Dental care in Russia: old and new challenges

[Jargin SV]

During Soviet time, necessity and possibility to spare dental tissue were undervalued. Early and sometimes questionable caries lesions were treated by extensive dry cutting often with dull rotary instruments, also during obligatory dental checks-ups at schools and some factories, often without asking a patient’s consent. Exploration with a probe was performed with application of excessive force. Together with poor quality of filling materials, it caused rapid iatrogenic enlargement of cavities: the fillings failed, cavities were further enlarged etc. Even today, the principles of minimally invasive dentistry are unknown by many practitioners. As for endodontic therapy, it can be seen from radiograms that quality of root canal treatment was on average insufficient, and sometimes only traces of filling material are visible in the roots. Large-scale privatization of dentistry, started in the 1990s, created new problems. Some private practitioners avoid conservative therapy of advanced lesions and persuade their patients towards extractions and prosthetics: so it is more economical for a dental praxis. Conservative treatment is sometimes plainly denied. In principle, all Russian citizens have a right for free medical insurance which covers the dental care (prosthetics not included). In reality, in free dental policlinics unofficial payments are not only accepted but encouraged, whereas non-paying patients are sometimes manipulated to the exit, to a private dentistry: rude examination with a probe, hints at poor quality of filling materials etc. Some practitioners at the policlinics receive also private patients, using state equipment and materials, the border between a state policlinic and a private praxis being thus effaced. All said, there are grounds for optimism: improved economy makes it possible today to modernize equipment, to introduce new methods and materials, whereas broadening international cooperation will make foreign experience and skills flow into our country. Hopefully, this letter will be only of historical interest in the near future. Jargin S.V. (Moscow)