Premise: mouth diseases are a global public health problem since they hit well 3.5 billion people. According to the experts of the scientific journal The Lancet, which signed a call for action two years ago, health policies have done little to counter this epidemic. «In Italy the DMFT (acronym for Decayed, missing and filled teeth, index that measures the number of decayed, lost and filled teeth due to dental caries, ed) dropped significantly in 6- and 12-year-olds. This basically thanks to the spread of fluoroprophylaxis. However, if prevention and early diagnosis interventions were really active, the number of dental professionals, in theory, could even drop. Because the diseases that the dentist deals with most, caries, gingivitis and periodontal disease and their respective complications, they are pathologies whose causes are well known and easily preventable using appropriate interventions, ”says Professor Antonio Carrassi who is also full professor of Odontostomatological Diseases at the University of Milan.
Fundamental inequalities
Like and more than other health sectors, dental care is characterized by underlying inequalities, both between industrialized and non-industrialized countries, and within the same country between different social classes. Italy does not escape these dynamics. The public often gives insufficient answers and so those who can turn to private practices. According to the Rbm-Censis Report (2019) over 90% of dental care is actually provided by the private individual. The relative expenses would be higher than 9.5 billion euros and in absolute terms (26%) those with the greatest impact on Italian families as regards health expenditure. Many are forced to give up treatment because they cannot afford it. The economic crisis triggered by the pandemic seems to have accentuated the phenomenon. On the other hand, the very numbers of the forces involved say it all. «The Italian public dentistry foresees the provision of a minimum number of services, the type of which is included in the essential levels of assistance (Lea) , a fact that determines a voluminous recourse of families to the private alternative with financing out of pocket (i.e. paid out of one’s own pocket, ed) », Adds Carrassi.
A question of high costs and inadequate remuneration
Ma because public dentistry, which also has a long and glorious tradition, continues to remain a “Cinderella”? “Public dentistry is marginalized and the direct consequence of hospitals’ lack of interest in dentistry is fundamentally related to costs, which dentistry has and which are substantial, and the reimbursements that companies have and which are, I believe, in most insufficient performance to cover even the expenses. I feel lucky because our healthcare company supports dentistry, also because it is a university dentistry. But we are not the rule ». An example can better understand what happens. «The reimbursement of the Lombardy Region for an ablation of tartar is 9.5 euros. This means that the more services a hospital provides in dentistry, the more likely it is produces deficits for his hospital. And that of tartar is just one of many cases. I could give the example of a crown, an implant. So let’s say that certainly a general manager does not enjoy the desire to promote and develop a dentistry department ». How to fix it? «It would be absolutely essential that i Drg (the remuneration system for healthcare services, ed) and the dental tariff were reviewed and updated and that dentistry was not considered, as it often is now, detached from the problems of public health ”.
May 7, 2021 (change May 7, 2021 | 20:29)
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