
Belfast 45 220
Birmingham 65 345
Bristol 48 250
Cardiff 53 290
Dundee 50 295
Glasgow 70 352
Leeds 52 272
Liverpool 43 266
London Barts 55 303
London Guys 145 725
Manchester 65 354
Newcastle 70 350
Sheffield 53 300
814 4322
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THE BRITISH DEPENDENT ISLANDS

Kingdom
United
All the islands are English speaking British There are no dental schools in the Channel
Crown dependencies. Officially, they are Islands, and registration as a dentist is with
not part of the UK. Their head of state is the UK General Dental Council, whose
Queen Elizabeth II, who appoints a ethical rules must be followed.
Lieutenant Governor for each of Jersey,
Guernsey (and its dependent islands), and Numbers 2003 Guerns Jersey
the Isle of Man. ey*
The Channel Islands Registered 35
dentists
The Channel Islands represent the last General practice 25
remnants of the medieval Dukedom of Public Dentistry 2.5
Normandy, which held sway in both France Hospitals 0
and England. They are located in the
*including Alderney (1)
English Channel, off the northwest coast of
France. The two largest islands are Jersey
and Guernsey, and there are a number of
smaller islands. The islands follow English
law but with local statute; justice is
administered by the Royal Courts of
Guernsey and Jersey. The islands of
Guernsey, Alderney, Herm and Sark are
normally referred to as "The Bailiwick of
Guernsey".
Guernsey and Jersey have separate

unicameral Assemblies.
Financial services - banking, fund

management, insurance, etc. - account for
about 55% of total income in the tiny
Channel Islands economy. Tourism,
manufacturing, and horticulture, mainly
tomatoes and cut flowers, have been
declining. Light taxes and no death duties
make them popular tax havens (taxes are
relatively low and there is no VAT levied on
goods and services).
The islands are not members of the

European Union, but enjoy a relationship
with the EU under the terms of Protocol 3
to the United Kingdom's 1972 Treaty of
Accession. Briefly this gives the islands the
benefit of access to the free trade area
without the obligation to harmonise their
laws and taxes. Specifically the islands are
not bound by EU Directives on tax or any
other matters. So, although the islands are
within the EU's customs territory, EU
competition rules do not apply to them,
except so far as is necessary to permit the
United Kingdom, of which they are
dependencies, to observe its obligations
under the 1972 Treaty of Accession.
Channel Islanders do not benefit from the
EU rules on the free movement of persons
and services within the Union, but EU
natural and legal persons enjoy “equal
treatment” under EU law.
__________________________________________________________________
495
______________________________________
Guernsey housing rights qualification, then the
person requires a housing licence to reside
Guernsey has a land area of 78 sq km and in local market housing. These licences are
a population of 64,818 (July 2003). Its issued by the Housing Authority and
capital is St Peter Port. The GDP is €20,000 numbers are restricted. The Housing
and the currency used is the Guernsey Authority also issues Right to Work
Pound, which has parity with the GB Pound. documents. Usually entry to Guernsey by a
There is no National Health Service on dentist is when a dentist here retires or
Guernsey, for dentistry or medicine. leaves the island. Jobs are advertised in
the usual dental press and the local
The 34 registered dentists in Guernsey ‘Guernsey Press’ newspaper. The setting
include 1 orthodontist, 1 surgical dentist up of practice premises is restricted by the
and 1 periodontist. Oral healthcare is Island Development Committee (IDC). The
normally provided in private practice, by IDC govern either new premises or a
the 25 general practitioners who are in 13 change of use of existing premises. Both
practices (including one on Alderney). They types of permission can be very difficult to
also attend to patients in hospital. The obtain.
hospital “Dental Unit” is the GDPs who
access the hospital facilities for their
patients. Emergencies are covered on a
rota of GDPs. It is a requirement of
practising and of the Guernsey Dental
Association (GDA) membership to take part
in the rota. There is one visiting Oral
Surgeon for more complex cases on
referral.
There is one registered orthodontic

specialist in private practice and one
visiting specialist. There is one resident
registered periodontic specialist. Dental
auxiliaries on Guernsey: there are about 10
hygienists, 5 technicians and one dental
nurse for each dentist (it is thought that 6
are qualified).
Public dental healthcare is provided for

children up to the age of nineteen, in full
time education. The School Dental Clinic
provides free dental care. Currently (2003)
the under 14’s are seen in the School
Dental Clinic itself and most of the 14 to 19
year olds are treated in private practice,
but funded by the School Dental Service
(Board of Health). Orthodontics is not
available under this scheme.
The Guernsey Social Security Authority

(GSSA) will pay for treatment for adults on
benefits, or after means testing. This
treatment is provided in private practice
paid for by the GSSA on a scale of fees.
The fee scale is agreed between the GSSA
and the Guernsey Dental Association
(GDA).
All dentists on Guernsey are members of

the GDA. Members fill the officer posts in
rotation.
Guernsey is not open to dentist

newcomers. The Board of Health registers
all dentists in the Bailiwick of Guernsey and
monitors numbers with the GDA. Also,
unless the individual dentist already has a
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Kingdom
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Jersey The Isle of Man is politically stable and
enjoys parliamentary government without
Jersey has a land area of 116 sq km and a party politics. Its 1,000 year-old parliament,
population of 90,156 (July 2003). Its capital Tynwald presides over the Island's
is St Helier. The GDP was €24,800 (PPP) in domestic affairs including, specifically,
1999 and the currency used is the Jersey taxation. The UK is responsible for the
Pound, which has parity with the GB Pound. Island's defence and foreign affairs.
Oral healthcare is provided mainly by the The island forms part of the EU single
55 General Practitioners on the island, market and VAT area but is otherwise not
under private arrangements. There is a part of the EU fiscal area. Under protocol 3
Jersey Dental Fitness scheme, for children of the UK’s Treaty of Accession, the Isle of
only, which the States (government) Man is part of the customs territory of the
subsidise at £6 (€8.50) a month to families Union. It follows that there is free
whose income is less than £34,657 movement of industrial and agricultural
(€50,000) a year – and whose children are goods in trade between the Island and the
between 11 and 18 (or up to 21 if they are Union. The Isle of Man neither contributes
in full-time education). to, nor receives from, the funds of the
European Union, thus guaranteeing the Isle
There is also a Community and Hospital of Man's fiscal independence. The Isle of
Dental Services Scheme, provided by 5 Man has an English common law type legal
salaried dentists, for those from 4 to 11 system and tends to follow English
years of age. For the over-65s, who are on legislation. There is an infrastructure of
low income, they have access to a sophisticated legal and other professional
Dental/Optical state-funded scheme which services, and direct taxation is low.
reimburses charges at up to £175 (€245)
per year. The programme is means tested The currency is the Isle of Man Pound,
to be restricted to those on low income. which also has parity with the GB Pound.
There is 1 orthodontist (who visits monthly There is no dental school on the Island and
from the UK), 1 resident orthodontist, 2 oral dentists register as such with the UK’s
surgeons, 1 restorative specialist, 2 General Dental Council, whose ethical rules
endodontists, 1 visiting periodontist and 1 are followed.
resident periodontist. There are also 6
hygienists, 3 dental technicians and about Oral Healthcare in the Island includes
70 dental nurses. private care from 31 General Practitioners,
who may also contract to work inside the
The Jersey Dental Association has 45 Island’s NHS – which follows closely the
members, from the 61 dentists on the regulations and statutes of the NHS in
island. It is not possible for persons who are England, but is wholly independent of this.
not residentially qualified for living on the
island to set up practice as an independent The Community Dental Service is an Island-
dentist in Jersey. wide service providing a range of
appropriate oral health care services within
The Isle of Man the NHS, for schoolchildren and for adults
with special needs. Screening for oral
The Isle of Man is a dependency of the health care services is carried out in all the
British crown but has never formed part of Island’s schools.
the United Kingdom. It is situated in the
Irish Sea approximately half way between Whilst the island does have a local dental
Ireland and Great Britain, and the land area committee, dentists are members of the
is 572 sq km. There is a population of British Dental Association and are attached
73,873 (2002) and the capital is Douglas. to an English Branch based on Liverpool.
For information: For information:
President, Jersey Dental Association President, Guernsey Dental Association

3 Bath Street Chertsey House Dental Group
St Helier Les Cornus
Jersey JE2 4ST St Martins
Tel: +44 1534 769 740 Guernsey GY4 6PR
Fax: +44 1534 239 639 Tel: +44 1534 237 781
E-mail: psyred@jerseymail.co.uk Fax: +44 1534 235 585
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E-mail: haselmere@guernsey.net
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Annex 1 - Information collection and validation

The original information was collected in This process was repeated for the second
early 1996, in three stages. Firstly, a edition and the content was extended to
questionnaire was circulated to the main include information about women in
dental associations in each of the 18 dentistry, specialisation and remuneration
countries i.e. the 15 countries of the EU, trends where appropriate and available.
plus Norway, Switzerland and Iceland. For
countries where there was no single main This third edition has been revised and
national association, more than one updated using two methodologies: for the
questionnaire was sent to obtain the most “candidate” (new) countries of the EU new
complete picture possible. The questionnaires were devised, based on an
questionnaire collected data about the analysis of the information supplied by the
basic legal framework, the oral healthcare different countries in the first and second
delivery system and the administrative editions. Interviews were then conducted
structure within which dentists work. It by the authors, with the representatives of
covered any official oral health system the relevant countries, at various
recognised by government, private international meetings during 2003. The
insurance and care plan schemes, and the data was then validated by e-mail with
organisation of dental practice including dental associations of the countries, before
hospital and public dental services, dental publication.
faculties and auxiliary personnel.
The data and information for the existing
After the initial exercise, validation EU countries was analysed and cross-
interviews were conducted between the checked for common information and then
spring and autumn of 1996 to clarify and the individual country sections were
extend the information provided by the marked by the authors for clarification,
questionnaires. These interviews were modification and revision, before being
broadly structured around the same topics sent to the 18 dental associations in
as the questionnaire, and lasted between February 2003. Following receipt by the
three and seven hours depending on the authors of the corrected country sections,
complexity of the dental health system in clarification of any ambiguous information
the country. was undertaken, again at international
meetings, before the revised sections were
The interview stage of the information sent to the associations for validation
collection process was essential for before publication.
identifying important differences between
countries, resolving potential ambiguities Documentary sources of information used
and exploring in detail those issues briefly were the websites of:
covered by the questionnaire, which were
more important for dental practice in a The European Commission
particular country. Given the non-standard The OECD
nature of health systems and the variable Union Bank of Switzerland
organisation of dental practice, the The European Chief Dental Officers
interviews captured information which a The Federation Dentaire International
“standard” data-collection instrument such The World Health Organisation
as a questionnaire alone would have The British Dental Association
missed. The CIA World Factbook
The first draft of each country chapter was and information supplied by the 31 dental
written primarily on the basis of the associations of the 29 countries involved in
interview notes, supported by the project.
questionnaire answers, and any other
documents which the national dental
associations were able to supply. The draft
of each country chapter was then checked
for clarity, completeness and accuracy,
before publication.
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Annex 2 – European Health Strategy

Community policies, health protection
OBJECTIVE concerns all key areas of Community
activity. This new strategy contains specific
To create a public health strategy which measures to address the obligation to
will reflect the Community's new incorporate health protection into all
responsibilities and allow it to play its role Community policies.
to the full by helping to raise the level of
protection while at the same time 4. The public health framework, which is
supplementing Member States' activities a key element of the strategy, includes
and responding to the main challenges of those measures which relate
public health. specifically to public health. A new
action programme is part of this
framework for which three main
CONTENTS strands of intervention are identified:
Communication from the Commission of 16

May 2000 to the Council, the European
Parliament, the Economic and Social
Committee and the Committee of the
Regions on the health strategy of the
European Community:
1. European Union citizens rightly attach

great importance to their health and
expect to be protected from possible
dangers. The Community has a crucial
role to play and is obliged to guarantee
a high level of protection for its
citizens. Due to the emergence of new
challenges and priorities in the field of
health, such as enlargement, the
emergence of new illnesses, pressures
on health systems and increased
Community obligations following the
amendments to the Treaty, in
particular Articles 3 and 152, it is
necessary to develop a new strategy.
2. This new strategy is the result of the

debate launched in 1998 with the
Communication of the Commission on
the development of public health policy
; it takes account of the results of this
debate as well as the experiences of
the action programmes and of previous
activities.
3. The strategy consists of two main

elements:
• a public health framework, including an

action programme in the field of public
health (2001-2006) and in public health
policy and legislation;
• development of an integrated
health strategy: as a result of the Treaty
provision which stipulates that a high level
of health protection must be ensured in the
definition and implementation of
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503
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optimum use of blood and blood
derivatives;
• improving information on • veterinary and phytosanitary;
health for all levels of society; measures are possible in this field
and it is envisaged that such
• setting up a rapid reaction
measures would be closely linked to
mechanism to respond to the major
the policies developed within the new
health threats;
global strategy on food safety
• tackling health contained in the White Paper on Food
determinants, particularly by Safety , particularly in the field of
addressing harmful factors related nutrition;
to lifestyle.
• the European Health Forum. It is
planned to set up this new
By emphasising the areas where Member mechanism to allow all those
States cannot be effective individually - involved in public health to play a
where coordination at Community level is part in drawing up health policy.
essential - the Community will be able to
optimise its impact with a limited budget
and will bring Community added value. It
is planned to extend the existing
programmes before the launch of the
new action programme until such time as
this is established.
5. In addition to the public health

programme, this public health
framework contains other legislative
measures in a range of sub-areas of
public health which will be developed
within the framework. These include:
• prevention and monitoring of

communicable diseases ; an
international network of
epidemiological surveillance and
control of communicable diseases,
set up in 1999;
• prevention of drug dependence;
activities to supplement the Union's
action plan to combat drugs 2000-
2004 ;
• combating nicotine addiction;
activities to supplement initiatives
already taken, such as the proposal
for a new directive to impose stricter
rules on the manufacture,
presentation and sale of tobacco
products [COM (1999) 594 final], and
the action programme's activities in
this field;
• the quality and safety of organs
and substances of human origin;
creation of a global strategy, which is
already being developed, on drafting
legislation on this subject;
• blood and blood derivatives.
Several measures have been planned
and are already being prepared, such
as a proposal for a directive
establishing a framework for quality
and safety standards, the creation of
a Community haemovigilance
network and the promotion of
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6. Creating an integrated strategy: To

• a priority task of the public health
ensure that the Community's global
programme will be to develop criteria and
health strategy is coherent, there has
methods, such as guidelines, for assessing
to be a close link between public health
the policies proposed and the way in which
measures and health-related initiatives
they are implemented, with the possibility
taken in other policy areas such as the
of an in-depth evaluation of the impact on
single market, consumer protection,
certain measures or policies;
social protection, employment and the
environment, as stipulated in the
Treaty. Such links alone are not
sufficient to guarantee total coherence, • the public health programme provides
so these have to be supported by new for the possibility of carrying out joint
mechanisms and instruments measures together with other Community
guaranteeing the contribution of other programmes and agencies; within the
Community policies to health Commission, mechanisms which guarantee
protection; the coordination of health-related activities
will be strengthened.
• as of 2001, proposals relating

specifically to health will include a
statement explaining how and why health
issues have been taken into consideration,
and describing the expected impact on
health;
The new strategy involves a range of significant and ambitious elements. It represents a
major commitment and is said to show the importance which the Commission attaches to
public health in Community policies.
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Annex 3 – EU Institutions
The major institutions of the Community The Commissioners are supported by their
include the European Commission, the individual cabinets of six or more
Council, the European Parliament, the permanent administrators, mainly drawn
Court of Justice, the Economic and Social from their own countries. A structure of
Committee and the Committee of the inter-cabinet committees ('chefs de
Regions, the Court of Auditors and the cabinet') plays a valuable role in identifying
European Investment Bank. The role of issues for the weekly Commission
each is briefly reviewed below. meetings.
The European Commission Future size of the Commission
The Commission is the body responsible for If this system of two commissioners from
developing and proposing Community each large, and one from each smaller
policy and legislation. The Council of country was maintained after EU
Ministers then discusses it and, if enlargement, the Commission would
appropriate, adopts or amends the become too large to be workable. There will
proposal. The Commission then already be ten new commissioners
implements the decision and supervises (bringing the total to 30) on 1 May 2004,
the day to day management of the policies. when ten new member states join the EU.
Essentially, therefore, it is the Civil Service
of the Community.
The Commission (until October 2004)

consists of 20 Commissioners (two from
Germany, Spain, France, Italy and the
United Kingdom, and one from each of the
other ten member states). Their principal
task is to act as guardian of the Treaties
and to initiate action against any member
states who do not comply with EU rules and
to grant derogations to those who wish to
be exempt from specific areas. Each
Commissioner is nominated by his/her
national government for a four year term of
office, during which, he/she acts only in the
interests of the Community. Of the 20, one
acts as President, 6 are Vice Presidents and
the remaining 17 are members of the
Commission. Each Commissioner is
assigned particular areas of Community
policy in which he/she formulates proposals
aimed at implementing the Treaties. These
are then discussed by the Commissioners
as a body. Decisions are thus made on a
Collegiate basis.
The Commission is divided into 24

Directorates-General (DGs), each with a
Commissioner who supervises its work.
Some Commissioners are responsible for
more than one Directorate. The DGs are
staffed by career officials recruited from
the member states who are responsible for
the technical preparation of the legislation
and its implementation. The number and
role of the DGs is revised from time to time
and matters relevant to dentists and dental
services cross Directorate boundaries.
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So, from the date when the 2004-2009
Commission takes office (1 November The Parliament's powers increased with the
2004), there will be only one commissioner Single European Act and it now exercises
per country. Once the Union has 27 democratic supervision over all Community
member states, the Council - by a activities. This power, which was originally
unanimous decision - will fix the maximum applied to the activities of the Commission
number of commissioners. There must be only, has recently been extended to the
fewer than 27 of them, and their nationality Council of Ministers, the European Council
will be determined by a system of and the political co-operation bodies. The
rotation that is absolutely fair to all European Parliament can also set up
countries. committees of inquiry.
The Council
The Council is the EC's decision maker,

adopting or amending the Commission's
proposals. The term 'Council' is used to
cover the meetings of ministers from the
Member States (Council of Ministers) and
the working groups of officials (Council
Working Groups) and the Committee of
Permanent Representatives of the member
States in Brussels (COREPER) which
prepares the discussions for the Council of
Ministers.
Specialist Councils meet to deal with

particular areas of policy such as Foreign
Affairs and Agriculture. They are attended
by the relevant Ministers from the Member
States and by the Commission. Similarly,
the Council Working Groups are attended
by the officials from the relevant
Department in the national capital, and/or
by the desk officer from its Permanent
Representation. The Permanent
Representatives (Officials of Ambassador
rank) attend the meetings of COREPER. In
addition the Heads of State/Government
meet twice a year for the European Council
(European summit) to discuss broad areas
of policy. Council meetings are chaired by
the Member State holding the Presidency,
which rotates on a half yearly basis.
The Treaties provide for three methods of

decision taking, depending on the nature of
the proposal and the Treaty Article on
which it is based. This can be unanimous -
none against, or by simple majority voting
with at least seven Member States in
favour, or by qualified majority.
The European Parliament
The European Parliament is a directly

elected body of members. The number of
MEPs from each country varies according to
the size of the Member State, ranging from
99 from Germany to 5 from Malta (see
below for numbers from each country).
Members are elected for five years and
form political rather than national groups.
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The Rome Treaties originally provided for overturned by a qualified majority in
the Commission to propose and the Council Council in the case of expenditure involving
to decide, after consulting Parliament. A legal obligations to third parties, such as
Community law becomes null and void if agriculture.
the obligation to consult Parliament is not
met. However, the Parliament’s role in the The Court of Justice
legislative process has been gradually
widened and strengthened, and its The Court of Justice is made up of 15
influence extended to the drafting and independent judges, with at least one from
adoption of Community legislation. The each Member State. It has two roles, firstly
European Parliament and the Council now to act on the request of any of the
share the power of decision equally in a Community Institutions, Member States or
large number of areas. individuals to suppress any measure
adopted by any of the EC institutions or
The Parliament can ask the Commission to national governments deemed
take a particular initiative where it incompatible with the treaties and,
considers it important. Its examination of secondly, to pass judgement on points of
the Commission’s annual programme of community law referred to it by national
work also gives Parliament the opportunity courts.
to emphasise its priorities.
There are four possible processes by which

the European Parliament may exercise its
legislative power, depending on the nature
of the proposal concerned:
1. Consultation (single reading)

2. Co-operation procedure (two
readings)
3. Co-decision procedure (three
readings)
4. The assent procedure (Parliament’s
assent is now needed for decisions
on the accession of new Member
States, association agreements
with third countries, the conclusion
of international agreements, a
uniform procedure for elections to
the European Parliament, the right
of residence for Union citizens, the
organisation and goals of the
Structural Funds and the Cohesion
Funds and the tasks and powers of
the European Central Bank).
Most of the detailed work in the Parliament

is conducted by specialist committees,
divided into subject areas, which examine
the Commission's proposals before they are
put to the Parliament. The Committees
appoint a ‘rapporteur’ (an MEP) for each
proposal, who is responsible for preparing a
report on it. This report includes a draft
opinion on the proposal, which is placed
before the Parliament for adoption or
amendment as policy.
The Parliament has the ultimate power to

dismiss the Commission as a whole, with a
two-thirds majority. It also has some input
into the budgetary process since it has the
final say on the draft budget drawn up by
the Commission and agreed by the Council.
However, its amendments can be
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1999- 2004- 2007- audit the Community's revenue and

2004 2007 2009 expenditure.
Austria 21 18 18
Belgium 25 24 24
Bulgaria - - 18
Cyprus - 6 6
The European Investment Bank
Czech - 24 24
Republic The European Investment Bank is the
Denmark 16 14 14 Community's bank. It provides loans to
Estonia - 6 6 help public and private investment in
Finland 16 14 14
industry and infrastructure. The capital is
France 87 78 78
Germany 99 99 99 provided by member states.
Greece 25 24 24
Hungary - 24 24
Ireland 15 13 13
Italy 87 78 78
Latvia - 9 9
Lithuania - 13 13
Luxembourg 6 6 6
Malta - 5 5
Netherlands 31 27 27
Poland - 54 54
Portugal 25 24 24
Romania - - 36
Slovakia - 14 14
Slovenia - 7 7
Spain 64 54 54
Sweden 22 19 19
United 87 78 78
Kingdom
(MAX) 626 732 786
TOTAL
Number of members of the European

Parliament 1999 to 2007
The Economic and Social Committee
The Economic and Social Committee, based

in Brussels, is a consultative body of 222
members representing employers, trade
unions and other interested bodies such as
farmers and consumers. Representation
from the liberal professions, including the
health professions is included in the latter
group. The Commission is required to take
note of its opinion on proposals relating to
economic and social matters.
The Committee of the Regions
This committee was created in 1996. Its

membership consists of representatives
from "local government" in the Community
and its function is similar to that of the
Economic and Social Committee. The
purpose of the Committee is to introduce
local democracy into the decision making
process.
The Court of Auditors
The Court of Auditors is based in

Luxembourg. Its 12 members are
appointed by the Council of Ministers, to
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Types of Community Legislation
Under the treaties, the Council and the

Commission may make regulations, issue
directives, take decisions, make
recommendations or deliver opinions.
Regulations apply directly to all Member

States. They do not have to be confirmed
by national Parliaments, and if there is a
conflict between national law and the
regulation, the regulation prevails.
Directives are compulsory, but it is left to

the Member States to translate them into
national legislation. If a state does not
introduce appropriate laws, the rights of an
individual are protected by the Directive.
Decisions are binding only on the Member

States, companies or individuals to which
they are addressed.
Recommendations and Opinions are not

binding, merely stating the view of the
institution that issues them.
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Annex 4 – Diplomas and Qualifications

Diplomas, certificates and other evidence of formal qualifications that
are mutually recognised
Notes
Title
Austria Doctor of Medicine (Dr.Med.Univ.) Dentists from non-EU countries have

with the Specialist Certificate to demonstrate the equivalence of
(Fachartz fur Zahn-, Mund-, und their education and training to an
Kieferheilkunde) (Dr.Med.Dent.). expert panel of the Universities of
Bescheid über die Verleihung des Vienna, Graz or Innsbruck.
akademischen Grades "Doktor der
Zahnheilkunde"
Belgium 'Diplome legal de licencie en science The official diploma of graduate in
dentaire/wettelijk dental science, awarded
diploma van licentiaat by the university faculties
in de tandheelkunde of of medicine, or by the
tandarts' Central Board ("Jury
Central") of university
examiners.
Cyprus Πιστοποιητικό Еγγραφής Diplomas are from other EU countries,
Оδοντιάτρου as there is no
undergraduate training
The Czech “Medicinae universae doctor in Following qualification there is a
Re disciplina medicinae mandatory vocational
pu stomatologicae”. training, with a
blic (MUDr) completion examination
Diplom o ukončení studia ve (until 2009).
studijním programu zubní lékařství A change in title is planned, and the
(doktor zubního lékařství, title for a dentist will
Dr.med.Dent.) probably be “MDDr” from
2009
Denmark 'Bevis for tandlaegeeksamen Official diploma certifying that the
(kandidateksamen)' holder has passed the examination in
dentistry, issued by schools of
dentistry together with the document
issued by the 'Sundhedsstyrelsen'
(National Board of Health) certifying
that he/she has worked as an
assistant for the required length of
time.
Estonia DDS Dentist
Diplom hambaarstiteaduse
õppekava läbimise kohta
Finland 'Todistus hammaslaaketieteen Certificate of the degree of licentiate
lisensiaatin in odontology, awarded by a
tutkinnosta/bevis om university faculty of medicine or
odontologi licentiat faculty of medicine or faculty of dental
examen' medicine and a certificate of practical
training issued by the competent
public health authorities.
France 'Diplome d'Etat de Awarded until 1973 by the university
chirurgien-dentiste' faculties of medicine or
(State diploma of dental the university joint
surgeon) faculties of medicine and
pharmacy.
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'Diplome d'Etat de docteur en

chirurgie dentaire' (State diploma of Awarded by the universities.
doctor of dental surgery),
Germany Zeugnis über die zahnärztliche Awarded by the competent
Staatsprüfung (the authorities.
State examination in The certificates from the competent
dentistry) authorities of the Federal Republic of
Germany stating that the diplomas
awarded after 8th May, 1945, by the
competent authorities of the German
Democratic Republic are recognised
as equivalent to those listed
Greece Πτυχιω οδοντιατρικις
τουΠανεπιστιμιου
'Ptychio odontiatrikis tou
Panepistimiou'
Hungary Fogorvos oklevél (doctor medicinae Is followed by a period of mandatory
dentariae, abbrev.: dr.med.dent.) or vocational training as
DDS residents, known as
“Központi gyakornok”
and then a completion
examination
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Iceland Candidatus odontologiae

Próf frá tannlæknadeild Háskóla
Íslands
Ireland The diploma of: The diploma of LDS is no longer
• Bachelor in Dental Science (B offered by Irish dental
Dent Sc.) schools
• Bachelor of Dental Surgery (BDS)

or
• Licentiate in Dental Surgery
(LDS)
Italy 'Diploma di laurea in odontoiatria e Awarded by the State examining
protesi dentaria' board.
accompanied by the
'diploma di abilitazione
all'esercizio dell
'odontoiatria e protesi
dentaria',
Latvia zobārsta (dentist)
Lithuania Aukštojo mokslo diplomas,
nurodantis suteiktą This title is conferred after one-year’s
gydytojo odontologo vocational training
kvalifikaciją
Odontologist of General Practice
Luxembourg 'Diplome d'Etat de docteur en Issued by the State Board of
médecine dentaire' Examiners.
(State diploma of doctor
of dental medicine),
Malta Bachelor of Dental Surgery (BChD) Issued by the University of Malta
Lawrja fil-Kirurġija Dentali
Norway Master of Dentistry
Vitnemål for fullført grad
candidata/candidatus odontologiae,
short form: cand. odont.
The 'Universitair getuigschrift van een University certificate indicating
Net met goed gevolg success in the dental
her afgelegd surgeon's examination.
lan tandartsexamen'
ds
Poland Stomatologist (1996 to 2004)
Dental Doctor (lekarz dentysta) –
from 2004
Dyplom ukończenia studiów
wyższych z tytułem “lekarz
dentysta”
Portugal 'Carta de curso de licenciatura em Diploma conferring official recognition
medicina dentaria' of completion of studies in dentistry,
awarded by an establishment of
higher education.
Romania Physician stomatologist The newly qualified dentist becomes a
“Probation physician stomatologist (1
year)/stagier” before receiving a
licence.
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Slovakia MUDr – Medicinae Universae There is a mandatory post-

Doctor. qualification 36 months training,
Vysokoškolský diplom o udelení followed by an examination by
akademického titulu interview.
“doktor zubného The new title MDDr is introduced for
lekárstva” (“MDDr.”) graduates who commence training
from 2004.
Slovenia "Doctor dentalne
medicine”(dr.dent.med.
)
Diploma , s katero se podjeljuje
strokovni naslov “doktor dentalne
medicine/doktorica dentalne
medicine”
Spain Licenciado en odontologia -
• Medico especialista en
estomotologia
• Medico especialista en cirurgia
maxilo-facial
Sweden 'tandlakarexamen' (university Awarded by schools of dentistry and a
diploma in dentistry) certificate of practical training issued
by the National Board of Health and
Welfare.
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Switzerland Swiss Federal Diploma for Dentistry

Titulaire du diplôme fédéral de
médecin-dentiste, eidgenössisch
diplomierter Zahnarzt, titolare di
diploma federale di medico-dentista
The United The diploma of: Issued by the universities and the
Kin • Bachelor of Dental Surgery (BDS royal colleges.
gd or BChD), or The diploma of LDS is no longer
om offered by UK dental
• Licentiate in Dental Surgery
schools
(LDS)
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Annex 5 – Specialist Diplomas & Qualifications

Specialist Diplomas and certificates that are mutually recognised
Orthodontics Oral Surgery
Austria No dental specialists recognised No dental specialists recognised

Belgium Tandarts specialist in de Orthodontie, Maxillo-faciale chirurgie, Chirurgie
Dentiste Spécialiste en Maxillo-faciale
orthodontie
Cyprus Πιστοποιητικό Αναγνώρισης του Πιστοποιητικό Аναγνώρισης του
Ειδικού Оδοντιάτρου στην Еιδικού Οδοντιάτρου στην Στοματική
Оρθοδοντική Χειρουργική
The Czech Attestation in maxillo-facial Attestation in oral and maxillofacial
R orthopaedics (atestace z surgery (atestace z orální
e čelistní ortopedie) a maxilofaciální chirurgie)
p
u
b
l
i
c
Denmark ‘Bevis for tilladelse til at betegne sig ‘Bevis for tilladelse til at bretenge sig
som specialtandlaege I som specialtandlaege I
ortodonti' (certificate hospalsodontologi' (certificate
awarding the right to use conferring the right to use the title of
the title of dental dental practitioner specialised in
practitioner specializing in hospital odontology), issued by the
orthodontics), issued by 'Sundhedsstyrelsen' (State Board of
the 'Sundhedsstyrelsen' Health).
(State Board of Health).
Estonia Specialist in Orthodontics Maxillofacial Surgeon
Residentuuri lõputunnistus ortodontia
erialal
Finland 'Todistus erikoishammaslaakarin 'Todistus erikoishammaslaakarin
oikeudesta oikomishoidon oikeudesta suukirurgian (hammas- ja
alalla/bevis om suukirurgian) alalla/bevis om
specialisttandlakarrattighe specialisttandlakarrattigheten inom
ten inom omradet omradet oralkirurgi (tand- och
tandreglering' (certificate munkirurgi)' (certificate of oral or
of orthodontist) issued by dental and oral surgery) issued by the
the competent authorities. competent authorities.
France Le titre de “spécialiste en orthodontie” Médecine spécialiste qualifié en
(the title of orthodontic specialist), stomatologie
issued by the authority recognised
competent for this purpose.
Germany 'Fachzahnärztliche Anerkennung fur 'Fachzahnärztliche Anerkennung fur
Kieferorthopadie' (certificate of Oralchirurgie/Mundchirurgie'
orthodontist), issued by the (certificate of oral surgery), issued by
'Landeszahnärztekammern' (Chamber the 'Landeszahnärztekammern'
of Dental Practitioners of the 'Länder'). (Chamber of Dental Practitioners of the
'Länder')
Greece Τιτλος τις οδοντιατρικις τις ιδικοτιτας Τιτλος τις οδοντιατρικις τις
τις ορθοδοντικις Titlos tis odontiatrikis ιδικοτιτας τις
idikotitas tis orthodontikis γναθοχιρουργικις
Titlos tis odontiatrikis idikotitas tis
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521
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gnathochirourgikis'.
Hungary Fogszabályozá szakorvosa bizonyítvány Dento alveoláris szájsebész or
Dento-alveoláris sebészet szakorvosa
bizonyítvány
Iceland There is no specialist training in
Iceland. However, they do recognise
specialists who have trained elsewhere
(for at least 3 years)
Ireland Certificate of specialist dentist in Certificate of specialist dentist in oral
orthodontics, issued by the competent surgery, issued by the
authority recognised for this purpose by competent authority
the competent minister. recognised for this
purpose by the competent
Minister.
Italy Diploma di specializzazione in 'Diploma di specializzione in 'Chirurgia
'Ortognatodonzia'. dontostomatologica'
Latvia Specialist in orthodontics Specialist in oral surgery
“Sertifikāts” – kompetentas iestādes
izsniegts dokuments, kas apliecina, ka
persona ir nokārtojusi
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Lithuania Licence of Odontologist Specialist Licence of Odontologist Specialist (oral

(orthodontist) surgeon). For the maxillofacial surgeon
Rezidentūros pažymėjimas, nurodantis specialty, there is a Licence of
suteiktą gydytojo ortodonto profesinę Maxillofacial Surgeon.
kvalifikaciją Rezidentūros pažymėjimas, nurodantis
suteiktą burnos chirurgo profesinę
kvalifikaciją
Luxembour No dental specialists recognised No dental specialists recognised
g
Malta Ċertifikat ta’ speċjalista dentali fl- Ċertifikat ta’ speċjalista dentali fil-
Ortodonzja Kirurġija tal-ħalq
The 'Getuigschrift van erkenning en 'Getuigschrift van erkenning en
N inschrijving als inschrijving als
e orthodontist in het kaakchirurg in het
t Specialistenregister' Specialistenregister'
h (certificate showing that (certificate showing that
e the person concerned is the person concerned is
r officially recognised and officially recognised and
l that their name is entered that his name is entered
a as an orthodontist in the as an oral surgeon in the
n specialists' register), specialists' register),
d issued by the issued by the
s 'Specialisten-Registratieco 'Specialisten-Registratiec
mmissie (SRC)' (Specialists ommissie (SRC)'
Registration Board). (Specialists Registration
Board).
Norway Specialist in orthodontics Specialist in oral surgery
Bevis for gjennomgått
spesialistutdanning i kjeveortopedi
Poland Dental doctor specialist II° of Dental doctor specialist II° of oral
orthodontics maxillo-facial surgery
Dyplom uzyskania tytułu specjalisty w Dyplom uzyskania tytułu specjalisty w
dziedzinie ortodoncji dziedzinie chirurgii stomatologicznej
Portugal Especialista em ortodontia (ortodontics) Especialista em cirurgia oral (oral
surgery)
Romania Physician specialist orthodontist Physician specialist maxillo-facial
surgery
Slovakia Specialist in dentofacial Maxillofacial surgeon ("maxilofaciálny
orthopaedics (čeľustný ortopéd) chirurg")
Slovenia Specialist in orthodontics Specialist in Oral Surgery
Potrdilo o opravlijenem specialističnem Potrdilo o opravljenem specialističnem
izpitu iz čeljustne in zobne ortopedije izpitu iz oralne kirurgije
Spain No dental specialists recognised No dental specialists recognised
Sweden 'Bevis om specialistkompetens i 'Bevis om specialistkompetens i
tandreglering' (certificate tandsystemets kirurgiska sjukdomar'
awarding the right to use (certificate awarding the right to use
the title of dental the title of dental practitioner
practitioner specializing in specializing in oral surgery) issued by
orthodontics) issued by the the National Board of Health and
National Board of Health Welfare.
and Welfare.
Switzerland Fachzahnarzt für Kieferorthopädie Fachzahnarzt für Oralchirurgie
Diplôme fédéral d'orthodontiste, Diplom
als Kieferorthopäde, diploma di
ortodontista
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The United Certificate of completion of specialist Certificate of completion of specialist

K training in orthodontics, issued by the training in oral surgery, issued by the
i competent authority recognised for this competent authority recognised for
n purpose. this purpose.
g
d
o
m
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Annex 6 – Content of undergraduate training and

education
The programme of undergraduate studies must include the following subjects. One or more of
these may be taught in the context of the other disciplines or in conjunction with them.
1. Basic subjects:
chemistry
physics
biology
2. Medico-biological subjects and general medical subjects

anatomy
embryology
histology, including cytology
physiology
biochemistry (or physiological chemistry)
pathological anatomy
general pathology
pharmacology
microbiology
hygiene
preventive medicine and epidemiology
radiology
physiotherapy
general surgery
general medicine, including paediatrics
oto-rhino-laryngology
dermato-venereology
general psychology, psychopathology, neuropathology
anaesthetics
3. Subjects related to dentistry

prosthodontics
dental materials and equipment
conservative dentistry
preventive dentistry
anaesthetics and sedation in dentistry
special surgery
special pathology
clinical practice
paedodontics
orthodontics
periodontics
dental radiology
dental occlusion and function of the jaw
professional organisation, ethics and legislation
social aspects of dental practice
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Annex 7 – Acquired Rights
Primary diplomas covered by Article 7 paragraph 3 of

Directive 78/686/EEC: this diploma has to
The Acquired Rights provisions are referred be accompanied by a certificate stating
to for dentistry in the relevant provisions of that this diploma was awarded following
Directive 78/686/EEC6 (Article 7 - general training in accordance with Directive
acquired rights provision), Article 7a 78/687/EEC and is treated by the Member
(specifically relating to dentists in the ex- State which awarded it as the one listed for
Democratic Republic of Germany) and that Member State in the Directive (Annex
Articles 19, 19a, 19b (specific acquired A of Directive 78/686/EEC as amended by
rights provisions for doctors who practised Directive 2001/19/EC).
dentistry in Italy, Spain and Austria).
Concerning Article 19 § 1, 19a and 19b of
The basic principle is as follows: Directive 78/686/EEC, the dates before
which doctors had to start their training in
The general acquired rights provision medicine in order to benefit from these
(Article 7 § 1 of the sectoral Directive provisions was: January 28th 1980 for Italy,
78/687/EEC, relating to dental January 1st 1986 for Spain and January 1st
practitioners) provides for the recognition 1994 for Austria. For Article 19 § 2 (as
of diplomas in dentistry, that relate to introduced by Directive 2001/19/EC),
training not meeting the minimum doctors had to start their training between
requirements of the Directive and January 28th 1980 and, at the latest,
undertaken in the Member States prior to December 31st 1984.
the implementation of the Directives. These
diplomas need to be accompanied by a
certificate of three-years of effective and
lawful professional practice, issued by the
competent authorities of the Member State
concerned. It has to be stressed that the
implementation date of the Directives in a
given Member State does not mean that all
training started before that date does not
meet the minimum requirements of
Directive 78/687/EEC. In some Member
States, the training fulfilled the minimum
requirements before the date of
implementation and therefore the
corresponding diplomas benefit from
automatic recognition under Article 2 of
Directive 78/686/EEC. It is up to the
Member State that delivered the diploma to
certify that the diploma in question is the
one covered by the Directive.
The principle is basically the same for the

Articles 19 (Italy, Spain and Austria) and
Article 7a (GDR).
The case of change in the designation of

the diploma awarded following training in
accordance with Directive 78/687/EEC, is
6
Directives 78/686/EEC and 78/687/EEC had to
be implemented at the latest by 28/1/1980
between 8 Member States (Belgium; Denmark;
Germany; France; Ireland; Luxembourg;
Netherlands and United Kingdom); by January 1st
1981 by Greece); by July 28 1984 (Italy); by
th
January 1st 1986 (Portugal); by January 1st 1991

(Spain); by January 1st 1994 (Sweden and
Finland); and by January 1st 1999 (Austria).
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529
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minimum training period referred to in the
Directives.
At the time of publication of the Manual
there was early news of a change of For example, if, before the implementation
regulations arising out of European Court of the Directives, a specialised training
decisions. Where an applicant dentist who course lasted two years in a given country
has qualified outside the EEA is an EU and three years following the introduction
national, or married to an EU national, an of harmonised rules in the Community, the
application for registration in another accompanying certificate which may be
member state must be considered on its required by the Member State where the
merits, in relation to the training received specialist wishes to take up residence
and the amount of dentistry already should state that the specialist has
undertaken outside the EEA – and not effectively practised in that capacity for
necessarily under the Acquired Rights two years.
rules. An application to a host country must
be considered within three months.
The Accession Countries

For the States that joined the EU in 2004,
the implementation date was the date of
their accession (1st May 2004). The
Acquired Rights refer to “a certificate of the
competent authority of the EEA state …
stating that [the dentist] has been
effectively and lawfully practising dentistry
in that EEA state for at least three
consecutive years during the five years
preceding the date of issue of the
certificate”. Also, there is a requirement for
“an attestation from the competent
authority of that EEA State stating that that
diploma has, on its territory, the same legal
validity as regards access to and practice
of the dental profession as the Scheduled
European diploma specified in relation to
that State”.
For the Czech Republic and Slovakia,

specific acquired rights (Articles 19c and
19d of Directive 78/686/EEC as introduced
by the Accession Treaty) are applicable to
doctors who started their medical training
in these States before accession. In
addition new specific acquired rights are in
place for dentists practising in Estonia,
Latvia, Lithuania and Slovenia, who
obtained their diplomas in the former
Soviet Union and Yugoslavia (new Article
7b of Directive 78/686/EEC as introduced
by the Accession Treaty).
Specialists
Similar rules exist for specialised training

which does not meet the criteria in the
Directives. However, the amount of
experience that is required varies
according to the individual situation. In
practice, an acceptable time is in most
cases equal to twice the difference
between the length of specialised training
that has been undertaken and the
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Annex 8 – Data Protection

Information relating to individuals, called European level, and this took the form of
‘personal data’, is collected and used in EC Directives.
many aspects of everyday life. An
individual gives personal data when he/she, In order to remove the obstacles to the free
for example, registers for dental treatment. movement of data without diminishing the
protection of personal data, Directive
These data may subsequently be used for 95/46/EC (the Data Protection Directive)
other purposes and/or shared with other was enacted to harmonise national
parties, such as a sick fund or insurance provisions in this field. As a result, the
company. Personal data can be any data personal data of all citizens has the
that identifies an individual, such as a equivalent protection across the EU. The
name, a telephone number, or a photo. existing fifteen Member States of the EU
Advancement in computer technology were required to bring their national
along with new telecommunications legislation in line with the provisions of the
networks is allowing personal data to travel Directive by 24th October 1998. In fact, by
across borders with greater ease. As a the end of 2003 all then existing member
result, data concerning the citizens of one states had done so.
Member State are sometimes processed in
other Member States of the EU. Therefore,
as personal data is collected and
exchanged more frequently, the EC
determined that regulation on data
transfers became necessary.
In this context, national laws regarding

data protection demanded good data
management practices on the part of the
entities who process data, called 'data
controllers'. These included the obligation
to process data fairly and in a secure
manner and to use personal data for
explicit and legitimate purposes. National
laws also guaranteed a series of rights for
individuals, such as the right to be
informed when personal data was
processed and the reason for this
processing, the right to access the data and
if necessary, the right to have the data
amended or deleted.
Although national laws on data protection

aimed to guarantee the same rights, some
differences existed. The EC decided these
differences could create potential obstacles
to the free flow of information and
additional burdens for economic operators
and citizens. Some of these were:
• the need to register or be authorised to

process data by supervisory authorities
in several Member States,
• the need to comply with different
standards and the possibility to be
restricted from transferring data to
other Member States of the EU.
Additionally, some Member States did not

have laws on data protection. For these
reasons, there was a need for action at
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The Data Protection Directive applies to
“any operation or set of operations which is Data controllers are required to
performed upon personal data” - called observe several principles:
processing of data. Such operations include
the collection of personal data, its storage,
disclosure, etc. The Directive applies to
• Data must be processed fairly and
lawfully.
data processed by automated means (for
example computerized practice • They must be collected for explicit and
management systems) and to data that are legitimate purposes and used
part of or intended to be part of non accordingly.
automated filing systems in which they are • Data must be relevant and not
accessible according to specific criteria, excessive in relation to the purpose for
such as paper patient records. which they are processed.
• Data must be accurate and where
The Data Protection Directive does not necessary, kept up to date.
apply to data processed for purely personal • Data controllers are required to provide
reasons or household activities (such as an reasonable measures for data subjects
electronic personal diary or a file with to rectify, erase or block incorrect data
details of family and friends). about them.
• Data that identifies individuals must
In addition, there is a separate Directive, not be kept longer than necessary.
Directive 97/66/EC, that deals specifically • The Directive states that each Member
with the protection of privacy in State must provide one or more
telecommunications. This Directive states supervisory authorities to monitor the
that Member States must guarantee the application of the Directive. One
confidentiality of communication through responsibility of the supervisory
national regulations. authority is to maintain an updated
public register so that the general
Who can be a data controller? public has access to the names of all
data controllers and the type of
Data controllers are the people or body, processing they do.
'which determines the purposes and the • In principle, all data controllers must
means of the processing,' both in the public notify supervisory authorities when
and in the private sector. A dental they process data.
practitioner would usually be the controller
of the data processed on his patients.
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Annex 9 – Code of Conduct for Electronic Commerce

There is a European-wide Code of Conduct, The professional information
which is an integral part of the General (commercial communication) must
Principles for a Dental Professional Ethical show the following information:
Code in the Countries of the EU and is
related to a dentist's information service
and commercial communication on the
• title of the practice if it has legal status
in the member state where the dentist
Internet and other methods of electronic
is established
communication. The Code, which was
produced in 2002 by the EU Dental Liaison • for all dentists providing dental care
Committee, as directed by the European mentioned on the site
Commission acting on articles in the EU o the professional title and the
Directive on Electronic Commerce, is country from which their title is
designed to guide dentists' derived
communications with other dentists and o licence and registration
consumers who are not members of the information, with the address
dental profession as well. A dentist is and other contact details of the
responsible for his conduct as an competent authorities or have
information service provider and for the a link to these authorities' Web
content of the commercial communication. sites, where appropriate
1. Mandatory Provider Information on

a Web site
A dental website must show the following

information about the information service
provider:
• the name and geographic address at

which the service provider is
established
• the details of the service provider,
including his electronic mail address
and telephone number (it may also
show a fax number).
• the professional title and the country
from which his title is derived, where
appropriate
• licence and registration information,
with the address and other contact
details of the competent authorities or
have a link to these authorities' Web
sites, where appropriate
2. Requirements for the professional

information (commercial
communication)
When providing professional information

through the Internet, the dentist must show
truthfulness, fairness and dignity. When
setting up a Web site the dentist must
ensure that the contents are not misleading
or comparative of skills. All the information
on the Web site must be honest, objective,
easy to identify and be in accordance any
national legislation and code of conduct in
the member state where the dentist is
established.
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o the professional rules

governing the practice of The following discretionary
dentistry in the member state information may be shown on a Web
where the dentist is established site
or the address and other
contact details of the • hours during which the practice
competent authorities may be accessed by telephone or
governing these rules or have a personal visit, if any.
link to these authorities' Web • details of urgent and emergency
sites, where appropriate care which is available at the
practice.
A dentist must have regard to professional • details of the provision of care by
propriety and the dignity of the profession the responsible dentist or other
when establishing a name for his Web site, dentists in the practice or at other
or his Email address. locations.
• a link to the professional
When the dentist or other person with association
responsibility for the information service • information which is permitted by
changes, the name of this person must be the professional rules of the
removed from the Web site within one country where the dentist is
month of the cessation of the responsibility. established
The relevant pages must show the date of If links to other Web sites are made, the
last modification of the page. dentist must ensure that links are only
made when relevant and should endeavour
When a description of care is given, such to ensure that these Web sites reflect the
information must not be comparative. principles of this code
The following information should be The following information must not be

shown on a Web site placed on Web sites
The admissions or acceptance policy to any Comparison of the skills or qualifications of

sick fund, national health service or any dentist, providing any service, with the
insurance scheme, when these are skills and qualifications of other dentists.
available at the practice.
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Annex 10 – Tooth Whitening in the EU

There has been considerable activity to withdraw the product from sale in the
relating to the “legality” of using tooth UK.
whitening products orally. This is an
explanation of the position in March 2004. The Medical Devices Directive (MDD) was
implemented in 1993 and, in 1995
UK REGULATIONS Ultradent was granted CE marking for
Opalescence in Germany. However,
The nature of the Directives of 1992 and its government bodies in the UK continued to
predecessor in 1976 were that, legally, take the view that Opalescence was a
they would only be enforced against the cosmetic product and therefore its supply
Member States themselves once they were would be prohibited regardless of the CE
passed through national legislation. The marking. As a result of this prohibition,
Cosmetic Products (Safety) Regulations Optident made a claim in court against the
1996 avoided the need for further national UK government, for infringement of Article
implementation of the Directives because 4 of the MDD (which protects the sale of
of its direct effect to all individuals, private articles bearing the CE mark from obstacles
or public. placed by Member States) and therefore a
wrongful interference with their business.
These regulations repeat the main The Court of first instance found that
provisions of the 1976 Directive in terms of Opalescence was a medical device within
the definition given to cosmetic products. the MDD; and the fact that it had a CE
However, for purposes of dentistry, the marking placed
main provisions are encompassed in
section 4 of the regulations, in which it is
stated: “no person shall supply a cosmetic
product which contains any substance
listed in column 2 of Schedule 2, unless the
requirements in columns 3, 4, 5 and 7 are
satisfied.” According to this, Hydrogen
Peroxide and compounds that release it
can only be present in oral hygiene
products up to a maximum level of 0.1%
(present or released).
The definition of “supply” is not made clear

in the Regulations, although “supply”
includes ‘offering to supply, agreeing to
supply, exposing for supply and possessing
for supply’. A definition of “supply” is given
within the Consumer Protection Act of
1987, so a dentist applying tooth-whitening
products at the practice in exchange for
consideration would very likely to be seen
to be “selling” the goods and therefore
“supplying” the goods.
CASE LAW
Ultradent Products Inc makes the bleaching
product Opalescence, and it is exclusively
distributed in the UK by Optident Limited.
The gel contains 10% carbamide peroxide
which releases 3.4% hydrogen peroxide
when in contact with teeth and would be
supplied only to dentists who consider it
appropriate for their patient, not sold
directly to patients over the counter. Sales
of Opalescence started in the UK in 1992,
but the extension of the Directive in June
1993 to limit oral hygiene products to 0.1%
hydrogen peroxide content forced Optident
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539
______________________________________
on it in one member state meant that the EU MEDICAL DEVICES EXPERT
relevant authorities in other member states GROUP
had to respect this and therefore allow free
movement of the product within their A meeting of the Group took place during
jurisdictions. The conclusion to this was October 2003, and they concluded: “There
that the government bodies had placed was a very long discussion in Brussels. All
unlawful obstacles in the way of the member states are of the opinion that a
marketing and supply of Opalescence in tooth whitening/bleaching material is not a
the UK. medical device”.
The matter was taken to the Court of However, their discussions only have an
Appeal by the government and a large part advisory capacity.
of the initial discussion about the status of
Opalescence was based on how it is used
and the relative safety of its use compared
with previous tooth whitening products. It
was emphasised that a dentist will make a
clinical decision as to whether its use is
appropriate for the particular patient, with
the whole procedure being subject to strict
supervision by the dentist, the patient
being unable to buy the product over the
counter. However, after lengthy arguments,
it was decided conclusively that
Opalescence is a cosmetic, not a medical
device and therefore subject to the
Cosmetics Directive.
Following the decision in the Court of

Appeal, Optident appealed further in June
2001 to the UK Supreme Court, the House
of Lords – which reached the same decision
as the Court of Appeal, and Optident
therefore lost its case.
GERMAN STATUTES
Towards the end of 2003 a German court
decided that tooth-bleaching products are
medical devices. The main reasons for the
decision in favour of them being medical
devices rather than cosmetics were:
• they are delivered on the advice of a

dentist
• they require custom made trays
• they work by bleaching teeth internally,
rather than as cleaning agents (non-
vital teeth need a cavity to be cut to
have the material supplied to the tooth)
• the consumer has to understand that
there are possible hazards in the
procedure – from drilling (non-vital
teeth) or from the materials touching
the soft tissues
The German judges felt that the English

judges had paid too much reliance on
intended purpose, rather than the effect of
the products. Also, German law pays high
regard to the consumer’s expectations and
understanding of the procedure.
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Annex 11 – A summary of the draft EU

Constitution (as at June 2003)
1. The EU member states agree to 6. The European Council, acting by
establish a European Union so that they consensus, is in charge of the Union’s
can work together where they need to. The political direction. Acting within its
Union has a Constitution setting out what is guidance, the Commission will propose EU
done at the European level. It can be laws, and the Council will decide on them,
changed if everyone agrees. Any European usually by majority vote and jointly with the
State can apply to join and can leave. European Parliament. (Articles 18-26, 32-
(Articles 1, 6, 57, 59, Part IV). 38).
2. The Union is based on certain 7. There will be a single market, with free
principles: human dignity, liberty, movement of goods, peoples, services, and
democracy, the rule of law, and respect for capital across the Union. (Articles 3-4).
human rights. It aims at promoting peace, 8. Member States co-ordinate their
its values, and its peoples’ well-being. It economic policies. There will be a single
treats all equally. (Articles 2-3, 44-46, 50- currency, the Euro, for member states that
51, 58). wish to participate and meet the
3. It is a Union of the citizens and States conditions. (Article 14).
of Europe. Its decisions are taken as closely 9. There will be common action, more in
as possible to the citizens. It respects its some areas than others, where it makes
Member States’ national identities, and the sense to work together: agriculture,
Member States must help each other fulfil fisheries, transport, environment, illegal
the Union’s objectives. It works openly. immigration, asylum, fighting crime, and so
(Articles 1,5, 7-8, 42, 49, Subsidiarity and on. In some areas, smaller groups of
National Parliaments Protocols). Member States can act together. (Articles
4. The Union has only the powers the 12-13, 16-17, 41,43).
Member States give it. It acts at EU level 10. Member states will act together in
only when it needs to. When it does act, its foreign and defence policy, where their
laws prevail over Member States’ laws. governments all agree to do so. Common
(Article 9-11). action will be coordinated through a
5. The main bodies of the Union are: a European foreign affairs representative.
European Council, comprising leaders of (Articles 15, 27, 39-40, 56).
the Member States; a Council with
Ministers from each member state; a
European Parliament with MEPs from each
member state; an independent
Commission; and a Court with Judges from
each member state. The European Council,
Commission and Parliament have
Presidents. The bodies must respect
fundamental rights and liberties, as
reaffirmed in the Charter. The union has a
Budget, which must balance. (Articles 18-
31, 52-55, Part II).
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Dental Liaison Committee in The EU

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Dental Liaison Committee in The EU

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Dental Liaison Committee in the EU

MANUAL OF DENTAL PRACTICE

Dr Anthony S Kravitz OBE

Dental Public Health Unit in the University of Wales,

© The Liaison Committee of the Dental Associations of the

About the authors2

The dental associations of 28 EU/EEA countries and Romania

The EU Directorate on Education and Culture has funded an innovative pan-European

Education, Training and Registration...............................................................180

Other Useful Information.................................................................................212

Other Useful Information.................................................................................257

Website www.umu.se/odont ...........................................................................461

Number of members of the European Parliament 1999 to 2007 .....................510

The data and information for the existing

Following receipt by the authors of the

Documentary sources of information used

Additional explanatory notes

It was not possible to obtain a single, valid

English language conventions have been

• Decimals are expressed with a point,

Part 1: The European Union

Principal objectives of the Union are:

Between March 1996 and June 1997 an The Institutions

The Convention was asked to draw up

• how to bring citizens closer to the

The Convention identified responses to the

• it proposed a better division of Union

• it established a simplification of the

• it established the necessary measures

For a summary, see Annex 11

The Economy of the EU

The traditional way of measuring the Cyprus

“wealth” of a nation is through its Gross Slovenia

Domestic Product (GDP). The GDP Hungary

measures output generated through Estonia

physically located within the confines of a

Chart 2 – PPP per capita 2001: source

These figures must be taken into account

So, GDP is a crude measure for oral

GDP per capita

$0 $10,000 $20,000 $30,000 $40,000 $50,000

Chart 3 – GDP per capita 2002, based

Part 2: The Dental Directives, Acquired Rights & the

Dentists wishing to practise in the EU must

Each country also has an information

In theory member states cannot put any

Some dentists who wish to emigrate, make

From the beginning of 1994, freedom of

Freedom of movement and the (2004) • Safeguards may be applied by Member

In Spain and Portugal, there is a tradition of

The issue of how to treat qualifications

The solution devised by the EU aims on the

The General Directives on the mutual

The first "Sectoral Directive" which covered

The first "General Directive" deals with

The second "General Directive" includes

In 2002 the Commission published a draft

The main changes affecting the dental

Finally, it is not clear whether migrants

The European Parliament, at its first

This page is intentionally blank

Part 3: Other Directives relevant to dentists

For the purposes of the Directive,