EU Manual of Dental Practice 2015

Edition 5.1
_______________________________________ __________ ______ __ __ __

Council of European Dentists

MANUAL OF DENTAL PRACTICE 2015

(Edition 5.1)

*****

Authors:

Dr Anthony S Kravitz OBE

and

Professor Alison Bullock

Professor Jon Cowpe

with

Ms Emma Barnes

Cardiff University, Wales, United Kingdom

© The Council of European Dentists

February 2015

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Preface
The revised EU Manual of Dental Practice (Edition 5) was commissioned by the Council of European Dentists1 in April 2013. The work has
been undertaken by Cardiff University, Wales, 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 Council.

This edition (5.1) corrects a number of errors identified after publication. All data are as 2013 and have not been updated to 2015 data.

About the authors2

Dr Anthony Kravitz graduated in dentistry from the University of Manchester, England, in 1966. Following a short period working in a
hospital he has worked in general dental practice 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 then EU
Dental Liaison Committee.
He gained a Master’s degree from the University of Wales in 2005 and subsequently was awarded Fellowships at both the Faculty of
General Dental Practice and the Faculty of Dental Surgery, at the Royal College of Surgeons of England.
He is an Honorary Research Fellow at the Cardiff University, Wales and his research interests include healthcare systems and the use of
dental auxiliaries. He is also co-chair of the General Dental Council’s disciplinary body, the Fitness to Practise Panel.
Anthony was co-author (with Professor Elizabeth Treasure) of the third and fourth editions of the EU Manual of Dental Practice (2004 and
2009)
President of the BDA from May 2004 until May 2005, he was awarded an honour (OBE) by Her Majesty The Queen in 2002.

Professor Alison Bullock: After gaining a PhD in 1988, Alison taught for a year before taking up a research post at the School of
Education, University of Birmingham in 1990. She was promoted to Reader in Medical and Dental Education in 2005 and served as co-
Director of Research for three years from October 2005.
She took up her current post as Professor and Director of the Cardiff Unit for Research and Evaluation in Medical and Dental Education
(CUREMeDE) at Cardiff University in 2009. With a focus on the education and development of health professionals, her research interests
include: knowledge transfer and exchange; continuing professional development and impact on practice; workplace based learning.
She was President of the Education Research Group of the International Association of Dental Research (IADR) 2010-12.

Professor Jonathan Cowpe graduated in dentistry from the University of Manchester in 1975. Following training in Oral Surgery he was
appointed Senior Lecturer/Consultant in Oral Surgery at Dundee Dental School in 1985. He gained his PhD, on the application of
quantitative cyto-pathological techniques to the early diagnosis of oral malignancy, in 1984. He was appointed Senior Lecturer at the
University of Wales College of Medicine in 1992 and then to the Chair in Oral Surgery at Bristol Dental School in 1996. He was Head of
Bristol Dental School from 2001 to 20004.
He was Dean of the Faculty of Dental Surgery at the Royal College of Surgeons in Edinburgh from 2005 to 2008 and is Chair of the Joint
Committee for Postgraduate Training in Dentistry (JCPTD). He has been Director of Dental Postgraduate Education in Wales since 2009.
His particular interest now lies in the field of dental education. He was Co-ordinator for an EU six partner, 2-year project, DentCPD,
providing a dental CPD inventory, including core topics, CPD delivery guidelines, an e-learning module and guidelines (2010-12).

Ms Emma Barnes: After completing a degree in psychology and sociology, Emma taught psychology and research methods for health
and social care vocational courses, and later, to first year undergraduates. Following her MSc in Qualitative Research Methods she started
her research career as a Research Assistant in the Graduate School of Education at the University of Bristol, before moving to Cardiff
University in 2006, working firstly in the Department of Child Health and then the Department of Psychological Medicine and Clinical
Neurosciences.
In 2010 Emma joined Cardiff Unit for Research and Evaluation in Medical and Dental Education (CUREMeDE) as a Research Associate.
Working in close collaboration with the Wales Deanery, (School of Postgraduate Medical and Dental Education), her work focuses on
topics around continuing professional development for medical and dental health professionals, and knowledge transfer and exchange.

1 CED 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 AnthonyKravitz@gmail.com

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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 34 countries

The dental councils of several countries
Nina Brandelet-Bernot , Sara Roda and the other Secretariat of the CED
Rob Anderson (Cardiff University)
Professor Elizabeth Treasure (Cardiff University)
Ms Ulrike Matthesius (British Dental Association)
Dr Howard Davies (European University Association)
Dr Nicolae Cazacu, (ex-Romanian College of Dentists)
Dr A Goldstein (Monaco)
Dr Marino Bindi (San Marino)
Dr Vijay Kumar
Dr Susie Sanderson

In addition, the authors obtained information from the websites of the following organisations, without direct contact with them:

The Federation Dentaire Internationale (FDI)

The European Commission, including Eurostat
The World Health Organisation (WHO)
Union Bank of Switzerland (UBS)
The Organisation for Economic Cooperation and Development (OECD)
The Committee of European Dental Officers (CECDO)
The CIA Worldfactbook
The International Monetary Fund (IMF)
The World Bank
Deloitte
Price Waterhouse Cooper

Disclaimer

The Manual was originally sent for publication in February 2014 and then re-publication in February 2015: data may have subsequently
changed.

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Contents
Preface ............................................................................................................................................................................................................. 3
Contents ........................................................................................................................................................................................................... 5
Introduction ....................................................................................................................................................................................................... 9
Background ................................................................................................................................................................................................. 9
The scope and presentation of the review .................................................................................................................................................. 9
Information collection and validation ......................................................................................................................................................... 10
Romania .................................................................................................................................................................................................... 10
Additional explanatory notes ..................................................................................................................................................................... 10
Definitions ................................................................................................................................................................................................. 10
Part 1: The European Union ........................................................................................................................................................................... 13
Membership of the EU .............................................................................................................................................................................. 13
Objectives of the EU ................................................................................................................................................................................. 13
National Parliaments ................................................................................................................................................................................. 14
The Economy of the EU ............................................................................................................................................................................ 14
Part 2: The Freedom of Movement and Acquired Rights ............................................................................................................................... 17
The Freedom of Movement ....................................................................................................................................................................... 17
Freedom of Movement and the Accession Countries ............................................................................................................................... 17
Freedom of Movement and family members ............................................................................................................................................ 18
Acquired Rights ......................................................................................................................................................................................... 18
Part 3: Directives involving the Dental Profession.......................................................................................................................................... 19
Recognition of Professional Qualifications................................................................................................................................................ 19
System of automatic recognition of professional qualifications for dental practitioners ........................................................................... 19
General system for the recognition of professional qualifications ............................................................................................................ 22
Automatic recognition on the basis of common training principles .......................................................................................................... 22
Matters relating to sectoral and general system professions .................................................................................................................... 22
Directive on Patients’ Rights in Cross-border Healthcare ......................................................................................................................... 23
Data Protection ......................................................................................................................................................................................... 23
Consumer Liability..................................................................................................................................................................................... 23
Misleading and Comparative Advertising.................................................................................................................................................. 24
Cosmetics Regulation ............................................................................................................................................................................... 24
Electronic Commerce ................................................................................................................................................................................ 24
Unfair Commercial Practices Directive ..................................................................................................................................................... 24
Medicinal Products and Medical Devices ................................................................................................................................................. 25
Directive on Prevention from Sharp Injuries in the Hospital and Healthcare Sector ................................................................................ 25
Part 4: Healthcare and Oral Healthcare Across the EU/EEA ......................................................................................................................... 27
Expenditure on Healthcare........................................................................................................................................................................ 27
Population Ratios ...................................................................................................................................................................................... 28
Entitlement and access to oral healthcare ................................................................................................................................................ 29
Financing of oral healthcare ...................................................................................................................................................................... 29
Frequency of attendance .......................................................................................................................................................................... 29
Health Data ............................................................................................................................................................................................... 30
Fluoridation ............................................................................................................................................................................................... 31
Part 5: The Education and Training of Dentists.............................................................................................................................................. 33
Dental Schools .......................................................................................................................................................................................... 33
Undergraduate education and training...................................................................................................................................................... 34
Post-qualification education and training .................................................................................................................................................. 34
European Dental Education ...................................................................................................................................................................... 36
The Bologna Process ................................................................................................................................................................................ 36
Part 6: Qualification and Registration ............................................................................................................................................................. 37
Part 7: Dental Workforce ................................................................................................................................................................................ 39
Dentists ..................................................................................................................................................................................................... 39
Specialists ................................................................................................................................................................................................. 42
Dental Auxiliaries ...................................................................................................................................................................................... 43
Continuing education for dental auxiliaries ............................................................................................................................................... 45
Numbers in the dental workforce .............................................................................................................................................................. 45
Numbers of dental auxiliaries .................................................................................................................................................................... 46

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Part 8: Dental Practice in the EU .................................................................................................................................................................... 47

Liberal (General) Practice ......................................................................................................................................................................... 47
Public Dental Services .............................................................................................................................................................................. 48
Public Clinics ............................................................................................................................................................................................. 48
Hospital Dental Services ........................................................................................................................................................................... 49
Dentistry in the Universities....................................................................................................................................................................... 49
Dentistry in the Armed Forces .................................................................................................................................................................. 49
Illegal Practise of Dentistry........................................................................................................................................................................ 49
Part 9: Professional Matters .......................................................................................................................................................................... 51
Professional representation ...................................................................................................................................................................... 51
European dental organisations ................................................................................................................................................................. 52
Professional Ethics.................................................................................................................................................................................... 52
Standards and Monitoring ......................................................................................................................................................................... 53
Advertising ................................................................................................................................................................................................ 53
Websites ................................................................................................................................................................................................... 53
Data Protection ......................................................................................................................................................................................... 53
Indemnity Insurance .................................................................................................................................................................................. 53
Corporate Practice .................................................................................................................................................................................... 53
Tooth whitening ......................................................................................................................................................................................... 54
Health and Safety at Work ........................................................................................................................................................................ 54
Part 10: Financial Matters.............................................................................................................................................................................. 55
Retirement ................................................................................................................................................................................................. 55
Dentists’ Incomes ...................................................................................................................................................................................... 55
Income Tax rates ...................................................................................................................................................................................... 56
VAT ........................................................................................................................................................................................................... 56

Individual Country Sections ............................................................................................................................................................................ 57

Austria............................................................................................................................................................................................................. 59
Belgium ........................................................................................................................................................................................................... 67
Bulgaria .......................................................................................................................................................................................................... 77
Croatia ............................................................................................................................................................................................................ 85
Cyprus ............................................................................................................................................................................................................ 93
Czech Republic ............................................................................................................................................................................................ 101
Denmark ....................................................................................................................................................................................................... 111
Estonia .......................................................................................................................................................................................................... 119
Finland .......................................................................................................................................................................................................... 127
France........................................................................................................................................................................................................... 137
Germany ....................................................................................................................................................................................................... 149
Greece .......................................................................................................................................................................................................... 165
Hungary ........................................................................................................................................................................................................ 175
Iceland .......................................................................................................................................................................................................... 185
Ireland ........................................................................................................................................................................................................... 193
Italy ............................................................................................................................................................................................................... 205
Latvia ............................................................................................................................................................................................................ 221
Liechtenstein ................................................................................................................................................................................................ 229
Lithuania ....................................................................................................................................................................................................... 231
Luxembourg .................................................................................................................................................................................................. 241
Malta ............................................................................................................................................................................................................. 247
Netherlands .................................................................................................................................................................................................. 255
Norway.......................................................................................................................................................................................................... 265
Poland .......................................................................................................................................................................................................... 275
Portugal ........................................................................................................................................................................................................ 287
Romania ....................................................................................................................................................................................................... 299
Slovakia ........................................................................................................................................................................................................ 311
Slovenia ........................................................................................................................................................................................................ 321
Spain............................................................................................................................................................................................................. 329
Sweden ......................................................................................................................................................................................................... 339
Switzerland ................................................................................................................................................................................................... 349
The United Kingdom ..................................................................................................................................................................................... 357
Smaller Countries Associated with the EU: (Andorra, Monaco and San Marino) ....................................................................................... 377

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Annex 1 - Information collection and validation ............................................................................................................................................ 385

Annex 2 – EU Institutions ............................................................................................................................................................................. 387
The European Parliament ....................................................................................................................................................................... 387
The European Council ............................................................................................................................................................................ 388
The Council ............................................................................................................................................................................................. 388
The European Commission..................................................................................................................................................................... 389
National Parliaments ............................................................................................................................................................................... 390
The Court of Justice (ECJ) of the European Union ................................................................................................................................ 390
The European Central Bank.................................................................................................................................................................... 391
The Court of Auditors .............................................................................................................................................................................. 391
The Economic and Social Committee (EESC)........................................................................................................................................ 391
The Committee of the Regions ............................................................................................................................................................... 392
Other Institutions ..................................................................................................................................................................................... 392
Annex 3 – Acquired Rights; Freedom of Movement .................................................................................................................................... 393
Acquired Rights ....................................................................................................................................................................................... 393
Freedom of Movement for Family Members ........................................................................................................................................... 394
Annex 4 – The four models of healthcare .................................................................................................................................................... 397
Annex 5 – European Health Strategy ........................................................................................................................................................... 399
Annex 6 – Directive on patients’ rights in cross-border healthcare .............................................................................................................. 403
Annex 7 – Data Protection............................................................................................................................................................................ 405
Annex 8 – Tooth Whitening .......................................................................................................................................................................... 407
Annex 9 – Code of Ethics for Dentists in the EU .......................................................................................................................................... 409
Annex 10 – Code of Ethics for Dentists in the EU for Electronic Commerce ............................................................................................... 411
Annex 11 – Patient Safety, Prevention of Risk and Environmental Concerns ............................................................................................. 413
Prevention of Healthcare Infections ........................................................................................................................................................ 413
Prevention of Sharps Injuries (Council Directive 2010/32/EU) ............................................................................................................... 414
Prevention from sharp injuries in the hospital and healthcare sector ..................................................................................................... 414
Regulation on European Standardisation ............................................................................................................................................... 416
Medical Devices ...................................................................................................................................................................................... 416
Commission Recommendation on Unique Device Identification ............................................................................................................ 416
Community Mercury Strategy and Related Ongoing Activities ............................................................................................................... 417
EU Waste Legislation (Directive 2008/98/EC) ........................................................................................................................................ 418
Annex 12 – EU Charter for the Liberal Professions ..................................................................................................................................... 419

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Tables and Charts

Table 1 - Patient re-examination periods .................................................................................................................................................. 29

Table 2 - Community fluoridation .............................................................................................................................................................. 31
Table 3 – Dental schools, numbers of students and gender .................................................................................................................... 33
Table 4 – Undergraduate Training greater than 5 years ........................................................................................................................... 34
Table 5 – Post-Qualification Vocational Training ...................................................................................................................................... 34
Table 6 – Continuing Professional Development (Education) .................................................................................................................. 35
Table 7 - Regulation of dentists (2013) ..................................................................................................................................................... 37
Table 8 - Numbers of dentists ................................................................................................................................................................... 39
Table 9 - Gender of dentists - percentage female .................................................................................................................................... 40
Table 10 – Dentist unemployment in 2013 ............................................................................................................................................... 41
Table 11 - Types of specialties, and numbers in each ............................................................................................................................. 42
Table 12 - Types of auxiliary recognised in each country ......................................................................................................................... 44
Table 13 - Regulators of dental auxiliaries................................................................................................................................................ 45
Table 14 – The total workforce ................................................................................................................................................................. 45
Table 15 – The numbers of dental auxiliaries ........................................................................................................................................... 46
Table 16 - Percentage of dentists who are practising in general practice ................................................................................................ 47
Table 17 –Dentists working in public dental services ............................................................................................................................... 48
Table 18 - Countries without public clinics ................................................................................................................................................ 48
Table 19 - Membership of national dental associations ............................................................................................................................ 51
Table 20 – Advertising not permitted ........................................................................................................................................................ 53
Table 21 – Indemnity Insurance mandatory .............................................................................................................................................. 53
Table 22 – Corporate practice permitted .................................................................................................................................................. 53
Table 23 – Inoculation against Hepatitis B mandatory ............................................................................................................................. 54
Table 24 – Mandatory continuing education relating to ionising radiation ................................................................................................ 54
Table 25 – Amalgam separators mandatory ............................................................................................................................................. 54
Table 26 - Normal (state) retirement ages ................................................................................................................................................ 55
Table 27 - Tax rates …………………………………………………………………………………………… ………………………………. 55
Table 28: The European Parliament ....................................................................................................................................................... 388
Table 29: EESC membership ................................................................................................................................................................. 392

Chart 1 – Gross Domestic Product per capita at Purchasing Power Parity in 2012 ............................................................................... 15
Chart 2 – Domestic Purchasing Power, including rent, in 2012 ............................................................................................................. 15
Chart 3 - Percentage of GDP spent on health by each country in 2007-12 ............................................................................................ 27
Chart 4 - Percentage of GDP spent on health by governments in 2007-12 ............................................................................................ 27
Chart 5 – Spending per capita on health ................................................................................................................................................. 28
Chart 6 - (Active) Dentist to Population ratio ........................................................................................................................................... 28
Chart 7 – The average Decayed, Missing, Filled Teeth at the age of 12 years (DMFT) ......................................................................... 30
Chart 8 – The proportion of children of 12 years of age with no DMFT .................................................................................................. 30
Chart 9 – The proportion of adults 65 years (or older) with no teeth (edentulous).................................................................................. 30
Chart 10 – The number of “active dentists” in each country.................................................................................................................... 40
Chart 11 – The gender of “active dentists” in each country..................................................................................................................... 40
Chart 12 – The proportion of “overseas dentists” in each country .......................................................................................................... 41
Chart 13 – Dental practices “list” sizes .................................................................................................................................................... 47

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Introduction
Background each of 32 countries. In addition to the 28 countries of the EU,
Iceland, Liechtenstein and Norway (the EEA), and Switzerland
In common with many other professionals, dentists and other are included. Greenland and the Faroe Islands are described in
dental professionals are increasingly seeking opportunities to the chapter for Denmark. There are self-governing islands in
work and live in other countries. Within the EU, the ability for the British Isles and a British Dependency in Europe - these
dentists to move and work in any country has never been have been included in the UK section. Monaco and San Marino
greater and many national dental associations have are also added for the first time in this edition. Although neither
experienced a considerable increase in the number of enquiries country is a member of the EU, they have strong ties with the
from members about practising in another country. The EU.
problems and expense of answering these questions on an ad
hoc basis, and the need for associations to conduct their Each country chapter includes:
national political negotiations in the context of international
experience, resulted in the European Union Dental Liaison A brief description of the historical background, political
Committee (EUDLC) commissioning the Dental Public Health system and any features of the country’s society,
Unit of the University of Wales Dental School in Cardiff (UK), in economy or geography that are significant for the
1993, to produce a comprehensive reference document organisation of health services.
describing the legal and ethical regulations, dental training
requirements, oral health systems and the organisation of The main features of the health system, including: how it
dental practice in 32 European (EU and EEA) countries. is funded, how health policy is decided, and how the
provision of health services is organised.
The scope and presentation of the review
The Manual’s primary aim is to provide comprehensive and A section on oral healthcare which provides a general
detailed information for dentists and dental professionals who overview of the bodies responsible for its provision, the
are considering working in another country. In fact, the Manual population groups who have access, and the services that
has proved to be of value to governments and regulators also. It are available to them.
is widely quoted in professional journals and papers.
A description of entry to and content of dental school
The authors have endeavoured to construct a basic, minimum (undergraduate) education and training, and the
framework as an introduction to the most relevant topics, and a requirements for registration - including the requirements
well-informed starting point for further questions which for legal practice, the bodies which approve applications,
individuals may raise. the documents which need to be submitted, and any other
conditions which need to be met. Additionally, any
It has been written as a practical “handbook” in which postgraduate education and training (including specialist
information is easy to find and to understand. The country training) is described. The paragraphs on Specialists list
chapters also aim to balance information about formal the dental specialties that are recognised, including the
requirements including laws, codes of practice and other formal training required for each, and its location and
regulations with descriptions of how things work in reality. duration.

An introduction to the EU and dental practitioners A section on what constitutes the dental workforce in each
country, including numbers of dentists and specialists.
The opening chapters outline the origins of the EU and its There are several paragraphs on Dental Auxiliaries, which
attitude to health; how the EU functions including descriptions list the types of auxiliary that are recognised, what
of its formal institutions (for example, the Commission, the procedures they are allowed to carry out, where they work
Council, the European Parliament, the Court of Justice) and the and the rules within which they may legally practise.
current membership of the EU. We have also described the EU
Directives which are directly relevant to dentists, and we have Paragraphs on Working in General Practice, Working in
listed relevant internet weblinks. the Public Dental Service (where appropriate), Working in
Hospitals, and Working in Universities and Dental
The comparative analysis Faculties. For each of these, there is a brief description of
the staff titles and functions, the minimum formal
Further chapters provide a simple comparative analysis of the qualifications required, and how dentists are paid. For
different systems for the delivery of oral healthcare service, the general or private practice this usually involves details of
nature of education, training and the constitution of the dental the administration of any fee-scales, whether
workforce, different practising arrangements, and other remuneration is part of a contract, rules for prior approval,
regulatory frameworks and systems within which dentists work. and some practical details of how to join or establish a
We have briefly covered ethical codes, the monitoring of practice.
standards, specialist and auxiliary personnel, and the relative
importance of oral health services provided outside general or A section on dentistry in each country which is described
private practice. as “Professional Matters” and includes an explanation of
the framework for dental practice in terms of professional
The country chapters organisations, ethical codes and any other systems for
monitoring standards and handling complaints.
The bulk of the Manual contains the detailed descriptions of the
oral health systems, and the ways in which dentists practise in

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A “Financial” section, which briefly introduces many Definitions
financial considerations for practice.
Percentage of Gross Domestic (or National) Product
Finally there is an “Other useful information” section (GDP/GNP) spent on oral health
which provides the name, address, telephone and fax
numbers, website and email address of the main national This refers the proportion of a country’s overall wealth which is
dental associations, together with some other general spent on dentistry – through national health/social insurance
data. AND private care, if known.
Information collection and validation Private care
The history of the editions, the sources of information used, and
the validation of these are listed in Annex 1. This refers to dental care that is paid for entirely by patients
either directly to the dentist or through private dental insurance,
Romania without any government or social insurance subsidy or
reimbursement. It does NOT refer to co-payments made
There was no cooperation from the dental associations and
through a national health or social insurance scheme.
other authorities, or the universities in Romania, to update the
information relating to that country. To collect information,
Private insurance for dental care
Cardiff University was greatly assisted by Dr Nicolae Cazacu,
the recent Secretary-General, of the Romanian College of
This refers to insurance for dental treatment which patients buy
Dentists, but his access to information was limited. Some of the
from independent insurance companies not directly controlled
information has been collected from general sources on the
by either the government or any social insurance scheme.
internet.

Additional explanatory notes Percentage of Oral Health (OH) expenditure private

It was not possible to obtain a single, valid reference date for all This refers to the total expenditure (in money terms) by patients
data across all countries of Europe. The collection of data on dentistry, using private care (as defined above) only.
took place during 2013, and so this should be assumed to Expenditure by patients on co-payments in any state scheme or
be the reference year for the data, except where another date through any social insurance is NOT included in this figure.
is shown.
Co-payments
UK English language conventions have been used for
expressing text, numbers and figures, so that: These are payments made by patients towards the cost of their
dental treatment in a state or social or private insurance
Decimals are expressed with a point, eg 5.3 scheme. Also, where the scheme involves reimbursement, the
Millions are expressed with a comma, eg 1,000,000 amount not reimbursed is a co-payment.
“Billion” refers to One Thousand Million
Vocational training
UK English conventions for spelling are used, for example
organisation is spelt with an “s”, rather than a “z”, as in This refers to a period AFTER graduation, following registration
some English speaking countries with the competent authority, when the new dentist practises in
The sign for the Euro is € and this is placed before the a mandatory supervised environment (such as a training
number, eg €100 practice or public clinic or hospital department). The training
Data was finalised in January 2014, so any financial or period may - but not necessarily - include mandatory further
currency problems after this date are not reflected here. education and a further examination before the dentist can
practise in a non-supervised environment, and own his or her
The Manual was produced using Microsoft Word 2010, own dental practice.
Build 14.0.7113.5005 (32-bit) and may display differently
in any other version. Cost of registration
Edition 5.1
This refers to the annual cost of registration (if any) with the
During 2014 several countries contacted the CED to advise that competent body which registers dentists in a country.
there were errors in the information published. Text changes
have been made and corrected data inserted at the request of Specialists
the following countries:
France Malta These are dentists who have completed a further period of
Germany Netherlands special training following their basic qualification as a dentist
Hungary Sweden and then been registered with some national authority as a
Lithuania “specialist”. The only EU-wide acknowledged specialists are
orthodontists, oral surgeons and oral maxillo-facial surgeons –
These were all effected in Jnauary 2015. The NMT but many countries have additional classes of specialists.
(Netherlands) became the Royal Dutch Dental Association
(KNMT) in June 2014, but the title has not been changed in the
Manual to reflect that all text and data relate to January 2014 or
earlier.

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Overseas dentists Salaried dentists who work in dentist-owned practices are also
described as general dental practitioners.
This refers to dentists who have received their primary dental
qualification in any country other than the listed (host) country, The income for the general practice may be derived from a
even if they are nationals of that host country. number of sources:

A dentist who is not a national of the host country, but has direct payments by patients, such as “co-payments” for
qualified in that country is not an “overseas dentist” for the state or social insurance schemes, or fully private dental
purpose of this Manual. care
payments from state or social insurance schemes
References by countries to “abroad” refer to another country payments by private insurance companies
other than their own.
The ownership of the practice, rather than the method of
Active dentists income, defines a general practice.

This refers to dentists who remain on their country’s register or Public dental services
other such list of dentists who practise in a clinic, general
practice, hospital department, armed forces, administrative “Public dental services” refers to dental care which is provided
office or university. The difference between the number of in government health centres or publicly owned clinics,
dentists in a country and the “active dentists” should represent organised by municipalities or some other local or national
those dentists who are retired or who no longer undertake any organisation, singly or collectively. Dental services are often
form of dentistry, including administrative dentistry. part of other local health services. The dentists working in these
clinics are paid by salary. Often they work part-time in the
General Practice (in some countries referred to as “Liberal” clinics and may fill the remainder of their working time in
Practice) general practice or some other category of dentistry.

This refers to a dental practice in premises in which the practice “Public dental services” does NOT refer to dental care given in
is wholly owned by a dentist (“general dental practitioner”) or a general practice through a state funded or social insurance
company (corporate); alternatively, the premises may be rented supported scheme.
from the government or some other (private) person or
company. Corporate Dentistry

The owner dentist or company is responsible for the running This refers to limited companies which own and manage dental
costs of the practice, including the employment and labour practices. The Board of the company may comprise non-
costs of those employed there, such as other dentists and dentists although usually at least one (if not all) of the members
dental auxiliaries. must be a dentist or dental auxiliary. The company will employ
the dentists (and dental auxiliaries) who provide the dental care.

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Part 1: The European Union
The European Union (EU) was set up after the 2nd World War. Principal objectives of the Union are:
The process of European integration was launched on 9 May
1950 when France officially proposed to create “the first Establish European citizenship
concrete foundation of a European federation”. The Treaty of Ensure freedom, security and justice
Paris which was signed on 18th April, 1951, created the Promote economic and social progress
European Coal and Steel Community (ECSC) in 1952. Six Assert Europe's role in the world
countries (Belgium, the Federal Republic of Germany, France,
Italy, Luxembourg and the Netherlands) joined from the very The EC treaty was amended on 1st July, 1987, by the Single
beginning. The success of this limited agreement persuaded European Act (SEA). This restated the objectives of the EC by
the six signatories to extend their commitment. formalising the commitment to the completion of the "Internal
Market" by 1992. The Act also extended the competence of the
To achieve this, on 25th March 1957, they negotiated and Community to new areas such as environmental improvement
agreed the two Treaties of Rome which created the European and the strengthening of social cohesion, and modified the
Economic Community (EEC) and the European Atomic Energy decision making process by extending the use of majority
Community (Euratom). These three collectively became known voting in the Council of Ministers.
first as the EEC, then as the European Community (EC) and
finally the European Union (EU). The 1993 Maastricht Treaty, which led to the creation of the
European Union, further developed these concepts and a
Subsequently, there have been several waves of accessions, "Green Paper" on European Social Policy was introduced in
so that by 1st January 2014 the EU comprised 28 Member December of that year. Issues addressed included
States. unemployment, social protection and social standards, the
Single Market and effective freedom of movement, equal
Membership of the EU opportunities for men and women and the transition to
Belgium, France, Germany, Italy, Luxembourg economic and monetary union.
and the Netherlands (March 1957) – were the
founding countries Between March 1996 and June 1997 an Intergovernmental
Denmark, Ireland and the United Kingdom Conference (IGC) developed the consolidated Treaty of
(January 1973) Amsterdam – which came into force on 1st May 1999 - revising
Greece (1981) the original Treaties on which the European Union was
Spain and Portugal (January 1986) founded. The IGC is the formal mechanism for revising the
Austria, Finland and Sweden (January 1995) Treaties, which are the constitutional texts of the European
Cyprus, the Czech Republic, Estonia, Hungary, Union. Any changes are agreed following negotiations between
Latvia, Lithuania, Malta, Poland, Slovakia and governments of the Member States which belong to the Union.
Slovenia (May 2004)
Bulgaria and Romania (January 2007) The extension of the EU to embrace the new countries of
Croatia (July 2013) Eastern Europe was agreed at the IGC held in Nice in 1999.
On 13th December 2007, EU leaders officially signed a new
On 1st January 1994, some of the privileges of the Community, Treaty at a Special Summit in Lisbon, which came into force on
for example "freedom of movement" were extended through the 1st December 2009.
Treaty on the European Economic Area (EEA) to the countries
of the European Free Trade Area (EFTA). These remaining Health
non-EU EFTA countries are Iceland, Liechtenstein and Norway.
One other EFTA country, Switzerland, was included in the initial The EU Health Strategy has 3 main objectives:
agreement, but withdrew after a referendum in which its
population rejected the concept. This decision has also fostering good health in an ageing Europe
delayed the involvement of Liechtenstein because of its protecting citizens from health threats
"customs union" with Switzerland. supporting dynamic health system and new technologies

Objectives of the EU In 2007, the European Commission published a White Paper for
an EU Health Strategy, following a wide-ranging public
The European Union is said to be based on the rule of law and consultation. This “aims to provide, for the first time, an
democracy. It is neither a new State replacing existing ones nor overarching strategic framework spanning core issues in health
is it comparable to other international organisations. Its Member as well as health in all policies and global health issues. The
States delegate sovereignty to common institutions Strategy aims to set clear objectives to guide future work on
representing the interests of the Union as a whole on questions health at the European level, and to put in place an
of joint interest. All decisions and procedures are derived from implementation mechanism to achieve those objectives,
the basic treaties ratified by the Member States. working in partnership with Member States”.

It has been suggested that European integration has delivered In 2013, a mid-term review of the Health Strategy was carried
half a century of stability, peace and economic prosperity. It has out, establishing that the strategy provides a coherent and
helped to raise standards of living, built an internal market, comprehensive map of the main health‑related issues.
launched the Euro and strengthened the Union's voice in the
world.

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The Member States can achieve more when working in citizens working overseas, but does include factors such as the
coordination at EU level in certain areas. The Strategy serves rental value of owner-occupied housing.
as a consistent guiding framework and reference for actions The measure of a country’s output of goods and services is
taken at EU level. calculated using personal consumption, government
expenditures, private investment, inventory growth and trade
For further information about the Strategy see Annex 5. balance. GDP is the broadest measure of the health of an
economy but is often expressed now in Purchasing Power
In 2009, there was a Commission initiative dealing with patient Parity (PPP) - see below.
safety, including a Council recommendation on patient safety
which in particular addressed the issue of Health Care The Gross National Product (GNP) is the total value of all
Associated Infections. For further information see Annex 11. final goods and services produced for consumption in society
during a particular time period. Its rise or fall measures
The Institutions economic activity based on the labour and production output
within a country. The figures used to assemble data include the
The EU is run by seven institutions, each playing a specific role: manufacture of tangible goods such as cars, furniture, and
bread, and the provision of services used in daily living such as
European Parliament (elected by the peoples of the
education, healthcare, and auto repair. Intermediate services
Member States);
used in the production of the final product are not separated
European Council (which has the role of driving EU policy-
since they are reflected in the final price of the goods or
making, headed by the President.);
service.
The Council (composed of representatives of each
Member State at ministerial level) The GNP does include allowances for depreciation and indirect
European Commission (driving force and executive body); business taxes such as those on sales and property. The GNP
Court of Justice (compliance with EU law); is not usually used nowadays as it does not facilitate
European Central Bank international comparisons in an accurate manner.
Court of Auditors (sound and lawful management of the
EU budget). PPP is a theory which states that exchange rates between
currencies are in equilibrium when their purchasing power is the
Five further bodies are part of the institutional system: same in each of the two countries. This means that the
exchange rate between two countries should equal the ratio of
European Economic and Social Committee (expresses the two countries' price level of a fixed basket of goods and
the opinions of organised civil society on economic and services. When a country's domestic price level is increasing (ie
social issues); the country experiences inflation), that country's exchange rate
Committee of the Regions (expresses the opinions of must be depreciated in order to return to PPP.
regional and local authorities on regional policy,
environment, and education); The basis for PPP is the "law of one price". In the absence of
European Ombudsman (deals with complaints from transportation and other transaction costs, competitive markets
citizens concerning maladministration by an EU institution will equalize the price of an identical good in two countries
or body); when the prices are expressed in the same currency.
European Investment Bank (contributes to EU objectives
by financing public and private long-term investments); For example, a particular TV set that sells for €750 in Calais
European Central Bank (responsible for monetary policy should cost £625 in Dover, when the exchange rate between
and foreign exchange operations). the UK and France is €1.20 = £1. Clearly, PPP between
different countries within the Eurozone is easier to measure.
So, looking at relative wealth for all the EU/EEA countries using
National Parliaments PPP has slightly changed the order of countries within the chart
The Lisbon Treaty, in 2009, gave the national parliaments of (Chart 1, next page), but still shows the apparent disparity
Member States greater powers at an EU level. Parliaments are between the richer and poorer countries of Europe.
now able to comment on draft legislations and other activities.
These figures must be taken into account when comparing
A number of agencies and bodies complete the system. For incomes and fees between individual countries.
further information about each institution, please see Annex 2.
So, GDP is a crude measure for oral healthcare comparisons,
The Economy of the EU and a better measure is GDP per capita, based on current
purchasing power parities
The traditional way of measuring the “wealth” of a nation is
through its Gross Domestic Product (GDP). The GDP For individuals, however, their own income and what this will
measures output generated through production by labour and buy may have more relevance. UBS bank produces data which
property which is physically located within the confines of a compares prices and earnings in the largest city in each
country. It excludes such factors as income earned by its EU/EEA country. The earnings data uses a basket of earnings
from various trades and professions:

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Chart 1 – Gross Domestic Product per capita at Purchasing Power Parity in 2012

Luxembourg
Norway
Switzerland
Austria
Netherlands
Ireland
Sweden
Iceland
Germany
Belgium
Denmark
UK
Finland
France
Spain
Italy
Slovenia
Czech Rep
Malta
Cyprus
Greece
Slovakia
Portugal GDP at PPP per capita
Estonia
Lithuania 2012
Poland
Hungary
Latvia
Croatia
Bulgaria
Romania

Source: International Monetary Fund, World Economic Outlook Database, April 2013
http://www.imf.org/external/pubs/ft/weo/2013/01/weodata/weoselco.aspx?g=2001&sg=All+countries

Domestic Purchasing Power

compared with Zurich = 100
Red= 2012 Yellow = 2003

Chart 2 – Domestic Purchasing 110.0

100.0
Power, including rent, in 2012 –
90.0
based on Zurich = 100
80.0
Source: UBS Price and Earnings 70.0
November 2012 60.0
50.0
40.0
30.0
20.0
Chart 2 shows the relative purchasing
10.0
power of all goods and rent, November
0.0
2012, based on Zurich, taking net wages
or salary into consideration. So, people
living in Luxembourg were in the second
best position to purchase goods or
services and those in Sofia the least.
These comparisons also take into
account currency as some of the
countries are not in the Eurozone..

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Part 2: The Freedom of Movement and Acquired Rights
A Directive is a piece of European legislation which is addressed to Member States. Once such legislation is passed at the European
level, each Member State must ensure that it is effectively applied in their legal system. The Directive prescribes an end result. The form
and methods of the application is a matter for each Member State to decide for itself. In principle, a Directive takes effect through national
implementing measures (national legislation). However, it is possible that even where a Member State has not yet implemented a Directive
some of its provisions could have direct effect. This means that if a Directive confers direct rights to individuals, then individuals could rely
on the Directive before a judge without having to wait for national legislation to implement it. Furthermore, if the individuals feel that losses
have been incurred because national authorities failed to implement Directive correctly, then they may be able to sue for damages. Such
damages can only be obtained in national courts.

Regulations are the most direct form of EU law - as soon as they are passed, they have binding legal force throughout every Member
State, on a par with national laws. National governments do not have to take action themselves to implement EU regulations. They are
different from directives, which are addressed to national authorities who must then take action to make them part of national law, and
decisions, which apply in specific cases only, involving particular authorities or individuals. Regulations are passed either jointly by the EU
Council and European Parliament, or by the Commission alone.

The Freedom of Movement Member States must be proportionate in relation to any

additional obstacles to prevent an EU national with an EU
The principle of freedom of movement of workers, which was qualification from practising. Also, although the Directives
established in 1969, was intended to "abolish any discrimination facilitate free movement, they do not override all internal
based on nationality between workers of the Member States requirements and a host country may place the same
(MS) in employment, remuneration and other conditions of work restrictions on an immigrant dentist as it does on its own
and employment". nationals.

In essence, this means that every worker who is a citizen of a Some dentists, who wish to emigrate, make use of the services
member state has the right to: offered by agents in a country to help them with the registration
procedures. Such services can be very expensive and are not
accept offers of employment in any EU country; normally necessary. Their use is not recommended.
move freely within the Union for the purposes of
employment; From the beginning of 1994, freedom of movement has also
be employed in a country in accordance with the applied to those EFTA countries who are members of the EEA4.
provisions governing the employment of nationals of that
country;
Freedom of Movement and the Accession
remain in the country after the employment ceases. Countries
The Accession countries had to ensure that, concerning the
Limitations to this fundamental principle will only be allowed if free movement of workers, there were no provisions in their
they can be justified on grounds of public policy, public security legislation which are contrary to EU rules and that all
or public health (including patient safety). provisions, in particular those relating to criteria on citizenship,
residence or linguistic ability, are in full conformity with the
Since 1980, freedom of movement has applied to dentists from acquis (of accession).
those Member States whose dental education and training met
the requirements of the relevant Directives. Any dentist who is The key issue is that of free movement of workers and it has
an EU national and has a primary dental degree or diploma been treated in a broadly similar way for all countries. The
obtained in a member state is able to practise in any country in political and practical importance of this area of the acquis and
the Union. the sensitivities and uncertainties surrounding mobility of
workers led to transitional measures. It was expected that the
Dentists wishing to practise in the EU must register with the predicted labour migration from the Accession countries would
competent authority in the country in which they wish to work. be concentrated in certain Member States, resulting in
The details of the competent authority which is responsible for disturbances of the labour markets there. Concerns about the
certifying that diplomas, certificates and other qualifications held impact of the free movement of workers were based on
by a dental practitioner meet the requirements are set out at the considerations such as geographical proximity, income
end of every country section. Articles 4c and 4d of the differentials, unemployment and propensity to migrate. The EU
Professional Qualifications Directive (PQD) 2013/55/EU (page was also worried that this issue threatened to alienate public
10), define the role of the home Member State authorities3. opinion and to affect overall public support for enlargement.
Each country also has an information centre which may be the The EU did not request a transition period in relation to Malta
registration body or national dental association which will and Cyprus, when they joined the EU in 2004. However then,
provide details of the registration procedure and any special and in 2007 and 2013, for all the other countries, a common
requirements that there may be. The names and addresses of approach was used.
these centres are at the end of every country section.

4
3 For more information, see:
http://eur- http://ec.europa.eu/dgs/internal_market/index_en.htm
lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2013:354:0132:0170 or
:en:PDF http://europa.eu/youreurope/advice/index_en.htm

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Under the transitional arrangement, the rights of nationals from Additonally, the main principles of the Directive give the right to
new Member States who were already legally resident and free movement and residence within the territory of the Member
employed in a MS were protected. The rights of family States – also to their family members.
members were also taken into account consistent with the
practice in the case of previous accessions. The Directive requires that family members of EU citizens are
treated as EU citizens. This includes the right of family
This arrangement was accepted by the Accession countries members to take up employment or self-employment, providing
subject to some minor adaptations. The transition period for they have the right of residence or permanent residence.
Bulgaria and Romania ended on 31st December 2013.5
The main conditions for a non-EEA national to be treated as an
Freedom of Movement and family members EEA national in a Member State (MS) are that the non-EEA
European Parliament Directive 2004/38/EC legislated on the national must be the family member of an EEA national (other
right of citizens of the EU and their family members to move than a national of the particular MS being applied to) and that
and reside freely within the territory of the Member States. The the EEA national is moving to work or reside in the particular
Directive was implemented on 30th April 2006. MS being applied to and their family member is accompanying
them.
For further information, please go to Annex 3
The entitlements given to the non-EEA family member are that
Acquired Rights they have the right to equal treatment in the particular MS being
applied to as a national of that particular MS. This right to equal
Where the evidence of formal qualifications as a dental treatment arises when the family member has the right to
practitioner or as a specialised dental practitioner, held by residence or permanent residence in the particular MS being
Member State nationals, does not satisfy all the training applied to.
requirements referred to in the Professional Qualifications
Directive (PQD), each Member State has to recognise as Persons who are EEA nationals themselves have rights from
sufficient proof evidence of formal qualifications issued by their own EEA nationality.
those Member States. This is only insofar as such evidence
attests to successful completion of training which began before Rights conferred by this Directive do not extend to a substantive
the reference dates laid down in Annex V [of the PQD] and is right to have professional qualifications recognised. Entitlement
accompanied by a certificate stating that the holder has been to be treated as an EEA national in the particular Member State
effectively and lawfully engaged in the activities in question for being applied to does not lead to automatic recognition of
at least three consecutive years during the five years qualifications. But, the applicant is entitled to equal treatment of
preceding the award of the certificate. his/her qualifications as a national of the particular MS being
applied to. The qualifications must be considered under the
Acquired Rights were also gained by those who were PQD of 2013 in the same way that qualifications gained in the
practising in the former East Germany, the Baltic States particular MS being applied are considered, if he/she
(having gained their qualifications in the Soviet Union) and possessed the same qualifications as the applicant.
some of those who had been practising in Italy. They were also
gained by dental professionals practising in Spain (relating to For further, detailed information about Acquired Rights, please
earlier medical training); Austria; Slovenia; and Croatia (in see Annex 3.
relation to the former Yugoslavia),

5
There are arrangements following the accession of Croatia in 2013.
Self-employed Croatians and students who are working only part-time
should not be affected by any restrictions on the Freedom of Movement.

However, several Member States have put initial restrictions on other

Croatian workers: Austria, Belgium, Germany, Luxembourg, the
Netherlands, Slovenia, Spain and the United Kingdom have imposed
restrictions on Croatians doing certain kinds of work. There is no
restriction on searching for work done in the initial 3 months of
residence.

Ten member states have not imposed any restrictions on Croatian job
seekers: the Czech Republic, Denmark, Estonia, Finland, Hungary,
Ireland, Lithuania, Romania, Slovakia and Sweden.

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Part 3: Directives involving the Dental Profession
Recognition of Professional Qualifications measures for a better use of existing instruments
such as the Internal Market Information (IMI) system.
The recognition of professional qualifications in dentistry is
currently regulated by Directive 2005/36/EC as amended by  Transparency of regulated professions
Directive 2013/55/EU (hereinafter PQD).
A regulated profession means that access to the profession is
This Directive establishes the rules under which a host Member subject to a person holding a specific qualification, such as a
State recognises professional qualifications obtained in one or university diploma, and that activities are reserved to holders of
more other Member States and which will allow the holder of such qualifications.
these qualifications to pursue the same profession in the host
Member State. It is applicable to all Member State nationals. Article 59 of Directive 2013/55/EU established a transparency
and mutual evaluation exercise to be carried out by Member
Professional qualifications obtained in a third country may also States, which seeks to reduce the number of regulated
be recognised by the host Member State under certain professions and to remove unjustified regulatory barriers
conditions specified in the Directive (Articles 2(2) and 3(1)(a) of restricting the access to a profession or its pursuit. It involves
the PQD). In case of dentistry, the initial recognition needs to examining the justification of the need for regulation against the
respect the minimum training conditions laid down in Title III principles of necessity, proportionality and non-discrimination.
Chapter III sections 1 and 4.
 Continuous Professional Development
Directive on the recognition of professional
qualifications (PQD) 2005/36 EC Under Article 22(b), Member States will promote the continuous
professional development of professionals who benefit from the
On 20th October 2005, Directive 2005/36 EC came into force principle of automatic recognition. These include, in particular,
and replaced the earlier Dental Directives (78/686 and 78/687 doctors of medicine, nurses responsible for general care, dental
EEC) and 13 others related to the recognition of professional practitioners,, veterinary surgeons, midwives, pharmacists and
qualifications of dental practitioners, doctors of medicine, architects also known as “sectoral professions”.
nurses responsible for general care, midwifes, pharmacists,
veterinary surgeons and architects. It improved and simplified Lifelong learning is of particular importance for a large number
the system of automatic recognition of dental qualifications. of professions. It is comprised of all general education,
vocational education and training, non-formal education and
A number of changes were introduced compared with the informal learning undertaken throughout life, resulting in an
previous rules, including greater liberalisation of the provision of improvement in knowledge, skills and competences, and may
services and increased flexibility in the procedures for updating include professional ethics (see Article 3 (1) (l)). Recital 39
the Directive. The Directive also aimed to make it easier for further states that it is for MS to “adopt the detailed
regulated professionals to provide services on a “temporary and arrangements under which, through suitable ongoing training,
occasional” basis in Member States (MS) other than the MS of professionals will keep abreast of technical and scientific
establishment with a minimum of bureaucratic impediment. process”.

Directive 2013/55/EU of the European Parliament and System of automatic recognition of professional
of the Council of 20th November 2013 (Amendments qualifications for dental practitioners (Chapter III
to Directive 2005/36 EC)6 of the PQD)
Each Member State automatically recognises evidence of
On 18th January 2014, Directive 2013/55/EU came into force,
formal qualifications (diplomas, certificates and other evidence
amending several provisions of Directive 2005/36/EC. The
attesting successful completion of professional training) giving
review aimed at making the system of mutual recognition of
access to professional activities as a dental practitioner and as
professional qualifications more efficient in order to achieve
a specialised dental practitioner, covered by Annex V, points
greater mobility of skilled workers across the EU.
5.3.2 and 5.3.3 of the PQD.
The main features of the amended Directive include: Article 35(5) of the PQD also establishes the principle of
the creation of a European Professional Card; automatic recognition for new dental specialties (and its
the introduction of the principle of partial access to inclusion in point 5.3.3 of Annex V of the Directive) that are
certain professions (not applicable to professionals common to at least two-fifths of the Member States.
benefiting from automatic recognition of their
professional qualifications such as dentists); The description of the professional activities of dental
the recognition of professional traineeships carried practitioners is defined under Article 36 of the PQD.
out in another Member State or in a third country; For the purposes of equivalence in qualifications, this Directive
the clarification and update of training requirements sets minimum training requirements for dentists:
for professions under the automatic principle regime
(and for dental practitioners, changes to the  Minimum training requirements, including length of
minimum duration of training); and training and content
Admission to training as a dental practitioner (basic dental
training) presupposes possession of a diploma or certificate
6http://eur-lex.europa.eu/legal-
content/EN/ALL/?uri=CELEX:32013L0055

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giving access, for the studies in question, to universities or specialist in the activity, and in the responsibilities of the
higher institutes of an equivalent level, in a Member State. establishment concerned.
The system of automatic recognition works on the basis of Admission to specialist dental training is contingent upon
coordinated minimum training requirements. Basic dental completion and validation of basic dental training as defined in
training must be for at least 5 years’ study, with the equivalent Article 34 of the PQD, or possession of the documents referred
ECTS credits7, and must consist of at least 5,000 hours of full- to in Articles 23 and 37.
time theoretical and practical training. That comprises, at least,
the programme described in point 5.3.1 of Annex V (of the The Commission is empowered to adopt delegated acts (in
PQD). This should guarantee that the person concerned has accordance with Article 57c) concerning the adaptation of the
acquired commonly agreed knowledge and skills. minimum period of specialist training to scientific and technical
progress.
Under Article 22(a) of the PQD, Member States may authorise
part-time training, provided that the overall duration, level and The Commission is also empowered to adopt delegated acts
quality of such training is not lower than that of continuous full- concerning the inclusion in point 5.3.3 of Annex V of the PQD of
time training. new dental specialties common to at least two-fifths of the
Member States.
The PQD provides a minimum programme of subjects to follow,
which leaves room for the Member States to draw up more  Recognition of traineeships
detailed study programmes. The list of subjects appears in
Annex V (of the PQD), point 5.3.1 and can be amended by Given that national rules organising the access to regulated
delegated acts to the extent required to adapt them to scientific professions should not constitute an obstacle to the mobility of
and technical progress. young graduates, when a graduate completes a professional
traineeship in another Member State or in a third country, the
Following the professional training they have received, aspiring professional traineeship will be recognised, under the
dentists will possess a training qualification which has been conditions laid down by Article 55a of the PQD, when the
issued by the competent bodies in the Member States, bearing graduate applies for access to a regulated profession in the
the titles described in the PQD, and will enable them to practise home Member State. In particular, the traineeship must be in
their profession in any Member State. accordance with the Member State’s guidelines on the
organisation and recognition of traineeships. Member States
Articles 23 and 37 of the PQD establish the conditions under may set a reasonable limit on the duration of the part of the
which dental practitioners can see recognised their professional professional traineeship which can be carried out abroad.
qualifications which were obtained before their country joined
 Diplomas guaranteeing compliance
the EU. This is known as the “acquired rights’ regime (see
Annex 3 of this Manual). In these cases, where the evidence of The PQD lists the diplomas from each Member State which
formal qualifications providing access to the professional serve as evidence of having completed dental training which
activities of dental practitioners and specialised dental complies with the minimum training requirements. Each
practitioners held by nationals of Member States do not satisfy Member State must automatically recognise these diplomas
all the training requirements described in Article 34 and 35, and allow the holder to practise in that Member State8.
each Member State must recognise as sufficient proof evidence
of formal qualifications issued by those Member States insofar  Knowledge of languages
as such evidence attests successful completion of training
which began before the reference dates laid down in the The knowledge of one official language of the host Member
Annexes 5.3.2 and 5.3.3 of the PQD, and is accompanied by a State is necessary in order for the professional (ie dental
certificate stating that the holders have been effectively and practitioner) to start practising in the host Member State.
lawfully engaged in the activities in question for at least three However, the control of the language by the host Member State
consecutive years during the five years preceding the award of can only be carried out after the recognition of the professional
the certificate. Further details specific to dental practitioners are qualification. It is important for professions with patient safety
mentioned under Article 37. implications, such as dentistry, that a language control is
exercised before the professional accesses such a profession.
 Specialist training However, language controls have to be proportionate for the job
in question and should not aim at excluding professionals from
Full-time specialist dental courses must be of a minimum of the labour market in the host Member State. The professional
three years’ duration and must be supervised by the competent should be able to appeal against such controls under national
authorities or bodies. They must involve the personal law.
participation of the dental practitioner who is training to be a
Employers will also continue to play an important role in
7
ascertaining the knowledge of languages necessary to carry out
Recital 17 of the Amended PQD - European Credit Transfer and professional activities in their workplaces.
Accumulation System (ECTS) credits are already used in a large
majority of higher education institutions in the Union and their use is  Partial access – Article 4f of the PQD
becoming more common also in courses leading to the qualifications
required for the exercise of a regulated profession. Therefore, it is The PQD applies to professionals who want to pursue the same
necessary to introduce the possibility to express the duration of a profession in another Member State. However, there are cases
programme also in ECTS. That possibility should not affect the other
where the activities concerned are part of a profession with a
requirements for automatic recognition. One ECTS credit corresponds
to 25-30 hours of study whereas 60 credits are normally required for the
completion of one academic year. Source: EN L 354/134 Official 8 http://eur-
Journal of the European Union 28.12.2013 lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2005:255:0022:0142
:en:PDF

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larger scope of activities in the host Member State. If the This term is not further defined in the Directive. The
differences between the fields of activity are so large that in assessment will therefore be a matter of judgement by
reality a full programme of education and training is required for competent authorities (regulatory bodies) in each case. The
the professional to compensate for shortcomings - if the European Court of Justice has already ruled on this issue,
professional so requests - a host Member State must grant providing further guidance on these terms.
partial access, determined on a case-by-case basis, to a
professional activity in its territory, only when all the following The dental practitioner under this regime is subject to the same
conditions are fulfilled: rules as national dental practitioners to practise the profession,
in particular disciplinary provisions and other rules related to
(i) the professional is fully qualified to exercise in the home professional qualifications.
Member State the professional activity for which partial
access is sought in the host Member State; o Exemptions
(ii) differences between the professional activity legally One of the key aspects of the principle of the free provision of
exercised in the home Member State and the regulated services in the PQD is the exemption, under certain conditions,
profession in the host Member State as such are so large from the requirement for migrants to be registered in a
that the application of compensation measures would professional organisation or body (see Article 6(a)).
amount to requiring the applicant to complete the full
programme of education and training required in the host However, in order to ensure the application of disciplinary
Member State to have access to the full regulated provisions to the dental practitioner, Member States may
profession in the host Member State; provide for automatic temporary registration with the competent
(iii) the professional activity can objectively be separated from authority or for pro forma membership with the professional
other activities falling under the regulated profession in the organisation or body. This is done when a copy of the
host Member State. declaration referred in Article 7(1) of the PQD accompanied by
a copy of the documents referred in Article 7(2) are sent by the
A Member State is able to refuse partial access to a profession, host competent authority to the relevant professional
if it is justified by overriding reasons of general interest. organisation or body. Competent authorities may not however
charge any additional costs for this.
The principle of partial access does not apply for professionals
benefiting from the principle of automatic recognition, ie the o Article 7 - declaration to be made in
sectoral professions, which include dental practitioners. advance for the first provision of services in
the Host Member State
 Principle of the free provision of services9
Member States may require service providers (ie dental
o Article 5 of the PQD practitioners) to inform competent authorities of their intention to
provide services on a “temporary and occasional” basis, by
This provision establishes the principle that Member States
providing a written declaration in advance. This declaration
must not restrict, for any reason relating to professional
must be renewed once a year if the service provider intends to
qualifications, the free provision of services in another Member
provide temporary or occasional services during the following
State if the service provider - a dental practitioner - is legally
year. It is of course open to regulators to review cases
established in a Member State as a dental practitioner. This
periodically once the migrant is registered in the Member State,
principle, and the provisions laid down in Title II of the PQD,
to assess whether or not the service provision is genuinely
only applies when the dental practitioner moves to the host
temporary and occasional.
Member State to pursue his/her activity on a temporary and
occasional basis. The “temporary and occasional nature” of the The service provider may provide this written declaration by any
services provided are assessed on a case-by-case basis, in means.
relation to their “duration, frequency, regularity and continuity”.
Member States may require under Article 7.2 of the PQD that
the declaration is accompanied by the following documents:
9 The Principle of the free provision of services is explained in the
Lisbon Treaty. The freedom of establishment, set out in Article 49 (ex (i) proof of the service provider’s nationality,
Article 43 TEC) of the Treaty and the freedom to provide cross border (ii) an attestation certifying that the holder is
services, set out in Article 56 (ex Article 49 TEC), are two of the legally established in a Member State for the
“fundamental freedoms” which are central to the effective functioning of purpose of pursuing the activities concerned
the EU Internal Market. and that he is not prohibited from practising,
even temporarily, at the moment of delivering
The principle of freedom of establishment enables an economic the attestation;
operator (whether a person or a company) to carry on an economic
(iii) evidence of professional qualifications;
activity in a stable and continuous way in one or more Member States.
The principle of the freedom to provide services enables an economic (iv) an attestation confirming the absence of
operator providing services in one Member State to offer services on a temporary or final suspensions from exercising
temporary basis in another Member State, without having to be the profession or of criminal convictions; and,
established. (v) a declaration about the applicant’s knowledge
of the language necessary for practising the
These provisions have direct effect. This means, in practice, that profession in the host Member State.
Member States must modify national laws that restrict freedom of
establishment, or the freedom to provide services, and are therefore A Member State may require additional information of the listed
incompatible with these principles. Member States may only maintain above if:
such restrictions in specific circumstances where these are justified by
overriding reasons of general interest, for instance on grounds of public (i) the profession is regulated in parts of that
policy, public security or public health; and where they are Member State’s territory in a different manner;
proportionate.
http://ec.europa.eu/internal_market/top_layer/services/index_en.htm

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(ii) such regulation is applicable also to all professional training which is comparable in terms of
nationals of that Member State; responsibilities and functions;
(iii) the differences in such regulation are justified
by overriding reasons of general interest diploma certifying successful completion of training at
relating to public health or safety of service higher or university level of a duration of at least three
recipients; and years and less than four years;
(iv) the Member State has no other means of diploma certifying successful completion of training at
obtaining such information. higher or university level of a duration of at least four
Under the PQD, the service provider is entitled to practise once years.
he/she has complied with all of the above. On an exceptional basis, other types of training can be treated
as one of the five levels.
 Use of professional and academic titles
For more details regarding the general system regime see
Articles 52 and 53 of the PQD regulate the use of professional
Articles 10 to 15 of the PQD.
and academic titles.
Dental practitioners should use the professional title of the host Automatic recognition on the basis of common
Member State. training principles (Chapter IIIA of the PQD)
Dental practitioners also have the right to use the academic title While taking into account the competence of Member States to
conferred on them in the home Member State in the language decide on the qualifications required for the pursuit of
of the home Member State. professions in their territory and on the organisation of their
education systems, the new provisions on common training
Where this academic title is liable to be confused in the host principles intend to promote a more automatic character of
Member State with a title which requires additional training not recognition of professional qualifications for those professions
acquired by the beneficiary, then the host Member State may which do not currently benefit from it. Indeed, the professions
decide on which terms the home academic title can be used. subject to automatic recognition, such as dental practitioner, are
General system for the recognition of excluded from this regime (see Article 49a (2) (e) of the PQD).
professional qualifications (Chapter I of the The novelty, however, is the possibility for common training
PQD). frameworks to also cover dental specialties that currently do
not benefit from automatic recognition provisions under the
This system applies as a fallback for all the professions (such PQD (see Article 49a(7) of the PQD). Common training
as dental auxiliaries) not covered by specific rules of recognition frameworks on such specialties should offer a high level of
(such as dentists) and to certain situations where the migrant public health and patient safety.
professional does not meet the conditions set out under the
automatic recognition regime (Chapter III of the PQD). Common training principles can take the form of common
training frameworks (meaning a common set of knowledge,
The conditions of recognition under the general system are skills and competences necessary for the pursuit of a specific
specified in Article 13 of the PQD. If the competent authority of profession) or of common training tests (meaning a
the host Member State thinks the training that the applicant has standardised aptitude test available in participating Member
received differs significantly from the training required in the States and reserved to holders of a particular professional
host Member State, the applicant may have to sit an aptitude qualification).
test, or complete an adaptation period of up to three years. Professional qualifications obtained under common training
frameworks should automatically be recognised by Member
The host Member State must, in principle, offer the applicant States. Article 49a(5) lays down the conditions under which
the choice between an adaptation period and an aptitude test. Member States can be exempt of this regime.
The host Member State can only derogate from this
requirement in the cases specifically provided for under Article Professional associations and organisations which are
14(3) of the PQD. representative at national or Union level will be able to propose
common training frameworks and common training tests.
The PQD distinguishes under Article 11 five levels of
professional qualifications so that they can be compared: Matters relating to sectoral and general system
attestation of competence which corresponds to general professions
primary or secondary education, attesting that the holder  European professional card
has acquired general knowledge, or an attestation of
competence issued by a competent authority in the home The PQD introduces a “European Professional Card”, which is
Member State on the basis of a training course not an electronic certificate issued by the professional's home
forming part of a certificate or diploma, or of three years Member State, which will facilitate automatic recognition in the
professional experience; host Member State. The introduction of professional cards will
be considered for a particular profession where:
certificate which corresponds to training at secondary
level, of a technical or professional nature or general in o there is clear interest from professionals, the
character, supplemented by a professional course; national authorities and the business community;
o the mobility of the professionals concerned has
diploma certifying successful completion of training at significant potential; and
post-secondary level of a duration of at least one year, or o the profession is regulated in a significant number of
Member States.

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 Alert mechanism For further information, especially how this relates to dentistry,
see Annex 7.
The existing rules already provide for detailed obligations for
Member States to exchange information. These obligations will Consumer Liability
be reinforced. In future, competent authorities of Member The main features of the Directive on Liability for Defective
States will have to proactively alert the authorities of other Products (85/374/EEC)11 include the principle of “liability
Member States, using the IMI system, about professionals who without fault”. The Directive establishes the principle of
are no longer entitled to practise their profession due to a objective liability or liability without fault of the producer in cases
disciplinary action or criminal conviction, through a specific alert of damage caused by a defective product. If more than one
mechanism. The alert should be made at the latest three days person is liable for the same damage, it is joint liability. The
from the date of adoption of the decision restricting or word “Producer” has a wide meaning including: any participant
prohibiting pursuit of the professional activity (in part or in its in the production process, the importer of the defective product,
entirety). any person putting their name, trade mark or other
 First provision of services distinguishing feature on the product, or any person supplying a
product whose producer cannot be identified.
For the first provision of services of certain service providers,
The injured person must prove: the actual damage, the defect
Member States are given the option, under Article 7(4) of the
in the product and the causal relationship between damage and
Directive, of requiring competent authorities to check the
defect. As the Directive provides for liability without fault, it is
professional qualifications. This applies to
not necessary to prove the negligence or fault of the producer
(i) professions which fall under the general system with or importer.
public health or safety implications
(ii) sectoral professions, in cases which fall within Article 10 of The general public is entitled to expect safety and determines
the Directive. the defectiveness of a product. Factors to be taken into account
include: presentation of the product, use to which it could
 Deadlines reasonably be put and the time when the product was put into
circulation.
The PQD does not allow much flexibility in stipulating the
deadlines within which competent authorities have to give the Producers are freed from all liability if they prove (in particular
service provider a decision. There is one month to acknowledge relation to dentistry) that the state of scientific and technical
receipt of an application and to draw attention to any missing knowledge at the time when the product was put into circulation
documents. A decision has to be taken within three months of was not such as to enable the defect to be discovered. The
the date on which the application was received in full. Reasons producer's liability is not altered when the damage is caused
have to be given for any rejection and it is possible for a both by a defect in the product and by the act or omission of a
rejection, or a failure to take a decision by the deadline, to be third party. However, when the injured person is at fault, the
contested in the national courts (see Article 51 of the PQD). producer's liability may be reduced.

Directive on Patients’ Rights in Cross-border For the purposes of the Directive, “damage” means damage
Healthcare caused by death or by personal injuries.

On 24th April 2011, Directive 2011/24/EU on patients’ rights The Directive does not in any way restrict compensation for
in cross-border healthcare entered into force. The objective of non-material damage under national legislation. The injured
the Directive is to clarify patients’ existing rights of access to person has three years within which to seek compensation.
healthcare services in EU Member States. This period runs from the date on which the plaintiff became
For further information see Annex 6. aware of the damage, the defect and the identity of the
producer. The producer's liability expires at the end of a period
Data Protection of ten years from the date on which the producer put the
product into circulation. No contractual clause may allow
Although national laws on data protection aimed to guarantee producers to limit their liability in relation to the injured person.
the same rights, some differences existed. The EC decided
these differences could create potential obstacles to the free National provisions governing contractual or non-contractual
flow of information and additional burdens for economic liability are not affected by the Directive. Injured persons may
operators and citizens. Additionally, some Member States did therefore assert their rights accordingly.
not have laws on data protection.
The Directive allows each Member State to set a limit for a
To remove the obstacles to the free movement of data, without producer's total liability for damage resulting from death or
diminishing the protection of personal data, Directive personal injury caused by identical items with the same defect.
95/46/EC10 (the Data Protection Directive) was enacted to
harmonise national provisions in this field. In January 2012, it
was announced that there would be a redrafting of the current
Data Protection Directive to create the General Data
Protection Regulation (GDPR).

10 11

http://ec.europa.eu/justice/policies/privacy/docs/95-46-ce/dir1995- http://eur-
46_part1_en.pdf lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:31985L0374:en:H
TML

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Misleading and Comparative Advertising For further information see Annex 8.

The Directives on Misleading and Comparative Electronic Commerce

Advertising12 were introduced to protect consumers,
competitors and the interest of the public in general, against The E-Commerce Directive14 was adopted on 8 June 2000.
misleading advertising and its unfair consequences. The objective was to ensure that information society services
benefit from the internal-market principles of free movement of
Misleading advertising is defined as any advertising which, in services and freedom of establishment, in particular through the
any way, either in its wording or presentation deceives or is principle that cross-border provision throughout the European
likely to deceive the persons to whom it is addressed or whom it Union cannot be restricted.
reaches; by reason of its deceptive nature, is likely to affect
their economic behaviour; or for those reasons, injures or is The Directive covers information society services and services
likely to injure a competitor. allowing for online electronic transactions, such as interactive
online shopping. Examples of sectors and activities covered
Comparative advertising is defined as any advertising that include online newspapers, online databases, online financial
explicitly or by implication, identifies a competitor or goods or services, online professional services (such as lawyers,
services offered by a competitor. doctors, accountants and estate agents), online entertainment
services (such as audio-visual streamed content), online direct
National rules may allow persons or organisations with a marketing and advertising and services providing access to the
legitimate interest in prohibiting misleading advertising, or Internet.
controlling comparative advertising, to take legal action and/or
go before an administrative authority. Consumers have to check The chief aim of the Directive is to ensure that the EU reaps the
which system (judicial or administrative) their national full benefits of e-commerce by boosting consumer confidence
authorities have chosen. and giving providers of information society services legal
certainty, without excessive red tape.
The national courts or administrative authorities have enough For further information, especially how this relates to dentistry,
power to order advertising to cease, either for a certain period including ethical guidance for the use of the internet, see Annex
or definitively. They can also order its prohibition if the 10.
advertising has not yet been published, but its publication is
imminent. A voluntary control by the national self-regulatory Unfair Commercial Practices Directive
bodies can also be carried out.
The Directive 2005/29/EC15 on Unfair Commercial Practices
Advertisers should always be able to justify the validity of any (UCPD) was adopted on 11 May 2005. There are 4 key
claims they make. Therefore advertisers (not consumers) have elements in the Directive, which are:
to provide evidence of the accuracy of their claims. a far reaching general clause defining practices which are
unfair and therefore prohibited;
Cosmetics Regulation
the two main categories of unfair commercial practices -
In the early 1970s, the Member States of the EU decided to Misleading Practices (Actions and Omissions) and
harmonise their national cosmetic regulations in order to enable Aggressive Practices - - are defined in detail;
the free circulation of cosmetic products within the Community. provisions that aim at preventing exploitation of vulnerable
As a result of numerous discussions between experts from all consumers;
Member States, Council Directive 76/768/EEC was adopted on an extensive black list of practices which are banned in all
27 July 1976. The Directive was then recast with the adoption circumstances.
of Regulation (EC) No 1223/2009, of 30th November 2009.
In particular, the Directive obliges businesses not to mislead
This new EU Regulation 1223/2009 - Cosmetics Regulation consumers through acts or omissions; or subject them to
came into force on 11th July 2013. aggressive commercial practices such as high pressure selling
techniques. The Directive also provides additional protections
However, even before that new regulation, in the Summer of for vulnerable consumers who are often the target of
2008 the European Commission commenced consultations, unscrupulous traders.
resulting in Directive 2011/84/EU13 of 20th September 2011,
amending the 1976 Directive. Article 2 stated that by 30th The Directive’s wide scope – it applies to all business sectors –
October 2012 all Member States had to adopt and publish the and flexible provisions means that it plugs gaps in existing EU
provisions necessary to comply with this Directive. Directive consumer protection legislation and sets standards against
2011/84/EC introduced only limited changes to the Annex of the which new practices are judged.
Regulation and is not the main legislation governing cosmetics
in the EU. The Directive’s broad scope means that it overlaps with many
existing laws. In addition, because the UCPD is a maximum

14
12 http://eur-
http://ec.europa.eu/justice/consumer- lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32000L0031:EN:
marketing/files/communication_misleading_practices_protection_en.pdf NOT
13 15

http://eur- http://eur-
lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2011:283:0036:0038 lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32005L0029:en:N
:en:PDF OT

24
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harmonisation Directive (i.e. setting out the maximum level of new Directive changed, or affected, some of the existing
restriction permissible in respect of unfair commercial practices provisions under the Directive 93/42/EEC on Medical Devices.
which harm consumers’ economic interests) a supplementary This section provides an overview of the major issues relevant
objective was introduced to achieve, where possible, some for the dental profession.
regulatory simplification.
Normally it is the dental technician who is the
Implementation of this Directive is said to help Member States manufacturer of a dental prosthesis. To be a
to ensure their consumer regimes are amongst the best in the manufacturer, a dentist would have to be registered as
world. A review published in 14th March 2013, stated that the such, meaning far-reaching obligations, such as
Directive had helped enhance consumer protection and registering all raw materials for prostheses etc.
required no amendment.16
Custom-made devices are excluded from the obligation to
carry CE marking.
Medicinal Products and Medical Devices
According to the Directive the patient is to be identified by
Medicinal products name, acronym or a numerical code.
The Directive requires that software which is used in
Medicinal products are only available for dental treatment if they medical devices or is a medical device itself (e.g.
are licensed by the Member State where they are used in electronics in the unit, UV lamp, x-ray machine) has to be
accordance with Directive 2001/83/EC and EC Regulation validated by the manufacturer. The burden on the dentist
726/2004.17 will depend on the instructions of the manufacturer – e.g.
if the manufacturer insists on revalidation every three
Further harmonisation of the regulations governing free years, then the dentist will have to comply.
movement of pharmaceuticals is established with the
establishment of the European Agency for the Evaluation of For custom-made devices, the manufacturer “must
Medicinal Products, in London18. The Agency is responsible for undertake to review and document experience gained in
co-ordinating the evaluation and supervision of medicinal the post-production phase”. This could be interpreted as
products for human and veterinary use in the Union, in order to meaning that if no experience was gained – i.e. if no
remove remaining barriers to trade. EudraVigilance is the negative incidents relating to the medical device were
European data-processing network and database management notified – then there would be nothing to review.
system for the exchange, processing and evaluation of
Individual Case Safety Reports (ICSRs) related to medicinal In 2012 a Proposal was submitted outlining several
products authorised in the European Economic Area. amendments to the Directive to address changes in medical
technology, standardise laws and improve access to
Medical devices information on devices. It was expected that the proposal will be
adopted in 2014. For more information, please see Annex 11.
The Medical Devices Directive (93/42/EEC)19, which applies
to all medical and dental products which are Directive on Prevention from Sharp Injuries in
non-pharmaceutical and inactive, also has as its major purpose the Hospital and Healthcare Sector
the removal of the final barriers to trade and sets requirements
governing safety and efficacy.
Directive 2010/32/EU21 recognises that health and safety of
workers is an important issue and is linked with the health of
The Directive requires all manufacturers to register with the
patients. Health and safety is a hospital and healthcare sector-
national competent authority and to observe certain design and
wide issue, and a responsibility for all workforce members.
manufacture requirements, clinical evaluation and conformity
assessment procedures and provide for verification. The
The framework agreement applies to all workers in the hospital
precise procedures and requirements vary according to the
and healthcare sector with the aim of providing the safest
classification of the product: as custom-made, class I, IIa, IIb or
working environment possible, minimising needlestick injuries
III, depending upon the nature of the device.
through integrated risk assessment practices. For further
information see Annex 11.
The EU Member States applied a new Directive 2007/47/EC20
amending Directive 93/42/EEC on Medical Devices and
Directive 90/385/EEC on Active Implantable Medical Devices,
as national law by March 21st 2010. The implementation of the

16

http://ec.europa.eu/justice/consumer-marketing/files/ucpd_report_en.pdf
17 http://ec.europa.eu/health/human-use/legal-framework/index_en.htm

18 http://www.emea.europa.eu/

19http://eur-
lex.europa.eu/LexUriServ/LexUriServ.do?uri=CONSLEG:1993L0042:20
071011:en:PDF
21http://eur-
20http://eur- lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2010:134:0066:0072
lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2007:247:0021:0055 :EN:PDF
:EN:PDF

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Part 4: Healthcare and Oral Healthcare Across the EU/EEA
Expenditure on Healthcare
The overall expenditure by countries on all forms of general healthcare (including dentistry) in the EU/EEA varies by a large amount,
generally but not wholly according to a country’s wealth as measured by GNP/GDP or PPP. However, there are major exceptions to this
rule – so whereas Luxembourg and Denmark have a high GNP/GDP/PPP, their spending on health is about the average of 6.1%.
Conversely, healthcare spending in Slovenia was high, in comparison with their GNP/GDP/PPP.

France
Netherlands Chart 3 -
Germany
Switzerland
Percentage of GDP
Denmark spent on health by
Austria
Belgium
each country in
Portugal 2007-12
Sweden
Spain
UK
Source OECD in
Norway 2007-1222
Italy
Finland
Greece
Iceland
Ireland
Slovenia
Malta
Slovakia
Hungary
Croatia
Czech Rep
%GDP spent on health
Bulgaria
Poland 2007-2012
Luxembourg (source: OECD)
Lithuania
Latvia
Cyprus
Estonia
Romania

2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0%

Netherlands
Denmark
France
An attempt was made to compare Germany
expenditure on overall healthcare in Austria
Norway
countries, with reported spending on Belgium
dentistry, but this was not possible as the UK
Sweden
interpretation of what constitutes spending Italy
on dentistry varied significantly. Some Iceland
Switzerland
countries provided data for state spending Spain
only (as there was no data for spending by Finland
Portugal
private patients) and some were unable to Croatia
supply overall spending data. Slovenia
Czech Rep
Ireland
Greece
Chart 4 - Percentage of GDP spent Malta
Slovakia
on health by governments in 2007-12 Luxembourg
Estonia Public health spend as a
Hungary % of GDP 2007-2012
Poland (source: OECD)
Romania
Lithuania
Bulgaria
Latvia
Cyprus

2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0%

22
nb: the percentages refer to different years recorded for each country, with the oldest at 2007 (Estonia) and the newest at 2012 (several
countries); no data for Liechtenstein was supplied

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Chart 5 – Spending per capita on health

Luxembourg The World Bank has

Monaco
Norway
published data about
Switzerland individual spending per
Netherlands capita: this almost
Denmark
Austria matches tables of GDP
Germany at PPP in each country.
Belgium
France
Ireland
Sweden
Finland
UK
San Marino
Iceland
Italy
Andorra
Spain
Greece
Portugal
Slovenia
Malta
Cyprus
Slovakia
Czech Rep
Hungary
Croatia
Poland
Lithuania
Health Expenditure per capita (PPP) 2011 (in Euros)
Estonia (source: World Bank April 2013)
Latvia
Bulgaria
Romania

€0 €1,000 €2,000 €3,000 €4,000 €5,000 €6,000

Population Ratios
Dentist:Population Ratio - 2012/13
One measure of the provision of dentistry/oral (EU average: red line)
healthcare in countries is the dentist to
Malta
population ratio. However, some caution should Ireland

be employed when using these figures, as there Hungary

Austria
are a number of factors which might skew the Nethlds
UK
conclusions.23 Poland
Switzerland
Slovakia
The population of the areas covered by this Spain
France
Manual was about 518 million in 201324. The Slovenia

dental associations reported that there were Latvia

Belgium
about 361,000 active dentists – which excludes, Romania
Estonia
for example, dentists totally retired or on Czech Rep
Italy
maternity leave (but still registered) - see Part 7, Sweden

Workforce. This leads to an (average) dentist to Finland

Iceland
population ratio of 1:1,433. The equivalent Greece
Luxembourg
figures for 2008 were 345,000 and 1:1,501 Germany

respectively, so there has been a small drop in Portugal

Croatia
“workload” for dentists. However, there were Norway
Denmark
wide variations from this figure: Cyprus
Bulgaria
Lithuania

Chart 6 - (Active) Dentist to Liechtenst…

Population ratio 0 500 1,000 1,500 2,000 2,500

See Part 7 (The Dental Workforce) for numbers.

23 A number of factors may make the interpretation of population ratios hazardous – eg what proportion of dentists are female (female
dentists are described by many commentators as having a smaller working life “output”), the level of support given by clinical auxiliaries,
whether dentists have chairside support from dental assistants and other factors.
24 Population figures derived from Eurostat – but dates are various in the period 2011-13

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Entitlement and access to oral healthcare treatment if they are covered by a parent’s sick fund or private
insurance.
In all countries of the EU/EEA oral healthcare is available
through private practice, using “liberal” or “general” It is important to note that whatever the actual route by which
practitioners. Although entitlement for all to receive state or individuals indirectly pay for their dental care, the administrative
insurance funded health care is a constitutional right in some mechanisms employed to keep dental care affordable (for
countries and a stated principle in others, it is rarely instance, fixed fees), appropriate (for example, prior approval)
guaranteed. and profitable to the private dentist, flexible, periodically
negotiated fee-scales are common to many systems. In the
For the majority of the population in Europe access to oral countries where direct patient payments are the dominant form
health care is determined by: of finance, there is typically a limited social security system.

the geographical proximity of ‘private’ dental practitioners; For the patient, the cost of care is further complicated by the
varying size of subsidy offered for different treatments. At one
the level of fees charged to patients for different extreme, individual dentists may contract with individual
treatments; and insurance schemes to provide certain care at certain prices.
access by particular population groups (for example However, in other countries there is a nationally negotiated
children) to special services. agreement between representatives of the dental profession -
the providers of care - and the purchasers of care, whether they
Where governments or other agencies offer financial are a union of sick funds, or the government.
assistance, or directly provide services, for particular population
groups who would otherwise not receive care, this is always a There appear to be four models of provision of healthcare,
restricted “standard package” of care. The standard package which are examined in more detail in Annex 4.
often only consists of basic conservative treatments
(examination, fillings), exodontia and some preventive care, but
Frequency of attendance
usually excludes all complex treatments (including, in many The decision about the frequency of attendance of patients to
countries, emergency care following an accident). There is receive oral health re-examinations is largely a decision
some evidence from individual countries that the content of the between dentists and their individual patients. However, there
standard package has been reduced since 2000, with a are a number of influences on these decisions, which may
consequent increase in co-payments. include individual and population disease levels, preventive
strategies (including water fluoridation), socio-economic and
Financing of oral healthcare cultural attitudes and external funding arrangements.
In every country examined, dental care is typically funded by We received estimates of patient normal re-attendance from
direct patient payments to a greater extent than other areas of most countries (many others reported that there was no
general health care. In most countries the reliance on, and measurable average attendance).
acceptance of, direct patient payments, especially for adults or
those with an income is exceeded only by that of the cost of All countries made the point that patients with active disease
drugs or payments for optometrists’ services. may be seen more frequently than the normal time period
reported. In almost every European country, the overall levels
While patient payments (or co-payments) for state or insurance of expenditure and the amount of care provided is directly
funded dental care are widely accepted across Europe, every influenced by the regulations which govern patients’ fees and
country also has a system (or systems) where individuals pay private dentists’ remuneration. Because of the dominance of
prospectively for their dental care, through insurance or taxation “private practitioners” in oral health care provision, regulations
(or both). This system is usually a part of, or closely reflects, about patient payments, fixed remuneration fees, and subsidy
the system of funding for general health care. There is no systems all affect the dentist’s incentive to treat and the
identified “model” system, except perhaps for general oral patient’s incentive to seek treatment.
health care for the adult population, where some form of “social
insurance” system is the most widely used. Approximately 6 The Czech Republic, Malta and
monthly Poland
Almost all countries have a specific alternative system which 9 to 12 monthly Denmark, Estonia, the Netherlands,
enables individuals to collectively pay for some of the costs of Slovenia and Switzerland
oral health care. These systems range from national social
Annual Austria, Belgium, Cyprus, France,
security systems or health services, state recognised or
Germany, Hungary, Ireland, Italy,
compulsory health insurance (from “sick funds”), to voluntary Latvia, Luxembourg, Norway,
insurance from private companies. Additionally, in every country Romania and the UK
there is some form of financial assistance, subsidy or special 18 months or more Finland, Iceland, Slovakia and
services for population groups who cannot afford to pay directly Sweden
or collectively for dental care, or have special oral health needs
(such as children, the unemployed, handicapped people, Table 1 - Patient re-examination periods
hospital inpatients or war veterans). As children are not in a
position to earn an income and pay for their own dental care, Some of these figures actually represent an average where, for
they most commonly have the best access to free or subsidised example, the country reported that the usual pattern of
care. Indeed, in countries with a national health service or a attendance was “every 12 to 18 months”.
state-organised social security system, the publicly funded
dental service is primarily for schoolchildren. In the other
countries children generally only receive subsidised dental

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Health Data
Chart 7 – The average Decayed, Missing, Filled Teeth at the age of 12 years (DMFT)

Average DMFT at 12 years of age

Unfortunately, health data is not collected by
Romania
Liechtenstein countries in a uniform manner on fixed
Hungary
Latvia dates, so comparison between the data
Poland
Bulgaria published by individual countries is difficult
Slovakia
Estonia and should be viewed with circumspection.
Czech Rep
Lithuania
Iceland
Greece
Slovenia
However, many countries do collect data on
Portugal
Norway
3 fixed items and publish these through
Spain
Malta
various sources (see the individual country
France
Finland
sections for sources and dates of collection).
Cyprus
Italy
Ireland
Austria
Sweden
Netherlands
Belgium
Switzerland
Luxembourg
UK
Germany
Denmark
0.00 0.25 0.50 0.75 1.00 1.25 1.50 1.75 2.00 2.25 2.50 2.75 3.00 3.25 3.50 3.75 4.00 4.25

Chart 8 – The proportion of children of 12 Zero DMFT at 12 years of age

years of age with no DMFT Denmark
Germany
UK
Sweden
Austria
Malta
France
Spain
Ireland
Slovakia
Luxembourg
Iceland
Poland
Netherlands
Finland
Slovenia
Greece
Czech Rep
Estonia
Belgium
Latvia
Norway
Lithuania
Hungary
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75%

Chart 9 – The proportion of adults 65 years (or older) with no teeth (edentulous)

Percentage edentulous at 65 years of age

Belgium
Poland
Ireland
Finland
Portugal
UK
Iceland
Greece
Hungary
Germany
Austria
Italy
Denmark
Spain
Czech Rep
France
Bulgaria
Norway
Lithuania
Slovenia
Slovakia
Malta

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

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Fluoridation
Table 2 - Community fluoridation

Community Fluoridation
Austria None
Belgium Some natural
Bulgaria Milk fluoridation schemes
Croatia None
Cyprus Some natural
Czech Rep Salt fluoridation
Denmark Some natural
Estonia None
Finland None
France Salt and free toothpaste
Germany Salt fluoridation
Greece None
Hungary Artificial public water fluoridation
Iceland None
Ireland Artificial public water fluoridation
Italy Natural fluoridation and free toothpaste
Latvia Free tablets and toothpaste for children at risk
Liechtenstein None
Lithuania None
Luxembourg None
Malta Some natural, plus free toothpaste scheme
Netherlands None
Norway None
Poland Some natural
Portugal Some free toothpaste schemes
Romania None
Slovakia Salt fluoridation
Slovenia Some natural
Spain Artificial public water fluoridation + natural in Canary Islands
Sweden Some free toothpaste schemes
Switzerland Salt fluoridation
UK Natural and public fluoridation and free toothpaste

Fluoride is a substance which gives protection to teeth against tooth decay, if ingested in optimal quantities, or applied to the surface of the
teeth by means of toothpaste or other methods.

Fluoride may be found naturally at optimal or suboptimal levels in water supplies or in some countries (Hungary, Ireland, Spain and the UK
by the addition of fluoride to the water supplies).

Other methods for providing fluoride for systemic ingestion are milk (Bulgaria), tablets (Latvia) and salt (the Czech Republic, France,
Germany, Slovakia and Switzerland). Many countries provide free fluoride toothpaste for those at risk of decay, especially children.

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Healthcare and Oral Healthcare

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Part 5: The Education and Training of Dentists
The content of the education and training necessary, and the titles of qualified dentists, are as described in the PQD.

The separate recognition and training of dentists is now a reality in all countries of the EU/EEA. The existence of a class of dentists (often
known as stomatologists), who were originally trained as medical doctors is also an historical legacy in Austria, France, Italy, Spain and
Portugal, and most of the countries which joined in the years after 2004 - but for all of these countries membership of the EU has brought
substantial changes in dental education.

Table 3 – Dental schools, numbers of students and gender

Year No of Public Private Annual Annual Percentage No of Course
schools intake graduates female females duration Dental Schools
Austria 2013 4 3 1 165 119 65% 77 6 years Cyprus, Liechtenstein and
Belgium 2012 5 5 0 NK 158 80% 126 5 years Luxembourg do not have dental
schools and rely on other EU/EEA
Bulgaria 2012 3 3 0 350 290 50% 145 5.5 yrs
trained dentists for their workforce.
Croatia 2013 3 2 1 148 113 69% 78 6 years
Czech Rep 2012 5 5 0 280 250 38% 95 5 years Across the EU/EEA, all dental
undergraduate education and
Denmark 2012 2 2 0 162 120 76% 91 5 years
training takes place in universities
Estonia 2013 1 1 0 32 30 87% 26 5.5 yrs – usually in Colleges or Faculties
Finland 2013 4 3 1 186 100 68% 68 5 years of Medicine or Dentistry.
France 2011 16 16 0 1,154 917 55% 504 6 years
In 2013, there were 200 dental
Germany 2012 30 29 1 2,222 1,813 62% 1,122 5.5 yrs schools in the EU/EEA – up from
Greece 2012 2 2 0 250 275 62% 171 5 years 184 in 2003. In each of Estonia,
Hungary 2013 4 4 0 310 245 58% 142 5 years Iceland, Latvia, Malta and
Slovenia there was only one
Iceland 2012 1 1 0 7 7 69% 5 5 years
school, whereas in Italy there were
Ireland 2013 2 2 0 86 68 54% 37 5 years 35 and 30 in Germany. However,
Italy 2013 34 32 2 984 883 47% 415 5 years although most were publicly
funded, many of these dental
Latvia 2012 1 1 0 35 32 87% 28 5 years
schools charge course fees to
Lithuania 2013 2 2 0 161 161 83% 134 5 years their students.
Malta 2013 1 1 0 8 8 38% 3 5 years
Netherlands 2013 3 3 0 243 268 57% 153 6 years
Additionally, 9% of schools were
wholly privately funded – these
Norway 2013 3 3 0 153 138 75% 104 5 years were in Austria, Croatia, Finland,
Poland 2013 10 10 0 1,231 809 80% 647 5 years Germany, Italy, Portugal, Romania
Portugal 2012 7 3 4 716 553 66% 365 5 years and Spain. No public funding
supported these institutions.
Romania 2013 10 8 2 1,800 1,700 70% 1,190 6 years
Slovakia 2013 4 2 2 117 101 60% 61 6 years In 2013, in the dental schools of
Slovenia 2012 1 1 0 70 50 70% 35 6 years the EU/EEA, there were over
70,000 dental students in training.
Spain 2012 17 12 5 1,379 1,379 67% 924 5 years
Approximately 12,000 graduate
Sweden 2012 4 4 0 339 200 63% 126 5 years each year (63% female – up from
Switzerland 2013 4 4 0 128 103 60% 62 5 years 53% in 2003).
UK 2013 16 16 0 1,100 1,052 56% 589 5 years
In half of EU/EEA countries
2013 199 180 19 13,816 11,942 7,522
entrance into dental school is by
90% 10% 63% means of a competitive
2008 196 176 20 14,401 11,582 examination – with a strict
90% 10% 61%
numerus clausus (restriction) on
the numbers. In some countries
2003 184 174 10 10,969 8,665 this examination is at the end of
95% 5% 53% the first year of training. In the
remaining countries the results of
the secondary school leaving examination or matriculation determine the entry into dental school.

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In France, access to dental faculties is by competitive Post-qualification education and training
examination at the end of the first year (common to medicine,
dentistry, pharmacy and midwifery) and the subsequent 5-year Vocational Training
dental course follows. The UK has three “graduate-entry” dental
In the 2009 Manual it was reported that about half of all
schools. Entrants must have a primary degree in biological
EU/EEA countries insisted on further post-qualification
sciences.
vocational training (VT) for their new graduates, before they
Annually, over 13,600 enter into dental schools as were given full registration, or entitlement to independent
undergraduates and across the EU/EEA on average about 84% practice, or entitlement to participation in the state oral
of that number eventually graduate as dentists. healthcare system as independent clinicians.

Undergraduate education and training Table 5 – Post-Qualification Vocational Training

Mutually recognised diplomas guarantee that, during the Belgium Full 12m
complete training programme, the student has acquired:
Croatia Full 12m
adequate knowledge of the sciences on which dentistry is Slovenia Full 12m
based and a good understanding of scientific methods, Germany NHS only 24m
including the principles of measuring biological functions,
Switzerland NHS only 24m
the evaluation of scientifically established facts and the
analysis of data; UK NHS only 12m
adequate knowledge of the constitution, physiology and
behaviour of healthy and sick persons as well as the
influence of the natural and social environment on the By 2013, only Belgium, Croatia and Slovenia had this as a
state of health of the human being, insofar as these requirement for full registration for independent practice – all
factors affect dentistry; with 12 months’ VT programmes. Poland’s VT ends with those
adequate knowledge of the structure and function of the graduating in 2016. Germany and Switzerland (both 24 months)
teeth, mouth, jaws and associated tissues, both healthy and the UK (12 months) have this as a requirement only for
and diseased, and their relationship to the general state of those working in their state healthcare systems.
health, and to the physical and social well-being of the
patient; The nature of VT means that usually the training of the new
adequate knowledge of clinical disciplines and methods, graduate takes place in a “sheltered” environment, under the
providing the dentist with a coherent picture of anomalies, direction or supervision of an experienced dentist. There may,
lesions and diseases of the teeth, mouth, jaws and or may not be parallel formal learning, in an educational
associated tissues and preventive, diagnostic and establishment such as a dental school and there may be a final
therapeutic dentistry; “completion” examination.
Suitable clinical experience under appropriate supervision.
The requirement to complete VT is not applicable to dentists
Whilst most teaching takes place in the language of the relevant from other EU/EEA Member States who hold the evidence of
country, about one third of all EU/EEA countries teach their formal qualifications, subject to automatic recognition under the
undergraduates in English for all or part of the curriculum. PQD.
The duration of training Continuing Education and Training
The criteria described below are the minimum training Every EU and EEA country has at least an ethical obligation for
requirements. A Member State may impose additional criteria dentists to undertake continuing professional education of some
for qualifications acquired within its territory. It may not, kind – and some arrangements to deliver this (see table 4
however, impose them on practitioners who have obtained overleaf).
recognised qualifications in another Member State.
Duration
A complete period of undergraduate dental training consists of
a minimum 5 year full-time course of theoretical and practical
instruction, for a minimum of 5,000 hours, given in a university,
in a higher-education institution recognised as having
equivalent status or under the supervision of a university. In 10
countries basic dental training is for more than 5 years:
Table 4 – Undergraduate Training greater than 5
years

Austria Germany
Bulgaria Netherlands
Croatia Romania
Estonia Slovakia
France Slovenia

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Table 6 – Continuing Professional Development (Education)

Mandatory Partially Requirements Not mandatory Not Comments

Mandatory but formal mandatory
systems
Austria Obligation only
Belgium Yes 60 hours in 6 years Re-registration required after 6 years
Bulgaria Yes 30 hours in 3 years
Croatia 7 hours per year
Cyprus** Yes 45 hours in 3 years
Czech Rep Yes Certificates of proficiency leads to higher fees from health systems
Denmark** Yes 10 hours per year Required only of DDA members
Estonia Yes
Finland Yes
France** Yes 1.5 days per year
Germany Yes 125 points in 5 years Required for recertification for sick funds, only (not private)
Greece Obligation only
Hungary Yes 250 hours in 5 years
Iceland Yes 75 hours in 3 years Only mandatory for those treating children in the system
Ireland 250 hours in 5 years Yes Obligation only
Italy Yes 150 hours in 3 years Minimum 30 and maximum 70 hours per year
Latvia Yes 250 hours in 5 years
Liechtenstein No information
Lithuania Yes 120 hours in 5 years
Luxembourg Obligation only
Malta Yes
Netherlands Obligation only
Norway** Yes 150 hours in 5 years Only mandatory for NDA members
Poland Yes 200 hours in 4 years
Portugal Yes
Romania Yes 200 hours in 5 years
Slovakia Yes 250 hours in 5 years
Slovenia Yes 75 hours in 7 years Followed by an examination
Spain Yes
Sweden Obligation only
Switzerland Yes 10 days per year Failure leads to lower fees.
UK Yes 250 hours in 5 years 75 hours has to be provable (verifiable)
** changed since 2009 Manual

In 2004 only 10 countries had a mandatory requirement to undertake a minimum amount of such training. By 2008, this had increased to
17 countries. In 2013, 16 countries had a mandatory requirement, with another 3 having a partial (qualified) requirement. Additionally, 6
countries, whilst not having a mandatory requirement, did have formal systems in place.

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
these may not be formally recognised under the PQD.

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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.
Training in specialised dentistry involves a full-time course of a Access to the second cycle is intended to require successful
minimum of three years' duration supervised by the competent completion of first cycle studies, lasting a minimum of three
authorities or bodies. years. The degree awarded after the first cycle would need to
be relevant to the European labour market as an appropriate
Such training may be undertaken in a university centre, in a level of qualification. The second cycle should lead to the
treatment, teaching and research centre or, where appropriate, master and/or doctorate degree, as in many European
in a health establishment approved for this purpose by the countries. By 2014, some countries had split their programmes,
competent authorities or bodies. The trainee must be while others have retained them.
individually supervised. Responsibility for this supervision is
placed upon the establishments concerned. The EHEA is not based on an international treaty, but most of
the signatory countries have also signed and ratified the Lisbon
European Dental Education Recognition Convention covering academic qualifications. The
The EU Directorate General for Education and Culture funded European Commission is a member of the Bologna Follow-Up
an innovative pan-European project DentEd, to promote a Group, along with higher education stakeholder organisations
common approach to dental education across Europe. Over six operating at European level, as well as the 49 ministers of
years many dental schools in the EU (including candidates for higher education. The EHEA is based on shared practice in
admission to the EU) received advice and peer support from such areas as quality assurance, qualifications frameworks,
visiting teams of dental academics, supported by several curriculum design, student and staff mobility. The official EHEA
international conferences on trends and strands in dental website is at http://www.ehea.info/
curricula. Work on dental education is continuing through the
Association for Dental Education in Europe (ADEE). Recognition of professional qualifications, however, falls within
the scope of EU legislation, at least for the EU/EEA Member
The Bologna Process States under EU Directive 2013/55/EU. Besides its major
innovations (the European Professional Card and the alert
The Bologna Process was launched in 1999 as the “Bologna mechanism) it is notable for the extent to which it has begun to
declaration”, when the education ministers of some 40 countries accommodate the principles and instruments of the EHEA: in
expressed the desire to create a European Higher Education particular, the European Credit Transfer and Accumulation
Area (EHEA). The goal was that it should be easy for students System (ECTS), the European Qualifications Framework
to move from one country to another within the Area and that (EQF), and competence-based curricula.
European higher education should be made more attractive to
non-European prospective students. The EHEA has been in The European University Association (EUA) has published a
place since 2010 – and by 2014 it covered 49 higher education briefing on the HE-related aspects of the Directive. It is
systems in 47 countries (both Belgium and the UK are available at:
considered to have two systems).
http://www.eua.be/eua-work-and-policy-area/building-the-
Amongst the proposals was the adoption of a system european-higher-education-area/bologna-and-professional-
essentially based on the splitting of the curriculum into two main qualifications.aspx
cycles – undergraduate (Bachelor) and graduate (Master).

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Part 6: Qualification and Registration
All countries of the EU/EEA require registration with a that the applicant is not suspended or prohibited from the
competent authority – more frequently this authority is separate pursuit of the profession as a result of serious professional
from the dental association, and may be government appointed. misconduct, or conviction of criminal offences relating to the
pursuit of any of his/her professional activities.
To legally practise in each country a basic qualification is
always required (degree certificates), but a certain amount of Language
vocational experience, evidence of EU citizenship, a letter of The December 2013 PQD does give Host Countries the right to
recommendation from a dentist’s current registering body and conduct language tests, for example, when patient safety is an
sometimes evidence of insurance coverage may be necessary. issue. The survey carried out for this Manual indicates that
When examining the situation in a particular country it is some countries anticipated this change to the Directive and
important to distinguish legal registration to practise in any introduced language testing prior to registration, using Patient
capacity (usually with government department or agency, Safety as the reason for this.
sometimes as a ‘licence’) from registration with a social security
or social insurance scheme. Where registration is with the Thus, Member States may require migrants to have the
national dental association or another non-governmental body a knowledge of languages necessary for practising the
private practitioner may also require a ‘licence to practise’ from profession. So, for example an employer (such as an NHS
a government ministry. Registration with social security or system) can insist on the necessary language skills prior to
insurance schemes will often depend on different criteria, and registration with the employing authority. But, this provision
may also entail linguistic, contractual as well as ethical must be applied proportionately, which rules out the systematic
obligations. imposition of language tests before a professional activity can
be practised.
For details in each country please see the relevant country
section of the Manual. Serious professional misconduct and criminal penalties
The same procedure is followed in the case of serious
The Use of Academic Titles professional misconduct and conviction for criminal offences.
The existing rules (in the 2005 PQD) provided for detailed
Provided that all the conditions relating to training have been obligations for Member States to exchange information. So, the
fulfilled, holders have the right to use their lawful academic title Member State of origin or from which the person comes must
or, where appropriate, its abbreviation, in the language of the forward to the host MS all the necessary information about any
Member State of origin or the State from which they come. disciplinary action which has been taken against the practitioner
Some Member States may require this title to be followed by concerned, or criminal penalties imposed on him/her.
the name and location of the establishment or examining board
which awarded it. The amended PQD reinforces the obligations. From 2014,
competent authorities of Member States will have to proactively
In some cases, the academic title can be confused in the host alert the authorities of other Member States about professionals
State with a title for which additional training is necessary. In who are no longer entitled to practise their profession due to a
that event, the host State may require that different, suitable disciplinary action or criminal conviction, through a specific alert
wording be used for the title. mechanism. If the host Member State has detailed knowledge
of a serious problem before registration, it must inform the
Good character and good repute Member State of origin or the Member State from which the
person came. The procedure, which then follows, is the same
For the purposes of temporary provision of services by dentists,
as that which governs good character and good repute.
in the event of justified doubts, competent authorities of a host
Member State may ask the competent authorities of the Physical or mental health
Member State of establishment to provide information about the
good conduct or the absence of any disciplinary or criminal Some Member States require dentists wishing to practise to
sanctions of a professional nature against the health present a certificate of physical or mental health. Where a host
professional, as well as any information relevant to the legality Member State requires such a document from its own nationals,
of his/her establishment. it must accept as sufficient evidence the document required in
the Member State of origin or the Member State from which the
In the case of an application by a dentist for establishment in person comes.
another Member State, the host Member State may demand,
Where the Member State of origin or from which the person
when deciding on the application documents produced by the
comes does not require a document of this nature, the host MS
competent authorities in the home Member State, other
must accept a certificate issued by a competent authority in that
documents: that they are of good character or repute, or that
State, provided that it corresponds to the certificates issued by
they have not been declared bankrupt, or that they have not
the host MS.
been suspended or prohibited from pursuing the profession, in
the event of serious professional misconduct or a criminal Duration of the authorising procedure
offence.
The procedure for authorising the person concerned to work as
Where the competent authorities of the home Member State a dental practitioner must be completed as soon as possible
does not issue such documents, they may be replaced by a and not later than three months after presentation of all the
declaration on oath or a solemn declaration. The host Member documents, unless there is an appeal against any unsuccessful
State may also require, in the event of justified doubts from the application.
competent authorities of the home Member State, confirmation

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If there are any doubts about the good character, good repute, Alternative to taking an oath
disciplinary action, criminal penalties, or physical or mental
health of the applicant, a request for re-examination may be Some Member States require their nationals to take an oath or
made which suspends the period laid down for the authorisation make a solemn declaration in order to practise. Where such
procedure. The Member State should give its reply within three oaths or declarations are inappropriate for the individual, the
months. host Member States must ensure that an appropriate and
equivalent form of oath or declaration is offered to the person
In the absence of a reply, leading to failure to reach a decision concerned.
by the host Member State within the three month deadline, the
applicant has the right to appeal under national law.
Table 7 - Regulation of dentists (2013)

REGULATION OF DENTISTS IN 2013

Name of regulator Cost per annum (2013)

Austria Austrian Dental Chamber via their regional organisations % of income

Belgium Federal Ministry of Health € 550
Bulgaria Bulgarian Dental Association by means of its Regional Colleges. € 77
Croatia Croatian Dental Chamber No fee
Cyprus Cyprus Dental Council & Cyprus Dental Association €35 + €130
Czech Rep Czech Dental Chamber and the Regional Authority* Included in annual sub
Denmark Health and Medicines Authority No fee
Estonia Healthcare Board/General Dental Council, within the Commission for Licence € 13
Finland National Authority for Medicolegal Affairs No annual fee
France Ordre National € 398
Germany Kassenzahnärztliche Vereinigungen (KZV) Included in annual sub
Greece Ministry of Health and Social Solidarity and Regional Dental Society Variable according to region
Hungary Ministry of Health No fee
Iceland T he Ministry of Health and Social Security € 52
Ireland Irish Dental Council € 200
Italy Federazione Ordini dei Medici Chirurghi e degli Odontoiatri Variable according to region
Latvia Health Inspectorate by order of the Ministry of Health No fee
Liechtenstein Amt für Gesundheitsdienste, a public authority € 820
Lithuania T he Licensing Committee at the Lithuanian Dental Chamber €19 + €58
Luxembourg Ministry of Health € 275
Malta Medical Council. Until 2011 overseas dentists need a work permit. € 35
Netherlands Ministry of Public Health Welfare & Sport - also, the BIG register € 80
Norway Norwegian Registration Authority for Health Personnel (SAK) € 200
Poland T he Regional Chamber of Physicians and Dentists (Okręgowa Izba Lekarska). None
Portugal T he Ordem dos Médicos Dentistas (OMD) Variable €250 to €1,000
Romania Romanian Collegiums of Dental Physicians Only initially
Slovakia T he Slovak Chamber of Dentists €4
Slovenia T he Medical Chamber of Slovenia No fee
Spain Regional colegios (central list held at Consejo General in Madrid) Variable €216 to €600
Sweden National Board of Health and Welfare unit for Qualification and Education € 77
Switzerland Federal Board but registers kept by each of the 26 Cantonal authorities No fee
UK General Dental Council € 685

* Dentists qualified outside the CR must register (free) with the Ministry of Health

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Part 7: Dental Workforce
The dental workforce provides oral healthcare and includes dentists, clinical dental auxiliaries and other dental auxiliaries. In some
countries stomatologists or odontologists still exist (for a description of these two classes, see later).

In all countries, whatever classes of dental auxiliaries exist, most oral healthcare is provided by dentists. The description of what a dentist
may provide is regulated by Member States. However, in relation to the Freedom of Movement, and the desire of professionals to practise
in another Member State, please see Part 3 (the Professional Qualifications Directive) for more information.

The regulations relating to dental auxiliaries are less circumscribed. So, the permitted duties of such as dental chairside assistants
(nurses), hygienists, therapists and clinical dental technicians may vary from country to 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.
Year of Population Number Female Number Female
data Registered Active Table 8 - Numbers of dentists
Austria 2013 8,489,482 4,820 42% 4,421 42%
Belgium 2011 11,153,405 8,879 48% 7,777 48% Despite the continued increase in
Bulgaria 2013 7,282,041 8,350 66% 8,350 66% the numbers, across the EU, many
Croatia 2007 4,475,611 4,537 65% 3,875 65%
dental associations report that the
geographical distribution remains
Cyprus 2013 865,878 1,073 49% 827 65%
uneven, with people in rural areas
Czech Rep 2012 10,516,125 9,354 65% 7,821 65%
often having large distances to
Denmark 2013 5,605,836 7,989 58% 5,161 83% travel to the nearest dental
Estonia 2013 1,324,814 1,615 87% 1,250 87% practice. Formal incentive
Finland 2013 5,434,357 5,925 69% 4,500 69% schemes are rare, and more
France 2012 65,657,000 41,505 40% 41,505 40% commonly a rural community will
Germany 2012 80,523,746 88,882 42% 69,236 42% create an opportunity itself to
Greece 2013 10,772,967 14,125 47% 9,000 47% attract a dentist.
Hungary 2013 9,906,000 5,500 57% 4,973 57% Also, in some countries, for
Iceland 2012 322,930 351 33% 269 33% example Germany, there are
Ireland 2013 4,591,087 2,627 44% 2,200 44% geographical manpower controls,
Italy 2012 59,685,227 58,723 34% 45,896 34% using incentives for setting up new
Latvia 2012 2,178,443 1,724 87% 1,474 87% practices.
Liechenstein 2013 37,009 57 48 The total number of registered
Lithuania 2013 2,962,000 3,660 83% 3,610 83% dentists in the EU/EEA in 2013 was
Luxembourg 2008 537,000 512 40% 452 40% about 440,000 (400,000 in 2008).
Malta 2013 421,364 230 36% 170 36%
The number of “active dentists”
Netherlands 2013 16,789,800 10,780 35% 8,773 35%
Norway 2013 5,063,709 5,350 47% 4,576 47% “Active dentists” refers to dentists
Poland 2012 38,533,299 33,633 78% 21,800 78% who remain on their country’s
Portugal 2012 10,487,289 9,097 57% 9,097 57% register or other such list of dentists
Romania 2013 20,057,458 15,500 68% 14,400 68% who practise in a clinic, general
Slovakia 2013 5,410,728 3,357 61% 3,298 61% practice, hospital department,
Slovenia 2013 2,060,253 1,762 63% 1,358 63% administrative office or university.
The difference between the number
Spain 2012 47,059,533 31,261 52% 29,000 52%
of dentists in a country and the
Sweden 2010 9,580,424 14,454 52% 7,528 52%
“active dentists” should represent
Switzerland 2013 8,058,100 4,850 28% 4,800 28% those dentists who are retired or no
UK 2013 63,887,988 40,156 45% 34,534 45% longer undertake any form of
dentistry including administrative
EU/EEA Totals 519,730,903 440,638 361,979 49% dentistry.

Some countries are unable to assess how many of these dentists are “active”, so accurate figures for the number of such dentists are
difficult to assess. But, from the information provided we estimate that about 361,000 dentists were active in 2013 (345,000 in 2008). So,
whereas the number of registered dentists has increased by 10%, the number “active” has only increased by 4.6%.

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Chart 10 – The number of “active dentists” in
each country
Numbers of "active" dentists

Liechtenstein
Malta
Iceland
Table 9 - Gender of dentists - percentage
Luxembourg female
Cyprus
Estonia
Slovenia
Latvia Latvia 87% Belgium 48%
Ireland Estonia 87% Cyprus 49%
Slovakia
Lithuania
Lithuania 83% Greece 47%
Croatia Poland 78% Norway 47%
Austria
Finland 69% UK 45%
Finland
Norway Romania 68% Austria 42%
Switzerland Bulgaria 66% Germany 42%
Hungary
Sweden
Czech Rep 65% France 40%
Belgium Croatia 65% Iceland 33%
Czech Rep Slovenia 63% Italy 34%
Bulgaria
Netherlands Slovakia 61% Ireland 44%
Greece Hungary 57% Luxembourg 40%
Portugal
Romania
Portugal 57% Nethlerlands 35%
Poland Spain 52% Malta 36%
Spain Denmark 58% Switzerland 28%
UK
France
Sweden 52%
Italy
Germany

The Gender Mix of Practising Dentists

The change of gender balance in some countries, with Percentage of active dentists who are female
the increase in proportion of female dentists who
historically are said to be unable to work for as many Switzerland
Iceland
hours as males, also alters the measure of whole-time Italy
working equivalence of the total number of dentists, Netherlands
Malta
even with the increased total numbers. France
Luxembourg
Germany
Across the EU/EEA 49% of active dentists are female, Austria
Ireland
but with wide variations. Generally, but not UK
Greece
exceptionally, countries with strong public dental Belgium
Cyprus
services (the Eastern European and Nordic countries) Norway
Sweden
had higher numbers of female dentists – nearly 90% Spain
Portugal
in Latvia – down to 28% in Switzerland. Hungary
Denmark
However, the trend is very much to an increase of Slovakia
Slovenia
females as a proportion of the dentist population. Czech Rep
Croatia
When the figures were last measured (2008) about Bulgaria
Romania
46% of dentists were female. There have been Finland
Poland
marked increases in several countries. For example, Lithuania
Estonia
the proportion of females is up from 33% to 52% in Latvia
Norway, 34% to 45% in the UK and 36% to 40% in 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
France.

Chart 11 – The gender of “active dentists” in each

country

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Workforce
Overseas dentists

This expression refers to dentists who have received their basic dental qualification in any country other than the listed (host) country, even
if they are nationals of that country. A dentist who is not a national of the country, but has qualified in that country is an “overseas dentist”
for the purpose of this Manual.
The harmonisation of qualifications and the introduction of “Acquired Rights” have made travel between EU/EEA countries for the purposes
of working as a dentist much easier.
We have examined countries’ reports of the numbers of overseas dentists working within their borders:

Chart 12 – The proportion of “overseas dentists” in each country

Overseas dentists
Switzerland
UK
Ireland
Spain
Norway
Austria
Iceland
Malta
Portugal
Hungary
Slovenia
Netherlands
Slovakia
Sweden
Czech Rep
Latvia
Finland
France
Romania
Lithuania
Germany
Poland
Belgium
Italy
Bulgaria
Estonia
0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0%

No figures were submitted for Croatia, Denmark, and Greece. Three countries – Cyprus, Liechtenstein and Luxembourg do not have their
own dental schools so, by definition, all dentists practising there qualified overseas (abroad), and are not shown. Since 2008, Austria,
Malta, Slovenia and the UK had a significant increase in the number of overseas dentists practising – whereas Sweden and Portugal
reported a reduced proportion.
Unemployment
Dentists are more likely to move to other countries than the one they graduated in, if 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 to move away from the area of the dental school.

In 2003 ten countries reported longer-term unemployment for dentists, but this had fallen to only five by 2008 (Croatia, Finland, Germany,
Greece and Italy). In 2013 the number had increased to 11 – as below.

Table 10 – Dentist unemployment in 2013

Austria Germany Luxembourg

Croatia Greece Switzerland
Bulgaria Hungary United Kingdom
Finland Italy

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Specialists
Table 11 - Types of specialties, and numbers in each
(nb: endodontics and periodontics are often combined as one specialty, so the numbers shown for some countries may actually be
combined)
Year Ortho OS OMFS Endo Paedo Perio Prostho DPH Others
Austria 2013 0 167
Belgium 2011 399 290 139
Bulgaria 2013 45 226 45 417 580 36 115 17 Yes
Croatia 2013 184 98 97 130 74 156 Yes
Cyprus 2013 46 12
Czech Rep 2012 337 72
Denmark 2013 290 98
Estonia 2013 62 25 Yes
Finland 2013 156 104 90 Yes
France 2012 1,981
Germany 2012 3,443 2,552 0 460
Greece 2013 476 174
Hungary 2013 379 139 157 254 65 924
Iceland 2012 15 4 2 3 8 5 3 Yes
Ireland 2013 140 49 5
Italy 2012 1,795 640
Latvia 2012 24 0 39 10 23 0 19
Liechtenstein 2013 2 1 1
Lithuania 2013 93 92 23 44 56 57 270
Malta 2013 7 1 9 2 3 3 3 Yes
Netherlands 2013 331 265 73 46 81
Norway 2013 206 68 0 63 20 90 65 Yes
Poland 2012 1,115 805 227 1,561 486 420 1,453 71
Portugal 2012 51 4 93
Romania 2008 412 157 234
Slovakia 2013 193 192 26 39 95 64
Slovenia 2013 84 24 34 24 36 16 24
Sweden 2010 265 145 47 83 101 134 Yes
Switzerland 2013 370 185 112 72
UK 2013 1,343 754 250 246 333 431 117 Yes
14,244 5,362 2,864
Luxembourg and Spain do not recognise specialists

Orthodontics and Oral Surgery/Oral Maxillo-facial (OS and OMFS) are the two specialties which are recognised formally in some way
by almost all of the EU/EEA countries described (the names, diplomas or other specialist qualifications recognised in each country
are listed above).
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 Directive.
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 dentistry. 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.

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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 12 (overleaf) 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.

Dental Hygienists Dental Assistants

There are Dental Hygienists in most countries (23), although In all countries, dentists have staff variously called dental
they do not need to register in 6 countries (Cyprus, the Czech surgery assistants, dental nurses, or dental chairside
Republic, Italy, Lithuania, the Netherlands and Poland). assistants, or dental receptionists who may assist with chairside
Slovenia has had hygienists since 2005, although there are no duties. However, the development is not as great in some
plans for registration of them. countries (Belgium, Greece and Portugal) where most dentists
work without the help of another person at the chairside, and
Qualification nearly always leads to a diploma or degree, with Cyprus, France, Lithuania and Poland less than half of dentists
which the hygienist has to register with a competent authority in work with such help.
most countries. Hygienist training in most countries with such
training is for 2 or 3 years, but in Hungary one year only is In about half of the countries there is a dental assistant or
necessary. Conversely, in the Netherlands, Lithuania and the nursing qualification available, and in half of these there is a
UK training may be for up to 4 years. registerable qualification, which the assistant may have to have
to work with the dentist.
There are varying rules within the different countries relating to
the degree of supervision of hygienists, and the duties they may Dental Therapists
perform. Many countries allow their hygienists to diagnose and
treatment plan. Please refer to the individual country sections to In a few European countries there is formal recognition of
check the varying rules. another type of clinically operating auxiliary – Dental Therapists,
who provide limited clinical conservation and exodontia services
Dental Technicians (Sweden, Switzerland and the United Kingdom) and
Orthodontic Auxiliaries (Sweden and the UK). Again, like
Dental Technicians, who provide laboratory technical services, hygienists, there are different rules about the duties they may
are recognised in all countries. Formal training is offered in all perform and the degree of supervision they may need.
but two countries (Luxembourg and Cyprus) and takes place in
special schools. The training is for a variable number years (2 In Latvia, therapists were trained in the 1960s, but few remain
to 5). In 22 countries they must be registered to provide in practice and further training has not taken place for many
services. years.

Dental technicians normally provide services only to dentists, Other Auxiliaries

although in most countries they are permitted to repair dental
appliances directly for patients, provided they do not need to Many countries permit dental nurses to provide oral health
take impressions or otherwise work in the mouth. education to patients, or have a formal class of auxiliary
(without registration) to provide this service.
Clinical Dental Technicians

Only 5 countries (Denmark, Finland, the Netherlands, the UK

and Switzerland in some cantons)25 allow Clinical Dental
Technicians or Denturists who may provide oral health services
– specifically full (complete) or partial dentures - directly to the
public. This means that they are trained to work inside the
mouths of patients. The United Kingdom introduced this class of
auxiliary only in 2007.

Training generally takes place in special schools, sometimes –

but not always - associated with the dental schools. The training
is for one or two years, often following prior training as a dental
chairside assistant or dental technician.

25Romania has reportrd having hygienists and denturists but

has not provided any further information

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Table 12 - Types of auxiliary recognised in each country

Country Dental Dental Clinical Chairside Dental Comments

Hygienist T echnician Dental Assistant T herapist

T echnician DCA

Austria R FT Some DCAs specialise in oral health prevention

Belgium R NFT
Bulgaria R NFT
Croatia FT NFT
Cyprus N R** NFT
Czech Republic N N FT/N
Denmark R N R FT/N Hygienists may work without supervision.
Estonia N R R
Finland R R R R
France N FT/N
Germany R R R
Greece R R
Hungary N R R
Iceland R R R Formal training must take place overseas
Ireland R N R FT/N R Orthodontic Therapists train in the UK. There are also Oral Health Educators
Italy N R FT/N
Latvia R R R R Training of Therapists ceased in 1976
Liechtenstein R R R Formal training takes place in Switzerland
Lithuania R R R There are also Assistant’s helpers, who do not need to be registerd
Luxembourg N NFT
Malta R R FT/N
Netherlands N N R FT/N* Hygienists and CDTs are independent professions (and are not auxiliaries)
Norway R R R
Poland N N NFT
Portugal R R FT/N
Romania R R There are Hygienists and CDTs, but there is no further information about them
Slovakia R R R There are Nurses and Assistants
Slovenia N R NFT
Spain R N NFT Technician registration is mandatory in some regions
Sweden R R FT/N There are also orthodontic operating auxiliaries
Switzerland R R R FT/N R There are Registered Dental Therapists and Denturists in some cantons
United Kingdom R R R R R There are Registered Dental, Orthodontic Therapists, Expanded Duties Dental
Nurses. There are also Oral Health Educators (who do not need to be registered).

Formal training is always necessary for Hygienists, Clinical Dental Technicians and Therapists – and always available for Dental
Technicians. It may be available for Chairside Assistants/Dental Nurses (as shown)
R = Registration with a competent authority necessary (always following formal training and qualification)
N = No registration necessary to work
NFT = No formal training or registration necessary
FT = Formal training available

Blank cell indicates that this class of dental auxiliary is not recognised

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Table 13 - Regulators of dental auxiliaries

REGULATION OF DENTAL AUXILIARIES IN 2013

Name of regulator
Austria Local trade federations
Belgium Registration with the Ministry of Health
Bulgaria Laboratories must register with the Ministry of Health
Croatia Techs must pass state exam of Ministry of Health to work
Cyprus Technicians must register with the Dental Technicians’ Council
Czech Rep No registration
Denmark Hygienists and denturists only: CDTs must register with the Health and Medicines Authority
Estonia Registration is with the Healthcare Board
Finland Registration is with the National Supervisory Authority for Welfare and Health
France No registration
Germany Kassenzahnärztliche Vereinigungen (KZV) - dental hygienists and assistants
Greece Technicians' registration is with the Ministry of Health and Welfare
Hungary Hygienists and DCAs register with the Ministry of Health, Master technicians by the regional Chambers of Industry*
Iceland Registration is with the Directorate of Health
Ireland Hygienists, CDTs and Orthodontic Therapists: Irish Dental Council
Italy Technicians have to be registered with the Camera di Commercio of each Province
Latvia Registration is with the Centre of Dentistry
Liechtenstein Hygienists and technicians register with the public Berufsbildungsamt
Lithuania The Licensing Committee at the Lithuanian Dental Chamber
Luxembourg Only a diploma allows a qualified technician to own a dental laboratory.
Malta Hygienists and technicians: Board for Professions Supplementary to Medicine
Netherlands Denturists must register with their Federation
Norway All auxiliaries (including Assistants) - the Registration Authority for Health Personnel (SAK)
Poland Register planned but none in 2013
Portugal Hygienists and technicians must register with the Ministry of Health
Romania Dental Technicians must register with the Romanian Order of Dental Technicians
Slovakia The Association of Dental Hygienists and the Chamber of Dental Technicians, register these, respectively.
DNs are registered with the Chamber of Midwives and Nurses and Assistants with the Chamber of Other Health Professionals
Slovenia Only technicians must register (with the Economy Chamber)
Spain Hygienists must hold a Certificate of Proficiency granted by the Ministry of Education and Culture
Sweden National Board of Health and Welfare (Hygienists and Technicians)
Switzerland Hygienists: professional education department of the Swiss Red Cross**
UK General Dental Council
** Entrepreneurial technicians running a private firm by the Court of Registration
** Registration of technicians ( and CDTs) varies across cantons. Therapists are SSO-trained and are also registered with the association

Continuing education for dental auxiliaries

Dental auxiliaries are required to undertake continuing education in Lithuania, Slovakia and the United Kingdom.

Numbers in the dental workforce

Table 14 – The total workforce

Number of dentists 442,027
Number of auxiliaries 681,850
Workforce total 1,123,877

From the figures in Table 14, it can be seen that the recorded total dental workforce is over 1.12 million workers (0.97m in 2008). Adding in
the workers not recorded here, such as cleaners, managers and those work in the dental trade, it is more than likely that over 1.5 million
people directly derive their employment from dentistry in the EU/EEA.

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Numbers of dental auxiliaries
Table 15 – The numbers of dental auxiliaries

Hygien- Techs CDTs Assist- Thera- Others F/T equiv Equiv Equiv Dents per
ists ants pists at 0.43 Wrkfrce PopRatio tech
Austria 0 620 0 10,200 0 0 0 4,421 1,920 7
Belgium 0 2,250 0 1,500 0 0 0 7,777 1,434 3
Bulgaria 0 1,235 0 No data 0 0 0 8,350 872 7
Croatia 0 1,691 0 631 0 0 0 3,875 1,155 2
Cyprus 458 130 0 34 0 0 197 827 1,047 6
Czech Rep 800 4,500 0 8,000 0 0 344 8,165 1,288 2
Denmark 800 1,100 565 4,400 0 0 587 5,748 975 5
Estonia 32 137 0 1,540 0 0 14 1,264 1,048 9
Finland 1,490 450 400 4,800 0 0 813 5,313 1,023 10
France 0 16,500 0 15,350 0 4,786 0 41,505 1,582 3
Germany 550 58,000 0 182,000 0 0 237 69,473 1,159 1
Greece 0 4,500 0 2,000 0 0 0 9,000 1,197 2
Hungary 1,000 3,000 0 4,668 0 0 430 5,403 1,833 2
Iceland 14 101 9 320 0 0 10 279 1,158 3
Ireland 458 350 24 1,262 5 0 209 2,409 1,905 6
Italy 6,000 13,023 0 95,000 0 0 2,580 48,476 1,231 4
Latvia 219 551 0 1,360 87 0 132 1,606 1,357 3
Liechtenstein 8 27 0 105 0 0 3 51 719 2
Lithuania 572 1,114 0 1,904 0 0 246 3,856 768 3
Luxembourg 0 82 0 390 0 0 0 452 1,188 6
Malta 21 53 0 100 0 0 9 179 2,354 3
Netherlands 3,200 5,000 370 19,000 0 0 1,535 10,308 1,629 2
Norway 902 703 0 3,671 0 0 388 4,964 1,020 7
Poland 2,500 7,000 0 9,725 0 0 1,075 22,875 1,685 3
Portugal 520 546 0 No data 0 0 224 9,321 1,125 17
Romania 100 4,500 8 2,000 0 0 46 14,446 1,388 3
Slovakia 187 1,392 0 3,610 0 0 80 3,378 1,602 2
Slovenia 15 251 0 870 0 0 6 1,364 1,510 5
Spain 13,200 11,135 0 37,000 0 0 5,676 34,676 1,357 3
Sweden 3,749 1,500 0 12,000 0 360 1,612 9,140 1,048 5
Switzerland 1,600 1,800 50 6,500 280 0 830 5,630 1,431 3
UK 6,291 6,283 233 48,465 2,194 322 3,749 38,283 1,669 5
EU/EEA Totals 44,686 149,524 1,659 478,405 2,566 5,468 382,814 1,358

“Equiv” means Equivalent [Workforce]

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Part 8: Dental Practice in the EU
Although countries in Europe exhibit many wide variations in usually dedicated to providing care to special groups such as
how general health care is provided (for example, in terms children, private practitioners are without a doubt the main, and
hospital ownership, manpower structure, and the balance often the only, provider of care to the adult population.
between primary and secondary care), the provision of dental
care, in most countries, is dominated by non-salaried Liberal (General) Practice
practitioners, working from privately owned premises (“private”
or “liberal” or “general” practitioners). Over most of the EU/EEA The methods of establishing a liberal or general practice are
these represent nearly 90% of practising dentists, with several similar across Europe, with younger dentists employed as
countries (Belgium, Iceland, Luxembourg, Malta and Portugal) associates or assistants before they can afford to buy their own
reporting virtually 100% of clinical dentistry being provided this practice. However, in countries where solo private practice
way. dominates (for example, France, Belgium and Norway) starting
positions as associates or junior partners are very difficult to
obtain. Government incentive schemes, usually to persuade
Table 16 - Percentage of dentists who are practising dentists to set up in sparsely populated areas are also very
in general practice rare. The importance of dentists as a liberal profession was
underlined by the adoption of the EU Charter for Liberal
Active dentists in full or part-time GP Professions, proposed by the Council of European Dentists and
Finland 44% Czech Rep 94% jointly developed and adopted with the representative
organisations of European doctors, community pharmacists,
Sweden 46% Liechtenstein 94% engineers and veterinarians. Please see Annex 12 for more
Slovenia 59% Portugal 94% information.
Lithuania 61% Cyprus 95%
Most dentists, as with any other business, have to take out
Denmark 66% Latvia 95%
commercial loans in order to purchase a practice. By buying an
Ireland 68% Slovakia 95% existing practice they usually buy a list of patients as well.
Norway 69% Germany 96%
Croatia 76% Bulgaria 96%
Many countries have some regulations which govern the
location of premises where dentists may practise but usually
Hungary 76% Estonia 96% there are only general planning requirements.
Greece 82% Belgium 97%
Austria 87% Romania 88% Generally, across Europe, dentistry in general practice is
carried out as small businesses, with only one, two or a few
France 90% Malta 98% dentists practising together (in Greece, it is only since 2001 that
Switzerland 90% Luxembourg 99% dentists can share a clinic or dental chair). However, in most
Italy 91% Spain 99% countries corporate practice is permitted (see Part 9 –
Professional Matters) and so there are large, multi-dentist group
UK 92% Iceland 100%
practices – for example in the United Kingdom one company
Poland 96% Netherlands 100% owns over 500 practices, employing several thousand dentists.
Total for the EU/EEA 89%
Dental associations suggest 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).
Only in countries where there is a large, publicly-funded dental Shopping malls do not seem to be popular in Europe, for dental
service is the numerical dominance of the general practitioner practices.
less pronounced. Even so, since the public dental services are
Dental Practice list sizes
List sizes (patients)
Poland
In many countries dental practices
Netherla nds maintain a “list” of regularly
Croatia
Hungary
attending patients. Sometimes
UK this list is recorded by the
Norway
Slovenia
National Health Service or social
Slovakia insurance scheme.
Greece
Slovakia
However, only a few dental
Czech Rep
Romania associations are able to estimate
Switzerland
Sweden
the average size of their dentists’
France lists, as there are too many
Lit huania
Germany
variables to affect the average:
Iceland
Spain

0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000 Chart 13 – Dental practices
“list” sizes

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Public Dental Services
For the purposes of the description of the delivery of healthcare outside liberal (general) or private practice, we describe this as Public
Dental Services. However, this is not strictly accurate as the boundaries between self-employed/salaried dentists, and privately
owned/publicly owned facilities have become blurred in recent years.
Table 17 –Dentists working in public dental services
So, there are salaried dentists in
private practice - usually as assistants PUBLIC CLINIC DENTISTS
or associates to the practice owner, P opula tion Ac tive P ublic Unive r- Hospita ls Arme d O the rs
de ntists c linic s sitie s* Forc e s
although these may be paid by the
state, by way of such as vocational Austria 2013 8,489,482 4,421 601 206 110 0
training. In the same way, whilst most Belgium 2011 11,153,405 7,777 0 200 0 10
liberal dentists own or rent their Bulgaria 2013 7,282,041 8,350 0 258 35 46
premises from the private sector, in Croatia 2007 4,475,611 3,875 446 137 No data No data 33
some countries (for example, Estonia) Cyprus 2013 865,878 827 39 0 2 0
they may be renting the facility from
Czech Rep 2012 10,516,125 7,821 0 295 30 31
the local health authority or
municipality – which may even be Denmark 2013 5,605,836 5,161 1,215 112 58 15
supplying the auxiliary staff, Estonia 2013 1,324,814 1,250 18 35 5 0
equipment and materials. Finland 2013 5,434,357 4,500 2,165 86 113 72
France 2012 65,657,000 41,505 2,828 393 219 48
Overall, about 11% of dentists in the
EU/EEA work in public dental service Germany 2012 80,523,746 69,236 450 2,000 200 450
clinics. This figure has hardly changed Greece 2013 10,772,967 9,000 452 237 452 71 836
since the last edition of the Manual. Hungary 2013 9,906,000 4,973 20 240 35 40
In some countries, the term “Public Iceland 2012 322,930 269 3 23 5
Dental Services” also applied to Ireland 2013 4,591,087 2,200 333 50 10 5
liberal practitioners working within the Italy 2012 59,685,227 45,896 3,157 400 300 100
NHS system of that country. For the Latvia 2012 2,178,443 1,474 10 31 31 0
purposes of the description in this Liechtenstein 2013 37,009 48 0 0 0 0
section of the Manual, this term is
Lithuania 2013 2,962,000 3,610 538 80 13
being applied to those who work in
(usually) salaried practice, in state or Luxembourg 2008 537,000 452
social insurance funded facilities Malta 2013 421,364 170 35 24 31 0
(clinics and non-private hospitals), Netherlands 2013 16,789,800 8,773 250 110 214 30
within any state system or social Norway 2013 5,063,709 4,576 1,109 234 35 23
insurance fund. Poland 2012 38,533,299 21,800 500 400 250 300
Public Clinics Portugal 2012 10,487,289 9,097 43 446 90 16
Romania 2013 20,057,458 14,400 1,200 950 234 80
Most countries have some form of Slovakia 2013 5,410,728 3,298 80 120 29 22
state service operating from publicly
Slovenia 2013 2,060,253 1,358 523 27 31 0
funded clinics. The “culture” of
dentistry provided from publicly Spain 2012 47,059,533 29,000 1,300 864 350 340
funded clinics is especially strong in Sweden 2010 9,580,424 7,528 4,065 431 N/R N/R
the Nordic and Baltic countries, Switzerland 2013 8,058,100 4,800 200 300 50 0
where, with the exception of Estonia a UK 2013 63,887,988 34,534 1,800 566 2,084 244 250
large proportion of active dentists 361,979 23,362 9,238 5,031 1,963 1,119
work in them.
6.5% 2.6% 1.4% 0.5% 0.3%
There are no public clinics in 7 Proportion of total workforce: 11.2%
countries; and, in many countries * For the purpose of this table, this includes private universities
dentists only work part-time in such
Bulgaria, Lithuania, Romania and Switzerland: "active" means registered dentists
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.
The common services provided by most of the countries with these clinics will include emergency care, domiciliary care, dental public
health support, preventive services and postgraduate training. These services are 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.
Table 18 - Countries without public clinics

Belgium Iceland
Bulgaria Liechtenstein
Czech Republic Luxembourg
Estonia

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Hospital Dental Services Dentistry in the Armed Forces
As said above, the strict definition of what is a hospital is not Many countries of the EU/EEA have national service in the
uniform across Europe. But, for the purposes of this section we armed forces. These countries and many of those with
are looking at premises which have facilities for patients volunteer armed forces, have formal arrangements to provide
undertaking general medical care to receive services for acute oral healthcare for their personnel, either from Armed Forces
or chronic care, either as in-patients for one or more nights, and Dental Units, or from local arrangements with public clinics.
as out-patients. Dental schools without these facilities are not
However, in Germany, Poland and the UK, the Armed Forces
part of this review.
Units are well developed and large numbers of dentists serve
All countries have hospitals which provide services for trauma, this way.
oral maxillo-facial surgery and pathological services. Most also
undertake postgraduate training for potential surgeons. There Illegal Practise of Dentistry
are state-funded facilities in every country, and some also have There were no reports of the illegal practise of general dentistry
private hospitals which provide some care. The practitioners across the EU/EEA. However, there are reports of the provision
involved in providing the care are usually salaried in public of dentures and tooth whitening procedures by persons not
hospitals – but in most countries they are also able to work legally able to provide these.
additional hours in private practice.
Several countries - Belgium, France, Greece, Hungary, Ireland,
Whether these services are provided as part of oral healthcare Italy and the UK - report illegal denturism, although with the
or medical healthcare depends upon individual countries. Apart introduction of (legal) clinical dental technicians in the UK in
from Iceland and Luxembourg salaried personnel are available 2008 this illegal practise is expected to reduce. ANDI (Italy)
for this provision, and there is often no charge for it. report a considerable amount of illegal practise in Italy by dental
technicians, some of which is thought (by ANDI) to be
In most countries there is provision for emergency dental condoned by medical practitioners, who cover for the
treatment for in-patients, but this is often provided by local technicians concerned. And VVT (Belgium) report that there is a
general practitioners. However, in six countries general dental move to introduce legal denturism into Belgium.
care is provided for patients who are not in hospital – often as
part of specialist services. These countries are Cyprus, Ireland Clinical Dental Technicians/Denturists may practise legally in
and Malta (with historical links with the UK), Spain, Sweden and Denmark, Finland, the Netherlands, parts of Switzerland and
the UK. Indeed, in the UK this service is very developed, with the UK – so the potential for illegal practise is reduced.
nearly 10% of practising dentists involved in providing this care,
or in postgraduate training. However, a continued problem in many EU/EEA countries is the
illegal provision of tooth whitening products in the mouth by
unqualified persons, even after the introduction of the 2011
Dentistry in the Universities Directive. In the UK, despite successful prosecutions in the
Some dental care is provided in dental schools, by academic courts by the General Dental Council, non-qualified persons
dentists and (in most countries) by dental students. However, it continue to offer whitening services using >0.01% hydrogen
is thought that the amount of oral healthcare delivered this way peroxide.
is very limited.

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Part 9: Professional Matters
Professional representation
Table 19 - Membership of national dental associations

Membership of dental associations and chambers Although all countries

have a main national
Mandatory membership in red dental association, some
Num bers Year Source have two or more (for
Austria Österreichische Zahnärztekammer 4,820 100% 2013 Chamber example, Belgium) and
many are primarily
Belgium Chambres Syndicales Dentaires 1,016 2012 FDI federations of the regional
Belgium Société de Médecine Dentaire 1,096 2012 FDI associations (for example
Belgium Verbond der Vlaamse Tandartsen 3,500 2012 VVT Germany, Greece and
Spain).
Belgium Vlaamse Beroepsvereniging voor 600 2012 VVT
Bulgaria Bulgarian Dental Association 8,350 100% 2013 BgDA The primary role of all
Bulgaria Association Médicale >150 2013 BgDA national dental
associations is to defend
Croatia Dental Chamber 6,859 100% 2012 Chamber
the interests of individual
Croatia Dental Society 1,748 100% 2012 FDI members and the dental
Cyprus Cyprus Dental Association 773 100% 2012 FDI profession as a whole.
Czech Rep Czech Dental Chamber 9,354 100% 2012 Chamber However, although the
national dental
Denm ark Association of PH Dentists 1,293 2013 DCPA* association usually plays
Denm ark Danish Dental Association 6,507 81% 2013 DCPA* an important role in
Estonia Estonian Dental Association 799 50% 2012 FDI determining the level of
Finland Finnish Dental Association 4,240 98% 2013 FDI
“standard fees”, in several
countries the association
France ADF 30,053 65% 2012 FDI is also the official trade
Germ any Bundeszahnärztekammer 69,236 100% 2012 BZÄK union for dentists.
Greece Hellenic Dental Association 9,000 100% 2013 HDA
In about one third of the
Hungary Hungarian Dental Association 718 88% 2012 FDI countries, membership of
Iceland Icelandic Dental Association 270 90% 2012 FDI the dental association or,
Ireland Irish Dental Association 1,700 82% 2013 IDA as is often known, the
Chamber, is mandatory –
Italy ANDI 23,396 2012 ANDI often because the
Italy AIO 7,053 2012 FDI association or chamber
Latvia Latvian Dental Association 1,474 100% 2012 LDA acts as the registration
Liechtenstein Liechtenstein Dental Association 28 2013 LDA
authority as well. In some
countries, as well as
Lithuania Lithuanian Dental Chamber 3,660 100% 2013 Chamber providing continuing
Luxem bourg Association des Médecins 410 90% 2013 AMMD education for dentists
Malta Dental Association of Malta 130 76% 2013 DAM (and dental auxiliaries),
the association or
Netherlands Nederlandsche Maatschappij 6,653 76% 2013 NMT
chamber is responsible
Norw ay Norw egian Dental Association 4,539 90% 2012 FDI for ensuring the
Poland Polish Dental Association (Society) 5,400 2013 Chamber participation in it.
Poland Chamber of Physicians & Dentists 21,800 100% 2013 Chamber
In those countries where
Portugal Ordem dos Médicos Dentistas 8,568 100% 2012 OMD membership is voluntary
Rom ania Romanian Dental Association 700 25% 2012 FDI uptake is very mixed. So,
Rom ania Romanian Soc of Stomatology 200 2012 FDI
whereas in Latvia 100%
of dentists are members
Slovakia Slovak Chamber of Dentists 2,906 87% 2013 Chamber of the association, in
Slovenia Medical Chamber of Slovenia 1,789 100% 2013 MCS many countries (Estonia,
Spain Consejo General de Colegios 31,260 100% 2013 Colegios Italy, Malta and the UK)
only about half of dentists
Sw eden Sw edish Dental Association 5,138 95% 2013 SDA
are members of the
Sw itzerland Société Suisse des médecines- 4,130 90% 2013 SSO national association.
UK British Dental Association 19,736 50% 2012 FDI
Total 310,902
* The Danish Confederation of Professional Associations

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European dental organisations in understanding the effects and implementation of EU
legislation, in particular members from the new Member
The Council of European Dentists (CED) States and EU accession countries
Cooperates with all major European associations of health
The Council of European Dentists, which commissioned this professionals and other liberal professions on policy
Manual, was established in 1961 at the request of the issues of common interest
Department of Social Affairs of the European Commission. It is
a European not-for-profit association which represents over The Council and member associations have worked closely
340,000 dentists across Europe. It was formerly called the EU with the European Institutions in a number of matters and are
Dental Liaison Committee (EUDLC), but its name was changed officially consulted by the European Commission on health
in May 2006. It is a council of dental associations, with all the matters.
member countries of the EU, except for Romania, being http://www.eudental.eu/
members in 2014. Attending as observers are representatives
of Iceland, Norway and Switzerland. The associations appoint The Association for Dental Education in Europe (ADEE)
up to two members each as delegates to the CED’s plenary
meetings – which are held twice a year, once in a host EU The Association for Dental Education in Europe was founded in
country, and once in Brussels. 1975 as an independent European organisation representing
Between plenary meetings an elected board and working academic dentistry and the community of dental educators.
groups attend to matters, and the CED has a permanent office Since then, ADEE has played an important role by enhancing
and secretariat in Brussels. the quality of education, advancing the professional
development of dental educators and supporting research in
The Board (of Directors) is composed of 8 members who serve education and training of oral health personnel.
for 3 years, being elected by the (plenary) General Meeting.
The Board formulates proposals for the CED policy, for The ADEE brings together a broad-based membership across
approval by the General Meeting. It secures and monitors the Europe comprised of dental schools, specialist societies and
proper and efficient administration of the CED. national associations concerned with dental education.

The Board generally meets four times a year. The ADEE is committed to the advancement of the highest level
of health care for all people of Europe through its mission
Much of the business of the Council is conducted by Working statements:
Groups and Task Forces. In 2014 there were 8 WGs, looking
after subjects such as Education, Patient Safety and Oral To promote the advancement and foster convergence
Health (etc). towards high standards of dental education.
To promote and help to co-ordinate peer review and
The CED task forces are active for limited periods of time, and quality assurance in dental education and training.
for specific and urgent issues, such as Antibiotic Use, and the To promote the development of assessment and
Internal Market. They are established by, and accountable to examination methods
the CED Board of Directors. To promote exchange of staff, students and programmes.
To disseminate knowledge and understanding on
The Council's objective is to develop and execute policy and education
strategy in order to: To provide a European link with other bodies concerned
with education, particularly dental education.
Promote the interests of the dental profession in the EU;
Promote high standards of oral health; http://www.adee.org/about/index.html
Promote high standards of dentistry and dental care;
Contribute to safeguarding the protection of public health;
Professional Ethics
Monitor, analyse and follow up on all the political and legal Dental practitioners in every European country have to respect
developments and documents of the EU that involve ethical principles. Whether formally expressed as laws, oaths
dentists, dental care and oral health; or as written guidelines these principles relate to their
Actively lobby the European Institutions and Parliament, in relationship with patients, other dentists and the wider public.
order to serve the legal and political interests of dentists,
including consumer protection issues The commonest method of providing dentists with ethical
To achieve these objectives, the CED: guidance is through a simple written code. This is usually
administered by the national dental association or in some
Monitors EU political and legislative developments which countries by the separate regulating body (for example, as in
have an impact on the dental profession France, Ireland and the UK). The application of these codes is
Issues policy statements and drafts amendments to usually by committees at a local level. The CED’s Code of
proposed EU legislation, so as to ensure that the views of Ethics can be found in Annex 9.
European dentists are reflected in all EU decisions
affecting them Dentists’ professional and other behaviour is usually also
Provides expertise for the EU institutions in the areas of governed by specific laws (such as the Dental Acts in Norway
health and consumer protection, training, safety at the and Iceland), more general medical laws (for example, in many
work place and internal market legislation of the new member countries of the EU, and in Austria, where
Provides a platform for the exchange of information dentists must also take the ‘Hippocratic Oath’) as well as laws
between national dental associations, and supports them on professional and business conduct.

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Standards and Monitoring against them. However, in some countries this indemnity
insurance is not mandatory (see below):
Although the threat of patient complaints is probably still the
strongest ‘control’ on the standard of care, increasingly oral Table 21 – Indemnity Insurance mandatory
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 Mandatory Indemnity
continuing education, as well as more basic controls on the Mandatory Overseas Mandatory Overseas
level of billing and patterns of treatment of individual Austria Yes No Latvia Yes No
practitioners.
Belgium Yes Lithuania Yes No
Some of the widest variations in dental practice across Europe Bulgaria Yes No Luxembourg Yes No
relate to the monitoring of standards. In most countries Croatia No Malta Yes
monitoring is not of the quality of care, but is simply an
Cyprus No Netherlands No Yes
administrative control, to ensure that the patient has been
charged the correct amount for the type and amount of Czech Rep Yes Yes* Norway Yes
treatment received. Denmark Yes** Poland Yes
Estonia No Portugal No
Only in a few countries are there “examining dentists”, who re-
examine the patients of selected dentists, to see that the dentist Finland Yes No Romania Yes
has fairly claimed payment for work done. However, in these France Yes Yes Slovakia Yes No
countries it is not usual for examining dentists to visit at Germany Yes No Slovenia Yes Yes*
random, and most re-examinations are the result of patient
Greece No Yes* Spain Yes Yes
complaints. In some countries the threat of patient complaints
offers the only real form of pressure on dentists maintaining the Hungary Yes No Sweden Yes No
standard of care. Iceland Yes No Switzerland No No
Ireland Yes Yes UK Yes Yes
Advertising
Italy Yes
There is tremendous variation across the EU/EEA as to what
* at additional cost ** included in membership of DDA
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 Eight countries reported that the mandatory or non-mandatory
Pages” classified telephone directories could be counted as indemnity insurance may extend to the dentist working in
advertising. In the following countries the rules are very tight another country – although this would usually be an adjacent
and practitioners are barred from any form of public country for working near the border or alternatively to any
announcements: country, but for a limited period (usually measured in months).

Table 20 – Advertising not permitted Corporate Practice

Most countries permit dentists to set up their practices as
Belgium Iceland Portugal limited liability companies (corporate bodies). Only in Germany,
France Luxembourg Romania Ireland, and Malta is this barred completely. There is no
information for Luxembourg.
Greece Malta Slovakia
In the countries in the following table non-dentists may wholly or
Advertising on the first opening of a dental practice only is partly own the company, but in all cases only dentists can be
permitted in Croatia, Cyprus and Slovenia. Only limited responsible for clinical matters and usually one or more dentist
advertising is permitted in Hungary. must be on the board of the company and at least one dentist
must be employed:
Websites
Table 22 – Corporate practice permitted
In contrast to the rules relating to advertising virtually all
countries permit the use of dental practice websites – with only Belgium Greece Portugal
Luxembourg and Malta dissenting from this. The Guidance to
Bulgaria** Hungary Romania
the Directive on Electronic Commerce, developed by the CED,
can be found in Annex 10. Croatia Iceland** Slovakia
Cyprus Italy Slovenia
Data Protection
Czech Republic Latvia Spain
All the countries of the EU, Norway and Switzerland have Denmark Lithuania Sweden
adopted the EU Data Protection Directive into their national
legislation. National law in Iceland covers this area of dental Estonia Netherlands Switzerland**
practice. Finland Norway United Kingdom
France** Poland
Indemnity Insurance
In all EU/EEA countries, professional Indemnity Insurance, to ** in these countries membership of the board of the company
ensure that proper compensation is available for patients who is limited to dentists only.
are harmed in some way. This thereby protects dentists against
having to pay damages and legal costs should a claim arise

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In Austria, dentists are allowed to form a so called Table 24 – Mandatory continuing education relating
“Gruppenpraxis”, which is a form of company, but these to ionising radiation
companies are only allowed to work outside of the social
security system. A non-dentist cannot be a part-owner and/or
on the board of such a company Austria Finland Luxembourg
Belgium France Norway
Tooth whitening Bulgaria Germany Poland
The current information about Tooth Whitening can be found in Croatia Hungary Slovakia
Annex 8.
Czech Republic Italy Slovenia
By 30th October 2012 all countries had complied with the Estonia Latvia United Kingdom
demand to enact regulations putting the Directive into effect. Finland Lithuania

Most countries have reported that in 2013 there were still many
non-dental professionals illegally continuing to undertake tooth Hazardous Waste
whitening using products with greater than 0.1% hydrogen
peroxide. Again, all countries have regulations relating to the storage,
Health and Safety at Work collection and disposal of waste, including clinical waste. Of
particular relevance to dental practices is the collection of waste
All EU/EEA countries have rules about protection of dental amalgam. Every country now recommends the fitting of
workers and patients, including items such as the prevention of “amalgam separators” – which collect waste amalgam before
cross infection. So, the use of one-use only disposables - such this reaches the main drainage system.
as (for example) needles and gloves is widespread, with
increasing numbers of items joining the list of “one-use only”. However, most countries insist upon these being fitted as a
mandatory requirement. Sometimes this is necessary just in
Inoculations against diseases, especially Hepatitis B for dental newly installed units, but often it is a mandatory requirement in
workers, are universal and recommended. However, in many every surgery, whether new or not. Only Denmark has been
countries inoculation against Hepatitis B is mandatory. There added to this list since 2008.
has been little change to this list since 2008.
Table 25 – Amalgam separators mandatory
Table 23 – Inoculation against Hepatitis B mandatory
Austria France Netherlands
Belgium Hungary Romania Belgium Germany Norway
Croatia Latvia Slovenia Croatia Greece Slovakia
Czech Republic Malta United Kingdom Cyprus Hungary** Slovenia
France Netherlands Czech Iceland Spain**
Republic Latvia Sweden
Ionising Radiation Denmark Luxembourg Switzerland
All countries have regulations relating to use of radiographic Finland Malta United Kingdom
equipment, which usually include mandatory regular inspection
of machinery and often recording of this in a central database.
** for new units only
All dentists learn about ionising radiation as part of their
undergraduate studies. However, in most countries the taking of
radiographs is not necessarily limited to dentists in dental
practices – other dental workers may undertake these if they
have had the necessary education and training.

In just over half the countries the regulations relating to ionising

radiation make continuing education about this subject
mandatory on a regular basis – usually a specified number of
hours in every 5 (or so) years:

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Part 10: Financial Matters
Retirement
All countries of the EU/EEA have a state retirement age, which is the age at which dentists working in the public dental services, or liberal
(general) dentists with contracts with a state system/sick fund have to retire. However, there is no universal rule about this, and it will vary
from country to country. All countries permit continued private practice beyond the normal retirement age – with a further upper age limit in
a few countries.

Retirement ages Table 26 - Normal (state) retirement ages

Austria 65/60 Latvia 62
This table shows the normal retirement ages for
Belgium 65 Lithuania 63
males/females in each country; the first figure is for
Bulgaria 63/60 Luxembourg 65 males, the second for females and where there is a
Croatia 65 Malta 65 variable age between genders. NB: Slovakia has a
Cyprus 65 Netherlands 65 variable retirement age for females with children
Czech Rep 63 Norway 67
Denmark 65 Poland 65/60
Estonia 63 Portugal 66
Finland 60 Romania 65/60
France 65 Slovakia 62
Germany 62-68 Slovenia 65
Greece 62 Spain 70
Hungary 62 Sweden 65
Iceland 67 Switzerland 65
Ireland 65 UK 65/60
Italy 65/63
Romania has a variable retirement age Table 27 – Tax rates in 2013
Dentists’ Incomes
Dentists who work within hospitals or for the public Top rate Standard Top rate Standard
dental service tend to be salaried employees, and of tax rate of VAT of tax rate of VAT
considerable numbers in general practice may Austria 50.0% 20% Latvia 24.0% 21%
work that way – either as assistants to practice
Belgium 53.5% 21% Lithuania 20.0% 21%
owners in fee-based systems, or salaried within
the state system (the UK). Bulgaria (1) 10.0% 20% Luxembourg 49.0% 15%
Croatia 40.0% 25% Malta (6) 35.0% 18%
Liberal/General private practitioners often contract Cyprus 35.0% 18% Netherlands (7) 52.0% 21%
to work part-time for the public dental service on a Czech Republic (2) 22.0% 21% Norway 54.3% 25%
fee-for-service basis.
Denmark 51.5% 25% Poland 32.0% 23%
Given that a fee-for-service (or fee-per-item) Estonia (1) 21.0% 20% Portugal 45.0% 23%
system dominates for all private practitioners Finland 31.75% 24% Romania (1) 12.0% 24%
across Europe, and for some dentists working from France 49.0% 20% Slovakia 25.0% 20%
hospitals or government health centres, the Germany 45.0% 19% Slovenia 50.0% 22%
process of establishing standard or maximum fees
Greece (3) 42.0% 23% Spain (8) 30.5% 21%
is an important part of any oral health system.
Hungary (1)(4) 16.0% 27% Sweden 57.0% 25%
A common model for deciding standard fees is to Iceland 46.22% 25.5% Switzerland 42.0% 8%
have a points system attaching relative values to Ireland (5) 41.0% 23% United Kingdom 45.0% 20%
each type of treatment, to reflect relative cost. A Italy 43.0% 22%
separate process then attaches a monetary value
Source: various
to each point. Sometimes the monetary values
attached to different treatments, are derived from (1) Flat rate
an overall ‘target income’ figure for the average (2)) Dental consummables VAT is 15%. Tooth whitening 21%
dentist. In this way it is possible for governments (3) VAT is 13% for intra-oral materials
to exercise partial control on overall expenditure. (4) VAT 5% for medicaments, 15% for materials
However, although in some countries the scale is (5) VAT 21% on dental equipment and materials
one of maximum fees, more often there are flexible
rules governing when a dentist can charge above (6) Some dental materials are charged at a lower VAT rate
the standard fee. (7) A lower VAT rate of 6% is applied to dental materials
(8) Lower VAT rate of 10% on dental equipment

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Income Tax rates However, within their costs dentists have to pay VAT on a
In all but a handful of countries, tax rates are progressive with number of services and consumables that they purchase (but
increasing incomes, but all countries do allow a certain amount not dental technicians’ labour costs) – and these costs are
of income before tax is applied. The highest rate reported was included within the prices that governments, insurance
in Sweden, with a top rate of 57%. However, in 2014, France companies and patients pay for dental care.
was introducing a rate of 75% on earnings over €1M. The
Most countries charge VAT for dental consumables and
lowest rate is in Bulgaria (10% flat rate on all earnings).
equipment at their standard rate, but several countries (marked
VAT in the table) do offer some lower VAT rates. Again, the levels of
VAT levied across the different countries, are very complex.
The cost of oral healthcare is specifically exempted from VAT The highest rate charged is 25.5% (Iceland), but the average is
charges in all countries, so dentists do not add VAT to the bills about 20 to 23%.
that patients pay.

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Individual Country Sections

EU joined 2004

EU joined 2007

EU joined 2013

EEA & Switz

Non-EU/EEA

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Austria
In the EU/EEA since 1995
Population (2013) 8,489,482
GDP PPP per capita (2012) €32,269
Currency Euro
Main language German

Entitlement to receive funded healthcare is through membership of health

insurance organisations (or sick funds). These are provided by public
compulsory and private supplementary insurance.

Number of dentists: 4,820

Population to (active) dentist ratio: 1,920
Members of Dental Association: 100%

Specialists do not exist in Austria and the use of dental auxiliaries is

very limited. Continuing education for dentists is mandatory.

Date of last revision: 7th January 2014

Government and healthcare in Austria

Austria is a landlocked, federal republic in the geographical workers, farmers and craftsmen), or the 9 health insurance
centre of Europe, surrounded by 8 adjacent EU states. institutions of large companies. The public compulsory
insurance schemes are funded mostly by members (89% of
There is a bicameral Federal Assembly or Bundes- their revenue), with employers paying half of each member’s
versammlung consisting of a Federal Council or Bundesrat (64 contribution. The public sick funds also earn some revenue
members; members represent each of the states on the basis through patients’ co-payments for treatment and retention fees
of population, but with each state having at least three (6% of revenue), and government subsidies (5%).
representatives; members serve a four- or six-year term) and
the National Council or Nationalrat (183 seats; members
elected by direct popular vote to serve four-year terms)
consisting of 9 federal states. The capital is Vienna.

The federal government looks after all the competences for

healthcare, including dentistry. There is a department for
healthcare in the federal ministry for health, family and youth.
Supplementary private health insurance mainly covers hospital
In Austria entitlement to receive healthcare is through care. The benefits generally include a more comfortable room
membership of health insurance organisations (or sick funds). and greater choice of doctor for inpatient care. There are about
These are provided by public compulsory and private 1 million private health insurance contracts offering these extra
supplementary insurance. Approximately 99% of the population benefits and their total expenditure is about one third of that of
are covered by the compulsory schemes which are often called compulsory health insurance schemes.
paragraph 2 insurance, if they are with one of the large public
regional institutions. Employees, their dependants and retired Anyone who is covered by a public insurance scheme is
people are either members of one of the 9 regional “public supplied with a so called “e-card” by their sick fund. They have
health insurance institutions” (one in each Bundesland), 4 to pay €10.00 per year for this, and it entitles them to free care
occupational insurance organisations (civil servants, railway for most of their treatment needs.

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Oral healthcare

Year Source
% GDP spent on oral health 0.65% 2007 CECDO* In almost all counties children’s teeth are examined regularly. A
federal programme of oral health surveys began in 1997. Each
% of OH expenditure private 40% 2007 CECDO
year the oral status in a subgroup of the population (500
persons) is examined.
*estimated
The dentists who work for the public dental service are only
Public compulsory health insurance allowed to offer treatments within the scheme of the social
security system. There are very few dentists working in
Public compulsory health insurance provides cover for 41 hospitals, mainly practising oral maxillo-facial surgery, for
conservative and surgical items, and 11 removable orthodontic emergency cases.
and prosthodontic treatments. Crowns and bridges, implants,
fixed orthodontic appliances and other complex or cosmetic All payments to dentists are done by the way of fees for
treatments have to be paid for by the patients. There is a treatments. Normally re-examinations would be carried out
prescribed fee scale for all dentists who are contracted to the annually. Domiciliary (home) Care is available in an emergency.
major public insurance organisations. Free or subsidised
treatment is provided by any dentist in exchange for the e-card
Private Care
issued by the sick funds. If the e-card is valid, the dentist can For private patients who wish to pay the whole cost of care
claim fees from the insurance scheme quarterly. themselves, the levels of fees payable are decided by the
individual dentist and are not regulated.
The small sick funds, largely those for particular occupational
groups, use the same list of items as a basis for dentists’ About 5% of the population use private insurance schemes to
remuneration but some have different levels of fees. Generally, cover some of their dental care costs. All such schemes are
standard items attract an insurance subsidy of 100%, or 80% personal, which supplement the public health system, and
with small funds, which is claimed by the dentist and the patient individuals insure themselves by paying premiums directly to an
pays the remainder where appropriate. For more complex insurance company.
types of treatment, for example removable prosthodontic The private insurance policies which people can purchase may
appliances the insurance schemes provide subsidies of up to be dental-only or contracts which provide a range of medical
50% of the cost. In such cases, where the overall value of the benefits including dental care. Private insurance companies
care is high, the treatment plan may have to be agreed with the are regulated by insurance law only and thus accept all the
insurance organisation. financial risks involved. Generally the level of the premiums is
Approximately 65% of dentists in general practice treat patients linked to the age of the insured individuals, and the insurance
within this system through the contracts with the public company may refuse to provide cover if the risk of costly
insurance institutions. The fees claimed by dentists contracted treatments is high.
with the major, public sick funds are set by the Association of
Austrian Health Insurances (Hauptverband der österreichischen
The Quality of Care
Sozialversicherungsträger) in annual negotiations with the The quality and standards of dental care are the responsibility
Austrian Dental Chamber. Dentists’ earnings are influenced by of the Austrian Dental Chamber. Checks are made mainly on
the level of pay negotiated for other doctors. Every regional the quantity of care provided, and the correct and fair payment
Ärztekammer proposes and negotiates its own level of fees. of fees, as recommended by the Dental Chamber (private
The average increase of the 9 regions then determines the services only).
increase of the national fee scale. Dentists may hold more than
one contract in order to treat patients with different insurance There are regional variations in these monitoring arrangements
organisations. but usually they concentrate on newly established dentists or
those performing more than the expected number of particular
As with general healthcare, approximately 99% of the treatments but random checks are carried out in some regions.
population are entitled to receive dental care in this way, with Sometimes the quality of care is also monitored by dentists
the rest holding a certificate from the local authority. employed by the insurance schemes.
There is no organisation entirely dedicated to children’s dental Another measure of the quality of care, and the only control for
care. However, some larger cities have dental clinics for dentists providing care to private patients, is patient complaints.
children ("Jugendzahnkliniken"). Children are covered by the
social sickness insurance of their parents and have the same The Dental Law introduced a countrywide system of quality
rights to dental treatment as their parents. This means that assurance in 2009. This system is organised by the Austrian
parents have to pay the same percentages for the treatment of Dental Chamber. Evaluations have to be done every 5 years,
their children as for themselves. and are done via self-evaluation based on a questionnaire
formulated by the quality assurance company, which is
There are institutions in every county ("Bundesland") which authorised by the Austrian Dental Chamber.
offer caries prevention programmes. These are mostly The answers to the questionnaire are verified in a randomised
educational programmes (how to brush teeth, what healthy food process.
to eat, etc.).

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Health Data

“DMFT zero at age 12” refers to the number of 12 years old children
with a zero DMFT. “Edentulous at age 65” refers to the numbers of
over 64s with no natural teeth

Fluoridation
There are no fluoridation schemes in Austria.

Education, Training and Registration

Undergraduate Training and Qualification
(Landeszahnaerztekammern). The annual fee for membership
In the past, to practice as a dentist in Austria required a medical in the Austrian Dental Chamber is a certain percentage of the
qualification (6 years’ training), followed by specialist income of the dentist, which is different in every region. All
postgraduate training in dentistry. So, until 2004, in order to dentists have to be a member of the Austrian Dental Chamber
register as a dentist, a practitioner had to have the recognised to be allowed to practise dentistry.
primary degree [Doctor of Medicine (Dr. med. univ.) with the
Specialist Certificate (Facharzt für Zahn-, Mund-, und Until the end of 1998, non-Austrian dental degrees were not
Kieferheilkunde), needed to demonstrate Austrian or EU recognised. Since then all EU dental degrees have been
citizenship, and to provide evidence of professional indemnity. accepted, but dentists from non-EU countries have to comply
with the rules of Directive 2005/36/EG.
However, in autumn 1998, to move progress towards mutual
recognition under the then EU Dental Directives, a separate There is no annual cost of the registration, but every registered
curriculum for dentists was introduced. Since then all new dentist has to be a member of the Austrian Dental Chamber,
dentists have had to study dental medicine. The study is with annual fees dependent on the income of the dentist.
divided into 3 sub-sections.
Language Requirements
Year of data: 2013 Though there are no formal linguistic tests to register - the
Number of schools 4 dental law requires a certain level of knowledge of the German
language. In cases of doubt the Austrian Dental Chamber
Student intake 165
requires a certificate about knowledge of the German language
Number of graduates (2012) 119 (European level C1). Austrian citizenship is generally awarded
Percentage female 65% on the condition that German can be spoken.
Length of course 6 yrs Continuing education
VT mandatory? No
Legislation includes an obligation to participate in continuing
education, but there is no minimum number of hours that have
to be undertaken and a dentist is free to choose the activity he
Graduation takes place at the three public (university) dental wants to join in.
schools in Graz, Innsbruck and Vienna and a new private
university dental school in Krems, which started in 2008, and There are several institutions which provide courses and
the first graduates from there are expected in 2014. training, including universities, scientific societies, medical or
pharmaceutical companies, national and international medical
Qualification and Vocational Training congresses, on a regular basis. The dentist can apply for a
Primary dental qualification diploma of education from the Austrian Dental Chamber, by
submitting the approvals of the different types of training he/she
The first dentists under the new system graduated in 2004. The has completed during this period.
title upon qualification (from June 2004) is Dr. med. dent.
Further Postgraduate and Specialist Training
Quality assurance for the dental schools is provided by In Austria no dental specialties are officially recognised, largely
government regulators. because dentistry itself was formally a specialist area of
medicine, until 1998. However, it is possible to train in any of
Vocational Training the 3 public universities in the “subspecialty” of oral maxillo-
facial surgery through a further 3 years education (officially, oral
There is no compulsory post-qualification vocational post-
surgery still is a sub-speciality of medicine). There are no
graduate training in Austria.
official guidelines as to whether the trainee is paid – this is a
Registration matter between the trainee and the university.

To achieve registration to practice in Austria applications must There are many associations and societies for dentists with
be made to the Austrian Dental Chamber (the competent special interests. These are most easily contacted via the
authority for dentistry) via their regional organisations Austrian Dental Chamber www.zahnaerztekammer.at

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Workforce
Dentists Auxiliaries

Year of data: 2013 In Austria, other than dental chairside assistants (Zahnärztliche
Total Registered 4,820 Assistentin), dental technicians (Zahntechniker) are the only
other type of dental auxiliary. There are no clinical dental
In active practice 4,421 auxiliaries.
Dentist to population ratio* 1,920
Percentage female 42%
Qualified overseas 766 Year of data: 2013
Hygienists 0
Technicians 620
* this refers to the population per active dentist Denturists 0
There is a small increase of the dental workforce, with 150 Assistants (estimate) 10,200
dentists (including overseas dentists) entering into dentistry Therapists 0
each year, so that the phenomenon of jobless dentists has Other 0
commenced. However, there was a post-1945 population
“bulge” (which included a bulge of dentists) and as a result
many of these dentists will retire early in this century, leading to Dental Technicians (Zahntechniker)
an expected reduction in the numbers.
Education or training is over a 4-year period and is provided by
Movement of dentists into and out of Austria qualified technicians and the dental practitioner confers the
Diploma. As a “special profession” there is a registerable
There is almost no movement of dentists out of Austria as far as qualification which dental technicians must hold before they can
can be established, but there are a considerable number of practice. The register or list is administered by local trade
dentists, especially from Eastern Europe and Germany, moving federations, which also have federal and state groups.
into Austria. Approximately 16% of overseas dentists are from
outside the EU/EEA. The permitted acts of dental technicians are the production of
prostheses (crowns, bridges, dentures and repairs), and they
Specialists are not allowed to work in the mouth of a patient, or have direct
contact with them.
In Austria no dental specialties are officially recognised. Oral
Maxillo-Facial surgeons are officially medical specialists 90% of technicians work in dental laboratories separate from
(although we have included their approximate number within dental practices and invoice the dentist for work done. 10%
the data for dental specialists for 2013). work directly with the dentist.

Dental Chairside Assistants

OMFS (2013) 167
Assistants are governed by the Austrian Dental Law and the
Kollektivvertrag, (the labour agreement between the union and
the Austrian Dental Chamber) and follow 3 years training under
the authority of the dentist.

They are paid by salary.

Officially there are no dental hygienists established in Austria,

but there are some dental nurses specialised in oral health
prevention, who have obtained a diploma after 3 years
professional practice and following the specific education
determined by the Austrian Dental Chamber.

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Practice in Austria
Oral health services are provided mainly in General Practice, employment opportunities, maternity benefits, occupational
both in the public and private sectors - about 19% of dentists health, and minimum wages.
work solely in the private sector.
Occupational health and safety regulations apply to all
companies. There are no standard contractual arrangements
Year of data: 2013 prescribed for dental practitioners working in the same practice.
General (private) practice 3,866 However, dentists who are contracted with the local health
Public dental service 601 insurance organisation cannot employ another dentist to carry
out the work.
University 206
Hospital 110 There is no available information regarding the size of a normal
dental “list”.
Armed Forces
General Practice as a proportion is 87% Working in the Public Service
The public insurance organisations also employ salaried
OMF surgeons are not registered as dentists but are listed in dentists to provide care. This service takes place in dental
these numbers as Hospital dentists clinics, health centres and hospitals – and competes with, and
is subject to the same standards as the other dentists
Working in Liberal (General) Practice contracted with the insurance scheme. The care provided is
therefore available to the same client groups, and provides the
Dentists who practice on their own or as small groups, outside same range of treatments. Patients have a free choice to go to
hospitals or schools, and who provide a broad range of general these clinics or a private dentist, but there is a political intention
treatments are in General Practice. Almost all are in single of the Austrian Dental Chamber to increase the numbers of
practice (this represents about 87% of all active dentists). patients seen in general practice, rather than the public dental
Dentists in general practice are self-employed. They claim fees service. Subsequently, some of these institutions have been
from the public insurance organisations and directly from closed.
patients, as described above. Those who hold contracts with The public dental service employs dentists within 82 different
the insurance organisations are often called ‘panel dentists’. institutions. There is no staff grade structure and no
About 23% of dentists in general practice do not hold a contract postgraduate training is required in order to work in the service.
with any of the public compulsory insurance schemes (sick
funds) and accept only private fee-paying patients. Most of the Working in Hospitals
“private dentists” are concentrated in the cities.
Dentists who work in hospitals are mostly those who are
Joining or establishing a practice employed to teach dentistry by the universities. Oral maxillo-
There are no rules which limit the size of a dental practice in facial surgeons are registered as doctors and work as salaried
terms of the number of associate dentists or other staff. employees of the regional governments which own most
Premises may be rented or owned, but only by dentists. There hospitals, or earn income on a ‘fee-for-service’ basis for one of
is no state assistance for establishing a new practice and the few private hospitals. Usually there are no restrictions on
dentists take out commercial loans from a bank. Local health seeing other patients outside the hospital. The titles are the
insurance organisations may have a geographical plan of areas same as those for hospital doctors; assistant (in training),
in need of more dentists (a Stellenplan) but ‘private’ dentists, Oberarzt and Primarius (head of department).
who are not contracted with any public insurance scheme, may Working in Universities & Dental Faculties
locate their practices anywhere. Generally there are very few
places where additional contracted dentists are needed. Dentists working in universities and dental faculties are
employees of the university. They are allowed to combine their
Normally dentists buy existing practices, mainly because that is
work with part-time work elsewhere and, with the permission of
the only way to become a ‘panel dentist’. However, it is not
the university, accept any amount of private practice work
possible to receive a list of patients. The only way the transfer
outside the faculty.
of patients can be achieved is by the seller of the practice
informing his patients about the new owner. The main academic position within an Austrian dental faculty is
that of head of department Professor and Dozent (chairside
Dentists are not allowed to employ other dentists (but dental
teaching only). There are no formal requirements for
assistants only) in their single practices. Even the so called
postgraduate training but most will have qualified by habilitation.
“Wohnsitzzahnärzte” (residence or locum dentists), who are
This involves the submission of a thesis, and evidence of
practising in the absence of another dentist - for example, in
original research.
case of illness, or maternity regulation - in a single practice are
not employed by the original dentist during the absence. To Working in the Armed Forces
determine the relationship of the dentist with their employees,
the union for each type of auxiliary has a contract which is There are no dentists working full time for the Armed Forces.
negotiated with the Chamber. A dentist’s employees are also Some dentists work part time in hospitals of the Armed Forces.
protected by the national and European laws on equal

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Professional Matters
Professional associations Dentists are allowed to promote their practices through
websites but they are required to respect the code of the
Austrian Dental Chamber, which is more restrictive than the
Number Year Source guidance of the Council of European Dentists.
Österreichische Zahnärztekammer 4,820 2013 Chamber
Insurance and professional Indemnity
Liability insurance is compulsory for dentists. Insurance may be
Since 2006, the only organisation representing dentists in
obtained from almost all private insurance companies and
Austria has been the Austrian Dental Chamber (Österreichische
provides cover for compensation if negligence is proven. The
Zahnärztekammer). The Chamber consists of 9 regional dental
cost of the premium depends on the maximum amount insured.
chambers and is self-financed through members’ subscriptions,
Generally this insurance does not cover Austrian dentists
which are usually earnings-related and are deductible for the
working abroad.
assessment of income tax. Membership by dentists is
mandatory. Tooth Whitening
Under the dental law of Austria tooth whitening can only be
Ethics and Regulation
done legally by a dentist and an examination or diagnosis by a
Ethical Code dentist is necessary anyway.
Tooth whitening is covered by the European Cosmetics
The Dental Chamber does not have a specific code of ethics or Directive so there is a legal limit on the concentration of
any other guidelines of good or ethical practice. However, peroxide.
dentists in Austria have to work under Dental Law, and take the
Hippocratic Oath before they can legally practice. The Corporate Dentistry
application of the law and the oath is primarily the responsibility
Dentists are allowed to form a so called “Gruppenpraxis”, which
of the Dental Chamber.
is a form of company, but these companies are only allowed to
Fitness to Practise/Disciplinary Matters work outside of the social security system. A non-dentist cannot
be a part-owner and/or on the board of such a company.
Complaints by patients are administered at regional level by the
Dental Chamber, and the Board of Arbitration is normally Ionising Radiation
convened before court action can be considered. The
Training in radiation protection is part of the undergraduate
examining committee consists of dentists and of delegates of
curriculum. The dentist in a practice would normally be the
associations for patient interests. If a complaint is upheld then
Radiation Protection Supervisor, having passed exams in the
the most likely form of sanction is a warning from the insurance
subject.
company. In extreme cases the right of the dentist to practice
can be removed by terminating their contract with the insurance A dental assistant can also be trained and qualified to take
company – although they could then still work without an radiographs and be a supervisor.
insurance contract.
There is a mandatory continuing education and training
In cases of complaint against private dentists the Dental requirement of at least 4 hours every five years.
Chamber offers an arbitration service with experts, before the
normal civil courts begin their proceedings. But neither patient Hazardous waste
nor dentists are obliged either to take part at the arbitration or to
follow the rulings of the arbitration. The EU Hazardous Waste Directive (requiring amalgam waste
to be collected as hazardous waste) has been incorporated into
In cases of gross negligence a dentist may be suspended Austrian law. The law is actively enforced.
immediately or lose the licence to practise altogether.
Amalgam separators have been legally required since 1995.
Data Protection There are regulations restricting who collects the waste to
registered or licensed carriers.
Every dentist is bound to the duty not to disclose confidential
information in any way to anybody, including health information Health and Safety at Work
on patients or any other data. The regulations of data protection
are subject to Austrian federal law. Workforce Inoculations are not compulsory and there are no
authorities to survey compliance, but inoculations are
Advertising recommended by the Austrian Dental Chamber, regarding

Advertising is allowed in Austria although there are some legal Workforce Inoculations are not compulsory and there are no
limitations, as defined in a special code edited by the Austrian authorities to survey compliance, but inoculations are
Dental Chamber. Limitations refer, for example, to the form of recommended by the Austrian Dental Chamber, regarding
the advertisement in print media and it is not permitted to possible liability of the dentist for any health damages.
include a dentist´s fees in any advertisement. Advertising on
radio or TV is not allowed at all, except for commentary on
medical and subject-specific issues.

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Regulations for Health and Safety

For Administered by
Ionising radiation district government ("Bezirkshauptmannschaft")
Electrical installations "Bezirkshauptmannschaft"
Infection control "Bezirkshauptmannschaft"
Medical devices "Bezirkshauptmannschaft"
Waste disposal "Bezirkshauptmannschaft"

Financial Matters
€11,000 to €25,000; 33.7% (€25,001 to €60,000); and 50%
Retirement pensions and Healthcare above €60,000. Married people are taxed separately.

Retirement pension premiums are paid at varying levels at an Taxes are levied on corporations (25% on distributed and
average rate of 22.8% of earnings, half by employer, half by undistributed profits), trade income, real estate, inheritance,
employee. Dentists are legally obliged to be members of two dividends, gifts, and several miscellaneous services and
schemes: one organised by the Österreichische Ärztekammer, properties. Capital gains and dividend income are also taxed.
(although since 2006 the chambers of medical doctors and
dentists have been separated, dentists are still obliged to be a
member of the pension scheme of the Chamber of Medical VAT
Doctors); and one with a main public insurance company. Standard VAT rate is 20% (since January 1984). Reduced VAT
rates are 10% on foodstuffs, books, pharmaceuticals,
Retirement pensions in Austria can be up to 80% of a person’s passenger transport, newspapers, admission to cultural and
average salary during the 15 years of highest-earnings. The amusement events, hotels. Most dental equipment and
normal retirement age in Austria is 65 years for men and 60 consumables are charged at the standard rate.
years for women, although dentists may practice beyond these
ages.
Various Financial Comparators
For the majority of the Austrian population general health care
is paid for at about 7.5% or less of annual earnings, half of Vienna 2003 2013
which is paid by an individual’s employer. At present this Zurich = 100
contribution is made up to a maximum assessment Prices (including rent) 85.2 70.2
(Höchstbemessung).
Wage levels (net of taxes) 52.3 53.5
Taxes Domestic Purchasing Power* 57.3 67.7
(* relative to net income)
Income tax for individuals is set up at up to 50% on a four-
bracket progressive schedule: 20.4% (on taxable income from Source: UBS August 2003 and November 2012

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Other Useful Information

Main national associations and Information Centre:

Österreichische Zahnärztekammer Scientific Society of Dentists
Kohlmarkt 11/6 Österreichische Gesellschaft für Zahn-, Mund- und
1010 Wien Kieferheilkunde, Verein Österreichischer Zahnärzte
AUSTRIA Auenbruggerplatz
Tel: +43 505 11-0 8036 Graz,
Fax: +43 505 11-1167 AUSTRIA
Email: office@zahnaerztekammer.at Tel: +43 316 385 2251
Website: www.zahnaerztekammer.at Fax: +43 316 385 3376
Email: dachverband@oegzmk.at
Website: www.oegzmk.at
Competent Authority: Publications:
Österreichische Zahnärztekammer Österreichische Zahnärzte-Zeitung
Kohlmarkt 11/6 Kohlmarkt 11/6
1010 Wien 1010 Wien
AUSTRIA AUSTRIA
Tel: +43 505 11-0 Tel: +43 505 11-0
Fax: +43 505 11-1167 Fax: +43 505 11-1167
Email: office@zahnaerztekammer.at Email: koenig@zahnaerztekammer.at
Website: www.zahnaerztekammer.at Website: www.zahnaerztekammer.at

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: office-zmk@meduniwien.ac.at E-mail: michael.rasse@i-med.ac.at
Website: www.unizahnklinik-wien.at Website: www.zmk-innsbruck.at

Dentists graduated 2012: 70 Dentists graduated 2012: 25

Number of students: 420 Number of students: 150

Graz Krems (New)

Universitätsklinik fur ZMK Graz Danube Private University
Auenbruggerplatz 12 Steiner Landstrasse 124, A-3500 Krems
A-8036 Graz Tel: +43 676 842 419 305
Tel: +43 316 385 – 22 48 Fax: +43 2732 70478 7060
Fax: + 43 316 385 – 33 76 E-mail: info@dp-uni.ac.at
E-mail: zahnklinik@medunigraz.at Website: www.danube-private-university.at
Website: www.medunigraz.ac.at/zahnklinik
Dentists graduated 2012: None
Dentists graduated 2012: 24 Number of students: 250
Number of students: 150

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Belgium

In the EU/EC since 1957

Population (2013) 11,153,405
GDP PPP per capita (2012) €29,170
Currency Euro
Main languages Dutch and French

General health care is mainly funded by deductions from salaries

which also cover retirement pensions, and a supplementary child tax.
T he amount contributed depends on income.

Number of dentists: 8,879

Population to (active) dentist ratio: 1,434
Members of Dental Association: Varies

Dentists may belong to one of 4 dental associations, depending upon

their language. In 2013 membership was about 74%. T he use of dental
specialists is widespread but there has been no development of clinical
dental auxiliaries. Continuing education for dentists is mandatory.

Date of last revision: 31st January 2014

Government and healthcare in Belgium

Belgium is an independent parliamentary monarchy, founded in Although the total budget for healthcare is decided by the
1830. The land area is just over 30,000 sq km. There is a well- government, it is divided between the five groups using a
established system of regional as well as national government. formula which takes into account social and economic factors,
It is also a country with three languages (the main ones being the number of people in each scheme, and occupational
Flemish, just under 60% and French just under 40%). This differences in health risk (eg the mine workers’ fund receives
affects dentistry because there are Flemish and French Dental more resources). Every six months, the budget of all of the
Schools and Dental Associations (see later). sectors are examined to determine what measures must be
taken to control any expected overspend.
The capital is Brussels. The bicameral Federal Parliament
consists of a Senate or Senaat in Dutch, Senat in French. The health budget in 2013 was €26.7 billion. There is a legally
There are three levels of government (federal, regional, and approved increase of 3% per year in health care expenditure,
linguistic community) with a complex division of responsibilities; with amounts above this having to be justified separately, for
this reality leaves six governments each with its own legislative example by lobbying from the dental profession.
assembly.
Year Source
The Institut National d'Assurance de Maladie et d'Iinvalidité
% GDP spent on health 10.6% 2011 World Bank
(INAMI)/Rijksinstituut voor Ziekte en Invaliditeits Verzekering
(RIZIV) is the Federal body responsible for managing the health % of this spent by government 75.6% 2010 OECD
system. The Institut acts as the adviser to the Minister of Social
Affairs, who makes decisions on behalf of the King. The King is
required to sign every application for new laws. The following ministers are responsible for different aspects of
health care:
Healthcare is mainly funded by deductions from salaries which
also cover retirement pensions, and a supplementary child tax. 1. Minister of Social Affairs decides treatment tariffs and
The amount contributed depends on income. Prevention is a oversees relations with sick funds
regional responsibilty. 2. Minister of Health decides registration, and how many
dentists are required
Individuals can choose to belong to one of over a thousand sick 3. Ministers of Education (2) control the basic education of
funds, which operate in five major groups. For all sick funds dental students in each region
central co-ordination ensures that the rules, fees and
reimbursements are the same.

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Oral healthcare
Oral health care is organised in the same way as general health Quality of Care
care. All sectors of the population are able to access dental
services. There are several ways in which standards of dental care are
Almost all dental care is provided in private practice together monitored.
with a very small amount in hospitals and universities.
The Institut has an administrative body which regulates the non-
About 3.1% of all government spending on healthcare is spent clinical administrative forms used in dentistry. It also has an
on dentistry. independent control department, staffed by medical doctors,
which checks that the treatment codes recorded agree with the
Year Source actual treatment undertaken.
% GDP spent on oral health 0.19% 2007 CECDO
% of OH expenditure private 40% 2007 CECDO The Institut may not comment on the quality of the dental
treatments, but has the right to examine any patient. This
usually happens only after a complaint (see Ethics).
Public compulsory health insurance Within the convention there are some quality standards. For
There is an agreed scale of fees for dental treatments, called example, a denture must include five stages of construction at a
the convention. This is jointly agreed by the dental associations minimum of four visits. As part of the convention a voluntary
and the sick funds working as a commission within the Institut. quality assurance accreditation system has been organised
Dentists generally charge patients for each item of treatment, since 1998.
and patients reclaim a proportion of the fees from their sick
fund. However, a “third party payment system” also exists, Dentists working ouside the Convention (approximately 32%)
where some dentists choose to receive reimbursement directly self-regulate for quality assurance, based on the possibility of
from the sick fund. claims for liability by patients.

Just over than two thirds of dentists (68%) were signed up to Since 2002 there has been a mandatory system of 10 hours
provide care within the Convention, in 2013. They may also continuing education per year (60 hours over 6 years), to
provide care outside the Convention, provided this is during preserve a dentist’s registration.
published hours.When a dentist breaks the rules of the
Convention, the patient has a right to demand an indemnity Health data
payment of 300% of the excess of the feescale.
Year Source
Almost the whole population is within a 15 minute bus access of DMFT at age 12 0.90 2010 WHO
a dentist. However, only approximately half of the population
DMFT zero at age 12 40% 2007 CECDO
attend a dentist regularly.
Edentulous at age 65 45% 2007 CECDO
The average number of patients on a dentist’s list is not known.
Patients normally attend for re-examinations every 6 months to “DMFT zero at age 12” refers to the number of 12 years old
the age of 18 years, then annually after then. children with a zero DMFT. “Edentulous at age 65” refers to the
numbers of over 64s with no natural teeth
Private Insurance Fluoridation
There are a few private insurance schemes mainly in the form There are no fluoridation schemes in Belgium. There is some
of group contracts for employees. The cover they offer is naturally fluoridated water at an acceptable level.
varied, as are the premiums charged.

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Education, Training and Registration
Undergraduate Training The current situation (in 2013) relating to the need for VT by
overseas graduates depends on the situation in the homeland
There are five dental schools, three French-speaking and two (country of qualification). Sometimes a supplementary
Flemish-speaking. Dental schools are part of the Faculties of academic learning is mandatory.
Medicine in universities. There is a mix of Catholic (private)
and State universities. VT in general practice includes a specific academic learning,
with a specific input from the dental associations.
In Flanders there is an entry examination before entering the
first year of training. In the French speaking universities there is The VT dentist is paid by the dentist supervisor.
a selection procedure after the first year of training.
Registration
Year of data: 2012
Number of schools 5 Before being able to practise a dentist must register with the
Student intake* 1,025 Federal Ministry of Health. There is no fee payable.
Number of graduates 158 Re-registration is mandatory after 6 years.
Percentage female 80%
Length of course 5 yrs Language requirements
* 920 in French schools
To register with the Ministry of Health a dentist should be able
and 105 in Dutch schools
to communicate in at least one of the three national languages
– Dutch, French or German.
Quality assurance for the dental schools is provided by the
Ministry of Education. Postgraduate and Specialist Training

Qualification and Vocational Training Continuing education

Primary dental qualification Continuing education spread over all aspects of the profession
(general medicine, radiology, prevention, practice management,
There are two titles awarded for clinical dentists graduating conservative dentistry, orthodontics, prosthodontics, …) is
from Belgian dental schools, after a 5-year course: mandatory to preserve registration. The requirement is 60 hours
over 6 years.
1 Flemish Master in de tandheelkunde
2 French Licencie en sciences dentaires Specialist Training
Vocational Training (VT) The main degrees which may be included in the register are:

To register to work in the INAMI/RIZIV as general dentists, 1 Algemeen Tandarts, Dentiste Généraliste
graduates have to follow a 1-year vocational training (3 years 2 tandarts specialist in de Orthodontie Dentiste Spécialiste
for periodontology and 4 years for orthodontics.as specialist en orthodontie
training) 3 tandarts Specialist in de Parodontologie / dentiste
Spécialiste en Parodontologie.
Despite the absence of a numerus clausus (by the Department
of Education) for the intake of students into the universities, a Specialist training is undertaken at the universities - for general
federal law has limited the number of places for vocational dentists 1 year, orthodontics 4 years, for periodontics 3 years
training to 170. (including the vocational training). Trainees are paid by the
Ministry of Health.

Oral maxillo-facial surgery is a medical specialty, which requires

6 years basic training and qualification in medicine, a 2-year
Master’s degree in dentistry and then specialised training in oral
maxillo-facial surgery for a further 4 years. This then is followed
up by one-year training in facial oncology.

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Workforce
Dentists Stomatologists, who are reducing in number, are usually
undertaking general dentistry. They train for 6 years in
Most dentists practice in general practice – although some also medicine, then 2 years as master in dentistry, finally 2 years
work in hospitals and dental faculties. specialisation in stomatology.

OMFS do two years supplementary training in addition to that.

Year of data: 2011
They are registered under the Medical Directives.
Total Registered 8,879
In active practice 7,777 Auxiliaries
Dentist to population ratio* 1,434
Percentage female (2007)** 48%
Qualified overseas** 118 Year of data: 2007
Hygienists 0
*active dentists only Technicians 2,250
**CECDO estimate (2007) Denturists 0
Movement of dentists across borders Assistants 1,500
Therapists 0
There is a small, but insignificant movement of dentists from
Belgium to its neighbouring countries (especially the
Netherlands), and a small number from the Netherlands into
Belgium. There are two types of auxiliaries in Belgium, dental technicians
and dental chairside assistants. There are no clinical dental
Specialists auxiliaries.

Three specialist titles are recognised in Belgium, orthodontics, Dental technicians

periodontics and general practice. Maxillo-facial surgery is also
recognised as a medical specialty. Dental technicians have a protected title, under the governance
of the Ministry of Economic Affairs, and receive undergraduate
Patients may go directly to a specialist, without referral. training in special schools (3 years) or in the dental laboratories
(“patronal training”).
Year of data: 2011
Orthodontics 399 They are registered by the Ministry of Health.
Endodontics
There are illegal denturists who are pressing the government
Paedodontics for legal status.
Periodontics 139
Prosthodontics Chairside assistants
OMFS (2007) 290
Dental chairside assistants undergo one year’s formal training,
Dental Public Health
in Flanders, but no registration. In 2013 about 120 a year were
training. In 2000, FDI reported that there were 800 chairside
Stomatology 286 assistants.

Training in the French speaking part of Belgium had just begun

These data are all for active specialists only. in 2013.

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Practice in Belgium
Almost all patient care is undertaken in General Practice. To overcome the above restrictions, the sick funds and some
private insurers offer supplementary insurances to meet the
Year of data: 2011 additional costs incurred.
General (private) practice 7,567
Joining or establishing a practice
Public dental service
University 200 There are no rules which limit the number of associate dentists
or other staff in a dental practice. Premises may be rented or
Hospital owned, and there are no limitations as to where they may be
Armed Forces 10 opened. There is no state assistance for establishing a new
General Practice as a proportion is 97% practice, so dentists must ivest their own money.
A practice must be registered at a specific address. Some sick
Working in General Practice funds own polyclinics.

In Belgium, dentists who practice on their own or as small There are no specific contractual requirements between
groups, outside hospitals or schools, and who provide a broad practitioners working in the same practice.
range of general treatments are said to be in General Practice. No domiciliary care is offered in Belgium. There are some
They represent almost all dentists actively practising in the isolated personal initiatives, but there is no organised care. In
country. Most dentists in general practice are self-employed 2013, VVT was conducting a pilot study, on behalf of
and earn their living through charging patients fees. RIZIV/INAMI, on special needs,
Fee scales
Working in the Public Dental Service
All payments to dentists are by way of fees for treatments (Item There is no public dental service in Belgium. Some schools
of service). Dentists have a fee scale agreement known as the initiate a service directly with dentists for dental health
convention with the social security. The convention sets the surveillance. Health education is also part of the school
level of reimbursement for patients for many types of dental curriculum, but in reality individual teachers decide how much
care but crowns, bridges, inlays, implantology and dental health education is included.
periodontology are excluded. Removeable dentures may be
reimbursed. Working in Hospitals
Orthodontics is only included if treatment starts before the age There are two types of hospitals in Belgium - private and
of 15 years. Private fees can be set for all of these excluded university. A few dentists are employed full-time in university
items, in which case there is no reimbursement to the patient. hospitals but most hospital dentists work part-time in private
These fees are only restricted by a professional ethic not to hospitals and part-tme in private general practice.
charge unreasonably high amounts.
Dentists can either be paid a salary or, more usually, charge
As mentioned under Oral Healthcare in Belgium the convention fees under the Convention arrangements for their patients
is negotiated between the national dental associations and the attending.
sick funds working as a committee. It is re-negotiated every
two years. Dentists then have to decide whether or not to Working in Universities and Dental Faculties
participate in the convention. Very few dentists work full-time in universities and dental
faculties, as employees of the university. They are free to
If dentists are “in the convention” they are obliged to charge the combine their work in the dental faculty with part-time work
appropriate fee and the patient claims a reimbursement. elsewhere.
Outside the convention they can, in principle, charge any fee
but the patient can still claim a reimbursement to the level The main academic title within a Belgian university is gewoon
allowed by the agreement. A dentist has to inform a patient hoogleraar/professeur ordinaire. Other titles include
whether or not he/she is in the convention. The benefit to the buitengewoon hoogleraar/professeur extraordinaire,
dentist of being in the convention is related to pension rights on hoogleraar/chargé de cours, docent/chargé d’enseignement
retirement. and assistent/assistent. Professors generally qualify by a
doctorate, aggregation and scientific experience. Promotion
Prior approval for treatment is only required for orthodontics. depends upon the number of years of teaching and numbers of
There are also limits to the number of times patients can publications in international scientific publications.
receive a subsidy for certain treatments. eg one panoramic
radiograph per year, removable dentures every seven years, Working in the Armed Forces
and once again for orthodontics there is a maximum of 36
monthly forfaits. A forfait is a fixed payment for a month in There are a few dentists working full time for the Armed Forces
which treatment has been carried out, no matter how many
visits are involved.

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Professional Matters
Professional associations Insurance and professional indemnity

There are 4 national dental associations recognised by the Liability insurance is compulsory for dentists. Professional
social security system (RIZIV-IMAMI): liability insurance is provided by private insurance companies.
Some dental associations also arrange group insurance, which
Number Year Source provides cover to reflect the responsibilities of a dentist’s
Chambres Syndicales Dentaires 1,016 2012 FDI
individual contract. The cost of the insurance varies according
to the cover, for example, providing implants approximately
Société de Médecine Dentaire 1,096 2012 FDI
doubles the premium. Liability insurance covers dentists for
Verbond der Vlaamse Tandartsen 3,500 2012 VVT working abroad.
Vlaamse Beroepsvereniging voor
Tandheelkunde (VBT) 600 2012 VVT Corporate Dentistry
Dentists are permitted to form companies in Belgium. These
must be registered at a specific address. Non-dentists may be
1. the Chambres Syndicales Dentaires (CSD) for French- shareholders or fully own the company.
speaking dentists
Tooth whitening
2. the Société de Médecine Dentaire (SMD) also fo French-
speaking dentists and Belgium has adopted the 2011 Cosmetics Directive.
3. the Verbond der Vlaamse Tandartsen (VVT) for Flemish Nevertheless, some illegal practice, with so called “no—
speaking dentists. peroxide products “ does take place.
4. The Vlaamse Beroepsvereniging voor Tandheelkunde
(VBT) for Flemish speaking dentists.
Membership of a dental association is not compulsory.
Health and Safety at Work
Inoculations against Hepatitis B are compulsory for the
Ethics and Regulation workforce (administered by the Ministry of Health). A separate
independent department of control inside the Institut monitors
Ethical Code
compliance.
There is no federal ethical code. The ethical codes of the dental
Regulations for Health and Safety
associations cover relationships and behaviour between
dentists, the contract with the patient, consent and
confidentiality, continuing education and advertising. For Administered by
Fitness to Practise/Disciplinary Matters Ionising radiation Central government
Electrical installations Central government
Patients may complain to the Provincial Medical Council. The Infection control Ministry of Health
disciplinary body comprises doctors, pharmacists, dentists,
nurses and midwives. If a complaint is upheld, the Council can Medical devices Ministry of Health
suspend the dentist from practice. There is also an appeals Waste disposal Regional government
process.

Within the dental associations there are ethical commissions Ionising Radiation
which also consider complaints.
There are specific regulations about radiation protection.
Data Protection Training in radiation protection is mandatory for undergraduate
dentists, who become the competent person in each practice.
Belgium has implemented the EU Directive on Data Protection. The dentist must undergo continuing training on radioprotection
of at least 3 hours each 5 years.
Advertising
Hazardous waste
Commercial advertising is strictly forbidden – Belgian legislation
strictly forbids publicity for dentistry. This legislation was re- Regulations cover the disposal of clinical waste including the
approved by the European Court in 2008 and 2012 as not being installation of amalgam separators. For waste disposal the
in contradiction to EU Regulations Flemish Dental association has a group contract..

Dentists’ websites with purely information are accepted in Amalgam separators have been required by law since 2002.
Belgium. All VVT members can subscribe without cost to have
a personal website on www.mijntandarts.be. Non members can
subscribe for €25 a year.

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Financial Matters
Retirement pensions and Healthcare
Social security must be paid on earned income. For employees, part of the social security is paid by the employer, and a smaller part by
the employee. The employer's social security contribution amounts to approximately 35%, while the employee's social security amounts to
13.07%, both uncapped.

The social security tax for the self-employed is capped at approximately €15,905.32 per year (2013 figure).

The state old age pension is called Rustpensioen/Pension de retraite. The standard pension age is 65, but it can be received from an
earlier age if pension rights have built up for a sufficient number of years (career condition). This includes any years in which rights to a
pension in a country other than Belgium have been built up.

The amount of the Belgian old age pension depends on:

 the number of years worked in Belgium, and
 the salary earned each year.

Taxes
National income tax:
Employees and self-employed individuals pay progressive income tax. The top rate is approximately 53.5% (including communal tax) and
starts at a salary level of €37,330 (2013 income and 2014 tax year figure).

VAT/sales tax
There is value added tax, payable at a standard rate of 21% on purchases, including dental equipment and materials. There are reduced
rates of 12% for restaurants and 6% for foodstuffs, books, water, pharmaceuticals, medical, books, newspapers, cultural and
entertainment events, hotels.

Dental services are not included in VAT.

Financial Comparators

Brussels 2003 2012

Zurich = 100
Prices (including rent) 75.7 67.0
Wage levels (net) 56.0 44.9
Domestic Purchasing Power @PPP 64.5 59.6

Source: UBS August 2003 and November 2012

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Other Useful Information

Competent Authority and Information Centre:

FOD Volksgezondheid/SPF Santé publique
Gezondheidszorg/Soins de santé
Victor Hortaplein 40 bus 10
1060 Brussel
BELGIUM
Tel: +32 2 524 98 33
Fax: +32 2 524 98 17
Email: aurelie.somer@health.fgov.be
Website: www.health.fgov.be
Dental Associations:
Flemish (Dutch) language: Flemish (Dutch) language:

Vlaamse Beroepsvereniging Tandartsen (VBT) Verbond der Vlaamse Tandartsen (VVT)

Franklin Rooseveltlaan 348 Vrijheidslaan 61,
9000 Gent 1080 Brussel,
BELGIUM BELGIUM
Tel: +32 9 265 02 33 Tel: +32 2 413 00 13
Fax: +32 2 414 87 27 Fax: +32 2 414 87 27
Email: vragen@vbt.be Email: verbond@vvt.be
Website: www.tandarts.be Website: www.tandarts.be
French language French language

Chambres Syndicales Dentaires (CSD) Société de Médecine Dentaire (SMD)

Siège social : avenue de la Renaissance, 1 Avenue de Fré 191
1000 Bruxelles 1180 Brussel
Boulevard Tirou 25 bte 9 BELGIUM
6000 Charleroi Tel: +32 2 375 81 75
BELGIUM Fax: +32 2 375 86 12
Tel: +32 71 31 05 42 EMail: info@dentiste.be
Fax: +32 71 32 04 13 Website: www.dentiste.be
Email: csd@incisif.org
Website: www.incisif.org

Publications:
VBT: Consultand (3-Monthly) CSD: L’Incisif
Editor: Guido Lysens Boulevard Tirou 25 bte 9
Franklin Rooseveltlaan 348 6000 Charleroi
9000 Gent BELGIUM
BELGIUM Tel: +32 71 31 05 42
Tel: +32 9 265 02 33 Fax: +32 71 32 04 13
Fax: Email: csd@incisif.org
Email: guido.lysens@tandarts.be Website: www.incisif.org
Website: vragen@vbt.be

VVT: Vvtmagazine (Monthly) SMD: Le Point (monthly)

Editor: Guy Kefel Editor: Olivier Custers
Vvtnieuws (Monthly) Avenue de Fré 191
Editor: Dirk Barbier 1180 Brussel
Vrijheidslaan 61 Tel: +32 2 375 81 75
1081 Brussel Fax: +32 2 375 86 12
BELGIUM EMail: info@dentiste.be
Tel: +32 2 413 00 13
Fax:
Email: redactie@vvt.be

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Dental Schools:
Brussels (French) Brussels (French)

Université Catholique de Louvain Univerisité Libre de Bruxelles

Avenue Hippocrate, 10, B 2.5721 Hôpital Universitaire Erasme
1200 Bruxelles Route de Lennik 808
BELGIUM 1070 Bruxelles
Tel: +32 2 7645752 BELGIUM
Fax: +32 2 7645722 Tel: +32 2 555 6118
Email: Fax: +32 2 555 6798
website: http://www.uclouvain.be Email:
Dentists graduating each year: 37 (2011/12) Website: www.ulb.be
Number of students: Dentists graduating each year: 21/ (2012)
Number of students:
Liège (French)

Université de Liège
Faculté de Médecine,
Avenue de l’Hopital, 1,
CHU du Sart Timan
B-4000 Liège
BELGIUM
Tel: +32 4 343 43 3
Fax:
Email:
Website: http://www.ulg.ac.be
Dentists graduating each year : 10 (2012)
Number of students:
Gent (Flemish) Leuven (Flemish)

Universiteit Gent KU Leuven

Dienst voor Mond-Tand-en Kaakziekten School voor Tandheelkunde
De Pintelaan 185 Kapucijnenvoer 7
B-9000 Gent 3000 Leuven
BELGIUM BELGIUM
Tel: +32 9 240 40 01 Tel: +32 16 33 24 07
Fax: Fax: +32 16 33 24 84
Email: Email:
Website: http://www.rug.ac.be Website: www.kuleuven.ac.be
Dentists graduating each year: 40 Dentists graduating: 50
Number of students: Number of students:

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Bulgaria

In the EU/EEA since 2007

Population (2013) 7,282,041
GDP PPP per capita (2012) €10,859
Currency Bulgarian Leva (BGN)
1.95 BGN = €1.00 (2013)
Main languages Bulgarian

General health care is mainly funded by deductions from salaries.

The system is designed as a state monopoly. It operates through the
National Health Insurance Fund.

Number of dentists: 8,350

Population to (active) dentist ratio: 872
Members of Dental Association: 100%

The use of specialists is widespread but there has been no development

of dental auxiliaries.
Continuing education for dentists is mandatory.

Date of last revision: 13th January 2014

Government and healthcare in Bulgaria

Bulgaria is in South-Eastern Europe, bordering the Black Sea
to the East, Romania to the North, Serbia and FYROM to the
West, and Turkey and Greece to the South. The land area is The mandatory health insurance system is designed as a state
110,550 sqkm.The capital is Sofia. The country is divided into monopoly. It has the exclusive right to grant mandatory health
28 districts. insurance and to guarantee the observance of the insurance
rights in respect of all nationals, following a public contract
The people’s ethnic origins are Bulgarian 84.8%, Turk 8.8%%, model. A National Framework Contract is signed every year
Roma 4.9%, other 1.4%. The religion is predominantly Eastern between the National Health Insurance Fund (NHIF) on one
Orthodox (76%) and Muslim 8%. side, and the Bulgarian Medical and Dental Associations – on
The head of state is the President and the head of government the other. The Contract comes into force upon sanction by the
the Prime Minister. The Council of Ministers is nominated by Minister of Health. The contracted annual package of activities
the prime minister and elected by the National Assembly. The
President of the Republic is elected by direct popular vote for a
Year Source
term of four years.
% GDP spent on health 7.3% 2011 World Bank
There is a unicameral National Assembly or NarodnoSybranie % of this spent by government 55.3% 2011 World Bank
(240 seats; members elected by popular vote to serve four-
year terms) in dental medicine varies according to the age.
The minimum age for voting and standing for election is The Bulgarian Dental Association (BgDA) reports that in 2012,
currently 18. the proportion of public resources spent on general healthcare,
including dental medicine, was 4.3% of GDP (3.2 billion BGN or
Healthcare in Bulgaria is based on mandatory health insurance, €1.6 billion).
governed by the Health Insurance Act (1998, State Gazette
#70), also encompassing voluntary health insurance. It creates
legislative framework for the organisation of the mandatory The total budget for the mandatory health insurance system for
health insurance. 2013, adopted by the Parliament, amounted to 2.71 billion BGN
(€1.39 billion).

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Oral healthcare
The proportion of the total budget for the mandatory health Quality of Care
insurance that was spent on dental medicine in 2013 was
4.47%. The NHIF monitors the quality of dental care in the system of
mandatory insurance, according to criteria negotiated with the
Year Source BgDA and included in the National Framework Contract.
% GDP spent on oral health 0.16% 2012 BgDA
The Ministry of Health, through its Medical Audit Agency, audits
% OH expenditure private No data
the quality of dental care according to its Dental Medicine
Standards.

In April 2009 the Bulgarian Council of Ministers adopted the The quality of dental care in private practice is not actively
proposed by BgDA National Oral Health Preventive Programme monitored. Some control is being carried out by the BgDA on
for Children of 0 to18 years (NOHPPC). the basis of the Ethical Code.
This is the link to the official website of the NOHPPC:
http://www.oralnaprofilaktika.bg/ Patient complaints are generally managed by the regional and
national Ethical Committees of BgDA and the Ministry of Health,
About 96% of dentists in Bulgaria work in general (liberal) and
practices. Thus, the dental services are delivered on this basis,
either through the National Health Insurance Fund (NHIF) or Health Data
privately. Among all Bulgarian dentists, over 6,100 had
contracts with the NHIF in 2013. Year Source
DMFT at age 12 * 3.03 2008 NOHPPC
The dental procedures in the mandatory health insurance DMFT zero at age 12 21% 2011 NOHPPC
sector are on a fee for service basis with a patient co-payment. Edentulous at age 65 14% 2013 BgDA
The scope and the extent of co-payment are different for
children and adolescents on one hand, and adults on the other.
“DMFT zero at age 12” refers to the number of 12 years old
There is no available information about domiciliary care, “list” children with a zero DMFT. “Edentulous at age 65” refers to the
sizes and frequency of patient re-examination periods in
Bulgaria. numbers of over 64s with no natural teeth.

Fluoridation
There is no systemic fluoridation in Bulgaria.

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Education, Training and Registration
Undergraduate Training Language requirements
According to theLaw of Health, the Ministry of Health shall
To enter a faculty of dental medicine of the university, a student assist EU citizens in acquiring the necessary knowledge of
has to have completed secondary school (usually at the age of Bulgarian language and professional terminology.
18). There is an entrance examination, which is similar to that of
medical students. The undergraduate course was fully “EU Non-EU foreign citizens are required to have a command of
compliant” on Bulgarian accession to the EU in 2007. Bulgarian language and professional terminology.
.
The following table shows the official number of students
ordered by the Ministry of Education and Science. Further Postgraduate and Specialist Training
Continuing education
Year of data: 2012
Number of schools 3 Continuing education (CE) is mandatory. A credit system has
been introduced and administered by the BgDA. A minimum of
Student intake* 350
30 credits is to be covered in no more than 3 years. The CE is
Number of graduates 290 delivered by the BgDA, or by other institutions, accredited by
Percentage female 50% the BgDA. CE is also delivered by the Medical Universities,
Length of course 5.5 yrs Military Medical Institute, Red Cross.
* estimated
Specialist Training

All the schools are public, and there are no private schools. Specialists train in the faculties of dental medicine, and in
accredited medical institutions. Specialisation is administered
Students, studying in the faculties of dental medicine, who have by the Ministry of Health, with the support of BgDA.
properly entered schools according to all the rules, do not
payany fees. Training lasts for 3 years and concludeswith a State
examination
However, from the data supplied by the BgDA it seems that a
large number of students are fee-paying from outside of The types of specialist are:
Bulgaria, as the numbers graduating appear to be much in
excess of the government funded student intake. General dental medicine
Orthodontics
Quality assurance for the dental schools is provided by the Oral Surgery
Ministry of Education. Paediatric dental medicine
Operative dental medicine and endodontics
Qualification and Vocational Training Periodontology and oral mucosa diseases
Prosthetic dental medicine
Primary dental qualification Dental image diagnostics
Social medicine and dental health organization
The primary degree in Bulgaria is Physician of Dental Medicine Dental clinical allergology- this is a specialty, which
with a Master Degree includes prevention and treatment of the pathology of all
(Лекар по денталн амедицина с образователна степен clinical cases in the mouth caused by allergenic reactions
Магистър). towards drugs and dental materials.

Vocational Training (VT) The titles obtained by specialists in orthodontics and oral
surgery, the two specialities recognised by the EU, are:
Dental graduates in Bulgaria are entitled to registration
immediately upon graduation. There is no postgraduate Специалист по ортодонтия (Specialist in Orthodontics)
vocational training. There is a 6 months mandatory pre- Специалист по орална хирургия (Specialist in Oral
graduate practical training in the faculties of dental medicine. surgery)

Diplomas from other Member States are recognised without the

need for any vocational training.

Registration
The prerequisite for registration is a primary degree in dental
medicine. The registration of a Physician of Dental Medicineis is
administered by the Bulgarian Dental Association (BgDA) by
means of its Regional Colleges.

Cost of registration (2013) € 77

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Workforce

Dentists Year of data: 2013

Orthodontics 45
Most dentists practice in general practice – although some also
Oral Surgery 226
work in hospitals and dental faculties.
Endo & Restorative 417
Year of data: 2013 Paedodontics 580
Total Registered 8,350 Periodontics 36
In active practice 8,350 Prosthodontics 115
Dentist to population ratio* 872 Oral Radilogy 5
Percentage female 66% OMFS 45
Qualified overseas 70 Dental Public Health 17
Dental Clinical Allergology 7

The Total Registered and the Total Active are the same
because (for example) those who are going on maternity leave
apply to not pay the annual fee, but still remain in the Register. Auxiliaries
However, others who do not pay their annual fees are removed There is no system of use of dental auxiliaries in Bulgaria, other
from the Register. than dental technicians.
There is a significant ratio discrepancy between the big cities
(with an excess of dental practitioners), and the rural areas Year of data: 2013
(where there is a deficiency of dental practitioners). Hygienists 0
Therefore, under pressure from theBgDA, the National Technicians 1,235
Framework Contract with NHIF now stipulates special Denturists 0
incentives for contractors practising in remote and deprived
Assistants No data
areas.
Therapists 0
There is no reported information about unemployment amongst Other 0
Bulgarian dentists.

Movement of dentists across borders

Dental technicians
There is no distinctmovement into Bulgaria by overseas
Dental technicians graduate from a 3 years’ special education
dentists. In 2008, 85% of the overseas dentists working in
programme with the degree of Professional Bachelor. The
Bulgaria were citizens of non-EU countries.
training is 3,240 hours, including 1,275 hours of theoretical
training, 1,365 hours practical training and 600 hours pre-
Since the beginning of 2007,over 800 Certificates of Good
graduate practice.
Standing have been issued to dentists by the BgDA (these are
for registration with other EU and Non-EU regulatory bodies).
The dental laboratories are 100% private and must register with
Ministry of Health. The scope of their activities comprises
Specialists
construction of dental and orthodontic appliances. Dental
technicians are not entitled to undertake any form of clinical
Patients have free access to specialists.
work.
The “Specialty” of General Dental Medicine is unique to
Denturists
Bulgaria and stems from an earlier era – being an automatic
analogue with the medical system. It was a mandatory pre- Denturism is unknown in Bulgaria and there are no reports of
requisite to train and qualify for this “specialty” to have a (illegal) denturists.
contract with NHIF. The law has now been amended to abolish
this duty. The data for these dentists remains at the 2008 level. Dental Chairside Assistants
.
After 1989, no specific training has been available for dental
General Dental Medicine (2008) 2,264 assistants (dental nurses). In 2013, general care nurses were
being registered by the respective professional association, and
an unknown number of them are working in the field of dental
medicine.

In 1989 there were about 6,000 dental assistants, but there

were very many fewer by 2013 – the number in dental clinics is
small.

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Practice in Bulgaria
Oral health services are provided on the base of general more than the annual scope of treatment then he/she has to
(liberal) practice in the mandatory health insurance system or pay the full dentist’s fee.
privately.
The BgDA does not regulate or recommend any fees in the fully
The data, except for general practice, remains the same as in private sector, and prices are set by the market.
2008.
Joining or establishing a practice
Year of data: 2013 There are no rules which limit the size of a dental practice or
General (private) practice 8,011 the number of associate dentists or other staff working there.
Public dental service 0
The practice has to be registered with the Regional Healthcare
University 258 Inspectorates – a division of the Ministry of Health. The
Hospital 35 location, size, structure etc, of the premises, are regulated by
Armed Forces 46 Bulgarian law.
General Practice as a proportion is 96%
The state offers no assistance for establishing a new practice,
and generally dentists rely on their own investments, or bank
credits.
Working in General Practice
Whilst dentists usually work on a self-employed basis, rarely
Virtually all Bulgarian dentists are working in the private sector they may be employed. Their auxiliaries are always employed.
on a self-employment basis in general (liberal) practice; most of
them are in individual practices for primary care. The Working in the Public Dental Service
registration of the dental practices as medical institutions is
administered by the Ministry of Health by means of its regional There is no public dental service in Bulgaria.
bodies – the Regional Healthcare Inspectorates. A small
amount of group practices are also registered. No special home care system exists. Physicians in dental
medicine may provide home care at their discretion, by patient
Most specialists practice in specialised centres of dental request.
medicine; there are also a few in individual or group specialised
practices. Working in Hospitals
Among general practitioners, over 6,100 (2013) have contracts A very small number of dentists work in hospitals as
with the National Health Insurance Fund (NHIF). Insured employees, salaried by the Ministry of Health. They undertake
patients are entitled to a specific package and volume of dental mostly oral surgical treatments.
procedures, covered by the Fund. The additional dental
services are fully paid by the patients. Working in Universities and Dental Faculties
Fee scales
Dentists working in faculties of dental medicine are salaried
employees of the university. They are allowed to combine their
As stated earlier, dental procedures in the mandatory health
work in the faculty with private practice.
insurance sector are based on co-payments and fee-for-service
base. In 2013, the annual scope for children and adolescents
The academic titles in the faculties of dental medicine are
(up to age 18) comprised1 extensive check + 4 curative
Professor, Associate Professor, and Assistant Professor.
procedures (including fillings, endodontics and extractions). The
annual scope for adults comprises 1 extensive check + 2
The faculties of dental medicine are involved in graduate
curative procedures (including fillings and extractions).
education, as well as postgraduate special education.
There is a small co-payment for children for endodontic
treatment only – approximately 20%. Orthodontic treatment for Working in the Armed Forces
children is not covered by the NHIF.
There are physicians in dental medicine working in the Armed
Endodontics, removable appliances, crowns and bridges for Forces.
adolescents are not covered by the NHIF. If a patient needs

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Professional Matters
Professional associations To keep and update the register of the profession.
Registering with the Association is a compulsory
The members of the ABD and AMSRS are also members of the prerequisite for practising dental medicine in Bulgaria.
BgDA To enforce the ethical principles of the profession and
penalise their infringement.
To inform and qualify its members.
Number Year Source To defend its members, etc.
Bulgarian Dental Association 8,350 2013 BgDA
Association of Bulgarian The Constituent Congress adopted the Constitution of BgDA,
Dentists >150 2013 BgDA which develops further the stipulations of the law in the spirit of
Association Médicale >150 2013 BgDA the professional self-government.
Scientifique Républicaine de Stomatologie The Constitution introduced the “functional field” principle in the
central management of the Association, via the establishment
of 7 Standing Working Committees (SWC), intended to perform
The Bulgarian Dental Association (BgDA) was among the its basic functions. Each Chairman of a SWC is elected by the
first dental professional organisations in Europe: it was founded Congress, and holds also the office of a Vice-President of the
on December 20th 1905, and for more than 40 years has been a Association.
powerful and authoritative representative of the interests of the The Constitution stipulates a territorial representation in the
profession. Managing Board by including in the Board representatives of all
the 28 Regional Colleges of BgDA.
However, the communist regime banned the medical and dental
associations in 1947, and replaced them with what are now The Law of the Professional Organisations and the Constitution
described as “obedient and toothless trade-unions”, uniting of BgDA constitute also the control bodies of the Association as
artificially the alleged interests of the so-called “health workers” independent commissions:
– doctors and auxiliary staff together. The centralised
healthcare system transformed the doctors from independent The Commission of Professional Ethics supervises the
specialists to salaried state employees, with no real moral, ethical and deontological issues in practising the
responsibility and stimulus. Private practice was prohibited from dental profession.
1971. The Control Commission controls the decisions of the
Managing Board, as well as their implementation, in terms
All this lasted until 1989, when the government regime ceased. of their adherence to the law and the Constitution of
The Bulgarian Dental Association was “resurrected” on March BgDA.
11th1990 in the city of Plovdiv, by a widely drawn national
conference of Bulgarian dentists, which actually turned out to The English text of the Constitution of BgDA is available at:
be the constituent assembly of the renewed organisation. The www.bzs.bg
Association quickly gained popularity and new members, The Association of Bulgarian Dentists (ABD) was
although membership was voluntary. Highly intensive activities established in 1997. It unites a group of dentists with common
were immediately undertaken in several directions: ideas regarding the problematic issues of the modern dental
reestablishment of private practice, cost evaluation of dental medicine.
procedures, professional ethical standards, defence of the
profession, information and qualification of the members. Main purposes of the organization are:

This initial period was characterised by the co-existence of the promotion of the prestige of the dental profession;
old, discredited public system and the renewed private dental implementation of the modern European and worldwide
care, which was quickly gaining power and overtaking the experience in the field of treatment of the dental illnesses
modern standards. This co-existence raised some specific of the Bulgarian citizens;
problems: disloyal competition, price dumping, dual standards continuous improvement of the professional skills of the
etc. Bulgarian dentists;
establishment of a system for postgraduate training and
In 1999 the Law of the Professional Organisations of Physicians qualification; participation in the work of the FDI;
and Stomatologists (Later: Physicians in Dental Medicine) active steps for solution of concrete issues related to the
established the new professional organisation: The Association European integration of the Bulgarian dentists;
of Stomatologists in Bulgaria (ASB). After the accession of organisation of annual completions for students - dentists
Bulgaria in the EU (2007), the Association regained the title and awarding of scholarships for excellent achievements
Bulgarian Dental Association (BgDA). and active work in programs related to the dental science;
active participation in the Bulgarian scientific activity..
The law entrusts to the Association functions, typical of the
similar professional organisations in the democratic world: Ethics and Regulation
To negotiate and contract with the National Health Ethical Code
Insurance Fund.
Bulgarian dental practitioners are subject to the “Code of
professional ethicsof the physicians in dental medicinein the

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Republic of Bulgaria”, adopted by the Congress of BgDA, Corporate Dentistry
signed by the Minister of Health and published in the State
Gazette. Individual and group dental practices may be owned and
managed only by physicians in dental medicine. Dental and
The Code contains the duties of the physicians in dental Medico-dental centres may be owned by any person, but has to
medicine ensuing from the practicing of the dental profession. It be managed by a specialist in the respective field, either
reflects the moral principles and criteria of professional conduct physician or physician in dental medicine with an additional
of the members of the dental profession. specialty in Health Management or Business Administration.

The Code contains regulations on: There are no limited companies owning dental practices.
 The duties of the members of the dental profession during Tooth whitening
practice;
 Promotion of the dental services; Tooth whitening is being practiced only by physicians in dental
 Relationships with the patients; medicine.
 Patients’ referral;
 Medical documentation and professional secrecy;
Health and Safety at Work
 Payment of the dental services; This issue is regulated by the Law of Health, and secondary
 Qualification; legislation. There are no mandatory vaccinations.
 Infringements and penalties.
Regulations for Health and Safety
The English text of the Code is available at:
www.bzs.bg For Administered by
Fitness to Practise/Disciplinary Matters Ionising radiation Government Agency of
Nuclear Regulation
The Commission of Professional Ethics has 9 members, all Electrical Government agency
dentists. installations
Infection control Ministry of Health –
The penalties for infringement of the Ethical Code vary in Inspectorate of Preservation
severity, from censure, financial penalty to erasure from the and Control of Public Health
register (for a term from three months to two years).
Medical devices Ministry of Health – Executive
Data Protection Agency on Drugs
Waste disposal Ministry of Environment and
In 2002, two laws came into force: the Law on Protection of Water Supplies and Ministry
Personal Data, and the Law on Protection of Classified of Health
Information.
Ionising Radiation
In 2006, the Law on Consumer’s Protection was been adopted.
These laws stipulate the use of personal and classified data. Ionising radiation is regulated by the Law of Health and the Law
of the Safe Use of Nuclear Energy, plus secondary legislation.
Advertising
During their dental education, physicians in dental medicine
According to Bulgarian law, no commercial advertising is take examinations in radiology, with an emphasis on dental
permitted in healthcare activities. Dental practitioners are diagnostics. Those who would like to have x-ray equipment in
permitted to promote their services in accordance to the law their offices, have to acquire a corresponding certificate issued
and the Ethical Code. by the Ministry of Health, according to the Medical Standard
“Image Diagnostics”, following a specialised education and a
Websites can be used provided they are absolutely factual and successful exam. The certificate has 5 years’ validity.
contain no commercial elements.
With a change in the Law of the Safe Use of Nuclear Energy in
2012 the regulations for dental x-ray equipment was changed
Insurance and professional indemnity from a licensing regime to a regime of information only.
Professional indemnity insurance is mandatory according to the The equipment is inspected annually. The maintaining services
Law of Health, and the Regional Colleges of BgDA cover the perform an annual prophylaxis and technical examination.
insurance of their members. It does not cover for Bulgarian
dentists working overseas. Hazardous waste
The disposal of hazardous waste is regulated by the Law of
Waste Management, plus secondary legislation.
Amalgam separators are only advised and they are not
mandatory.

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Financial Matters
Retirement pensions and Healthcare
0.4% - 1.1% for occupational accident and professional disease
The retirement ages in Bulgaria are 63 for men and 60 for
fund (rate depending on the field of activity), 3.5% for general
women. Up until the new pension reform was approved in
illness and maternity fund 1% for the unemployment fund and
December 2011, Bulgaria's retirement age was 63 years for
8% for the health insurance fund
men and 60 years for women. Plans are for these to be
increased gradually so that by 2020 it will be 65 years for men Payments are capped at BGN 200 (€100) a month
and the same for women soon after 2020.
VAT/sales tax
Taxes and Insurance
VAT in Bulgaria is 20%, and does not apply to healthcare
National income tax services; however, it applies to drugs, medical devices,
Since 2008, there has been a flat income tax of 10% of instruments, equipment, consumables and other products used
income.Tax is 0% for capital gains from disposal of shares on a in medicine and dental medicine. There is a reduced rate of 9%
regulated Bulgarian / EU / EEA market by EU / EEA residents, for hotel services.
5% for dividends and liquidation quotas and 7% for income from
voluntary life insurance received after the termination of the
Various Financial Comparators
insurance policy.
Sofia 2003 2012
Mandatory insurance contributions
Zurich = 100
Health care in the mandatory health insurance system is funded
Prices (including rent) No data 35.5
by mandatory health insurance payments amounting to 8% of
the income due by all Bulgarian citizens. Wage levels (net) No data 10.3
Domestic Purchasing Power at No data 26.3
The total is between 30.7% and 31.4%, paid by both the PPP
employer and the employee. This includes 12.8% - for the
pensions fund, 5% for the universal pensions fund
Source: UBS January 2003 and November 2012

Other Useful Information

Important Contacts::

Bulgarian Dental Association (BgDA) Ministry of Health:

49, Kniaz Dondukov Blvd. 5, SvetaNedelya Square
1000 Sofia, Bulgaria 1000 Sofia, Bulgaria
Tel.: +35929874797 Tel.: +35929301152
Fax: +35929888724 Tel./Fax: +35 929811820
Gateway: +359888407226 E-mail: press@mh.government.bg
Email: office@bzs.bg Website: www.mh.government.bg
Website: www.bzs.bg
National Health Insurance Fund Association Medicale Scientifique RepublicaIne Stomatologie
1, Krichim Str. 1, St. Georgi Sofiiski Blvd.
1407 Sofia, Bulgaria 1431 Sofia, Bulgaria
Tel: +35929659130 Tel.: +35929522818
Tel./Fax: +35929659124 Fax:
EU integration: +35929659130 Mobile: +359887300550
Email: jvatkova@nhif.bg Email: toppir@abv.bg
Website: www.nhif.bg Website:

Dental Schools: The numbers of annual intake of government funded Bulgarian citizens as students is the same each year, and is recorded here.
However, data for fee-paying foreign students varies annually.
Sofia Plovdiv Varna (established in 2005)
Medical University Medical University Medical University
Faculty of Dental Medicine Faculty of Dental Medicine Faculty of Dental Medicine
1, Sveti G. Sofiiski Blvd. 3, Hristo Botev Blvd. 55, Marin Drinov Str.
1432 Sofia, Bulgaria 4002 Plovdiv, Bulgaria 9002 Varna, Bulgaria
Tel: +35929522818; Tel: +359896610286 Tel: +359888226863
+35929541247; E-mail: doc.todorov@yahoo.com E-mail: svechtarov@yahoo.co.uk
+35929523548 E-mail: doz_kukleva@abv.bg
E-mail: info@stomfac.org Numbers of annual intake: 30
E-mail: fdent@abv.bg Numbers of annual intake: 60 Dentists graduating (2012): 60
Dentists graduating (2012): 90
Numbers of annual intake: 80
Dentists graduating (2012): 140

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Croatia

In the EU/EEA since July 1st 2013

Population (2013) 4,475,611
GDP PPP per capita (2012) €13,566
Currency Croatian Kuna (HRK)
7.50 HRK = €1.00 (2013)
Main languages Croatian

Healthcare is funded through general taxation and an additional “health

contribution” which is paid by everyone receiving any kind of wage,
compensation or pension.

Number of dentists: 4,537

Population to (active) dentist ratio: 1,155
Members of Dental Chamber: 100%

The use of specialists is widespread but there has been no development

of dental auxiliaries.
Continuing education for dentists is mandatory.

Date of last revision: 2nd January 2014

Government and healthcare in Croatia

Croatia is located in South-eastern Europe, bordering the Adriatic Sea (and Italy), between Bosnia and Herzegovina, Slovenia, Hungary,
Montenegro and Serbia. The land area is 56,542 sq km. The capital is Zagreb.

The lands that today comprise Croatia were part of the Austro-Hungarian Empire until the close of World War I. In 1918, the Croats, Serbs,
and Slovenes formed a kingdom known after 1929 as Yugoslavia. Following World War II, Yugoslavia became a federal independent
Communist state under Marshal Tito. Although Croatia declared its independence from Yugoslavia in 1991, it took four years before the
occupying Yugoslav army was mostly cleared from Croatian lands. Under UN supervision, the last YU army-held enclave in eastern
Slavonia was returned to Croatia in 1998.

The political system is a parliamentary democracy. The chief of state is the President and the head of government is the Prime Minister.
The cabinet is the Council of Ministers, named by the prime minister and approved by the parliamentary Assembly. There is a unicameral
Assembly or Hrvatski Sabor (152 seats; members elected from party lists by popular vote to serve four-year terms).

Elections: the President is elected by popular vote for a five-year term (eligible for a second term); the leader of the majority party or the
leader of the majority coalition is usually appointed Prime Minister by the President and then approved by the Assembly.

The minimum age for voting and standing for election is currently 18.

Administratively Croatia is split into 21 counties (zupanije, zupanija - singular) among which is a capital - city (grad - singular).

A few Basic Laws are the regulatory frame of Croatian healthcare system (Law of healthcare protection, Law of obligatory healthcare
insurance, Law of voluntary healthcare protection, Law of dentistry). The system is basically social and a basic range of medical, dental,
radiology, laboratory services are free and available for all citizens of Republic of Croatia.

Healthcare is funded through general taxation and an additional “health insurance contribution” which is paid by everyone receiving any
kind of wage, compensation or pension.

HNB is the Croatian National Bank

Year Source
% GDP spent on health 7.8% 2012 HNB
% of this spent by governm't 85.0% 2012 HNB

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Oral healthcare
The Croatian healthcare system (including dental healthcare) is
contribution based (similar to taxation) and financed from the The Quality of Care
State Budget.
The state authorities provide rules about the space, equipment
Year Source and the qualifications needed to provide dental care. The state
% GDP spent on oral health No data 2012 Chamber insurance company (HZZO) provides a list of services, contents
% OH expenditure private No data 2012 Chamber and worth of each service provided by the state. The Croatian

Dental Chamber (see later) describes the standards needed to

The responsibility for planning oral healthcare lies with the perform these services. All services are listed. Billing is actively
Ministry of Health, which through the state owned insurance checked by HZZO to ensure that bills reflect the amount of work
agency the Hrvatski Zavod za zdravstveno osiguranje (HZZO) done.
finances and provides all services in paying for healthcare
under the strategic direction of the Ministry. The agency is self-
regulating and ultimately under the supervision of the Croatian Radiology, laboratories and their equipment are strictly
Parliament (Hrvatski Sabor). monitored by the authorities.
Branches of the HZZO are in the municipalities.
Patient rights are protected by the Patient Rights Protection
The dental services are delivered through the network of dental Law (2004).
offices throughout the state. Some of the offices are private but
about half have contracts with the HZZO. The network of dental The Croatian Chamber (see later) has an expert committee with
services is defined and a ratio of 2,200 patients per dentist is a system to supervise the quality of the clinical dentistry
the prescribed standard. A small proportion of offices remain in provided, whether in the private sector or through the HZZO.
former public health centres and work for the HZZO. A
proportion of dental care is delivered by totally private dental Patient complaints should be managed initially by the dentist.
offices. The patients may be covered by private dental Patients’ rights are protected by law and if dissatisfied they can
insurance for reimbursement. complain to the Chamber. Proven complaints are reimbursed by
the insurance company having a contract with the Chamber.
Formally and practically all citizens of Croatia have the right to This reimbursement covers all treatments in both sectors.
elect their doctor of dental medicine – a contractor of the HZZO
and receive dental care. However, not all citizens use this right, Health Data
despite the fact that they are paying for it through their
contributions. They have made a decision to receive care from Year Source
privately run dental offices. DMFT at age 12 4.00 2011 Croatia Med
DMFT zero at age 12 55% 2011 Croatia Med
State and private companies often offer their employees the
Edentulous at age 65 No data
additional benefit to their salaries of a contract with private
health insurance companies for the delivery of private care.
“DMFT zero at age 12” refers to the number of 12 years old
The basic package of dental services provided by the state children with a zero DMFT. “Edentulous at age 65” refers to the
through HZZO ensures almost all basic dental procedures numbers of over 64s with no natural teeth.
(restorative, endodontic, basic periodontal, oral surgery, oral
diseases, orthodontics up to 18 years, prosthodontics partially) Croatia Med is the Croatian Health Insurance Fund
and emergency dental care are available and have to be
provided immediately when requested. If the contractor is not Fluoridation
able to perform the required procedure he has the right to direct
the patient to a specialist, who is again a contractor with the There are no mass fluoridation schemes (such as water, milk or
HZZO. salt)) but dentists routinely undertake fluoride treatments of
deciduous and permanent teeth in children.
Routine oral examinations would normally be undertaken
annually for patients and a dentist would be looking after about
2,200 patients on a regular basis.

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Education, Training and Registration
Undergraduate Training and Qualification After that the trainee dentist must pass the state exam held at
the Ministry of Health and organised by the staff of the school of
To enter dental school a student has to have completed dentistry and Ministry. After this exam has been passed, the
secondary school (cca. age 18). There is an entrance dentist obtains a Licence from the Croatian Dental Chamber.
examination which consists of scoring from secondary school
grades, scoring from a written exam and scoring from a manual Only then a dentist is licensed to work independently.
skills exam.
Dentists who have qualified from outside of Croatia do not need
to undertake vocational training if are they from EU countries.
Year of data: 2013 Dentists from countries outside the EU/EEA need to pass
Number of publicly funded schools 2 written exam, as a confirmation of their qualifications.
Number of privately funded schools 1
There is no fee for registration in Croatia.
Student intake (2013-14) 148
Number of graduates (2012) 113 Language Requirements
Percentage female 69%
There is a formal need to understand and speak the Croatian
Length of course 6 yrs
language to a basic level, to register.

Further Postgraduate and Specialist Training

The oldest dental school is in Zagreb, which was founded in
1962; the school in Rijeka was founded 1973. The dental Continuing education
school of Split was founded in 2006 and is privately funded. All
curricula are tailored according to the Bologna Declaration.
Continuing education is mandatory and the rules are set in law.
In the 2013-14 academic year there was a total of 926 The requirement is 7 hours of formal training each year. CE is
undergraduate students. organised by the Chamber (the number of courses and
standards). Courses are given by dental school staff and private
Quality assurance for the dental schools is provided by the organisers.
Ministry of Education.
Specialist Training
Qualification and Vocational Training
Specialist training is organised by the dental schools of Zagreb
Primary dental qualification and Rijeka. Training lasts for 3 years and includes a University
examination and written specialist thesis.
The primary degree which is included in the register is:
Specialist education leads also to a degree, for example:
doktor stomatologije (dr.stom.) or “Specialist in Endodontics”
Doctor of Dental Medicine (DMD) in English
There is training in 8 main specialties:
Vocational Training (VT)
Pedodontics
There is post-qualification VT for Croatian graduates. Endodontics and Restorative dentistry
Family dentistry
Registration Oral surgery
Oral medicine
To register in Croatia, a dentist must have a recognised degree Orthodontics
or diploma awarded by the university and have completed one Periodontics
year of mandatory training or “residence,” under the supervision Prosthetics
of experienced dentists. At least 6 months of this training must
be undertaken in dental school and 6 months in one of the There is also a medical specialty of Oral Maxillo-facial surgery.
experienced private or contractor dental offices. There is
practical and theoretical training. The trainees are salaried as The specialist title is issued by the competent authority - the
non-dentists, without a licence with maximum salaries of €7,000 Ministry of Health but a list that the public may consult is not
(gross) a year. kept.

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Workforce

Dentists Auxiliaries

Year of data: 2013 Year of data: 2013

Total Registered 4,537 Hygienists 0
In active practice 3,875 Technicians* 1691
Dentist to population ratio* 1,155 Denturists 0
Percentage female 65% Assistants 631
Qualified overseas No data Therapists 0
Other 0
* this refers to the population per active dentist * there are an unknown number of
unregistered technicians
There is an increase in workforce as demand rises. However,
the dentist unemployment rate is reported by the Chamber as
“high” (132 unemployed and registered at the Croatian There is no system of use of dental auxiliaries in Croatia other
employment service in July 2013). There are some overseas than dental technicians and dental assistants.
qualified dentists working in Croatia. In 2013 there were 5 with
a proper licence. Dental Technicians

Movement of dentists across borders Dental technicians train for 4 years in respective secondary
schools (6 schools in Croatia), and they receive a diploma on
The Chamber has suggesed that there is an increased interest qualification, for dental technicians. All dental technicians have
to work in Croatia as a dentist. to undertake one-year of vocational training after secondary
school, after which they have to pass state examination of the
Ministry of Health, in order to be free to work.
Specialists
Technicians are not obliged to register, although most of them
A patient has the right to go to a specialist but has to be are registered with one of two existing Dental Techicians
referred by his contracted dentist. Patients can also go without Associations in Croatia. In 2010 the “Chamber of Dental
referral, but then this is fully private and the patient has to pay Technicians” was established and became a part of Croatian
for the service. Dental Chamber. In 2013, the Chamber of Dental Technicinas
had 1,691 members.
Year of data: 2013
Orthodontics 184 It is not compulsory to undertake continuing education, but most
Oral Surgery 98 technicinans do, due to competition and demands in everyday
Endo & Restorative 97 practice, especially those in private sector.
Paedodontics 130
Technicians normally work in independent commercial
Periodontics 74 laboratories or laboratories within the national health service
Prosthodontics 156 institututions, or in the laboratories which are part of private
Oral Medicine 95 polyclinics. Nobody knows exactly, but it is thought that most
OMFS 45 are employed within the private sector. They are not able to
treat patients at all directly.
Family Dental Medicine 4

Dental Assistants
Family Dental Medicine is unique to Croatia. It is an amalgam of
dentistry focused on all dental problems related to family from Medical auxiliaries are used by some dentists as Chairside
birth to death – “Family dental doctor”. Assistants but training is strictly informal and there is no
qualification or registration. There is no guide to numbers, so
above is an estimate.

Many are members of the Croatian Dental Chamber.

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Practice in Croatia
Oral health services are provided mainly in General Practice, Additional oral healthcare includes what is not included in basic
both in the public and private sectors.. package and it is the remainder of periodontics, major oral
surgery and advanced prosthetics. Not included in the
additional oral healthcare is most of fixed prosthetics and
Year of data: 2013 orthodontics after 18.
General practice (owners) 2,512
The Dental Chamber recommends fees but these are not
General practice (employees) 419
obligatory for their members.
Public dental service 446
University/Hospital 137 Joining or establishing a practice
Hospital No data
Armed Forces No data There is a book of regulations that regulates the size of dental
practices, what should be included in the practice, the size of
Others 33
entrance door, the entrance for disabled persons etc. The same
General Practice as a proportion is: 76% applies to group practices, polyclinic institutions and other
practices.

“Others” refers to dentists working in incorporated dental Regarding location, a private practice can be established
offices. The number is included in the final row, “General wherever the entrepreneur – dental doctor - finds appropriate
Practice as a proportion of all dentists”. space that suits the requirements of an Act about the minimum
office space conditions (about 40 sq. m, requiring dental chair
In Croatia the hospital dentists are also academics, hence the office, waiting room, two restrooms, and an entrance for
combined total. Also, many dentists practise in more than one disabled persons). But, most contractors who rent formerly
sphere of practice. state owned dental offices, situated in state buildings - “Public
health homes” – are said (by the Chamber) not to have working
Just over half of general practitioners are in purely private conditions that answer the requirements of the “Act”.
practice and just under half are mixed practice (private and
HZZO). To start the dental practice a location permit is needed first from
the municipality. After that several documents are needed in
order to proceed:
Working in General Practice
1. Degree certificate;
In Croatia, dentists who practice on their own, or as group 2. State exam certificate;
practice, or in so called “polyclinic” institutions or incorporated 3. Croatian residency;
dental practice are said to be in “private practice”. The numbers 4. Confirmation of not being prosecuted.
working this way include contractors with HZZO who are
providing primary public oral health care but also have the right After submitting all requested documents the Ministry of Health
to provide private services not included in the package of asks the Chamber for their opinion, included in the letter of
primary dental care. confirmation. When the dental office is ready to function a three
member commission from the Ministry checks it from the legal
Most doctors of dental medicine in practices are self-employed and clinical point of view and formally approves the start. Only
but additionally there were over 400 employees of private after that a permit to start the dental practice (or joint dental
dental offices in 2008. practice, or polyclinic) is issued.

Most dentists in private practice earn their living through

charging fees for treatments. Patients pay for the service when
Working in the Public Dental Service
it exceeds their right given by the state included in the package
(in offices having a contract with HZZO). A small number of offices remain in former public health centres
and work only for the HZZO.
Patients without any contract with insurance companies pay for
the full service in offices. Children (until 15 years of age) have to be registered to a
dentist contracted with the HZZO if they want free service.
Fee scales Disabled and bed ridden persons also have to be registered to
the contracted dental office to receive primary dental care.
There are two levels of insurance: obligatory oral healthcare
and additional oral healthcare. However, from 2008 additional
healthcare is also obligatory but still has the name of additional
Working in Hospitals
and will depend on a person’s salary/income. Those dentists working in hospitals also work for the Dental
Schools of Zagreb or Rijeka, so they are numbered in the
The package of obligatory oral healthcare includes University group. Indeed, almost all dentists teaching in these
paedodontics, restorative dentistry, endodontics, oral diseases, dental schools are at the same time members of hospital clinics
(partially) periodontics, minor oral surgery and prosthetics, at the University hospital clinical centres of Zagreb and Rijeka.
orthodontics (until the age of 18). For anything not included the
patient pays a bill.

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There are restrictions on these dentists seeing other patients The academic titles are: Assistant, Assistant Professor,
outside hospital. It is obligatory for the staff member to obtain Associate Professor and Professor.
the permit to work outside hospital, from the Director of the
Clinical institution and additionally amounting to no more than To become an Assistant Professor or higher one must obtain
20% of working time. first the Ph.D. level and also finish a specialist clinical training.

Patients requiring oral surgery would either receive it from an The quality of clinical care, teaching and research in dental
oral surgeon in a primary care setting (in a general practice) or faculties is performed by its staff and through students working
for more serious procedures would go to the hospitals in the in teams under the direction of experienced teaching and
bigger cities. academic staff.

The complaints procedures are the same as those for dentists Epidemiological surveying in Croatia would normally be done by
working in other settings. academic dentists.
The complaints procedures are the same as those for dentists
Working in Universities and Dental Faculties working in other settings.

Dentists working in dental schools are salaried employees of Working in the Armed Forces
the University (and University Clinics). Until the early 2000s
they were not allowed to work elsewhere but now they have There are dentists working in the Armed forces but data are not
that possibility – but only after the Director’s permit (see above). obtainable.

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Professional Matters
Professional associations
Website promotion is permitted and not under any control.
Number Year Source
Dental Chamber 6,859 2012 Chamber Insurance and professional indemnity
Dental Society 1,748 2012 FDI
Patient indemnity insurance is not compulsory for doctors of
dental medicine, but voluntary.
The Croatian Dental Chamber is an independent, professional,
non-political association, founded in 1995 in Zagreb as an The compensation covers medical and dental treatment
organisation of doctors of dental medicine. It is a legal entity expenses, other necessary expenses caused by the injury, loss
empowered to represent the rights and professional common of income, pain and suffering, permanent functional defect and
interest of dentists, as well as to care about reputation and permanent cosmetic injuries. Claims for compensation have to
advancement of the dental profession in the Republic of be presented to the Dental Chamber’s Committee.
Croatia.
In theory the insurance should cover for work done by Croatian
Total number of dentists in Croatia is 4,537 but dental dentists outside Croatia, but there is no information available
technicians and dental assistants are also the members of about whether this has actually applied.
Dental Chamber – hence the increased number shown.
. Corporate Dentistry
Membership of the Chamber is obligatory by Statute for
dentists. There are full-time staff based in Zagreb and also Doctors of Dental Medicine can own other non-dentist
regional offices without full-time staff. The Chamber organises companies and non–dentists can own or part own incorporated
Continuing Education and is responsible for monitoring its companies and share in any profits.
uptake by dentists.
Tooth Whitening
Patient complaints which have not been satisfied by the
individual dental practice’s complaints procedure are Tooth whitening in Croatia comes under the Cosmetic Directive.
investigated and settled by the Chamber.
Health and Safety at Work
Ethics and Regulation Employees are protected by the “Law of Safety at Work”.
Doctors of dental medicine have to swear to Hippocrates’ Oath, Hepatitis B vaccination is mandatory (with rare medically
follow all medical and human standards and, above all, rightful documented exclusions).
action towards patients and colleagues. This includes using Regulations for Health and Safety
scientifically based and proven techniques and materials; this
also includes a protection of patients’ rights (which are also For Administered by
protected by the Law).
Ionising radiation Ministry of Health
Fitness to Practise/Disciplinary Matters Electrical installations Ministry of Health
Infection control Ministry of Health
Supervision of the practise of dentistry is by the Dental
Medical devices Ministry of Health
Chamber and by the Ministry of Health. There were 34
complaints made against dentists in 2012. Waste disposal Ministry of Environment
Protection
Based on the decision of the Chamber’s Committee for a
misdemeanour or proven mistake, the Committee can impose
an Admonition, a Public Admonition, a Financial Penalty, Ionising Radiation
Amending damages, and temporary or permanent withdrawal of
the licence to practise. There are specific regulations about radiation protection.
Training in radiation protection is mandatory for the competent
Data Protection person in each practice – in Croatia, the dentist. The dentist
must undergo continuing training, within the general
There is a Data Protection Law which ensures that no data can requirements for continuing education.
be issued or printed without the patient’s and/or an employer’s
consent. Hazardous Waste

Advertising The EU Hazardous Waste Directive is incorporated into law and

actively enforced. Amalgam separators are legally required.
Advertising is permitted only when a doctor opens an office, or
when moving from one address to another, otherwise no
advertising is permitted.

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Financial Matters
Retirement pensions in Croatia are from 40% to 60% of regular
Retirement pensions and Healthcare working salary.
The official retirement age in Croatia in 2013 was 65 – male, 60 Taxes
– female.
Residents are taxed on worldwide income, while nonresidents
There are three main insurancebased schemes: Pension are taxed only on Croatian source income. Spouses are
insurance – covers risks of old age, invalidity, employment separate persons for tax purposes.
injury and occupational disease, and death. Health insurance
– covers the risk of temporary incapacity for work due to Taxable income is based on total income from employment,
sickness or maternity and health care. Unemployment self-employment, property and proprietary rights, capital,
insurance – covers the risk of unemployment and also insurance and other income less personal allowances. Gross
promotes employment and the rehabilitation process of income is reduced by the employee’s pension contribution
unemployed persons disabled at work. payments (20% of gross income). Each individual is entitled to
a personal allowance of HRK 2,200 per month (2013). The
The main principles of these social security branches are that deduction may be further increased for each dependent family
these are public, general and compulsory. They cover the member.
insured persons and are based on contributions paid by
employees, employers, self-employed persons, and are partly Rates are 12% to 40%, depending on gross income.
financed by the State budget. They are based upon solidarity of
members, except for the second pillar of funded pension VAT/sales tax
insurance.
The standard rate of VAT has been 25% since March 2012.
a) I pillar : Pay as you go (PAYGO) system fi nanced by There is a lower rate of 10% on hotels and newspapers. Dental
contributions and state budget revenues - 15% of gross and medical services are excluded.
earnings
b) II pillar: Compulsory pension insurance based on
individual capitalized savings - 5% of gross earnings.
Various Financial Comparators:
c) III pillar: Voluntary pension insurance based on individual
No data published by UBS
capitalized savings.

Other Useful Information

Main national associations and Information Centre:

Hrvatska komora dentalne medicine Specialist associations and societies:

Croatian Dental Chamber Dentists’ scientific organisation:
Hrvatsko stomatološko drušvo
Kurelčeva 3, 10000 Zagreb Hrvatski liječnički zbor,
Tel: +385 1488 6710 Šubićeva 9, 10000 Zagreb
Fax: +385 1481 6540 Avenija Gojka Šuška 6, 10040 Zagreb
Website: www.hkdm.hr Tel: +385 1290 3067
E-mail: hkdm@hkdm.hr Fax: +385 1286 4250
Website: hsd@kbd.hr
Competent Authority: Publications:
Ministry of Health Vjesnik dentalne medicine
Ksaver 200a, 10 000 Zagreb Dental Design
Prisavlje 14, 10 000 Zagreb Smile
Tel: +385 1460 7555
Tel: +385 1467 7005
Tel: +385 1469 8300
Tel: +385 1616 9111
Web : http://www.zdravlje.hr

Dental Schools:
Zagreb Rijeka Split
University of Zagreb University of Rijeka University of Split
Stomatološki fakultet Sveučilišta u Stomatološki fakultet Sveučilišta u Rijeci Stomatološki fakultet u Splitu
Zagrebu Braće Branchetta 20, 51 000 Rijeka Šoltanska 2, 21000 Split
Gundulićeva 5, 10000 Zagreb Tel: + 385 51 65 1111 Tel: + 385 21 557903
Tel: +385 1 480 2111 Fax: + 385 51 67 5806 Fax: +385 21 557895
Fax: +385 1 480 2158 Web: www.medri.hr/studiji/stomatologija Website: www.mefst.hr
Web: sfzg@sfzg.hr
Student intake 2013-14: 33 Student intake 2013-14: 30
Student intake 2013-14: 85

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Cyprus
In the EU/EEA since 2004
Population (2012) 862,000
GDP PPP per capita (2012) €20,856
Currency Euro
Main languages Greek, T urkish & English

In Cyprus oral healthcare is provided largely through fully liberal,

private general practice, as the public sector is very small. T he
amount contributed depends on income.

Number of dentists: 1,073

Population to (active) dentist ratio: 1,042
Members of Dental Association: 100%

T he use of dental specialists is restricted as is the development of

clinical dental auxiliaries.
Continuing education for dentists is mandatory.

Date of last revision: 10th October 2013

Government and healthcare in Cyprus

The Republic of Cyprus is on an island in the eastern national legislation, health care in the public sector is provided
Mediterranean Sea. Turkey lies to the north and Syria to the by the Government Medical and Dental Services and is
East. The land area of the island is 9,250 sq km, which governed by the Government Medical Institutions and Services
makes it the third largest island in the Mediterranean. The General Regulations of 2002.
highest point on the island (Mt Olympus) is 1,951 m. The
capital, Nicosia is near the geographical centre of the island. The introduction of a General Health Insurance Scheme
(GHIS) is scheduled for 2015. The GHIS will:
Independence from the UK was approved in 1960 with
constitutional guarantees by the Greek, Turkish and UK 1. Provide general medical services, specialised in medical
governments. services, inpatient care, diagnostic tests, drugs,
rehabilitation services and preventive dental care for
However, following military intervention by Turkey in 1974, the children up to 16 years old and medical treatment
island has been de facto divided, with a northern 37% being abroad.
controlled as "Turkish Republic of Northern Cyprus", declared 2. Change the structure of health care services, as well as
in 1983, recognised only by Turkey, and unaccepted as a legal the way providers are remunerated for their services.
entity by the rest of the world. There have been UN-led direct Primary care Physicians will be paid on a combined
talks between the two sides to reach a comprehensive manner, 3-tiered approach (capitation rate, quality
settlement to the division of the island from time to time but no assurance, reward right referral pattern); specialists will
progress has been made. The Republic of Cyprus became a be paid on a fee schedule. Hospital services payment will
member of the EU in 2004. The AcquisCommunautaire will not be paid on the Diagnostic Related Groups (DRGs)
be applied in the north part, for the time being. system.
3. Introduce elements of competition between the private
The Republic is governed as a presidential democracy. The and the public sector to stipulate greater efficiency,
legislative power is administered through the House of quality and effectiveness in the provision of health care
Representatives and the judicial power is executed by the services.
Supreme Court and the District Courts. There are six
administrative districts. Improved institutional capacity, organisational structure and
human resources through changes are expected to take place
About 81% of the population are Greek-Cypriot (including in order to provide the necessary infrastructure for the
about 9,000 Maronites, Armenians and Latins), 11.0% are implementation of the GHIS.
Turkish-Cypriot and 8% foreign residents and workers.
Current legislation stipulates that financial criteria must be
A National Health System had not yet been established by taken into account to define eligibility for receiving health care
2013. Health care is provided by the government (public by the public sector.
sector), the private health care sector, and some schemes
covering specific population groups. According to Cypriot The CSS is the Cyprus Statistical Service.

Year Source
% GDP spent on health 6.0% 2010 CSS
% of this spent by governm't 41.5% 2010 CSS

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Oral healthcare
Oral health care in Cyprus is provided by dentists and dental The proportion of the population receiving oral healthcare
auxiliaries employed by the government (Dental Services of the regularly (in a two-year period) is not known, but there is data
Ministry of Health) and by private (non-governmental) dentists for the public sector. Around 20 patients a day would normally
and dental auxiliaries financed by payments by patients or a be seen.
source other than the government. Some dentists have
contracts with workers´ unions or other semi-governmental Oral examinations would normally be undertaken annually, or
organisations, as well as insurance companies. They would more frequently where active disease is present. There is an
uneven distribution of dentists in Cyprus, but as the roads are in
a very good condition and Cyprus is a small place, there is no
Year Source
actual problem of access.
% GDP spent on oral health 0.06% 2010 CSS
% of OH expenditure private 97% 2010 CSS Domiciliary care is normally provided by the Public Service, in
certain cases.

normally be paid on an item of service system. Private Insurance

A comprehensive spectrum of services is provided from the
Public Dental Services including conservative and surgical Only a very small proportion of the population is covered by
treatment, as well as removable dentures. 83% of the private insurance companies.
population has almost free access to public oral healthcare
(they pay only €3 regardless of the offered care and €75 for a Quality of Care
denture). Primary school children receive free treatment from
the public sector. For orthodontic care from the public sector There are no routine checks and there is reliance on patients
only children up to the age of 18 receiving welfare assistance making complaints. The Cyprus Dental Association in
are eligible. collaboration with the Ministry of Health, were in 2013 preparing
a new legal Act that will regulate the operation of dental clinics.
In the private sector, patients pay directly and the price is not
regulated. Where there is insurance company involve-ment, the Health data
fees are agreed between the dentist and the company.
Year Source
With the implementation of the General Health Insurance DMFT at age 12 1.14 2010 Min of Health
System (GHIS), the Ministry of Health has recommended the
DMFT zero at age 12 54% 2010 Min of Health
following adjustments related to Public dental services:
Edentulous at age 65 No data
 Primary/preventive dental care up to the age of 16;
 Provision of dental services in Foundations (in mobile “DMFT zero at age 12” refers to the number of 12 years old
dental units); children with a zero DMFT. “Edentulous at age 65” refers to the
 Public Dental Health; numbers of over 64s with no natural teeth
 Dental Treatment for pupils aged 10 from private sector
dentists - after the student’s reference by dentists from the Fluoridation
public sector;
 Dental Treatment for schools (in mobile dental units); There is no fluoride adjusted water scheme in Cyprus, although
 Second degree dental care (Dental Surgery, a very small proportion of the population receives fluoridated
Paedodontics, Periodontology) for special groups; water at or above optimal levels (naturally fluoridated).
 Third Degree dental care services (Removable prosthetics
and Oral/Maxillofacial Surgery - local and general
anaesthesia) for special groups.

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Education, Training and Registration
e. Any person who has not ceased to practice because
Undergraduate Training of professional misconduct.

There are no dental schools in Cyprus. About 75% of dentists In order to be allowed to practise dentistry in Cyprus,
practising in Cyprus have graduated from EU/EEA universities registration with the Cyprus Dental Council is mandatory first,
- mainly Greek Universities (Athens and Thessaloniki). To for recognition of his/her title. Then, in order to practise the
study in Greece, a student has to pass the entry exams profession, he/she has to be registered with the Cyprus Dental
organised by the Ministry of Education of Cyprus; there are Association (the professional body) so all dentists are
usually 15 posts allocated for Cypriot citizens each year. If a members.
student wishes to study in other countries he/she has to fulfil
the requirements imposed by the country concerned. Exempted from the registration with the Cyprus Dental
Association are the dentists who would like to provide services
Qualification and Vocational Training according to the relevant sectoral Directives. If an EU dentist
wants to be established in Cyprus he/she also has to be
Vocational Training (VT) registered with both CDC and CDA, but for a dentist who wants
to provide services for a limited time period, registration with the
There is no post-qualification training in Cyprus. CDC only is necessary. Nevertheless, with the new PQD
Directive, the new harmonised legislation will state that if a
dentist wishes to provide services, she/he will have to have a
Registration pro forma registration with the professional association.
According to the Articles 19A (1) and (2) of the amended Language requirements
Dentists’ Registration Law 2004:
Language requirements have been imposed with the new
(1) A dentist national of a Member State who holds one of amended legislation (harmonisation with the EU Directive
the titles referred to in Annex V and is a resident of an 2005/36) as regards the license to practice. The CDC requires
EU Member State has the right to provide services in basic knowledge of the Greek language, verified by a personal
the Cyprus Republic without being registered with the interview.
Dental Council. (In this case he/she is registered in a
record kept by the Dental Council)
(2) In accordance with this Article, the Dental Council
Cost of registration CDC (2013) € 35
keeps a record of the names of dental practitioners who
provide services. Cost of registration CDA (2013) € 130

According to the amended Dentists’ Registration Law 2004

Article 4(1) the following persons are entitled to be registered as
a dentist, if the Dental Council’s requirements are met: Further Postgraduate and Specialist Training

a. Any person whose age is 21 years old and above. Continuing education
b. Any person who is a national of the Republic of Cyprus
Since 2012, the Cyprus Dental Association (CDA) has
or is married to or is a child of a national of the
implemented a programme of Continuing Professional
Republic of Cyprus who has his permanent place of
Development of Dentists (CPDD). This programme is
residence in, or is a national of a MemberState.
mandatory for all dentists (private and public sectors) in order to
c. Any person who holds a diploma, certificate or other
obtain the Certificate of the Clinical Competence (CCCA).
title applied to Annex III or holds a diploma or title
which is not applied to Annex III but complies with the
This is obtained by accumulating a minimum of 45 Modules of
requirements at Annex IV, which is recognised by
Education (ME) in a period of 3 years. In a next step, and after
KYSATS and approved by the Dental Council or
the implementation of the Dental legislation, the Certificate of
covered by the provisions in Article 4A.
Clinical Competence Act, this will be connected to the renewal
d. Is a person of good character presenting a certificate of
of the licence to practise dentistry in Cyprus, from the CDA.
the "judicial record" or, in the case of nationals of
Member States, an equivalent document issued by a
Specialist Training
competent authority in the Member State of origin or
the Member State from which the foreign national
There is no specialist training in Cyprus. All specialists train
comes, given that this is updated (not more than three
overseas.
months since the date of issue up to the date of its
presentation).

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Workforce
Dentists Specialists usually practice in the towns, but as Cyprus is small
there is no actual problem for patients to access them. About
All dentists practising in Cyprus qualified overseas. In 2001 two thirds of the Oral surgeons have had dental training only
about 66% qualified in EU/ EEA countries, with the remainder and the remainder have received medical and dental training.
qualified in third countries. The specialty of Oral-Maxillofacial Surgery is also recognised
by the Cyprus Medical Council.
Year of data: 2013 Auxiliaries
Total Registered 1,073
In active practice 827 Year of data: 2013
Dentist to population ratio* 1,042 Hygienists 0
Percentage female 49% Technicians 130
Qualified overseas 1,073 Denturists 0
Assistants in public sector 34
Therapists 0
Of the 1,073 registered (in 2013), 136 were working outside
Cyprus, 63 were not active and 47 were retired.
Dental Hygienists
There was no reported unemployment amongst dentists in
2013. There were 7 hygienists reported as working in Cyprus in 2008,
but there is no data now (in 2013), as this is not a recognised
Movement of dentists across borders profession.

There is no significant movement of dentists from and to Dental Technicians

Cyprus. Dentists from the UK mainly come to get established in
Cyprus, but not in large numbers. Cypriot dentists move to Technicians are trained in Greece, the UK, other European
other EU/EEA countries (mostly theUK) to get postgraduate countries, or the USA. The minimum requirement, for a dental
education and to work. technician to be registered, is 3 years study, after the
completion of the secondary school studies. They normally
Specialists work in separate dental laboratories and invoice the dentist for
work done.
Since 2004, when new laws were enacted, the recognised
specialties are: They have to be registered with the Dental Technicians’
Council, comprised of 7 members, 1 public dental technician, 1
Orthodontists who have received at least 3 years’ public dentist, 1 private dentist and 4 private dental
training, and technicians. There is no reported illegal practice.
Dento-alveolar surgery, after basic dental training plus at
least 4 years’ training, and.
Dental Chairside Assistants
Oral Surgery, after basic dental training plus at least 3
years’ specialist training, and
Oral Maxillo-facial surgeons, after basic medical and Dental assistants are not qualified and in most cases are
dental training plus at least 4 years’ specialist training. trained by their employers. There is no formal education
programme.

The CDA reported that they had no information about how

Year of data: 2013 many are employed in the private sector.
Orthodontics 46
Dento-alveolar Surgery 11
Oral Surgery 1
OMFS 8

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Practice in Cyprus
Only a small proportion of dentists work for the Public Health Joining or establishing a practice
Services in the Dental Services of the Ministry of Health, and in
the Armed Forces - these dentists cannot practise privately. There are no specific rules about the location of a practice, for
The others are private practitioners. the time being. There is no government assistance to set up
new practices, and these are usually funded through bank
There is no data available for the private sector relating to how loans.
many patients would normally see in a day, but in the public
sector a dentist can treat about 15 patients daily. Most dental practices in Cyprus are solo practices. Only a small
percentage of general dental practitioners work as assistants or
associates.
Year of data: 2013
General (private) practice 787 Working in Hospitals (the Public Dental Service)
Public dental service 39
University Public Dental Services run 56 clinics in 5 district hospitals, 8
urban, 23 rural health centres and 2 foundations. Dentists
Hospital working at the public sector are all salaried and are not
Armed Forces 2 permitted to undertake private practice. Primary and secondary
General Practice as a proportion is 95% dental care is provided at all the public clinics, while tertiary
care is provided only at the district hospitals.

There are also a few small private hospitals, but only 3 or 4

Working in General Practice clinicians provide services there, mostly oral maxillofacial
surgery.
Most dentists practice in private practice. They work in a
completely liberal, private fees-for-service system. However, Working in the Armed Forces
there is a suggested minimum price, in a list set by the Cyprus
Dental Association. There are just a couple of dentists working full time for the
Armed Forces.

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Professional Matters

Professional associations Data Protection

Cyprus has been harmonised with EU Legislation in regard to

Number Year Source data protection.
Cyprus Dental Association 773 2012 FDI
Advertising

There is a single main national association, the Cyprus Dental Advertising is not generally allowed. A dentist can display the
Association. The Association was founded and was established title he/she bears, if this title is recognised by the Dental
by law in 1968 - with five local Dental Associations also. These Council. However, when a young dentist is starting practice he
are Nicosia-Keryneia, Limassol, Larnaka, Pafos and Famagusta or she may put an advertisement in a newspaper.
Local Dental Association one in each District of Cyprus. Each
Dentists may use websites to inform the patients on general
dentist, under the Dentists Registration Law should be
dental issues or inform their colleagues on a special kind of
registered with the local Dental Association where he/she
service they provide.
practises dentistry.
Insurance and professional indemnity
There are 23 members of the council of the Association and
they elect the President, Vice-President, Secretary and There is no mandatory professional indemnity cover in Cyprus.
Treasurer. Also, there is a scientific committee and executive However, discussions have been held in the Parliament and in
committee. They have their regular meetings every two months the CDA on this topic, but by 2013 it was still not mandatory by
and the elections for the new members of the council every law.
three years.
Corporate Dentistry
The Association represents private and public dentists and
combines this role by trying to emphasize to common This is permitted in Cyprus. Non-dentists may wholly or partly
professional matters. own the company, but in all cases at least one dentist must be
The local dental associations have representatives in the Board employed
of the CDA.
Tooth whitening
The CDA has owned a new building since 2007 and has one Cyprus has been harmonised with EU Directive since October
full-time secretary. 2012.
The Dental Council is made up of 4 dentists from the private The CDA reported that there have been a few instances of
sector and 3 from the public sector. The Council is appointed by illegal practice, which have been reported to the police.
the Council of Ministers. It is the competent authority for the
registration of dentists in Cyprus and for the recognition of
dental specialities.
Health and Safety at Work
Most members of the dental workforce have been vaccinated
Ethics and Regulation with Hepatitis B vaccine, but this is not mandatory.
Ethical Code
Ionising Radiation
Dentists work under an ethical code which covers relationships There are specific regulations about radiation protection,
and behaviour between dentists, the contract with the patient. according to the relevant EU Directives. Licensing of ionising
The ethical code is administered by the Cyprus Dental radiation equipment is regulated through legislation and there
Association. are licensed users of ionising radiation, dentists are included.
Fitness to Practise/Disciplinary Matters There is no mandatory continuing education for ionising
radiation. Dentistscan attend seminars organised on this issue
Complaints from patients are presented to the Cyprus Dental by the Ministry of Labour andMinistry of Health.
Association and to the Court, depending on the nature of the
complaint. The Disciplinary Committee of the Cyprus Dental Hazardous waste
Association judges the complaints. Dentists from both the public Cyprus adopted the European legislation on waste disposal in
and private sectors sit as members of the committee. A 2005. The disposal of clinical and hazardous waste is collected
complaint may be referred to the courts, depending on its and managed by a licenced company. The Public Dental
severity. Service and all private practices have a contract with a private
company for the safe disposal of clinical and hazardous waste.
Usually the remedies have to do with monetary compensation.
The final sanction of the professional body could be the
withdrawal of the licence for a specific duration of time. The
final sanction of the court could be a sum of money to be paid
to the patient as penalty. The right of appeal is based on the
National Law.

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For Administered by
Ionising radiation The Ministry of Labour and the Ministry of Health
Electrical installations The Ministry of Communication & Works in collaboration with the Electricity
Authority of Cyprus
Infection control The Ministry of Health
Medical devices The Ministry of Health and the Ministry of Commerce, Industry and Tourism
Waste disposal The Ministry of Agriculture, Natural Resources and Environment.

Financial Matters
Retirement pensions and Healthcare In addition to income tax, social insurance premiums are paid
as a percentage of salary. Employers pay a 6.8% contribution
National normal pension age is 65 (63 if disabled).Pensions for plus various funds and employees pay 6.8% also. Self
dentists in the public sector are monitored through the Pensions employed persons pay 12.6% of income.
Law of the civil servants. Public health workers receive a
pension based on the years of service they have had in the civil VAT/sales tax
service and on their final salary.
The Standard rate of VAT is 18% (since January 2013). The
Dentists in the private sector can work past this retirement age. rate will be raised to 19% in 2014. There are two reduced rates:
They claim their pension according to their contributions to the 8% (hotels, restaurants) and 5% on foodstuffs, books,
Social Insurance fund during their working life. pharmaceuticals, medical, passenger transport, news-papers,
admission to cultural entertainment and sporting events.
Since 2011, for dentists working in the private sector, it has Medical and dental services are not subject to VAT.
been mandatory to contribute to the "Dentists and Doctors
Pension Fund".

Taxes
National income tax:
Cyprus has a progressive tax rate, commencing at 20% on
incomes over €19,500 to 35% on earnings over €60,000. There
are various allowances and exemptions.

Other Useful Information

Main national association and Information Centre: Main information Centre:

Cyprus Dental Association Dental Services
1, 28 Octovriou Str., 2414 Nicosia,Cyprus Nicosia GeneralHospital
or 1450 Nicosia
P.O. Box 27898 Cyprus
2434 Nicosia, Cyprus Tel;+357 22801620
Tel: +357 22 819 819 Fax +357 22669148
Fax: +357 22 819 815 Email: director@ds.moh.gov.cy
Email: cda@cytanet.com.cy Website: www.moh.gov.cy
Website: www.dental.org.cy
Main Professional Journal Competent Authority:
Dental Revue (ODONTIATRIKO VIMA) Cyprus Dental Council
1, 28 Octovriou Str., 1, 28 Octovriou Str.,
2414 Nicosia, 2414 Nicosia,
CYPRUS CYPRUS
or or
P.O. Box 27898 PO.Box2434
2434 Nicosia, 2434 Nicosia,
CYPRUS CYPRUS
Tel: +357 22 819 819 Tel: +357 22 819 819
Fax: +357 22 819 815 Fax: +357 22 819 815
Email: cda@cytanet.com.cy Email: www.dental.org.cy
Website: www.dental.org.cy Website: cdcouncil@dental.org.cy

There are no dental schools in Cyprus

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The Czech Republic
In the EU/EEA since 2004
Population (2013) 10,516,125
GDP PPP per capita (2010) €20,790
Currency Czech Crown (CZK)
27.56 CZK = €1.00 (2013)
Main languages Czech

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.

Number of dentists: 9,354

Population to (active) dentist ratio: 1,345
Members of Dental Chamber: 100%

Specialists are available and the use of clinical auxiliaries is limited to

dental hygienists. Continuing education for dentists is mandatory, but
Date of last revision: 5th January 2014 participation can lead to Certificates of Proficiency and higher fees for
dental practitioners.

Government and healthcare in the Czech Republic

The Czech Republic is a small country in terms of population employee, then both the employer and employee share in the
and land area coverage (78,864 sq km). payment of premiums, where the employee pays one third of
the whole amount and the employer the remaining two-thirds -
The Czech Republic is a sovereign, united and democratic 4.5% (employee) and 9% (employer) of income respectively, in
country. Its government is divided into three branches - the total 13.5% of the gross wage. Self-employed individuals
legislative, represented by Parliament, the executive, participating in the public health insurance pay premiums
represented mainly by the President and the government, and themselves in the form of a monthly deposit, and following end-
the judicial branch, represented by courts at various levels. The of-year accounting.
country is administered as 13 regions. Praha, the capital, has
regional status, too. Year Source
% GDP spent on health 7.5% 2011 OECD
Czech healthcare is founded on the following principles of
% of this spent by government 84.2% 2011 OECD
solidarity (“spreading the risk”), a high level of autonomy, multi-
source financing by predominantly public health insurance, the
free choice of physician and health care facility, the free choice
of health insurer in the framework of public health insurance, The State is the premium payer for some individuals who are
and equal accessibility to services provided for all insured. participants in public health insurance, by transferring the
legally required amounts from the State budget to the insurer.
Healthcare is provided predominantly on the basis of obligatory This group includes for children not otherwise provided for (up
public health insurance. The public health insurance system is to 18 years or up to 26 years old by studying), pensioners –
provided by 7 (state-approved) health insurance companies. receiving pension from the Czech pension insurance scheme,
The system (sick fund) provides a legally prescribed standard mothers on maternity leave or those who take full-time care of
package of healthcare. Contractual health insurance is only of a at least one child up to 7 years old or two children up to 15
supplementary nature. years old, national servicemen, persons in custody or serving
their sentence, and others.
Persons participating in public insurance are required to pay
premiums regularly. Public health insurance payers are various Persons with permanent residence in the CR but who are
and include: employees, employers, self-employed individuals neither employees nor self-employed persons, nor persons for
and the State. whom the state pays the premiums, are required to pay the due
premium deposit payments to their insurer.
If the participant in the system of public health insurance is an

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Oral healthcare
The healthcare budget is annually estimated according to the Less than 1% of dentists (mainly in Praha and the other larger
expected amount of money in the insurance fund. About 5% of cities) work completely outside the system of health insurance,
the public healthcare budget is spent on dentistry. in fully liberal practice. The prices of dental care in their
practices are contractual and their patients must pay the full
Year Source cost of their dental care, directly negotiated with the dentist. So
% GDP spent on oral health 0.36% 2006 Chamber the fees are totally unregulated (according to a feedback of the
market).
% OH expenditure private 60% 2007 CECDO

A full-time working dentist would normally have about 1,600

patients regularly attending. Oral re-examinations are covered
Oral healthcare is coordinated by the Czech Dental Chamber by the health insurance fund and normally would be carried out
(Česká stomatologická komora – CSK). for most adult patients every 6 months.

Public compulsory health insurance In some parts of Czech Republic there is a shortage of
orthodontists and specialists for oral surgery, periodontology or
The insurance fund is the compulsory public health insurance paediatric dentistry.
system mentioned above. The system of money distribution is
limited by government health policy. The Quality of Care
Up to 80% of dental care is paid from the health insurance
system and the balance is through fully liberal practice. The The Dental Chamber (CSK) becomes involved when a patient
Sick Funds are self-regulating under national legislation. complains about the quality of care. The complaint may be
made:
The dental services are delivered through a system of university
clinics, or by private dentists and dental laboratories. In 2012, to the health insurance company
about 90% of dental care was delivered by private dentists. to the Dental Chamber
to the Regional authority
The insurance system provides cover for all standard
conservative items such as amalgam fillings, basic endodontic By law, the CSK is empowered to access and examine
treatment (canal filling using any suitable paste material), complaints filed against dentists. Final complaints are
surgical and periodontal items and for a few basic prosthodontic processed by the regional, professional board of examination –
items. There is no co-payment by the patient for the standard Regional Dental Chambers´ Auditing Boards. The authority to
items (the list of items and their description is presented in the examine a dentist’s professional malpractice or ethical
Collection of Laws. There is no annual limit of treatment range, misjudgement is carried by the relevant professional disciplinary
for an individual patient. bodies – the Regional Dental Chambers’ Honorary Councils
and the Czech Dental Chamber’s Honorary Council.
Cosmetic fillings and non-basic endodontic treatment (methods
of lateral or vertical condensation of gutta-percha points or Health data
Thermofil-type systems), implants and fixed orthodontic
appliances in adults have to be paid for completely by patients.
Crowns and bridges, partial dentures and removable Year Source
orthodontic appliances are paid partly from sick funds and partly DMFT at age 12 2.60 2007 WHO
by the patient. The percentage is different for various DMFT zero at age 12 29.0% 2007 CECDO
prosthodontic items, for example: Edentulous at age 65 17.0% 2007 CECDO

metallo-ceramic crown = 15-20% is paid from sick fund,

80-85% by patient,
partial dentures with casting framework = 30-60% is paid “DMFT zero at age 12” refers to the number of 12 years old
from sick fund, 40-70% by patient. children with a zero DMFT. “Edentulous at age 65” refers to the
numbers of over 64s with no natural teeth
There is no prior approval for treatment and no provision for
domiciliary (home) care. Fluoridation
Children under 18 years receive health insurance system cover There is no fluoridation of the water supplies in the Czech
for the higher cost - the adult patient self-payment part of their Republic. There is some fluoridation of salt on a voluntary
dental care (for all types of fillings, all types of endodontic basis. Dentists recommend the use of fluoride toothpaste or
treatment, and the higher cover element of prosthodontic other local fluoride agents individually, according to age and
items). dental status of the patient.

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Education, Training and Registration
Undergraduate Training
The CSK statutorily maintains a register containing the dentists´
To enter dental school students must successfully finish high data, including qualifications and professional performance
school, with a school-leaving certificate. They must successfully data.
pass a theoretical entrance examination. No other vocational
entry is needed. Requirements for foreigners to practice dentistry in the Czech
Republic:
Year of data: 2012
Number of schools 5 1. Recognition of a university diploma under the authority of the
Ministry of Health
Student intake 280 2. Adequate knowledge of the Czech language – successful
Number of graduates 250 completion of a test of qualification in the Czech language
3. Permission for long-term or permanent residence
Percentage female 38% 4. The qualification achieved in any EU country is accepted.
Length of course 5 yrs Authorisation for the practice of dentistry on the territory of the
Czech Republic is under the authority of the Ministry of Health
VT mandatory? No and is necessary for the dentists from non-EU countries. It
consists of a professional written and oral examination
5. Membership in the Czech Dental Chamber (CSK).
Dental schools are known as Stomatologická klinika Lékařské The CSK registers all who:
fakulty, of a university (Stomatological Clinic of the Faculty of - have duly completed studies at a school of medicine at a Czech
Medicine of the University). or foreign university and successfully completed a final
examination in dentistry
Following the Czech Republic’s accression to the EU in 2004, – are authorised to practice dentistry on the territory of the Czech
dental studies have been under a new a curriculum, compliant Republic.
with to the Directive of the EU.
The fulfilment of the requirements stated above leads to
authorisation to practice.
The responsibility for quality assurance in the faculties is by the In order to begin private practice, it is subsequently necessary to
Ministry of Education, the Chancellor of the University and the fulfil the requirements of the CSK for the issuance of a licence for
Dean of the Faculty. the practice of practical dentistry.
Qualification and Vocational Training
Primary dental qualification Further Postgraduate and Specialist Training
Continuing education
Until 2003, the title on qualification was MUDr., the same title as
for a doctor in general medicine, but the text on the diploma is Participation in continuing education has been obligatory since
specified: “Medicinae universae doctor in disciplina medicinae 2004.The system is delivered mainly by CSK, but also other
stomatologicae”. The legislation for a change of title was providers can take part in the system. There are organised
subsequently changed and the title for a dentist is now “MDDr” theoretical and practical lectures.
Diplom o ukončení studia ve studijním programmeu zubní
lékařství (doktor zubního lékařství, MDDr. This change of title is The result of the CSK continuing postgraduate education cycle
in relation to the newly formed study of dentistry has been from is a Certificate of Proficiency, issued by the CSK;
the year 2004.
Dentist Practitioner with Certificate of Proficiency
Vocational Training (VT) Dentist Practitioner with a Certificate of Proficiency in
Periodontology
There is no post qualification vocational training. MDDr Dentist Practitioner with a Certificate of Proficiency in Oral
graduates are able to work in the Czech Republic, and in other Surgery
EU countries, immediately upon qualification. Dentist Practitioner with a Certificate of Proficiency in
Paediatric dentistry
Vocational training is not mandatory for graduates of other Dentist holding a Certificate of Proficiency in Orthodontics
Member States’’ dental schools, also.
The Certificate of Proficiency is evidence of the education of the
Registration dentist, for patients. The attendance of dentists on
recommended practice-oriented courses or theoretical lectures
Dentists must register with the Ministry of Health, the Czech is evaluated by credits. The participant in continuing
Dental Chamber (CSK) and the Regional Authority. To register, postgraduate education can receive the Certificate if the
a dentist must have a recognised qualification, permission for required amount of credits and the prescribed spectrum of
permanent residence in the Czech Republic, a work permit, and educational actions, during two years, is fulfilled.
knowledge of Czech language by test.
The Certificate is valid usually for 3 to 5 years – it can be then
However, for Czech dentists there is no registration in the repeated, if the conditions of postgraduate education are
Ministry of Health, so no registration fees. For foreign dentists fulfilled. The holder of a Certificate has higher settlements for
(non-Czech) the Ministry of Health recognises the qualification some dental care issues (about 10% higher) from the system of
and this process is free of charge. health insurance - the patient does not pay more.

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There is also specialist training in clinical dentistry for of the
university dental clinic employees.
Certificates of Proficiency
Year of data: 2012 All specialist training takes place in clinics in universities and is
undertaken by university teachers who have been accredited
Paedodontics 20 for specialist training.
Periodontics 500
Prosthodontics The titles a specialist receives on gaining their diploma are:
Oral Surgery 513 Orthodontics: attestation in maxillo-facial orthopaedics
Dental Public Health Diplom o specializaci (v oboru ortodoncie)
Oral Surgery: attestation in oral and maxillofacial surgery
Diplom o specializaci (v oboru orální a maxilofaciální
Specialist training chirurgie)
Clinical dentistry: attestation in complete dentistry Diplom
There is specialist training in two EU recognised dental - klinická stomatologie
specialties: orthodontics and oral-maxillo-facial surgery. To
enter specialist training a dentist must have completed 36 The responsibility for registration of specialists lies with the
months in general dental practice (or, for oral surgery, medical Chamber under the State Educational System in healthcare.
practice is acceptable). Then to complete the specialist training The dentists in specialist training are usually salaried
in orthodontics it takes 3 years and in oral-maxillo-facial surgery employees (or part-time employees) of the universities where
6 years; on completion there is an examination. the training is held.

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Workforce
Dentists
Year of data: 2012
Hygienists 800
Year of data: 2012
Technicians 4,500
Total Registered 9,354
Denturists 0
In active practice 7,821
Assistants 8,000
Dentist to population ratio* 1,345
Therapists 0
Percentage female 65%
Other 0
Qualified outside the CR or Slovakia 385
all figures approximate

* The “dentist to population ratio” means the figure of active

dentists including specialists to the figure of population.
There is no obligatory registration of dental hygienists, dental
The difference between the total registered and those who are technicians and dental assistants in the Czech Republic.
“active” is from those who are retired, on maternity leave or
other similar reasons. Dental Hygienists
The Chamber has advised that there were no reports of Hygienists are permitted to work in the Czech Republic,
unemployed dentists in 2013. provided they have a diploma (DiS). They train in a special
higher school specifically for dental hygienists (3 years),
Movement of dentists across borders following 4 years in any high school. Since 2008 there has been
a Bachelor degree (BSc) available, following study of 3 years,
There is no significant movement of dentists from the CR to its for dental hygienists. Both methods of qualification of dental
neighbouring countries. Approximately 30 dentists a year enter hygienists are acceptable in the Czech Republic.
from other countries and a similar number of Czech dentists
receive a “good-standing” certificate for working abroad. Hygienists work under the supervision of a dentist only, and
their duties include scaling, cleaning and polishing, removal of
Specialists excess filling material, local application of fluoride agents, the
insertion of preventive sealants and Oral Health Education.
Year of data: 2012 They do not need to be registered if they work as an employee.
Orthodontics 337 Hygienists would normally be salaried. In 2007 no hygienists
OMFS 72 were unemployed – the demand is higher than supply.
Clinical Dentistry
Dental Technicians
There are different ways of training for dental technicians: 4
*In 2012, 30% of orthodontists were male, and 87% of OMFSs years study in a high school specifically for dental technicians
were male. (assistant of the dental technician, he/she can work as
employee only), or study in a higher school specifically for
Additionally, about 75% of dentists hold a Certificate of dental technicians (3 years of study following 4 years in any
Proficiency, which entitles them to apply to the Health insurance high school) – those with a higher degree of education also
company for higher fees – see previous section. This includes receive a DiS. In 2008 a Bachelor degree study (BSc) for 3
practitioners with a General Dental proficiency. years for dental technicians was also started. Both methods of
qualification of dental technicians are acceptable in the Czech
Whilst a referral by a generalist to a specialist is the norm, Republic.
patients are not precluded from making direct access to
specialists (or dentists with the certificates of proficiency). Dental technicians construct prostheses for insertion by
dentists. They normally work in commercial laboratories, only a
Auxiliaries few are employees of dentists or of clinics. Technicians can be
There are two kinds of clinical auxiliaries, Dental Hygienists and owners of the laboratory and than they are self-employed or
Dental Technicians. Additionally, there are dental nurses and they are normally salaried (the employees).
receptionists.
The Chamber has no reports about illegal dental practice by
dental technicians.

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Dental Assistants (Nurses) or dental assistants can be general nurses with training
by the dentist. They are educated in high school for
Dental assistants must have an appropriate education: nurses, for 4 years, with a leaving examination.
accredited specialised course for dental assistants They are permitted to undertake oral health education.
or 2 years of study at the school for dental assistants

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Practice in the Czech Republic
the registration of local health state authorities. If the applicant
fulfils all the necessary conditions (qualification, lack of
Year of data: 2012 disciplinary convictions, hygienic bylaws, equipment of the
General (private) practice 6,500 practice) there is no ground to refuse his application. There is a
one-off registration fee to the Regional Authority, which was
Public dental service 0 1,000 CZK (€40) in 2012. A new practice has no claim for a
University 295 contract with any health insurance company – it depends on the
Hospital 30 will and demand of the health insurance companies.
Armed Forces 31 In 2013, about 5,926 dentists were self-employed in their own
General Practice as a proportion is 94% practices (or as partners within corporate bodies) and about
1,600 dentists were employees in these private practices.

Working in the Public Clinics

Working in Liberal (General) Practice
There are no public dental clinics in the Czech Republic.
Fee scales
For dentists working within the system of health insurance it is
Working in Hospitals
obligatory (by law) that they complete a price list of items Dentists who work in hospitals (university or big regional
partially covered by the insurance system, or items which are hospitals) are normally salaried employees. Hospitals are
fully covered by the patient. The prices are calculated in each usually owned by state (university hospitals) or privately (joint
practice independently and they are not regulated. So, for stock companies), and the dental services provided are usually
example, the common range of prices for metallo-ceramic full scale and oral surgery.
crown in 2013 was between 2,500 and 4,500 Czech Crowns,
(about €100 - €180). Control of the price-lists is maintained by These dentists will also assist in the education and training of
the financial authority and is checked routinely, by audit of bills dental undergraduates.
and documentation, or as a result of a complaint by a patient.
About a half the dentists working in hospitals are specialists, the
For those items partially covered by the scheme, the insurance others in training. They can be either fully or partially employed
element is taken out of the calculated price. The prices of items – some of them work concurrently in private practice.
fully covered from insurance system are in fact the same in all
health insurance companies and are valid for a year. New Working in Universities and Dental Faculties
prices are scheduled as a result of negotiations between the
These dentists are normally full-time salaried employees of the
health insurances and delegates of dentists (usually the
University. Some of them are allowed the combination of part-
President and Vice-president of the CSK).
time teaching employment and private practice (with permission
of university).
For payment, the contracted dentist sends an invoice with the
list of patients and the provided dental care, to the health All the dentists in Universities are “MUDr.” or “MDDr.” The
insurance company (usually monthly and on a floppy disk or additional titles of university teachers are: assistant (title As.)
stick or by e-mail) – payment by the insurance company follows docent (Doc. – associate professor), or professor (Prof.).
in 30 days.
For the positions of docent and professor it is necessary to
Joining or establishing a practice pass “habilitation” - this involves a further degree (publication
activities and a record of original research) and a public lecture
There are no stated regulations which specifically aim to control in front of the Scientific Council of University. The study for a
the location of dental practices. There are also no other PhD is also required (earlier it was adequate to have a CSc.,
regulations or factors which effectively restrict where dentists leading to the PhD). The CSc. – candidatus scientiarum, was a
may locate. Any type of building may be used which fulfils the scientific degree used in the Czech Republic until 1990. The
legislative claims to dental practice. But rules exist which study for obtaining of a CSc. was similar to a PhD. The PhD
define, for example, the minimum size of rooms for dental has been used in the Czech Republic since the 1990s.
practice, disabled facilities, etc. There is no limit to the
maximum number of partners etc. Epidemiological studies are undertaken by the Czech Statistical
Institute and the Institute of Health Information and Statistics of
The law does not allow the selling of a list of patients. The state the Czech Republic.
offers no assistance for establishing a new practice, and
generally dentists must take out commercial loans from a bank. Working in the Armed Forces
To establish a new practice private dentists have to complete About 50% of dentists serving in the Armed Forces are female.

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Professional Matters
Professional associations issue. The ethical code has been adapted according to the CED
ethical guidelines.
The Czech Dental Chamber (Česká stomatologická komora –
CSK) was established in law in 1991. The CSK is a regular Data Protection
member of the FDI World Dental Federation.
Data Protection is regulated by the law which follows the EU
Number Year Source Directives.
Czech Dental Chamber 9,354 2012 Chamber
Indemnity Insurance

Liability insurance is compulsory (by the law) for all dentists in

To work a dentist must be registered with the Chamber (see the Czech Republic – the amount of cover is not pre-
Registration - earlier), however inactive dentists do not need to determined. Dentists usually choose the range from 1,000,000
be members of the Chamber. It is an independent, self- to 5,000,000 CZK (€32,000 - €160,000). Costs are up to €250
governing, non-political, professional organisation, forming an per year (in 2013) for this insurance. For work abroad it is
association of dentists with the purpose of protecting common necessary to make a special supplement to the contract.
interest, maintaining a professional level and ethics. The CSK
resolves complaints and executes disciplinary powers toward its
Corporate Dentistry
members. It defines requirements on operating a dental
practice and confirms compliance with the dentists´ professional
Anyone can own a dental practice (non-dentists need a dentist
performance requirements. present, as a warranty of proficiency), and there is also
provision for them to be run as companies. In 2008, there were
The CSK is organised on territorial basis with Regional Dental 244 non-state (private) health companies in the Czech
Chambers (61) forming the basic organisational units. The Republic.
supreme body of the Chamber is the CSK Assembly consisting
of 92 members elected by Regional Dental Chambers. The The parties for a company have to prepare and present a report
Assembly elects the President, Vice-President, the Executive (settlement) about their activities, about relations inside the
Board (15 members), the Auditing Board (7 members), and the company etc. and then they need to request judgement for
Honorary Council (9 members). All bodies’ persons are elected registration in the Companies Register.
for a 4-year term.
Tooth whitening
The CSK is engaged in life-long learning programmes for
dentists. The CSK confirms compliance with life-long learning The Czech Republic has implemented the EU Directive
requirements by issuing the Certificates of Proficiency.
2011/84/EU concerning cosmetic products. Whitening
procedures are under Cosmetic rules and are not covered
Ethics and Regulation within the health insurance system.
Ethical Code
Agents with a peroxide concentration higher than 6% are not
permited for use in dental practice. The Czech Dental Chamber
There is an ethical code in the Czech Republic, which is
has no official verification about any iillegal practise of tooth
administered by the Czech Dental Chamber. Breaches of the
whitening but it probably exists.
ethical code are administered by Regional Auditing Boards of
Czech Dental Chamber and Honorary Councils of Czech Dental
Chamber. Health and Safety at Work
Fitness to Practise/Disciplinary Matters By ministerial regulation, dentists and those who work for them
have to be inoculated against Hepatitis B and later be checked
A rightful complaint is submitted to the regional Honorary regularly for sero-conversion. The employer usually pays for
Council of the Czech Dental Chamber and the outcome of a inoculation of the dental staff.
complaint may be a reprimand, a penalty or even the loss of
licence (the dentist cannot be suspended immediately). Any Ionising Radiation
serious break of the law can be referred to court and even
result in imprisonment. The complaint is heard by the Training in radiation protection is mandatory for undergraduate
professional body – the regional Auditing Board of the Czech dentists (it is part of the curriculum).
Dental Chamber. An appeal is possible to the higher
disciplinary body of the Czech Dental Chamber. The undergraduate education in radiation protection is not
sufficient for independent work with dental X-ray apparatus or
Advertising with orthopantomographs – the dentist has to pass an
examination by State office for Nuclear Security every 10 years.
Advertising is permitted under the framework of the ethical
code, but this does not include the use of advertisements on Radiation equipment is registered by the State office for
the TV or radio. Nuclear Security and the function of this equipment must be
under control of an accredited company (with revision every
Czech dentists may use websites, within the ethical code – year).
although the code does not include a specific section on the

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Hazardous waste

Amalgam separators have been obligatory since 2004, as part of a dental unit. The dental office must have the contract with an accredited
company for the disposal of amalgam and exchange of the separators.

The disposal of clinical hazardous waste must be ensured by an accredited company.

Regulations for Health and Safety

For Administered by
Ionising radiation State office for Nuclear
Security
Electrical installations The State accredits
electrical technicians
Waste disposal Local government
Medical devices Ministry of Health
Infection control Ministry of Health and
local authorities

Financial Matters
Retirement pensions and Healthcare

The normal age for retirement is 63 in 2013 (it will increase in average salary within the calendar year. Capital gains generally
the future), although dentists and staff can work past then. are taxed at 15%, but may be exempt if certain conditions are
Those working in hospitals and universities can also work after satisfied.
63 years of age.
VAT
There is a state-funded system of pensions, of which dentists
and their staff are a normal part. The pension would be about Standard VAT rate is 21% (since Jan 2013). There is reduced
50% of last declared income. This is the same for employed rate of 15% foodstuffs, books, medical, pharmaceutical,
and self-employed dentists. Any additional insurance pension passenger transport, newspapers, admission to cultural
depends on the individual contract and the amount insured. sporting and entertainment events, hotels.

All dental services (including prostheses are exempt from VAT,

Taxes except for cosmetic tooth whitening (21%). Purchase of dental
materials (filling materials, impression materials, instruments)
Residents are taxed on their worldwide income; nonresidents has a 15% VAT rate.
are taxed only on Czech source income. For taxable income,
there are five basic sources of income: employment, Various Financial Comparators
entrepreneurial activity, capital, leased assets and “other.”
General taxable income is
defined as the difference between actual gross income and Prague 2003 2012
allowable expenses. Domestic sources - dividends and interest Zurich = 100
– are taxed separately under a lump sum withholding system.
Prices (including rent) 41.8 46.8
Deductions are granted for mortgage interest, life and Wage levels (net) 12.4 19.0
supplementary pension insurance and gifts. Personal Domestic Purchasing Power* 32.0 36.9
allowances are also available.
(* relative to net income)
The tax rate is 15%, with a 7% increase in the rate for income
from employment and entrepreneurship exceeding 48 times the Source: UBS August 2003 & November 2012

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Other Useful Information

Main national association: Competent Authority:

Czech Dental Chamber Contact Name: doc. MUDr. Jiří Zemen, Ph.D.
Ceska Stomatologická Komora Tel: +420 603 927 134
Slavojova 22, Praha 2 Fax: +420 234 709 616
128 00 E-mail: j.zemen@gmail.com or
Czech Republic j.zemen@volny.cz
Tel: +420 234 709 610 Website: www.dent.cz
Fax: +420 234 709 616
E-mail: csk@dent.cz
Website: www.dent.cz
Details of information centres:

Name: Ústav zdravotnických informací a statistiky ČR Name: Ministerstvo zdravotnictví ČR (Ministry of

Tel: +42 022 497 2243 Health)
Fax: +42 022 491 5982 Palackeho nam. 4, 128 01, Praha
E-mail: sekretariat@uzis.cz Tel: +42 022 497 1111
Website: www.uzis.cz Fax: +420 2 2497 2111
E-mail: mzcr@mzcr.cz
Website: www.mzcr.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 Karlovy univerzity Name of University: 1. lékařská fakulta Karlovy
v Plzni univerzity
Tel: +42 377 593 400 Tel: +42 224 961 111
Fax: +42 377 593 449 Fax: +42 224 915 413
E-mail: marie.kleckova@lfp.cuni.cz E-mail: info@lf1.cuni.cz
Website www.lfp.cuni.cz Website: www.lf1.cuni.cz
Dentists graduating each year: cca 50-60 Dentists graduating each year: cca 50-60
Number of students: cca 280 Number of students: cca 290
City:Hradec Králové City:Olomouc
Name of University: Lékařská fakulta Karlovy university Name of University: Lékařská fakulta univerzity
v Hradci Králové Palackého
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: jiri.pridal@upol.cz
Website: www.lfhk.cuni.cz Website: www.upol.cz
Dentists graduating each year: cca 50-60 Dentists graduating each year: 50 - 60
Number of students: cca 280 Number of students: cca 290
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
Dentists graduating each year: cca 40
Number of students: cca 250

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Denmark
In the EU/EEA since 1973
Population (2013) 5,605,836
GDP PPP per capita (2012) €28,996
Currency Kroner (DKK)
7.46 DKK = €1 (2013)
Main language Danish

Denmark has a highly decentralised National Health Service, largely

funded by general taxation. Oral healthcare is free for children (0-18)
and subsidised for adults.

Number of dentists: 7,989

Population to (active) dentist ratio: 1,086
Members of Danish Dental Association: 81%

There are two specialist degrees in Denmark – oral surgery and

orthodontics – and there is a well-developed system of dental auxiliary
support for dentists. Continuing education for dentists is not mandatory,
except for members of the Dental Association

Date of last revision: 30th January 2014

Government and healthcare in Denmark

Denmark is geographically small country of 43,094 sq km.

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 5 regions and 98 municipalities.

Denmark has two dependencies; Greenland and the Faeroe Islands. They are both independent in health matters – but follow the Danish
national legislation.

Denmark has a national health service funded by general taxation. There are few additional special taxes and very few private insurance
contributions involved. Dental care for adults is only partly subsidised by the government (approximately 17.5%). The amount paid by the
patients is dependent on the treatment but in general the patients pay the majority of the treatment costs.

The management of health care is highly decentralised, with the individual regions running most services and the municipalities
responsible for some public health commitments.

The Danish Health and Medicines Authority is responsible for the administration of the legislation concerning dentistry.

Year Source
% GDP spent on health 11.1% 2010 OECD
% of this spent by governm't 85.1% 2010 OECD

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Oral healthcare
Oral healthcare is provided in one of two ways. For children Dental care for elderly living in nursing homes and for mentally
under 18, all care is free of charge and is usually provided at and physically handicapped living in their own homes but
school. For adults a system of government subsidies is unable to use the normal dental care system is part of the
available through private dental practitioners for most common municipalities dental care service
types of treatment.
Free dental care may be available for adults, for example, if the
Year Source treatment needs to be carried out in a hospital.
% GDP spent on oral health 0.19% 2006 DDA
% of OH expenditure private 80% 2008 DDA Private dental care
A substantial number of Danish adults (about 30%) buy private
These are the latest figures supplied by the Danish Dental health insurance. There is a single scheme, “Health Insurance
Association (DDA) in 2013. The actual governmental spending Denmark” (Sygeforsikringen Danmark) which is a personal
on healthcare was: scheme with the premium paid by the individuals concerned.
€11,213M Cover may be obtained within one of three groups, depending
The public dental service (children 0-18): €253M on the items of care included.
Spending on adult care: €160M
About 62% of all oral healthcare spending is on private dentistry
Spending on oral healthcare represented 3.7% of the total
public healthcare spend. The Quality of Care
The regional councils monitor standards and spending of oral
Dental services for children health services. This is mainly done by auditing the treatment
figures which every dentist has to submit in order to claim public
Dental services for those aged 0 to 18 are organised by the subsidy. Any dentist who carries out particular treatments by
municipalities and is free of charge. In 2013 there were 98 more or less than 40% of the regional average has to provide
muncipalities in Denmark 91 of them employed their own an explanation.
dentists and had their own premises for examining and treating
children. The Danish Health Care Quality Assessment Programme

At the age of 16 children may change to a private practitioner The programme is a joint Danish system intended to support
with the full cost of treatment still being met by municipalities, continuous quality improvement of the Danish health care
until they are 18 years old. services as a whole. In principle, the Quality Programme
comprises all patient pathways in the health care services.
In a few rural areas, there are municipality contracts with local
private practitioners to treat the children. Within these services The programme comprises all Danish public hospitals, including
all treatment is free, including orthodontic care. their cooperation with and relations to other institutions and
sectors. The intention is that subsequent versions of the Quality
Programme will gradually be extended to include the remaining
Dental services for adults sectors of the health care services, including private health care
institutions and vendors entering into agreements with the
For adults, a system of subsidies for dental healthcare is public health care services.
operated by an agreement between the regions and the Danish
Dental Association. Under this system the patient pays a part Health data
of the fee to the dentist. The other part is claimed through the
region.
On average patients pay 82.5% of costs and the public about Year Source
17.5%. In general the subsidy is higher for preventive care and DMFT at age 12 0.60 2011 OECD
essential treatments, and lower for expensive treatments such DMFT zero at age 12 72% 2007 NBH
as oral surgery. Subsidies for the 18 to 25 year-olds are higher. Edentulous at age 65 27% 2007 OECD

The main treatments for which subsidies are paid include

examination & diagnosis, fillings, oral surgery, periodontology, Danish Health and Medicines Authority
and endodontics. For most adults, orthodontics, crowns and
bridges, and removable prosthodontics have to be paid for in “DMFT zero at age 12” refers to the number of 12 years old
full by the patient. children with a zero DMFT. “Edentulous at age 65” refers to the
numbers of over 64s with no natural teeth.
Several groups may receive extraordinary subsidies towards
their dental treatment, for example, patients with cancer and Fluoridation
Sjögren and patients with a poor economic status. There is no fluoridation scheme in Denmark. Some parts of the
country have naturally occurring fluoridated water.

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Education, Training and Registration
Undergraduate Education and Training EU qualified dentists wishing to own a practice need a
permission to practise independently, from the Danish Health
The general admission requirement to dental school is a and Medicines Authority, as mentioned above.
secondary school education. For specific admission
requirement prospective students are advised to contact the Registration
universities. Foreign applicants must be skilled in Danish.
Dentists are registered at the Danish Health and Medicines
Year of data: 2012
Authority (see more at www.sst.dk). There is no annual
Number of schools 2 registration fee.
Student intake 162
Dentists working in Denmark are s advised to hold a
Number of graduates 120
membership of the Danish Dental Association, even though this
Percentage female 76% is not mandatory. Contact info@tdl.dk.
Length of course 5 yrs Language requirements
Foreign dentists have to be skilled in Danish as all records must
be written in Danish and dentists must be able to communicate
The dental education is 100% government funded and there is with patients, relatives, hospital staff etc.
no tuition fee. Students do have to pay for books etc. The
education is a 2-cycle curriculum (3+2) with a bachelor degree Non-EU nationals may have to have an oral and written
(after the first cycle) and a master after the second. language test in Danish, conducted by the National Board of
Health, before registration.
The education is accredited by the Danish Accreditation
Institution. Continuing Education and Specialist Training
requirements
Qualification and Vocational Training
Continuing education
Primary dental qualification
Continuing education (CE) is not mandatory (by the Danish
Having completed dental education, candidates receive an Health and Medicines Authority) to retain authorisation as a
authorisation from the Danish Health and Medicines dentist.
Authority.The authorisation gives the right to work as a dentist
under supervision. However, the Danish Dental Association has a compulsory
requirement for CE to all its members. Practising dentists who
Dentists educated outside Denmark (including dentists from the are members of the DDA must complete a minimum of 25 hours
Nordic countries and the EU/EEA countries) must hold a Danish of CE annually. Within the first three years after graduation this
authorisation in order to use the title “dentist” in Denmark. is reduced to 10 hours.

As a result of international agreements, different rules govern Specialist Training requirements (Acknowledgement)
the recognition of qualifications obtained abroad, depending on
the applicant’s nationality, and where the education took place. Denmark and The Danish Health and Medicines Authority only
The Danish Health and Medicines Authority provide and recognise two types of specialists’
(Sundhedsstyrelsen) issues the certificate. Please see more on acknowledgments.
www.sst.dk
Orthodontics (Ortho) (3 years)
Diplomas from EU countries are recognised according to the Oral Maxilla Facial Surgery (OMFS) (5 years)
EU Professional Qualifications Directive.
A third speciality is planned in paediatric dentistry.
Vocational Training The requirements for applying to undertake specialist training
There is no formal post-qualification vocational training. are at least two years working experience. Trainees are paid by
the hospital (OMFS) or dental school (Ortho). There is no tuition
If a dentist wishes to own a practice or become a chief dental fee.
officer in the municipal dental care system, a permission from For a specialist’s degree in OMFS, 5 years of specialist training
the Danish Health and Medicines Authority to practise is required. The experience must be gained in departments of
independently must be obtained. To obtain this the dentist Oral Surgery, Oral Pathology and Medicine, Ear, Nose and
needs to have worked for a minimum of 12 months with a Throat, and Anaesthetics. There are no requirements for both
minimum of 1,440 hours. In that period the dentist must have DDS and MD for this degree.
treated both adult patients and children – each group for a
minimum of 360 hours. To receive this permission the dentist For specialists in Orthodontics, 3 years of specialist training is
must pay approximately €160 (in 2013) to the The Danish required. The experience must be gained within a Department
Health and Medicines Authority. of Orthodontics.

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Workforce
Dentists
There are 3 classes of dental auxiliaries, besides dental
Year of data: 2013 assistants – hygienists, technicians and clinical dental
technicians:
Total Registered 7,989
In active practice* 5,161 Dental Hygienists
Active dentist to population ratio 1,086
Dental hygienists undertake 3 years training, obtaining a non-
Percentage female 58% universital bachelor diploma. Upon qualification they are
Qualified overseas No data authorised by the Health and Medicines Authority.
* active dentists: 2010 data
They may work in practice after graduation, but they must
register to be able to own their practice, without supervision of a
The Danish Dental Association estimated that after 2013 there dentist, which is permitted in Denmark. Hygienists can
would be a slight decrease of the workforce, due to fewer undertake basic diagnostics. Hygienists are mainly found in the
dentists being educated than those dentists retiring. fields of Oral Health Promotion and Disease Prevention.
Hygienists are allowed to administer local infiltration analgesia.
Movement of dentists across borders
Dental Technicians
There is little movement of dentists in and out of Denmark.
Training for dental technicians is for up to two years at special
Specialists dental technician schools. There is theoretical and practical
training. There is no registerable qualification for dental
As written above, only orthodontics and Oral Maxilla-Facial technicians, so there is no list of registered dental technicians.
Surgery are recognised specialties in Denmark. Dental laboratory technicians work mostly in laboratories,
hospitals or dental faculties and are salaried, but some are
employed by dentists in private practice.
Year of data: 2013
All of their work may be carried out without the supervision of a
Orthodontics 290
dentist.
OMFS 98
Clinical Dental technicians

OMF surgeons and orthodontists may run their own practices Clinical dental technicians/denturists must undertake a 4-year
but most specialists in Oral Maxilla Facial Surgery work in training period in a special dental technician school and there is
hospitals. Most orthodontic specialists are employed in the some time spent in practice. They need a licence from the
Public Health System. Health and Medicines Authority to be allowed to practice
independently. They may provide full removable dentures
Usually a dental practitioner refers a patient to a specialist for without the patient being seen by a dentist. However for partial
selected treatments. Patients are also able to consult a dentures, a treatment plan from a practitioner is required, and a
specialist without a referral and have free choice both of the patient presenting any pathological changes must be referred to
dentist and specialist that they wish to visit. No formal extra fee a dentist.
is given to specialist treatment.
Dental Assistants (Nurses)
Many societies which represent special interests in dentistry
exist. The Danish Dental Association can establish contact with These may provide any kind of assistance to the dentist at the
these societies. chairside. Training is carried out either on the School for Dental
Assistants, Hygienists and Technicians, or in Technical Schools
Auxiliaries in several municipalities.

Year of data: 2008

Hygienists 800
Technicians* 1,100
Denturists/Clinical Dental Techs 565
Assistants** 4,400
Therapists 0
* estimate by DDA
** 800 Student assistants

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Practice in Denmark
Other than for reclaiming Government subsidy payments, there
Year of data: 2013
is no additional requirement to register when working in private
General (private) practice 3,431 practice. There are no standard contractual arrangements
Public dental service 1,215 prescribed, although the ethical code of the DDA provides some
University 112 guidelines. Dentists who employ staff, must comply with
minimum wages and salaries regulations, and must meet
Hospital 58
occupational health and safety regulations. Maternity benefit
Armed Forces 15 (the amount is half of normal pay) is payable four weeks before
General Practice as a proportion is 66% and 14 weeks after birth. In addition to that it is possible to get
Number of general practices 2,208 benefit from the local authorities. Once a dentist employs more
than 4 employees strict rules on occupational security apply.
Monitoring the standards of private dental practice is the
Working in Private Practice responsibility of the Society of the 5 regional bodies with the
DDA. The monitoring consists of statistical checks and official
Dentists who practice on their own, in small groups, or
procedures for dealing with patient complaints.
employed by other dentists outside hospitals or schools, and
who provide a broad range of general rather than specialist Working in the Public Dental Health Service
care are said to be in private practice.
Of the 98 municipalities in Denmark, 91 employ dentists. These
All dentists in private practice are self-employed or employed by
dentists are working in universities, the armed forces, hospitals
the owner of the practice and earn their living partly through
and public dental health services/schools. People who are
charging fees for treatments and partly by claiming government
unable to take care of their own oral health are also treated
subsidies for adult care. The government pays for all dental
within the public dental health service.
treatment of children, up to the age of eighteen. Very few (less
than 1%) dentists in private practice accept only fee-paying Dentists within the public dental health service may apart from
patients. In more rural areas where it may be uneconomic to the clinical work carry out administrative tasks.
organise a separate public dental service for children some
practitioners may be contracted by the kommune/municipality to There are no further official requirements for working as a
provide this service. dentist in the public dental health service. However,
orthodontists must be qualified in this specialty.
Once registered with the region a dentist in private practice may
generate two-column bills, one column to be paid directly by the In general within the public dental health service it is possible to
patient, the other to be claimed by the dentist from the work full or part-time as a dentist.
government. The dentist may present a bill to the patient after
each visit or after a complete course of treatment, depending on Working in Hospitals
what has been agreed. Dentists who work in hospitals are mostly specialists in oral
surgery. All dentists are the employees of the hospitals, which
Payments to dentists (Fee scales)
are owned and run by regional government. Dentists working in
hospitals will also often combine treating patients with
All payments to dentists are by way of “item of service” fees.
administrative tasks.
For preventive care and essential treatments the subsidy is
higher (around 40 %), and for expensive treatments such as Working in University
oral surgery it is lower. The main treatments for which
subsidies are paid include examination and diagnosis, fillings, Dentists working in dental faculties are employed by the
oral surgery, periodontology, and endodontics. For most adults, university. Whilst they all have teaching responsibilities, they
orthodontics, crowns and bridges, and removable may have additional responsibilities to treat patients in
prosthodontics have to be paid for in full by the patient. university clinics (Clinical teacher), or have a mixture of
Subsidies are also higher for 18 to 25 year-olds. management, research and student supervisory responsibilities
(Professor, or Assistant Professor/ Associate professor). There
The fee is defined in a departmental order, but the agreement are also external lecturers who provide teaching in specialties.
parties (Danish Regions and the DDA) typically supply the
government with recommendations. Clinical teachers usually work part-time at dental schools and
part time in practice.
Joining or establishing a practice
Although there are no official requirements, dentists at the
grade of Assistant Professor/Senior Lecturer or above will
Before dentists may establish their own practice they must gain
generally have a PhD. a Doctorate or other postgraduate
permission to practice independently from the National Board of
scientific qualifications.
Health. There are no rules which limit the size of a dental
practice and the number of associate or employed dentists or The two universities undertake epidemiological studies.
other staff. Premises may be rented or owned and there is no
state assistance for establishing a new practice. Generally Working in the Armed Forces
dentists must take out commercial loans from a bank to finance Dentists are trained to treat patients in periods of peace and
new developments. war. Furthermore dentists in the armed forces are working with
quality monitoring and educational work.

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Professional Matters
Professional associations Fitness to Practise/Disciplinary Matters

Number Year Source

There are two systems dealing with complaints. One relates to
complaints against dentists working with “the agreement of
Association of PH Dentists 1,293 2013 DCPA* adult dental care” - (Tandlægeoverenskomsten) and the other
Danish Dental Association 6,507 2013 DCPA* to all other complaints (Patientombuddet).

* The Danish Confederation of Professional Associations The complaint system under the Tandlægeoverenskomst is
managed in the regions, by committees served by regional
politicians and members of the DDA. The sanctions can vary
The Danish Dental Association (DDA) organises dentists of all from a reprimand to a recommendation to the NBH to take
categories, for example dentists in general (private) practice, away the authorisation to practise. The decisions can be
municipally employed dentists or dentist employed at brought to the Dental Appeal Comittee.
universities. Approximately 81% of all active dentists hold
membership of the DDA. The system under Tandlægeoverenskomsten also deals with
the money issue, but it is a compulsory patient insurance that
The main goals of the DDA are: gives the patients compensation when entitled.

to look out for the interests of all dentists in all aspects The Patientombuddet deals with complaints about other
of the profession dentists and auxiliaries.
to promote oral health within the Danish society
and further develop all aspects of dental care to the Protection of Data and information
Danish population
The rules for data protection follow the EU Directives.
The Association of Public Health Dentists (APHD) organises
primarily municipally employed dentists. It was founded in 1985 Advertising
and works for better pay and employment conditions and the
Association has declared health care policy goals. Advertising must be matter-of-fact, sober and adequate and it is
illegal to promote oneself or one’s practice at the expense of
Many members of the APHD are also members of the DDA others. Sponsorship is also permitted and the use of radio and
websites. However the use of live footage is not permitted.
Ethics and Regulation
It is permissible for a dentist to set up and have a website for
Ethical Code his/her practice and many dentists have one. There is a website
(www.sundhed.dk) which is owned by the public, where the
The practice of dentistry is mainly governed by an ethical code. dentists in private practice are all published – together with all
This applies to all dentists, but with slight variations between other health personnel (in private practice).
dental services. Other laws and regulations exist which relate
to negotiating the system of subsidies, monitoring the billing of Dental Patient Insurance
patients and dealing with patient complaints. These are
described where appropriate in the relevant sections. People being treated in the public or private healthcare system
are covered by the Danish Act on the Right to Complain and
The clauses of the The Code of Ethics and Professional Receive Compensation within the Health Service.
Statutes of the Danish Dental Association describe:
1. Purpose of the code Patients may be able to receive compensation for injuries
2. The position of the dentist within society caused by treatment and examinations, or by drugs. This right
3. The dentist’s relationships with the patient to compensation is not based on whether a dentist has
4. The dentist’s relationship with the public, public authorities assumed responsibility for the injury due to an error on the
etc. dentist’s part.
5. The dentist’s relationship with colleagues
6. The dentist’s relationship with his staff The Dental Patient Insurance does not consider whether an
7. The dentist’s relationship to the association and error has been made, but only whether there is an injury which
profession should be covered. The insurance is therefore a "no fault"
8. Special provisions compensation scheme.

Apart from the ethical requirement that all care should “preserve Indemnity Insurance
and improve the health of his patients” there are few restrictions Liability insurance and insurance for industrial injury for staff are
on the treatments which a dentist may provide. A dentist compulsory for all private dental practitioners. As a member of
should not however carry out any care to which the patient has The DDA, a private dental practitioner will have such
not consented, or for which the dentist does not possess the insurances, as well as legal expenses insurance and industrial
necessary specialist knowledge.
injury for owners.

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Corporate Dentistry Hazardous waste

Dentists are allowed to form companies, and non-dentists may The Hazardous Materials Act is very strict – and amalgam is on
be on the board of such a company. Non-dentists can not have the list. Only approved companies or individuals are allowed to
the majority on the Board – nor indeed comprise the whole collect amalgam. The dentist must have written documentation
Board. for their disposal and to whom. The municipality (kommune)
provides guidance.
Tooth whitening
Denmark has adopted the 2011 Cosmetics Directive. There is Amalgam separators are generally mandatory.
no record of illegal activities, and no way of knowing that for
sure. It is possible that it is happening on a small scale. Regulations for Health and Safety

Health and Safety at Work

For administered by
Workforce Inoculations, such as Hepatitis B are not compulsory Ionising radiation Radiation Institute, Danish Health
in Denmark. and Medicines Authority

Ionising Radiation Electrical installations Kommuner /Municipality

government
There are specific regulations about radiation protection and it Infection control DS2451-12 and Statens Serums
is mandatory for undergraduate dentists to take training in radio Institut
protection. Continuing education in ionising radiation is not
mandatory. Occupational Health Safety Danish Ministry of Labour,
Administration (OHSA) Arbejdstilsynet
All new x-ray equipment must be registered by the Danish Waste disposal Kommuner/Municipality
Health and Medicines Authority. government
Arrangement of working Danish Ministry of Labour,
places and staff security Arbejdstilsynet

Financial Matters
Retirement pensions and Healthcare investment returns and the rates being offered in the annuity
market.
While the government pays approximately 85% of the national
costs of healthcare, 15% comes from individuals through co- Taxes
payments for treatment. For dental care this ratio is reversed
since the national cost of caring for adults’ dental health is 20% National income tax:
government-funded, with the remaining 80% paid by patients.
Individuals are entitled to an annual personal allowanceof
Normal retirement age is 65 but dentists may practice beyond 42,900 DKK (€5,750) before income tax is payable. Most
this age. personal income is subject to AM tax of 8%. This tax is
deducted from the income before the other taxes are
National pension insurance premiums are paid at about 10% of calculated. The income tax rates are progressive and comprise
earnings (an average of approximately 8,000 DKK to 10,000 state, municipality and church taxes. The lowest tax rate is
DKK per year per employee (€1,070 to €1,340). approximately 36% up to a marginal income tax rate of 51.5%
(on incomes over about €65,000 per year).exclusive of church
Denmark’s pensions system was described by the Mercer tax.
Index, in 2013, as “the best in the world”. It consists of a public
basic pension scheme, a means-tested supplementary pension VAT/sales tax
benefit and fully funded, mandatory private schemes, run by
large funds rather than individual companies. The Index VAT is generally applied at one rate, and with few exceptions.
classified the system as the first in the world to be an A grade The current standard rate of VAT (in 2013) is 25%. That makes
and awarded it an overall index value of 82.9. The unique A Denmark one of the countries with the highest value added tax.
grade ranking was described as being “awarded in recognition A number of services have reduced VAT at 0%, for example,
of the country’s well-funded pension system, its high level of publishing newspapers and rent of premises (the lessor can,
assets and contributions, the provision of adequate benefits and though, voluntarily register as VAT payer, except for residential
a private pension system with well-developed regulations”. premises), and travel agency operations.

Final salary pensions are run by employers who contribute to a Dental treatment is excluded from VAT, as are insurance,
central pot of money and take on the risk of investing it. The financial services, postal, medical, education and passenger
payout is guaranteed, linked to salary. With defined contribution transport. . However, costs related to purchase of dental
schemes an individual invests in his own pot, with the employer equipment, instruments and materials are subject to VAT at
usually contributing, and retirement income depends on 25% and will be reflected in the prices.

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Various Financial Comparators

Copenhagen 2003 2012

Zurich = 100
Prices (including rent) 97.9 86.6
Wage levels (net) 74.8 70.5
Domestic Purchasing Power at PPP 68.3 68.1

Source: UBS August 2003 & November 2012

Other Useful Information

Main national associations and information Competent Authority:

entre:
The Danish Dental Association Danish Health and Medicines Authority
Tandlægeforeningen Axel Heides Gade 1
Amaliegade 17 DK 2300 Copenhagen S
Postboks 143 Tel: +45 72 22 74 00
DK 1004 Copenhagen K, Fax:
Tel: +45 70 25 77 11 Email: sst@sst.dk
Fax: Website: www.sst.dk
E-mail: info@tandlaegeforeningen.dk. Ministry of the Interior and Health Information
Website: www.tandlaegeforeningen.dk website:
Association of Public Health Dentists in Denmark www.sundhed.dk
Peter Bangs Vej 36.3.
DK 2000 Frederiksberg
DENMARK Publications:
Tel: +45 33 14 00 65
Fax: The Danish Dental Journal Tandlægebladet
Email: info@deoffentligetandlæger.dk or c/oThe Danish Dental Association/
info@doft.dk Tandlægeforeningen

Dental Schools:
Copenhagen Åarhus

School of Dentistry School of Dentistry

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 Tel: +45 89 42 40 00
Fax: +45 35 32 65 05 Fax: +45 86 19 60 29
Email: odont@ sund.ku.dk Email: odontologi@au.dk
Website: www.odont.ku.dk Website: www.odont.au.dk
Dentists graduating each year: 70 Dentists graduating each year: 50
Number of students: Number of students: 357

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 staff who act as Inuit interpreters also.
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. Today the system in the Faroe Islands is the same as in Denmark as a whole.

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Estonia
In the EU/EEA since 2004
Population (2013) 1,324,814
GDP PPP per capita (2012) €16,720
Currency Euro
Main language Estonian (65%)
Russian (28%)
Estonia
Healthcare is funded through general taxation, with an additional special
tax for health, which is paid by employer at 13% of salaries. Much is
also funded by patients as 96% is private.

Number of dentists: 1,615

Population to (active) dentist ratio: 1,208
Members of Estonian Dental Association: 50%

There are three specialisms – oral maxillo-facial surgery, orthodontics

and clinical dentistry. The use of auxiliaries is limited to a few hygienists.
Continuing education is not mandatory, but there is a general
requirement to keep skills updated.

Date of last revision: 30th January 2014

Government and healthcare in Estonia

The Republic of Estonia, Eesti Vabariik in Estonian, lies on the Local governments can also provide support. The source of
eastern shores of the Baltic Sea. The name Eesti is apparently income of the health insurance is 13% of the social tax or 13%
derived from the word Aisti, the name given by the ancient of the employee’s gross salary paid by the employer.
Germans to the people living northeast of Visla. Estonia is Health insurance is based on the solidarity principle: health
situated on the level north-western part of the East-European service is not dependent on the amount of social tax paid for
platform, on which there are only slight variations in elevation. the specific person. The health insurance fund pays the cost of
The average elevation is only about 50m and the highest point health services to the medical institution for the insured person.
(Suur Munamägi) is only 318m above sea level.
In Estonia all persons are entitled to receive emergency care
With the Gulf of Finland in the north, and the Baltic Sea in the regardless of having health insurance or not.
west, Estonia shares land borders with Russia to the east and
Latvia to the south. Estonia comprises an area of 45,215 sq. On 1 January 2010, three Estonian governmental health
km., making it larger than, for instance Denmark, Switzerland, authorities (i.e. the Health Protection Inspectorate, the Health
the Netherlands, Belgium and Albania in Europe. Care Board and the Chemicals Notification Centre) were united
into one joint Health Board. The Health Board is a government
The capital, Tallinn, is on the Northern shore. agency within the Ministry of Social Affairs. Its main fields of
activity are:
In 1991 Estonia gained its independence as a state. The new
Constitution of 1992 established the principles of the State, medical devices;
setting Estonia as a democratic parliamentary republic – with a healthcare;
President, Prime Minister and Cabinet and a State assembly communicable diseases and control;
known as the Riigikogu. Elections to the Riigikogu take place environmental health;
every 4 years. Local governments, separated from the central chemical safety.
power, are based on 15 counties.
Total health expenditure in 2011 was €944.6M, an increase of
Since 1989, the population in Estonia has been dropping, by 4% over 2010. Public health expenditure was 4.7% of GDP, so
21% between 1990 and 2013, due to emigration and negative private expenditure was 1.3% of GDP. In other words, about
natural growth. 80% of health expenditure was public and about 20% private.

Healthcare delivery in Estonia is provided through private Year Source

practice and a statutory health insurance system (Sick Funds). % GDP spent on health 6.0% 2011 OECD
The membership of the system is appointed by the Parliament. % of this spent by government 78.3% 2011 OECD

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Oral healthcare
of the population visit a dentist within any 2-year period. This is
Year Source
what dentists ask from patients.
% of GDP spent on oral health 0.30% 2011 Ministry
% of OH expenditure private 66% 2006 Ministry In some private clinics dentists give a guarantee for the
technicians work only if the patient visits the dentist every 6
months for two years.
“Ministry” refers to the Ministry for Social Affairs
Access to oral healthcare may be difficult for patients who live
in some urban areas, as well as all those in rural areas, as
It has not proved possible to obtain meaningful up to date salaries there are generally too low for what is almost private
figures for what percentage of the total expenditure on oral care, with the low reimbursements. Indeed, there may be
health is paid for by patients directly (ie private) and what difficulties for patients, all over Estonia, obtaining prosthetic
percentage is paid for by government (ie public). The Estonian treatment under the scheme.
Dental Association has reported that the public proportion is
reducing.
Private dental care
Public dental care As stated previously, most adult dental treatment is provided
under fully (liberal) private contract between patients and their
Almost all adult oral healthcare in Estonia is provided through dentists. There is no regulation of private fees and there are no
general (private) practice. Dental care services for adult dental insurance schemes in Estonia.
patients (over 19) are paid by patients and reimbursed by the
sick fund although emergency care (traumas, infections) is
actually paid by the sick fund, but only for those who are The Quality of Care
members of it. Patients who do not have insurance can have
only first aid. There are no routine quality checks, so the system relies on a
complaint from a patient, for monitoring purposes.
Since October 1st 2002 the Sick Funds have provided this
limited financial support for oral healthcare. Treatment is Health data
provided and is free for children under 19 years of age,
provided they visit a dentist with a contract with the Sick Fund.
Other patients do not receive reimbursement exept pensioners Year Source
– in 2013, €19 for a checkup and €255 for prosthetic work once DMFT at age 12 2.40 2012 OECD
during a 3-year period.. Orthodontic treatment is free to children DMFT zero at age 12 25% 2003 OECD
under 19 years - with severe malocclusion - with all kinds of
Edentulous at age 65 No data
appliances

Pregnant women, or nursing mothers whose child is less than “DMFT zero at age 12” refers to the number of 12 years old
one year of age, can receive reimbursement of up to €28.76. children with a zero DMFT. “Edentulous at age 65” refers to the
numbers of over 64s with no natural teeth
Oral examinations would normally be undertaken every 6 to 12
months, more frequently for patients with periodontal
conditions. There is no prior approval system for treatment. The
Fluoridation
Estonian Dental Association reports that they believe that most There are no specific community fluoridation schemes in
Estonia.

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Education, Training and Registration
Undergraduate Training country. The register is administered by the Healthcare
Board/General Dental Council, within the Commission for
To enter dental school a student has to have completed Licence (the competent authority). There is full information
secondary school (usually at the age of 18). There is an available at:
entrance examination. http://www.tervishoiuamet.ee/index.php?page=158
Language requirements
Year of data: 2013
There are no formal linguistic tests in order to register, although
Number of schools 1 dentists from outside the EU are expected to speak and
Student intake 32 understand Estonian.
Number of graduates 30
Further Postgraduate and Specialist Training
Percentage female 87%
Length of course 5 yrs Continuing education

Continuing education is not mandatory, but under Estonian

Until 2003 the student intake was higher (40). legislation there is a general requirement to keep skills updated.
Postgraduate education is delivered through the Tartu
The dental school is situated within the Faculty of Medicine in University Postgraduate Training Centre and the Estonian
the University of Tartu. It is publicly funded. The dental course Dental Association.
has been “EU-compliant” for some years, so most Estonian
graduates have been able to work elsewhere in the EU from Specialist Training
May 1st 2004.
There is training in 3 specialties:
Quality assurance for the dental school is provided by the
Ministry of Education and Social Affairs. Orthodontics
Oral Maxillofacial Surgery
Qualification and Vocational Training Clinical Dentistry

Specialists train in the University. There is no minimum of years

Primary dental qualification pre-training (working as a dentist after basic education), before
entering specialist training. Training lasts for 3 years for
The primary degree which may be included in the register is Orthodontics and Clinical Dentistry and 5 years for Oral
“DDS Dentist”. Maxillofacial Surgery. All postgraduates must pass a university
examination. The specialist education and training leads to a
Vocational Training (VT) degree, “Specialist in Orthodontics”, “Maxillofacial Surgeon” or
“Specialist in Clinical Dentistry”. Specialists in Clinical Dentistry
There is no vocational training for dentists in Estonia. undertake training in endodontics, periodontics and
prosthodontics.
Registration
Only orthodontics is recognised by the Healthcare
Board/General Dental Council and registered as a specialty, in
Cost of registration (2013) € 13 addition to Oral Maxillo-facial surgery, which officially is a
dental specialty under a law introduced in 2002. Specialists in
Restorative (Clinical) Dentistry were recognised from 2004,
To register in Estonia, a dentist must have a recognised degree and need to be registered as such.
or diploma awarded by the university, or from another EU

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Workforce
Dentists Hygienists

Year of data: 2013 In 2012, it was reported that there were 2 hygienists in Estonia,
who had been trained outside the country, and 32 who had
Total Registered 1,615 trained in Estonia. They are permitted to work under the
In active practice 1,250 supervision of a dentist.
Dentist to population ratio* 1,358
The 32 hygienists are not registered because their education is
Percentage female 87% thought to be too short and there is no such dental auxiliary
Qualified overseas 4 specified as “hygienist”. However, in 2013 work was being done
by the dental association to recommend a professional
standard for them, so that in the near future they can be
* active dentists only formally recognised.

The majority of dentists are self-employed and there is no All hygienists are salaried. The Insurance Fund does not pay
reported unemployment amongst dentists in Estonia. for their service.

Some dentists practise in more than one sphere of practice.

Dental Technicians
Movement of dentists across borders
The title is legally protected and there is a registerable
There is only small movement of overseas dentists into Estonia qualification which dental technicians must obtain before they
and little outwards. can practice. They train in the country’s special technicians’
school, for a period of 3.5 years. The register is held by the
Specialists Healthcare Board.

Specialists work mainly in private practice and patients access Their duties are to prepare dental prosthetic and orthodontic
them by referral from other dentists. appliances to the prescription of a dentist and they may not
work independently, except for the provision of repairs to
prostheses.
Year of data: 2013
Orthodontics 62 Individual technicians are normally salaried and work in
commercial laboratories which bill the dentist for work done.
Paedodontics
Clinical dentistry 19 There is no reported illegal activity.
includes Periodontics,
Dental Nurses
Prosthodontics & Endo
Oral Surgery Nurses follow 3.5 years training of Medical Nurse, and then are
Dental Public Health trained in dentistry by the dentist, with institutional support.
They receive a diploma, which they must register with the
OMFS 25
Healthcare Board.

Their duties are to assist the dentist, including the cross

Auxiliaries infection control. They are paid by salary by their employers.
The system of use of dental auxiliaries is developing in Estonia.
Dental Therapists

In earlier years it was reported that there were dental therapists

in Estonia (26 in 2008), but by 2013, none were practising.
Year of data: 2013
Hygienists 32
Technicians 137
Denturists 0
Assistants 1,540
Therapists 0

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Practice in Estonia
Working in Public Dental Service
Year of data: 2013 Public Dentistry ceased to exist from the beginning of 2004.
General (private) practice 1,200 The last dental clinic was privatised. Local government can
Public dental service partly own clinics or support them financially
University 18
Working in Hospitals
Hospital 35
Armed Forces 5 Hospitals in Estonia are all public foundations. All the hospital
General Practice as a proportion is 96% dentists are Oral maxillo-facial surgeons who work as salaried
employees. They undertake mostly surgical treatments.

Dentists who practice on their own, or as small groups, outside There are generally no restrictions on these dentists seeing
hospitals or health centres, and who provide a broad range of other patients outside the hospital, in private practice. The
general treatments are said to be in private practice. Many only quality of dental care is assured through dentists working in
work part-time in private practice. Some private dentists provide teams under the direction of experienced specialists. The
some publicly funded or assisted oral healthcare, mainly for complaints procedures are the same as those for dentists
children. working in other settings.

About 90% of private practitioners work in single dentist Working in Universities and Dental Faculties
practices.
Dentists who work in the dental school are salaried employees
Most dentists in private practice are self-employed and earn of the university. About half work part-time - they are allowed to
their living through charging fees for treatments. The patient combine their work in the faculty with part-time employment in
pays the dentist in full and some then reclaims a partial or full private practice, elsewhere.
reimbursement from the local office of the sick fund.
The senior academic title within the Estonian dental faculty is
Fee scales that of university professor, who since 2002 must be DDS.
Other titles include docents and teachers. There are no formal
Since September 1998, there has been a partnership for the requirements for postgraduate training but docents and
negotiations on fee scales between the Sick Fund Price professors will have completed a PhD, and most will also have
Commission and the Estonian Dental Association. received a specialist clinical training. To be elected to the post
of professor a dentist must have published scientific research of
Joining or establishing a practice at least 3 dissertations. Apart from these there are no other
regulations or restrictions on promotion.
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 The quality of clinical care, teaching and research in the dental
Tallinn or Tartu, where the dentist to population ratio has fallen faculty is assured through the old traditions of Tartu University
to 1:750. The opening of a practice is subject to the approval by (formed in 1632) and a Ministry of Education curriculum which
the local health department. Existing practices are also bought has been accredited by the international commission 2002,
and sold on the open market. following a DentEd visit in 2001.

Practices can be found in all types of accommodation. Within Any epidemiological studies are local – being undertaken by
practices, there is a minimum limit to the size of rooms and the enthusiastic teachers only.
facilities supplied. The state offers no assistance for
establishing a new practice, and generally dentists must take Working in the Armed Forces
out commercial loans from a bank. There are no rules relating
to the numbers of dentists or partners in the practice. There are around 5 dentists working full time for the Armed
Forces.

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Professional Matters
Professional Associations patient or the doctor/dentist may complain to the Court.

There is one professional association, the Estonian Dental Data Protection

Association (EDA) - Eesti Hambaarstide Liit.
Estonia has a Data Protection Law and all dentists who apply
Number Year Source for the permission to work, have to first have permission from
Estonian Dental Association 799 2012 FDI the Data Protection Service. The EU Directive has been
adopted by Estonia.

The Association represents private and public health dentists Advertising

and combines this role by trying to emphasise common,
professional matters. The EDA represents Estonia at Advertising is permitted, provided that it is legal, decent,
international meetings. honest and fair – and may take place in any of the mediums
such as TV, radio and the press. However, comparison of
The EDA is run by a Board, secretary and 40 (elected) council skills with another dentist is not permitted.
members. It is established to protect dentists as liberal
professionals, and represent members in negotiations with Dentists are allowed to promote their practices through
local authorities, ministries and legal bodies. It provides websites subject to the usual rules of “legal, decent, honest
members information about changes in legislation and offers and fair”, but they are required to respect the legislation on
advice to dentists on legal affairs. Together with the Society, Electronic Commerce, and the data protection law.
the EDA arranges lectures and conferences.
Insurance and professional indemnity
The ESS was first founded in 1921. Annual dental meetings
are organised by the ESS. Estonian dentists have a “Responsibility Insurance”, but this is
voluntary.
There is also an Estonian Dentistry Students Association.
Corporate Dentistry
Ethics and Regulation
Dentists are allowed to form “limited companies” and non-
dentists may be part or full owners of such companies.
Ethical Code
Tooth whitening
Dentists are subject to an ethical code which is based on the
Council of European Dentists’ Ethical Code.
Tooth whitening comes under Cosmetic legislation if the
hydrogen peroxide is up to 5.5%..Only dentists may use this on
Supervision of this is by the Estonian Dental Association.
patients. In 2013 there was some illegal practice but the Health
However, the Ethical Code is not mandatory, it is only
Board was focussed on stopping this.
recommended, so dentists may receive only a written warning,
on non-compliance, or removal as a member of the
Association. Health and Safety at Work
Fitness to Practise/Disciplinary Matters Hepatitis B vaccinations for dentists and their staff are not
mandatory, and the practice owner must pay for any voluntary
If this is unsatisfactory for patients then they may make a claim inoculations undertaken.
to the Consumer Protection Bureau. For disciplinary purposes a
complaint by a patient is investigated by a “Treatment Quality Ionising Radiation
Commission”, which is appointed by the Ministry of Social
Affairs, Health Department’s Supervision Department. Patients There are specific regulations relating to radio protection.
may also write an application to the Consumer Protection Training is mandatory for undergraduate dentists and then they
Service, but they send their complaint to the Health become the competent person to direct radiation. They must
Department’s Supervision Department first. undertake continuing education every five years.

In the Treatment Quality Commission there is one dentist, who The Radiation Protection Centre registers and controls radiation
is appointed by the Ministry of Social Affairs Health equipment.
Department, as a dental councillor. A patient will be examined,
if it is necessary, by a commission appointed by the dental Hazardous waste
councillor. If it is reported to the Treatment Quality Commission
that quality is below standard, then they may call to order the Amalgam separators are not required by law, although they are
dentist and demand that he undertakes and passes courses, or advised.
they may suspend temporarily the 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

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Regulations for Health and Safety

For Administered by
Ionising radiation Radiation Protection Centre
Electrical installations Health Protection Bureau
Infection control Health Protection Bureau
Medical devices Heath Protection Service
Waste disposal Health Protection Bureau

Financial Matters
Retirement pensions and healthcare Taxes
National income tax:
State pensions are financed by a social tax paid by all
employers on behalf of their employees and by the self- The rate of income tax is a flat rate of 21% (2013).
employed. The rate of social tax is 33% of the gross payroll.
The share of social tax allocated for pensions is 20% of the VAT/sales tax
gross payroll (13% is allocated for health insurance). The state
pension is based on the principle of redistribution, ie the social The standard VAT rate is 20%. A reduced rate of 9% is
tax paid by today’s employees covers the pensions of today’s available on such items as books, newspapers, medicines and
pensioners. accommodation. Medical and dental services are not included
in VAT.
Men have the right to old age pension at the age of 63 and
women at the age of 60.5. The pension age for men and Various Financial Comparators
women will be equal by 2016 with the women's qualifying age
gradually rising to 63. People working after reaching the
pension age are entitled to a full pension, regardless of their Tallin 2003 2012
work income. The pension can be up to €336 a month. Liberal Zurich = 100
dental practitioners may work until any age. Prices (including rent) 46.1 48.9
There are two supplementary schemes. To encourage Wage levels (net) 11.9 21.4
participation in the supplementary pension schemes, there are Domestic Purchasing Power at PPP 15.6 37.0
tax incentives.

Source: UBS August 2003 & November 2012

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Other Useful Information

Dental associations and information centres:

Estonian Dental Association: Estonian Dentistry Students
1) Narva mnt 5-76 Association
10117 Tallinn Raekoja plats 6
ESTONIA 50013 Tartu
Tel: +372 64 59 001 ESTONIA
Fax: +372 64 59 001
Office:
2) Lille 12-5 Nooruse 7-901
51003 Tartu 50408 Tartu
ESTONIA ESTONIA
Tel: +372 7319 855 Tel: +372 7 381 241
Fax: +372 7428 608 Fax:
Email: info@ehyl.ee
Email: tallinn@ehl.ee Website: www.ehyl.ee
Website: www.ehl.ee
Competent authorities: Tartu Dental school:
Health Board The General Dental Council
Gonsiori 29 29 Gonsiori Str, The Dean
Tallinn 15157 Tallinn 15157 Prof.Mare Saag
Estonia Estonia Clinic of Stomatology,
Tel: +372 650 9840 Tel: +372 6509840 Tartu University
Fax: +372 650 9844 Fax: +372 6509844 Raekoja Platz 6
Email: info@terviseamet.ee Email: info@tervisemet.ee 51003 Tartu
Website: www.terviseamet.ee Website: www.terviseamet.ee ESTONIA
Tel: +372 7319 855
Fax: +372 7428 608
Email: mare.saag@kliinikum.ee
Website: http://www.med.ut.ee/stom

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Finland
In the EU/EEA since 1995
Population (2013) 5,434,357
GDP PPP per capita (2012) €27,544
Currency Euro
Main language Finnish 95%
Swedish 5%

Healthcare is funded largely through general taxation, with an additional

special tax for health which is paid by everyone including those who
have retired.

Number of dentists: 5,925

Population to (active) dentist ratio: 1,208
Members of Finnish Dental Association: 98%

The use of dental specialists and the development of dental auxiliaries

are both well advanced.
Continuing education for dentists is not mandatory.

Date of last revision: 31st January 2014

Government and healthcare in Finland

Finland is a Nordic country. 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).
Finland was a province and then a grand duchy under Sweden from the 12th to the 19th centuries, and an autonomous grand duchy of
Russia after 1809. It won its complete independence in 1917.
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 2013 there were 19 ministers in the Cabinet.
Regional government is organised through 6 provinces, and 320 municipalities.
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.
For more information please consult http://www.stm.fi/c/document_library/get_file?folderId=6511570&name=DLFE-26813.pdf

Year Source
% GDP spent on health 8.8% 2011 OECD
% of this spent by governm't 74.8% 2011 OECD

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Oral healthcare
A comprehensive survey of oral health in adults was conducted with the Cross-border Health Directive, the Ministry will publish
as part of a nationwide study of health status in Finns in year information in 2014 about what care will be reimbursed from
2000. Over 6,000 persons took part in the study, which included other Member States.
clinical and radiological oral examination. The results are
published by the National Public Health Institute in pdf-form: Private Care
http://www.terveys2000.fi/julkaisut/oral_health.pdf Private care is available to Finnish residents, but as of 2013
there were no private insurance schemes offering to finance
this.
New results from year 2011 will be published in due course, see
http://www.thl.fi/en_US/web/en The Quality of Care
The responsibility for planning oral healthcare lies with the Although the state authorities provide recommendations for
Ministry of Social Affairs and Health, but the actual service is dentists, for example for filling materials and practice hygiene,
usually provided by municipalities. The government social the standards of dental care are not actively monitored in
insurance agency (the Kansaneläkelaitos or KELA), also private practice in Finland. The only routine system is random
provides some assistance in paying for healthcare, again under checks on billing by the KELA. They assess the average cost
the strategic direction of the Ministry. The agency is self- per patient and ensure that the calculated bill reflects the
regulating, under the supervision of the Finnish parliament and amount of work done. Care provided in health centres is
has its own budget. However if the KELA has a budget deficit subject to quality assurance.
the government is obliged by law to make up the total spent,
Patient complaints are generally managed by the National
Year Source Supervisory Authority for Welfare and Health or the Consumer
Complaints Board, supplemented by a patient ombudsman
% GDP spent on oral health 0.40% 2007 CECDO
system. Also, since the Patient Injury Act in 1987 there has
% of OH expenditure private 60% 2007 CECDO been a Patient Insurance Centre which may indemnify injuries
which occur during treatment. Liability insurance is, however,
from taxation. included in the membership fee of the Finnish Dental
Association. In addition, X-rays are actively monitored by the
About three quarters of the population receive oral healthcare authorities.
regularly (in any two-year period) and oral examinations would
normally be undertaken every 1-2 years. Health Data
The dental services are delivered either through the system of
public health centres, or by private dentists, denturists and
Year Source
dental laboratories. About 36% of dental care is state-funded
(half by the municipalities, half by central government) and 56% DMFT at age 12 0.70 2009 WHO
is paid for directly by households. 7% of the balance is paid by DMFT zero at age 12 42% 2007 CECDO
KELA and 1% by employers. Edentulous at age 65 40% 2007 CECDO
Municipalities must organise their health care so that patients
will receive an assessment of their need for non-emergency “DMFT zero at age 12” refers to the number of 12 years old
treatment from a health care professional – not necessarily a children with a zero DMFT. “Edentulous at age 65” refers to the
doctor – within three days, while the necessary treatment must numbers of over 64s with no natural teeth
be provided within 3 to 6 months. However, emergency
treatment must be provided immediately. Fluoridation
The legislation also applies to dental care where treatment must
at least be initiated within 6 months of the treatment There are no fluoridation schemes in Finland.
assessment. The Ministry has also published definitions for the
necessary treatments in various sectors of dental care – ie
those included in the guaranteed access system. In connection

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Education, Training and Registration
Undergraduate Training Language Requirements
To enter dental school a student has to have completed There are no formal linguistic tests in order to register for EU
secondary school (usually at the age of 18). There is an graduates, although dentists are expected to speak and
entrance examination, which is similar to that of medical understand Finnish (or Swedish in certain areas).
students. The undergraduate course lasts for 5.5 years.
However, an employer can require that the dentist speaks
There are four dental schools: the University of Eastern Finland, Finnish and/or Swedish.
University of Helsinki, University of Oulu and University of Dentists from outside the EU have to prove (by examination)
Turku. Dental schools are part of the Colleges of Medicine. that they are proficient in either the Finnish or Swedish
languages.
Year of data: 2013 Further Postgraduate and Specialist Training
Number of schools 4
Student intake 186 Continuing education
Number of graduates 100
Continuing education is not mandatory (except in radiation
Percentage female 68% protection), but under Finnish legislation there is a general
Length of course 5.5 yrs requirement to keep skills updated. Continuing education is
delivered mostly through the Finnish Dental Society Apollonia.

Specialist Training
Quality assurance for the dental schools is provided by the
Ministry of Education. Specialists are trained in Universities; also, in health centres
and hospitals which have contracts with the universities.
Qualification and Vocational Training
Primary dental qualification There is a minimum of 2 years pre-training (working as a dentist
after basic education), before entering specialist training.
The primary degree which may be included in the register is: Training lasts for 3 years (Oral and Maxillofacial Surgery, 6
years) and includes a university examination. Specialist
Licentiate in Odontology (hammaslääketieteen lisensiaatti)
education led also to a degree, eg specialist in orthodontics.
(HLL).
However, from 2014, a university degree is no longer awarded
for medical and dental post-graduate studies.
Vocational Training (VT)

From 2014, a vocational training period of six months is part of Oral Surgery was combined in 1999 with Oral maxillo-facial
the undergraduate training, which will be extended to 5.5 years. surgery, as a medical specialty. There are about 100 post-
The vocational training will be done in salaried positions, in graduate positions in the country, so there is a limit to how
community health centres, with a monthly salary of many can train. Trainees are paid approximately €44,000 a
approximately €3,000. year (2013).

Diplomas from other EU countries are recognised without the There is training in 5 main specialties:
need for vocational training. Orthodontics
Dental Public Health
Registration Oral Maxillo-Facial Surgery
Clinical Dentistry
To register in Finland, a dentist must have a recognised degree Oral Diagnostics
or diploma awarded by the universities. The register is
administered by National Authority for Medicolegal Affairs (the Clinical Dentistry is a specialty with 4 subgroups. These are:
competent authority).
cariology
A “decision” fee on licensing for Finnish qualified dentists periodontology
is €100 (2013). Where a dentist’s qualification was in
prosthodontics
another EU/EEA country this is €400.
paedodontics
For those from outside the EU/EEA this is €600. For these
dentists the education of the applicant will be evaluated by Oral Diagnostics is a specialty with 3 subgroups. These are:
a Finnish university (usually the dental school in the
University of Turku) and there are usually clinical and oral radiology
theoretical tests, paid for by the applicant. oral pathology
There is no annual re-registration fee. microbiology

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The titles obtained by specialists in orthodontics and oral Erikoishammaslääkärin tutkinto, suu ja leukakirurgia
surgery, the two specialties recognised by the EU, in Finnish / Specialtandläkarexamen, oral och maxillofacial
and Swedish are: kirurgi

Erikoishammaslääkärin tutkinto, hampaiston (Certificate of completion of specialist training in oral

oikomishoito / Specialtandläkarexamen, surgery)
tandreglering

(Certificate of ompletion of specialist training in

orthodontics)

Workforce

Dentists
The annual intake of dental students has been increased since
2003 and also more dentists from outside Finland have been
Year of data: 2013 licensed. According to the workforce prognostics the number of
Total Registered 5,925 working age dentists will remain quite stable until the 10 years
from then. There were sufficient numbers of dentists in 2013 to
In active practice (estimated) 4,500
service the population with oral healthcare - the problem is an
Dentist to population ratio* 1,208 unequal geographical distribution of them.
Percentage female 69% Again in 2013, there was some small reported unemployment
Qualified overseas 200 amongst dentists - about 20-30 dentists, 0.5%. Unemployment
benefits for salaried dentists are described by the FDA as
“being good”.
* active dentists only
Movement of dentists across borders
The register does not distinguish between working or retired
persons. About 80% of the foreign dentists working in Finland qualified in
the EU/EEA and 20% outside the EU/EEA.
Of the 4,500 working-age dentists described as “active” the In 2013, about 160 Finnish qualified dentists were working
FDA estimates that 180 were not actually working in 2013. abroad.
Many dentists practice in more than one sphere of practice.

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Specialists Dental hygienists work usually as part of the dental team,
although they can work independently. The examination,
There are 5 dental specialities that are recognised under the diagnosis and treatment planning is, by Health Care
National Supervisory Authority for Welfare and Health: Professionals Act of 1994, restricted to physicians and dentists.
Orthodontics However, dental hygienists can undertake “health checks”. This
Oral Maxillo-Facial Surgery is described by the FDA as a “grey area”. Treatment planning
Dental Public Health can cover a two years’ time span and the hygienist works then
Clinical Dentistry under the directions given by the dentist. In KELA, the
Oral Diagnostics organisation subsidies the dentist´s examination and for referral
it is a prerequisite that the patient gets a reimbursement from
Patients can normally consult a private specialist without the hygienist doing the work.
referral, but in public care other routines may be necessary.
Hygienists may undertake infiltration local anaesthesia. They
In the following table, the specialty of “Clinical Dentistry” has not take legal responsibility for their work and may accept payment
been broken down into the known sub-specialties from patients, if they have a practice of their own. However, this
is very rare – in 2013 only about 20 hygienists operated this
Year of data: 2013 way
Orthodontists 156
Otherwise, they are normally salaried.
Clinical Dentistry 291
OMFS 104 Dental Technicians
Dental Public Health 90
The title is legally protected and there is a registerable
Oral Diagnostics 31 qualification which dental technicians must obtain before they
can practice. Like hygienists, there is an entrance examination
into a polytechnic, where they undertake 3.5 years education
Auxiliaries and training. A register is held by the National Supervisory
Authority for Welfare and Health. Their duties are to prepare
The system of use of dental auxiliaries is well developed in dental prosthetic and orthodontic appliances to the prescription
Finland and much oral health care is carried out by them. In of a dentist and they may not work independently.
Finland, apart from chairside dental surgery assistants, there
are three types of clinical dental auxiliary: Individual technicians are normally salaried and work in
commercial laboratories which bill the dentist for work done.
Dental hygienists
Dental technicians Denturists
Denturists
In Finland, denturists are operating auxiliaries who can provide
Year of data: 2013 complete dentures to the public. There is a qualification and the
Hygienists 1,490 register is held by the National Supervisory Authority for
Technicians 450 Welfare and Health.

Denturists 400 They train in the same school as hygienists/technicians, and

Assistants 4,800 there is an entrance examination. Their training lasts an
Therapists 0 additional half-year (the person must be a dental technician
first).
Other 0
They work mostly in their own private practices. Whilst they do
receive referrals from dentists, generally their patients come
All data estimated by the FDA directly from street. Whilst they cannot provide partial dentures
it is reported that they do so, illegally. There is control of their
Dental Hygienists ethics and practices by the authorities, as with dentists, but their
fees are not regulated. Their average earnings are thought to
The title is legally protected and there is a registerable be less than dentists.
qualification which dental hygienists must obtain before they
can practice. There is an entrance examination into a Dental Chairside Assistants
polytechnic, where they undertake 3.5 years education and
training, which includes basic professional studies and studies Assistants follow 2.5 years training under the authority of the
to boost occupational skills. The register is held by the National dentist and with institutional support. They receive a diploma,
Supervisory Authority for Welfare and Health. which they need to register. Registration is by the National
Supervisory Authority for Welfare and Health and they are paid
by salary by their employers.

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Practice in Finland
Oral health services are provided in both the public and private required for any treatment under any of the schemes for
sectors with about half of dentists in each sector. receiving free care or a subsidy.

Year of data: 2013 Joining or establishing a practice

General (private) practice 1,994
There are no rules which limit the size of a dental practice or
Public dental service 2,165 the number of associate dentists or other staff working there.
University 86 However, private group practices are supervised by the
provincial government. Apart from this there are no standard
Hospital 113
contractual arrangements prescribed for dental practitioners
Student Health Service 72 working in the same practice. Premises may be rented or
Other settings 70 owned and are normally in houses, flats or business premises -
not usually in shops or purpose-built clinics. The state offers no
General Practice as a proportion is 44%
assistance for establishing a new practice, and generally
dentists must take out commercial loans from a bank. When
starting a new practice private dentists have to inform the local
Working in General Practice health authorities.

Dentists who practice on their own or as small groups, outside The premises for the surgery are usually rented, but the
hospitals or health centres, and who provide a broad range of equipment is usually owned by a single practitioner or by the
general treatments are said to be in private practice. In 2011, (small) company owned by the working dentists. The auxiliaries
dentists who worked in this way, provided approximately 50% of are usually employees for this company but the dentists can be
the care for the adult population. In 2013, about 30% of private either employees or (more frequently) working as independent
practitioners worked in single dentist practices. dentists.

Despite the emergence of companies, most dentists in private Working in the Public Dental Service
practice remian self-employed and earn their living through
charging fees for treatments. The patient pays the dentist in full Public services are provided mainly in health centres organised
and and all citzens are entitled to reclaim partial reimbursement by municipalities singly or collectively. Dental services are part
from the local office of the KELA. However, usually now the of other local health services. A local chief dental officer is
reimbursement is taken into account when paying the dentist´s responsible for arrangements, together with other local
bill, so called “immediate-reimbursement”. For example: authorities.
The dentist´s fee is €100, KELA´s subsidy is €35, the patient The main principle is that municipalities are - in general -
thus pays €65 to the dentist, and the dentist claims the responsible for the health services for people in need, but also
remaining €35 from KELA after treatment. the Ministry of Social Affairs ensures that municipalities act
within the law.
http://www.kela.fi/web/en/reimbursements-of-the-costs-of-
private-medical-treatment gives further information. Municipalities obtain their funding for these services from the
central government, but most of the financing must come from
Fee scales their own internal funds, through taxes. Patients also pay quite
a large co-payment. Despite these fees the charges are about
The compensation from the public health insurance (KELA) is half of what patients pay in private sector. Treatment is free of
30-35% of the fees charged by private dentists. A private charge to people under 18 years of age.
practitioner is free to decide the price for treatment (fee-for-
service) but the compensation is calculated from KELA’s price The procedure for handling of complaints is the same as in the
list. private sector - however, the Consumer Complaints Board is
only for the private sector.
Treatments which do not attract a government subsidy include In single municipalities, there are different types of procedures
fixed and removable prosthetics and most orthodontics or for monitoring quality, but there is no national quality system in
dental laboratory costs. Orthognatic surgery cases are normally public health sector.
covered – a prerequisite is a statement from orthodontist and
oral surgeon. War-veterans have some better benefits, like their A dentist working in a health centre can get a higher position
prosthodontic care being included in the scheme (as a partial usually through specialist training or by being chosen for the
reimbursement). position of a local chief dental officer.

The Finnish Dental Association is not allowed - due to The provision of domiciliary (home) care is not very common in
competition law - to make any recommendations for fees and Finland, and is usually provided by public health dentists.
prices are set by the market. However, the majority of dentists Salaries of dentists employed in public health clinics are
stay within a 15-30% range. Prior approval for treatment is not approximately 20% lower than those of private practitioners.

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Working in Hospitals The main academic title within a Finnish dental faculty is that of
university professor. Other titles include teachers and
Dentists work in hospitals as salaried employees of the local assistants. There are no formal requirements for postgraduate
municipality (or a federation of municipalities), or one of the training but senior teachers and professors will have completed
small number of private hospitals. They undertake mostly a PhD, and most will also have received a specialist clinical
surgical treatments, but also other demanding treatments and training. Apart from these there are no other regulations or
“normal” treatment to hospital patients. restrictions on promotion.

There are generally no restrictions on these dentists seeing The quality of clinical care, teaching and research in dental
other patients outside the hospital. The quality of dental care is faculties is assured through dentists working in teams under the
assured through dentists working in teams under the direction direction of experienced teaching and academic staff. The
of experienced specialists. The complaints procedures are the complaints procedures are the same as those for dentists
same as those for dentists working in other settings working in other settings.

Working in Universities and Dental Faculties Working in other settings

A small number of dentists work in the Student Health Service
Dentists working in dental schools are salaried employees of (YTHS), and for companies which hire a dental workforce. The
the university. They are allowed to combine their work in the Armed Forces, public administration and associations are also
faculty with part-time employment or private practice elsewhere. employers of a few dozen dentists.

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Professional Matters
Professional associations consumer with information on his or her position, consumer
goods, their quality and marketing. Municipal consumer advice
There is a single main national association, the Finnish Dental is provided free of charge.
Association. The Association represents private and public
health dentists and combines this role by trying to emphasise to Data Protection
common, professional matters. In 1993, a law on patients’ rights came into force. The law
concerns patients' right to information, the right to see any
Number Year Source
medical documents concerning them and the right to autonomy.
Finnish Dental Association 4,240 2013 FDI A medical ombudsman was also introduced by the law.
However, the ombudsman’s role to the patient is advisory
The Finnish Dental Association looks after the professional, only.
economic and social interests of its members. The Association
operates as a link between dentists working in various Advertising
professional fields and aims to maintain strong professional
cohesion. Advertising is permitted, subject to national legislation and a
The Association promotes treatment of oral and dental diseases professional code of ethics. Dentists are permitted to use the
in Finland and sponsors oral healthcare. The Association post, press or telephone directories, without obtaining prior
pursues sound oral health care and availability of high-quality approval.
services across the country.
Dentists are allowed to promote their practices through
The association´s highest policy body is a 40-member websites but they are required to respect the legislation on Data
representative body. The Board consists of 11 members and is Protection and Electronic Commerce.
led by the President of the Association. In the office in 2013
there were 20 people working, led by the Executive Director. Insurance and professional indemnity
About 95% of active dentists were members.
Under the Patient Injuries Act 1987 (amended in May 1999), the
Ethics aim was to withdraw from fault liability as a prerequisite for
compensation, ie “no-fault insurance”. Patient insurance is
Ethical Code therefore compulsory for doctors and dentists, and the Finnish
Dental Association provides an optional scheme for those
Dentists are subject to the same ethical code as their medical members who work in private practice. The scheme provides
colleagues. For example, they must only use proven cover for all patient injuries caused during dental care. Within
techniques and must constantly update their clinical skills. this cover negligence is not a prerequisite for compensation -
There is also a special law to protect patients’ rights, consent no proof of malpractice is needed and compensation is
and confidentiality. The Finnish Dental Association has its own provided for financial losses over €200 (thus excluding
ethical code. insignificant injuries).

There are no specific contractual requirements for dentists The insurance only covers bodily injuries which are likely to
working in the same practice. A dentist’s employees however have resulted from treatment, so 100% certainty is not
are protected by the national and European laws on equal necessary. However, the law does not mean that all injuries that
employment opportunities, maternity benefits, occupational occurred in connection with medical and dental treatment are
health, minimum vacations and health and safety. compensated for. In other words, certain consequences that
patients might suffer were left outside of the scope of this
Fitness to Practise/Disciplinary Matters insurance.

Supervision of the practice of the medical and dental When considering whether a consequence could have been
professions is by the National Supervisory Authority for Welfare avoided, the evaluation is based on the standard of an
and Health, with about 15 complaints being made against experienced medical professional and top specialist skills are
dentists each year. Another avenue for complaint can be the not presumed.
provincial government. There is also a Consumer Complaints
Board, which is only for private practitioners. This receives Compensation is paid for bodily injuries which are likely to result
about 30 complaints against dentists a year. from treatment injury, a defect in the equipment, an infection
which originated from treatment (in certain cases), an accident
The consequences of a complaint which is upheld can be a which is connected with an examination or treatment, wrongful
written warning, a reminder of duty to exercise proper care, an delivery of pharmaceuticals or other unreasonable injury.
admonition or even a restriction on the right to practice
dentistry. The compensation covers medical and dental treatment
expenses, other necessary expenses caused by the injury, loss
There are also local consumer Ombudsmen. When a problem of income, pain and suffering, permanent functional defect and
arises, a consumer can get in touch with the consumer advisor permanent cosmetic injuries.
in his or her own municipality. The advisor will provide the

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Claims for compensation have to be presented to the Patient Health and Safety at Work
Insurance Centre within three years of the date at which patient
has learned or should have known about the injury. There is legislation in the field of employee protection. HepB
Notwithstanding this, compensation has to be claimed not later vaccination is not mandatory, however most dentists and dental
than ten years from the event that led to injury. nurses have had it administered.
In 2012 the Patient Insurance Centre received 675 claims from
Regulations for Health and Safety
dental patients, 60% from private sector and 40% from public
sector. More than a third of these patients obtained
compensation. Most common dental injuries were root canal For Administered by
perforations, during root canal treatment, or nerve injuries
connected to teeth extractions. Mean compensation in the Ionising radiation Government owned company
private sector was approximately € 3,300. Electrical Government owned company
installations
Fees for the insurance do not vary according to the type of Infection control The National Institute for
treatments undertaken by dentists. In 2014, a general dental Health and Welfare
practitioner would pay €525 annually for this. Failure to insure
Medical devices National Supervisory Authority
by a dentist leads to an eventual increased insurance premium.
for Health and Welfare
The premium covers a dentist’s work in Finland only, and not Waste disposal Local municipality government
for work undertaken overseas.

Corporate Dentistry Ionising Radiation

Training in radiation protection is part of initial dental training
PlusTerveys is built only for dentists and physicians, but other and further training is mandatory – 40 hours every 5 years. A
companies can vary and non-dentists may own or part own dentist may take radiographs or can delegate this task to a
these companies and share in any profits; this is not being trained dental nurse.
regulated. Oral Hammaslääkärit Plc is a company for dental
care services, which is listed on the NASDAQ OMX Helsinki. Hazardous Waste
There are other companies as well.
The EU Hazardous Waste Directive 91/689 was incorporated
Tooth Whitening into Finnish laws in 1993. Amalgam separators have been
legally required since 1997.
In Finland, Council Directive 2011/84/EU on tooth whitening
products has been implemented into legislation. However,
national competent authorities have considered tooth whitening
products also as medical devices and the legal situation is
unclear in 2014.

Financial Matters
Retirement pensions and Healthcare
In addition, there is a social security charge called 'the health
insurance contribution of the insured' paid by individuals (2%).
The national insurance premiums (5,2% of earnings) include a
contribution to the national pension scheme. Retirement
VAT/sales tax
pensions in Finland are typically 60% of a person’s salary on
retirement.
There are 3 levels of value added tax, at the following rates
(from January 2013):
The official retirement age in Finland is 63 to 68, although the
average age of retirement was 60.5 in 2013. Dentists practice,
 standard rate (24%),
on average, to a little over 60 years, although they can practice
past this age.  reduced rate (14%): This reduced rate is for the supply of
foodstuffs, animal feed and restaurant and catering
Most of general health care is paid directly through income tax. services
 lowest rate (10%): This rate is for the supply of books,
Taxes pharmaceutical products, and a number of other items.
National income tax:
Medical and dental services are not subject to VAT. Cosmetic
Income tax on earned income is paid to the local town or city procedures, such as cosmetic surgery, are subjected to VAT
(15% to 20%), paid to the church (1% to 2% - although tax from 2014.
voluntary) and is paid to the State on a progressive scale of
6.5% to 31.75% for incomes over €100,000.

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Various Financial Comparators (Source: UBS August 2003 & November 2012)

Helsinki 2003 2012

Zurich = 100
Prices (including rent) 84.5 80.3
Wage levels (net) 56.6 56.0
Domestic Purchasing Power at PPP 61.5 64.0

Other Useful Information

Main national associations and Information Centre:

Suomen Hammaslääkäriliitto Specialist associations and societies: National Institute for Health and Welfare (THL)
(Finnish Dental Association) Dentists’ scientific organisation: P.O. Box 30, 00271 Helsinki, Finland
Fabianinkatu 9 B Finnish Dental Society Apollonia Tel. +358 29 524 6000
00130 Helsinki, FINLAND Bulevardi 30 B E-mail: info@thl.fi
Tel: +358 9 622 0250 00120 Helsinki, FINLAND Website: www.thl.fi
Fax: +358 9 622 3050 Tel: +358 9 680 3120
Email: toimisto@hammaslaakariliitto.fi Fax: +358 9 646 263
Website: www.hammaslaakariliitto.fi E-mail: toimisto@apollonia.fi
Website: www.apollonia.fi
Competent Authority: Publications:
National Authority for Medicolegal Affairs The Finnish Dental Journal
PO Box 265 (Suomen Hammaslääkärilehti-Finlands
00531 Helsinki Tandläkartidning- Finnish Dental Journal)
Finland Fabianinkatu 9 B,
Tel: +358 295 209 111 00130 Helsinki, FINLAND
Fax: +358 295 209 700 Email: toimisto@hammaslaakariliitto.fi
Email: kirjaamo@valvira.fi Homepage: www.hammaslaakarilehti.fi
Website: http://www.valvira.fi/en/

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: juha.varrela@utu.fi
E-mail: hanna.thoren@helsinki.fi Website: www.med.utu.fi/dent/en/
Website: www.helsinki.fi/hammas/eng/index.html Dentists graduating each year: 25
Dentists graduating each year: 35 Number of students: 100
Number of students: 200
Oulu Kuopio
University of Oulu University of Eastern Finland
Department of Dentistry Institute of Dentistry
Aapistie 3 Kuopio campus
90220 Oulu, Finland P.O.Box 1627
Tel: +358 8 537 5011 FI-70211 KUOPIO
Fax: +358 8 537 5560 Tel: +358 290 4450 1111
E-mail: pertti.pirttiniemi@oulu.fi E-mail: jari.kellokoski@uef.fi
Website: www.oulu.fi/hammaslaaketiede/ Website: www.uef.fi/en/hammas/etusivu

Dentists graduating each year: 35 The school was reopened in 2010

Number of students: 220

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France

In the EU/EEA since 1957

Population (2013) 65,657,000
GDP PPP per capita (2012) €27,177
Currency Euro
Main language French

T he social insurance system is established by law and is divided into

3 major branches, the Sickness Funds, Pensions and Family.
France T hese are managed independently of the state. Most oral healthcare
is provided by ‘liberal practitioners’ according to an agreement called the
Convention. Almost all dentists practise within the Convention.

Number of dentists: 41,505

Population to (active) dentist ratio: 1,582
Members of CNSD: 36%
Members of ADF 65%

T he use of recognised specialists was limited to orthodontics but since

2011 oral surgery and oral medicine has been recognised. T here are no
clinical dental auxiliaries.
Continuing education has been mandatory since 2004.
Date of last revision: 26th January 2015

Government and healthcare in France

France is a democratic republic with a President, elected by The government prepares every year - in Autumn - a bill (projet
universal suffrage. There is a bicameral Parliament or de loi de financement de la sécurité sociale) and submits it to
Parlement, which consists of the Senate or Sénat (348 seats - the Parliament. The Parliament discusses and votes the text,
members are indirectly elected by an electoral college to serve including the new annual budgets of the sickness funds. Then
nine-year terms; elected by thirds every three years) and the the Caisse controls the application of the bill.
National Assembly or Assemblée Nationale (577 seats -
Within the Assurance Maladie there are three major Caisses:
members are elected by popular vote under a single-member
the CNAMTS (Caisse Nationale d’Assurance Maladie des
majoritarian system to serve five-year terms). There is a third
Travailleurs Salariés), which covers salaried workers and their
chamber, le Conseil Economique, Social et Environnemental,
dependants (82% of the total population); the RSI (Régime
the Economic, Social and Environmental Council, with an
social des Indépendants), for independent professionals; and
advisory function, composed of representatives of the
the MSA (Mutualité Sociale Agricole) for agricultural workers.
associations and the professional world.
The Assurance Maladie itself is funded by personal
Although the organisation of government is centralised, two contributions and income tax.
political and administrative structures exist below the national All citizens have an equal and constitutional right to receive
level where there are 22 regions and 101 departments healthcare, and the system is organised in the same way
(including 5 overseas: French Guyana, Martinique, throughout the country. Every individual is automatically
Guadeloupe, Reunion, Mayotte). Most French institutions affiliated to one of the three caisses according to their economic
exhibit strong liberal traditions and this is mainly reflected in the status. This obligatory insurance gives them the right to be
medical and dental professions. totally or partially reimbursed for their health expenses for
themselves and their dependants.
The Overseas Territories, (Polynésie Française, Wallis-et-
Futuna, Terres Australes et Antarctiques Françaises) are fully
part of the French Republic. However, territorial governments Year Source
are totally independent in the field of health. % GDP spent on health 11.6% 2011 OECD
% of this spent by governm't 77.0% 2010 OECD
The social insurance system was established by law in 1945
and is divided into three major branches, the Sickness Funds
(Assurance Maladie), Pension (Retraite) and Family Generally, hospital expenses, as well as primary care costs, are
(Allocations Familiales). Each of these is managed by Councils partially or totally paid by securité sociale and complemented
which are independent of the state. The councils are made up by additional individual insurance (private).
of representatives of the employers and employees who
finance the systems. The Caisse d’Assurance Maladie of the In 2011, the part of Social Security (sickness funds) in the
sickness branch, is administered by a board with an elected funding of the “consumption of medical care and goods” was
president and a government-appointed director. Social security 75.5%. Hospital expenses represent more than half of the
is a “private law association”, under the control of the state. expenses of Social security and ambulatory care represent
The social insurance system was changed in 2004, as a result 21.1%.
of the last health reform, and functions in the following way.

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Oral healthcare
Public compulsory health insurance complementary insurances cover all or part of the fees not
covered by mandatory insurance
Most oral healthcare is provided by ‘liberal practitioners’
according to an agreement called the Convention (after For prosthetic and orthodontics, these complementary
negotiation between the representative professional unions of insurances cover at least the 30% of the fees not covered by
dentists and the Caisse). 98% of dental surgeons in France mandatory insurance (it means that complementary insurance
practise within the Convention. If a dental surgeon is not in the may pay for more than 30%, depending on the scheme). It is to
Convention then the patient cannot reclaim all or part of the be noted that some of these schemes may cover more than the
cost. responsibility costs of the social security caisses.

All those legally resident in France are entitled to treatment There are two types of complementary insurance: the
under the Convention. Children and teenagers aged 6, 9, 12, “mutuelles”, covered by the “code de la mutualité” and for which
15 and 18 can benefit from a prevention examination covered the member, in most of the cases, has no need to provide a
100% by health insurance (mandatory at 6 and 12). This health questionnaire; and private insurances, covered by the
examination is directly paid to the dentists by the Caisse. The insurance code and for which the members have, in most
following necessary care (conservative treatment and sealants) instances, to provide a health questionnaire. The dental
is totally covered as well. surgeon has no role in selling those products.

For conservative and surgical treatments the practitioner must A law passed in June 2013, provides for the generalisation of
charge fees according to the Convention and the patient can complementary health insurance and collective agreements to
reclaim up to 70% (limit set by the Caisse). For other all employees and all enterprises in 2016, regardless of their
treatments, eg orthodontics and prosthodontics, dental size. This law will also apply to dentists and their employees.
surgeons may set their own fees, having informed the patient of
the estimated cost. The Caisse, (subject to prior approval for The Quality of Care
orthodontic treatments), usually covers a part of these fees on
the basis of a scale which has not much changed in the last 40 The statutes for social insured citizens allow patients to ask for
years. The patient pays the whole fee to the dental surgeon, the expertise of the treatment received to be examined, if
who then transmits electronically this information to Social he/she is not satisfied. Complaints can be sent either to the
Security to enable the refunding to the patient. Social Security Caisses, or to the departmental Council of the
Ordre National, or follow a normal legal procedure (see later).
Year Source In case of litigation, the practitioner may be assisted by a
colleague. No law provides for however a “guarantee of result”.
% GDP spent on oral health 0.94% 2007 CECDO
% of OH expenditure private 95.0% 2007 CECDO Domiciliary care can be provided on request, by a limited
number of patients, such as those ill or disabled. Once
requested, a dental surgeon must provide this care.
A Universal Sickness Insurance (Couverture Maladie
Universelle, CMU) was created on 1st January 2000 to promote Health Data
the access to care for the “weaker” part of the population.
Practitioners are directly paid by Social Security Caisses and
complementary insurances. The fees for conservative and Year Source
surgical care and prosthetics are set by the Government. Only DMFT at age 12 1.20 2007 OECD
conservative and surgical care fees have been reviewed since DMFT zero at age 12 56% 2007 CECDO
– last in 2006. Edentulous at age 65 16% 2007 CECDO

About two-thirds of the population visits a dentist at least once a

year. “DMFT zero at age 12” refers to the number of 12 years old
children with a zero DMFT. “Edentulous at age 65” refers to the
Private insurance for dental care numbers of over 64s with no natural teeth.

In 2013, approximately 90% of people used complementary Fluoridation

insurance schemes, either by voluntary membership or through
Fluoridated salt has been sold in France for more than 25
the CMU to cover all or part of their treatment. There are many
years. Fluoride toothpastes are sometimes freely given to
such schemes. The financial risk is taken by the insurance
children in the framework of education campaign, although
company. With regard to conservative and surgical care, these
these goods are largely available over the counter.

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Education, Training and Registration
Undergraduate Training
Cost of registration (2013) € 398
Access to dental studies is open after Baccalaureat (12 years of
primary studies). Access to dental faculties is by examination at
the end of the first year (common to medicine, dentistry,
pharmacy and midwifery). The number of students admitted to
A further role of the Ordre National is to check the conditions of
2nd year is set annually by the Ministry in charge of Health
registration of foreign dentists (automatic recognition) including
together with the Ministry in charge of Education. The duration
appropriate diploma and French language ability.
of dental studies is 6 years, ending with an examination. A
thesis is necessary to obtain the title of doctor in dental surgery
Language requirements
and is required to practise. It has to be presented within 18
months after the 6th year of dental curricula. The president of the departmental section of the “Ordre” judges
the language skills of the candidate.
Year of data: 2011
Number of schools 16 Further Postgraduate and Specialist Training
Student intake 1,154 Continuing education
Number of graduates 917
The ethical code gives the moral duty to every practitioner to
Percentage female (2004 data) 55% undertake continuing education during his professional life.
Length of course 6 yrs In 2011, new arrangements were made introducing
“Developpement Professionnel Continu” (different from the EU
CPD), for a duration of 1.5 days per year, per dentist. It is
NB: the number of graduates does not include Lille and Nice controlled by the Ministry of health and organised by different
dental societies or associations.
The dental schools are all state funded.
Specialist Training
The responsibility for quality assurance in the faculties is by the
Ministry of Education, the Chancellor of the University and the Since 2011, France has recognised three dental specialties:
Dean of the Faculty. orthodontics, oral surgery and oral medicine.
 Orthodontics - Training lasts for 6 semesters, part-time and
Qualification and Vocational Training takes place in university clinics. A national specialist diploma
Primary dental qualification is then awarded by the authority recognised competent for
this purpose: “diplôme d’études specialisées d’orthopédie
The degrees which may be included in the register are: dento-faciale”. The professional title is: “chirurgien-dentiste
spécialiste qualifié en orthopédie dento-faciale”.
Diplome d'état de chirurgien-dentiste (Dental Surgeon) – before  Oral Surgery: training lasts for 8 semesters, part-time and
1972 takes place in university clinics. It is a specialty common to
or medicine and dentistry. A national specialist diploma is then
Diplome d'état de docteur en chirurgie dentaire (Doctor in awarded by the authority recognized competent for this
Dental Surgery). purpose: “diplôme d’études spécialisées en chirurgie orale”.
The professional title is: “chirurgien-dentiste specialiste
Vocational Training (VT) qualifié en chirurgie orale”.

There is no post-qualification vocational training.  Oral Medicine: training lasts for 6 semesters, part-time and
takes place in university clinics. A national specialist diploma
Registration is then awarded by the authority recognized competent for
this purpose: “diplôme d’études spécialisées en médecine
One of the functions of the Ordre National is to administer the bucco-dentaire”. The professional title is: “chirurgien-dentiste
registration of dental surgeons. It ensures that the dental specialiste qualifié en médecine bucco-dentaire ”.
surgeon has a diploma that is legally required. It also controls
processes of de-registration for disciplinary or health reasons. Stomatologists

The list of dental surgeons is held primarily by Departmental NB: Stomatologists are doctors specialised in stomatological
Dental Councils, but a national list is also available. The sciences (medical specialty). In 2013, only a few of them were
Council has a consultative role in the monitoring of educational still being trained. This speciality has now been replaced with a
standards in the universities. 4-year training, common to dentists and doctors, and the title is:
médecin spécialiste en chirurgie orale.
Practitioners have to pay an annual charge in order to remain
on the register.

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Workforce
Dentists In 2013, the first specialists in oral medicine and oral surgery
were still being trained.
In 2008 an increase to the student intake was decided by the
public authorities, because of a predicted shortage of dental There are also specialists in maxillo-facial surgery but, as
surgeons by 2015. stated earlier, this is a medical specialty.

Year of data: 2012 Auxiliaries

Total Registered 46,104 In France no auxiliaries are allowed to work in the mouth. The
In active practice 41,505 only recognised auxiliary personnel are dental assistants,
receptionists and dental technicians.
Dentist to population ratio* 1,582
Percentage female 40%
Qualified overseas 1,420 Year of data: 2010
Hygienists 0
Technicians 16,500
It was reported by the CNSD that there were no unemployed Denturists 0
dental surgeons in 2013.
Assistants 15,350
Movement of dentists Therapists 0
Receptionists 4,786
In 2012, about 3% of dentists practising in France had qualified
abroad. There were 283 such new registrations that year.
Dental Assistants
Year of data: 2012
Dental assistants qualify after 18 months alternative training in
Total 1,420 dental practice. This training representing 590 hours is mainly
EU graduates 776 governed by a “parity” body: the Commission paritaire nationale
EEA graduates 7 de l’emploi et de la formation professionnelle, CPNEFP. They
do not have to register.
Convention d’établissement* 474
Others (Minister's discretion) 163 Dental Technicians

Dental technicians (prothésistes dentaires de laboratoire) do

*The Convention d’établissement is an agreement between not need to be registered. They undertake a minimum 3 years
foreign countries and France. The dentists authorised to training in laboratories and schools. They have no direct
practice are foreigners with French qualification. contact with patients, working only under the prescription of the
dental surgeon.
It is not possible to identify the number of French dentists
practising abroad. Most dental surgeons use independent laboratories and there
were 4827 craft or industrial laboratories employing salaried
Specialists workers in 2012. Some practitioners employ technicians directly
in their own private laboratories.
As stated above, since 2011 there have been three dental
specialties recognised in France – orthodontics, oral surgery There are still some cases of illegal denturists/clinical dental
and oral medicine. Those last two started two years ago. technicians in 2013 – a few prosecutions are mounted each
year by the CNSD and on each occasion the technician has
About one dentist in every 20 specialises in orthodontics. Most been found guilty of illegal practice.
orthodontists work in private practice. There is no referral
system in France for access to dental specialists – patients may
go directly to them.

Year of data: 2012

Orthodontics 1,981

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