A short review of Russian dental care
The article is devoted to comparing the methods of treating dental diseases in Soviet times and in modern Russia, studying the causes of these differences, analyzing statistical data on the provision of dental services to adults and children. Also the article sheds the light upon the classification of dental facilities in Russia, depending on the cost and quality of services provided.
A dentist in Russia has been called «zubnoiy vratch» (a tooth doctor). One of the most widespread dental diseases in Russia has always considered to be caries. During Soviet time, necessity and possibility in spare dental tissue were undervalued. The motto of Soviet health care was priority of prophylaxis, which was realized by more or less regular medical checkups at schools, factories and institutions .
The attitude to these checkups was often rather formal. As for dental care, initial and sometimes questionable carious lesions were treated by dry cutting, often with dull rotary instruments, with excessive removal of dental tissues. Exploration with a probe was habitually performed with the application of excessive force. Together with poor quality of filling materials, these procedures caused acceleration of the restoration/re-restoration cycle and rapid enlargement of the cavities: the fillings failed, the cavities were further enlarged, which eventually led to fractures and extractions .
As for endodontic therapy, it can be seen in today's radiograms that the quality of root canal treatment was often inadequate, and sometimes only traces of filling material were visible in the roots. Quality of treatment was additionally impaired by limited availability of effective anaesthesia. Endodontic treatment was usually performed without local anaesthesia, after arsenic trioxide devitalization of dental pulp.
One of the problems of Russian dentistry in general was a limited access to foreign researchers works . Overview of Russian literature from the last two decades has showed that the concept of minimally invasive dentistry has remained largely unknown, and the traditional approach to the caries treatment (extension for prevention) has never been seriously questioned. The term «minimally invasive dentistry» has recently appeared only in some Russian publications. Such articles are free from comprehensive analysis of literature and largely aimed at promotion of certain products .
Nowadays there are many dental care facilities in Russia, although most are concentrated in the big cities, and the vast majority of them are private rather than public. According to the classification based on the level and cost of services, there are three types of dentistry clinics in Russia:
1. Economy class polyclinics – these are basic state-provided clinics, where one can get a certain amount of treatment for free using state-funded insurance. Extra services are available for a fee.
2. Business class polyclinics – these may be public and private, they offer a wider range of services, and most of them are available for a fee.
3. Luxury VIP clinics – these are mostly situated in Moscow and include world-class specialists performing advanced treatment using the latest technology. Some of the major clinics have the capacity to treat up to 100 people at once, and there may work English-speaking dentists .
Theoretically, all citizens of Russia have the right for free medical insurance, which covers dental treatment (including prosthetics). However, the boundary between state polyclinics and private clinics is being blurred nowadays. Dental costs in Russia can be quite high, so adults and children can be charged unequally in different clinics. According to the World Health Organisation report in 2011 only 6.1% of adults received dental treatment compared to 44.9% of children .
In our opinion, the best way to improve dental care in contemporary Russia is dental propaganda of the same ethical principles as in general medicine, such as «dentistry for the patient» instead of the «dentistry for the dentist». Besides, economical progress of dental practice is needed, so that they could survive using more extensively preventive and minimally invasive methods .
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- Maksimova O.P, Rybnikova E.P, Petlev S.A. Back to the medical approach to the treatment of dental caries (in Russian)// Klinicheskaya stomatologiia. 2004.
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