A National Audit Office (Riigikontroll) audit shows that more than 40 percent of the adult population has not been to a dentist in five years. This shows that the goals of the dental care benefits system established in 2017 have not realized, as €40 yearly is not enough for lower-income people to receive dental care services.
Both dentists and the Health Insurance Fund (Haigekassa) admit that it is late to prevent problems now and support schemes must be drawn up to help those with serious oral and dental health issues.
Dentist Triinu Võlli noted that the patients with the first issues are those that have not been to a dentist in at least five, maybe even 10, years. "It is a long-term process. Patients in their 50s often tell me they have experience with dental care from a long time ago, when the service was painful and unpleasant, which scared them off. In addition to the financial side," Võlli said.
Bills for a single problematic tooth can reach a couple hundred euros. The common denominator for the 400,000 people who have not received any dental care over the past years has been a smaller income. And that is regardless of the €40 dental care benefit yearly.
"We can say we have not achieved the desired effects. For us to have 280,000 people that used benefits last year, shows that it is partially used. But the fact that the number of dentist visits among those with lower incomes and worse dental health is so low, shows that the benefits have not worked," National Audit Office auditor general Ines Metsalu-Nurminen said.
"I do not think this €40 motivates anyone to go to the dentist. There are some patients that say they have not used the benefits this year, but it was meant to be a measure in negotiations to motivate people to go to the dentists. It does not fulfill this, we have often thought that this money is not spent wisely, it could be used better," Estonian Dental Association vice president Mare Saag said.
All insured adults receive €40 a year in dental care benefits, but they still have to cover half of the bill. An increased benefit - €85 yearly - is available to pensioners, pregnant women, recipients of unemployment benefits and subsistence allowance and people with partial or no ability to work.
Triinu Võlli would see all medical bills presented to the Health Insurance Fund and not the patients. While the benefits scheme has brought some clients to visit the dentist, dentists have noticed that a "some for all" approach still leaves some people aside.
"We just had an older lady with complete toothlessness, meaning they did not have any teeth in their months. She needed two total prosthesis. One costs €450, the other is €900. She gets €260 in state aid, she has to pay €640. If we think about how much pensioners receive in pension, she cannot pay for this," Võlli said.
"These are the saddest stories to me. And then we have a whole lot of 15-17 year-olds that are partially incapable of working. The resources are allocated to them, but they do not use it. Perhaps this money can be moved from one box to another, where it may be more necessary?" the dentist added.
The National Audit Office assessed that the entire dental care system needs a more need-based approach.
"There are two paths here. Do we assess the need for treatment separately and the benefits are linked to an objective need, meaning the more a person needs dental care, the more the state supports them. Or do we link the benefits to income, so that those with lower incomes have a greater chance of receiving benefits," Metsalu-Nurminen noted.
Health Insurance Fund spokesperson Külli Friedemann said she agrees with the idea of dental care being better targeted. "We have done this, if a person needs dental care based on need. The greater question is now the target group, the incomes of which we will base better dental care on," Friedemann said.
The current benefits cover the cost of a regular dentist visit. So if all Estonians had visited dentists since they were children once a year, the current benefits would be enough. While the recommendation is to go to a dentist once a year, people mostly take care of their teeth when things get serious.
Dentists say cavities are just the tip of the iceberg. Moreso as dental health is not just a matter of beauty - caries or gingivitis can boost the development cardiovascular and lung diseases.
"People mostly do not even notice inflammation in the mouth. They start moving only when some teeth change places or when someone tells them they have bad breath. They start thinking about the issue then," Mare Saag said.
Dentists admit that priorities are often the cause of the issues. "We have quite a few younger women, who only have roots where teeth should be, but their nails and eyebrows are done. And then the main issue is that dental care is too expensive. Actually, if you count up all other costs, you could get some work done on your mouth," Triinu Võlli said.
Free service not being enough of a motivator for some is also reflected in the state of children's teeth in Estonia. Only 58 percent of children under the age of 20 went to a dentist last year.
"We actually have a lot of children with broken teeth and then there is an age group, where parents say the child is grown enough, I can bring my school as an example - we have 400 students in the school and you cannot look at half of them, because parents have signed a statement that say they do not want our treatment," Triinu Võlli said.
Health Insurance Fund representative Külli Friedemann noted that only consequences are dealt with currently. "It is clear that dental care does not cover for what has been left undone. Either the state has not contributed enough or the person has not. But we can point out that dental care for children is free. Use the opportunity to have them enter adulthood with strong teeth, this will also bring costs down," Friedemann said.
Although preventative work must be worked on, people who have already dealing with consequences, should not be left aside because they do not have enough money for treatment.
Triinu Võlli said preventative works are too late already. "We are talking about prevention, of course, and flossing and brushing, but people want to get their teeth fixed. It is a little like living on a rainbow, if we were to prevent everything, we would not need dental care. But we have many patients today that need this treatment. We must treat them," Võlli said.
Dental care is the only medical service in Estonia, which the Health Insurance Fund does not cover out of the social tax. Dental care would cost some €156 million out of the €1.7 billion Health Insurance Fund budget.
"I would first want to reach those with serious issues stemming from income, that is our first target group. For us to be able to pay for the entire population's dental care, I think that is very far into the future," Külli Friedemann noted.
Editor: Kristjan Kallaste