May not appreciate that amalgam separators are mandatory in the UK.
In some dental schools may have treated very few patients in person before qualifying.
Country : Lithuania
Population: 3,299,000 (2011)
Number of registered dentists: 3,773 (2012)
Number of active dentists: 3,773 (2012)
Qualified overseas: 74 (2012)
Number of dentists registered in the UK by 2007: 105 by 2008: 102 by 2009: 127 by 2010: 148 by 2011: 162
In 2012, there were 3,773 registered dentists, some 83 per cent of whom were female. About 20 per cent of the dentists work in the public service and about 80 per cent in private practices, (17). The active dental workforce is stable but increasing slowly. There is no reported unemployment among dentists. Approximately 200 dentists asked for a “Certificate of Good Standing” to work abroad through the years from 2004 to the end of 2006, but there is no a reliable source of information of how many of them have left Lithuania (5).
The system of the State Social Insurance in Lithuania covers nearly all residents. It is based on the principle of solidarity. Some patients (children, the elderly and the disabled) may receive some or their entire oral healthcare free. Adults must pay for part or for all of the costs of their treatment, (5).
Oral health care expenses may be reimbursed from state or municipal and mandatory health insurance funds, supplemented by health insurance funds and contributions from patients. Only essential oral health care services are provided free of charge. The Ministry of Health sets the fees for the services provided by state, district and municipal institutions. Private fees are set by dentists themselves. Adult dental care in public dental service is partly funded by reimbursement from public insurance and partly paid for by the patient. Private oral health care must be covered in full by the patient (17). The Mandatory Health Insurance fund covers a fixed amount of money for prostheses for the retired and disabled.
The membership to the Chamber (Dental Association) is mandatory for all dental care professionals.
There is a well developed use of specialists for advanced dental care. Continuing education for dentists and dental auxiliaries is mandatory. Dental auxiliaries (dental care professionals) are considered vital in the dental practice.
Summary of relevant points
1. Regulatory Mechanisms
Dentistry in Lithuania has special laws: “Law on Dental Practice” and the “Law on the Dental Chamber”. Dental care is also regulated by laws approved by the Minister of Health and the Lithuanian Dental Chamber.
The Licensing Committee at the Lithuanian Dental Chamber is the official unit, responsible for organising and giving licences to all dentists and dental specialists.
To establish a new private dental practice, dentists have to gain approval from the local state authorities and a licence from the health authorities. It has to be insured by a health insurance company.
All dental workers must undergo a medical examination annually. The dental workforce is recommended to be vaccinated against Hepatitis B and to be checked regularly for sero-conversion.
Infection control is regulated by law. Non-compliance leads to sanctions.
Liability insurance is compulsory for dentists and dental hygienists. The insurance does not cover dentists working outside Lithuania.
There is a requirement to have a licence to use radiation equipment and it is mandatory that every five years dentists attend eight hours of courses on ionising radiation.
Amalgam separators are not mandatory. The use of amalgam is not popular with patients or dentists.
Anyone can own a dental practice but the person responsible for the organisation of the clinical treatment must be a dentist.
2. Education and Training
There are no entrance examinations to the dental school, students are selected according to the grades of the secondary education final examinations, and annual marks averages
The undergraduate training programme lasts for five years. Teaching languages are English and Lithuanian.
Vocational training for dentists is now included in the five year undergraduate curriculum
After vocational training, dentists are granted a licence to practice independently.
There are six recognised specialties: endodontics, orthodontics, paediatric dentistry, periodontics, prosthodontics, oral surgery. Training for all of them lasts for three years with the exception of oral maxillofacial surgery which lasts for five years after six years of general medicine.
3. Support Systems
The Dental Chamber (association) is in charge of the implementation of self government of dentists. It coordinates their activities, pursues the strategic tasks of dental care within the healthcare system, manages the development of dental activities such as education of patients, professional training of dentists and medical culture, and organises drafts of legal acts relating to the activities of dentists, dentists specialists and dental care professionals to be presented to the Ministry of Health.
Membership of the Lithuanian Dental Chamber is compulsory.
Dental nurses, dental technicians and dental hygienists are known as oral health care specialists. They must be registered with the Lithuanian Dental Chamber and have licences to practice and also need to undertake continuing education.
Dental hygienists are trained in two colleges for three years and in Kaunas University of Medicine for four years. Graduates of Kaunas University of Medicine receive a bachelor degree and the qualification of dental hygienist.
Dental hygienists can practice as employee, employer or freelancer. They may accept payments from patients. They have competence to diagnose and to plan treatment for patients (under prescription of a dentist) and their duties include scaling, cleaning and polishing, whitening, removal of excess filling material, local application of fluoride agents, application of preventive sealants and oral health education. They may give local anaesthesics.
Dental technicians train for three years. Technicians normally work in commercial laboratories, only a few are employees of dentists or dental practices. They have legal responsibility for their work but do not accept payments from patients.
Dental nurses train for three years in a College specifically for dental assistants. Courses on infection control and emergency care are obligatory. In addition to assisting dentists, they are permitted to undertake oral health education.
5. Dental care Delivery
The national health insurance system scheme offers reimbursement of the cost of some dental treatment. Only essential dental care services are provided free of charge.
About 13 per cent of dentists work part-time in public and part-time in private practice
Public oral health care is free of charge, for children and teenagers under the age of 18 years. Prosthodontic care for pensioners and the disabled is reimbursed with a fixed sum of money. For adults between 18 and 65, dental care in the public dental service is partly financed by the fund and partially (to cover dental materials) by copayments from patients.
The Ministry of Health establishes the cost of dental care services provided by state, district and municipal institutions.
Dentists who work in hospitals are salaried employees. Hospitals usually are publicly owned, and the dental services provided are oral and maxillofacial surgery. These dentists will also assist in the dental education and training.
Dentists can work as full-time or part-time employees of universities. Their salary range is 700 to 1200 Euros per month.
The Lithuanian Dental Chamber coordinates the continuing education of dentists and oral care specialists
In order to remain registered a dentist needs to attend the courses and obtain a certain number of professional training hours: 120 hours in five years for dentists, 60 hours for dental hygienists and dental technicians and 50 hours for dental nurses (chair-side assistants).
The quality of dental care is monitored by the Lithuanian Dental Chamber in different ways and emphasis is placed on quality improvement and assurance. Quality improvement is achieved through continuing education and the development of standards and certification.
The State Health Care Accreditation Agency under the Ministry of Health is the institution for health care services. It's main functions are to represent and defend patients' rights to effective, accessible and safe health care.
The Chamber is involved with patient complaints about the quality of care.
A complaint may be made by a patient to: the health insurance company, the Dental Chamber, the State Health Care Accreditation Agency, complaints have to be initially investigated at the dental practice.
Where there is a violation of professional ethics in the dental practice, or patient safety compromised, there is a range of penalties which are normally administered by the Regional Ethical Committee of the Dental Chamber. The Dental Chamber is usually involved in the investigation of complaints.
The penalties may include a reprimand, a penalty or even the loss of the licence to practice (the dentist cannot be suspended immediately). Any serious breach of the law can be referred to court and may even result in imprisonment.
Key Points to Consider When Inducting or Supporting a Dentist Qualified in Lithuania
Have limited experience of UK monitoring procedures (e.g. NHS dental services) or UK requirements for clinical governance (e.g. clinical audit);
May have little experience of working in a multi practitioner environment;
Will have no experience of working with a dental therapist, an orthodontic therapist, or a clinical dental technician in Lithuania;
May not have used amalgam for fillings.
Country : Malta
Population : 417,600 (2011)
Number of dentists: 190 (March 2012)
Number of dentists in active practice: 142 (2012)
Number qualified overseas: 24 (2012)
Number of dentists registered in the UK in 2007: 31 in 2008: 37 in 2009: 33 in 2010: 34 in 2011: 35
In March 2012, the number of registered dentists in Malta was 190, with 142 in active practice. Thirty four percent of dentists were female (5).
Referrals to public clinics are made according to established guidelines. Additionally, dentistry is delivered to all school children within school dental clinics. Private medical insurance only covers specific dental procedures, such as surgical interventions (5). A specific dental insurance was launched in 2011, however, to date very few patients have taken out this insurance.
In the public sector, the quality of dental care is assured through dentists working under the direction of experienced specialists. An annual check by health inspectors ensures that all dental clinics are set up and function according to requisite regulations (5).
The EU Hazardous Waste Directive is incorporated into law and actively enforced. The use of amalgam separators is a compulsory requirement. There are specific regulations regarding radiation protection, as defined by the Public Health Act, Health and Safety regulations, the Radiation Protection body and the enabling act from the Prime Minister. Employers are required to ensure that they have undertaken adequate training, and that their staff are also provided with training (5).
There is a non-compulsory form of vocational training in existence in Malta. Upon qualification, students are strongly encouraged to join the scheme. No system for Foundation Training exists (18).
The Medical Council provides the dentist with a license to work.
Summary of relevant points
1. Regulatory Mechanisms
Dentists are automatically registered with the Medical Council of Malta following graduation, and the cost of registration is currently 35 Euros annually (2012). The President of Malta provides a dentist with a licence to work.
Dentists are subject to the same ethical code as their medical colleagues.
Hepatitis B vaccinations are mandatory in Malta and are provided free by the Health Department.
Professional indemnity insurance is not mandatory.
The concept of “corporate dentistry” does not exist in Malta.
Specific regulations exist defining radiation protection protocols, as defined by the Public Health Act, and the enabling Act of the Prime Minister, Health and safety regulations and the Radiation protection board. Continuing education and training in radiation protection is not a mandatory requirement (5).
2. Education and Training
The primary degree, listed on the register of the Medical Council, is the Bachelor of Dental Surgery (BChD)
There is a non-compulsory form of foundation training in existence. Thus if FT is not undertaken, a graduate dentist still has a licence to practice after completing the five-year degree.
There are two dental specialities in Malta which are officially recognised by the member states of the European Union. Specialist training started in orthodontics in January 2010 and in Oral Surgery in 2011.
3. Support Systems
The principal national association is the Dental Association of Malta (DAM), and approximately 80 per cent of active dentists are members.
4. The Dental Team
The Board of Professions Supplementary to Medicine maintains the register of dental hygienists. Dental hygienists work under the prescription of a dentist, in a clinic or private practice. Their duty of care includes basic periodontal treatment and delivering oral hygiene instruction.
A formalised four-year training pathway exists for dental technicians. Their register is managed by the Board for Professions Supplementary to Medicine.
A two-year course for Dental Assistants was implemented in October 2007, with a total of 15 trainees. In 2012, it was estimated that 85 per cent of dentists working in private practice worked with a dental chair-side assistant (18).
5. Dental care delivery
Dental services are provided in both the public and private sectors. The Public Primary Healthcare Service provides free and basic dental care to children and adults. The general population is entitled to examinations and preventive care, periodontal treatment, and oral surgery (with or without hospitalisation) within the public dental service, provided free of charge. In addition, the Public Healthcare Service offers emergency care on Sundays and National holidays. Children (0 - 15 years) and specific patient groups, including institutionalised patients, the Police, and Armed Forces of Malta, are eligible for free restorative care. Free orthodontic treatment is also provided to all children up to the age of 16. Other types of treatment are only offered to adults under special circumstances.
The majority of dentistry in primary care is delivered by private practitioners. Most dentists in private practice are self-employed, and work on a fee-per-item basis. Approximately 60 per cent of private practitioners work in single-chair practices. No official fee scale exists, and pricing is unregulated in Malta.
Although approximately 35 per cent of the population has private health insurance, it only covers a very limited range of dental treatment such as surgical interventions. To date very few patients have registered with the new dental insurance scheme (Denplan).
The normal frequency for routine oral examinations is every six months.
6. Quality assurance mechanisms
Continuing dental education is not mandatory in Malta, but the Dental Association of Malta, together with the Faculty of Dental Surgery, organise regular accredited lectures and courses which award continuing dental education points to participants. The Department of Primary Care organises an Annual Dental Conference. Proposals for legislation to make continuing dental education compulsory for the renewal of a licence to work as a dentist are awaited, (5). Continuing education and training in radiation protection, is not a mandatory requirement (5).
A patient is entitled to lodge a complaint and demand compensation, before either a medical court or a common court. Maltese dentists are governed by the Health Care Professions Act which came into being on the 21st November 2003. A complaint can be lodged by anybody, including lay people with an interest in the case. In the private sector, it is the Medical Council of Malta which manages such issues.
In the public sector, the quality of dental care is assured through dentists working under the direction of experienced specialists. The complaints procedures are the same for dentists working in other clinical settings. An annual check by health inspectors ensures that all dental clinics are set up and functioning according to requisite regulations
Key Points to Consider When Inducting or Supporting a Dentist Qualified in Malta
Dentists qualified in Malta:
Have limited experience of UK clinical governance requirements (e.g. clinical audit);
On graduation will have had limited experience of working in a public dental service;
Will probably not have undertaken a formalised foundation training programme in Malta;
May have little experience of working within the wider team of dental care professionals;
May not appreciate professional indemnity is compulsory in the UK;
Will have no experience of working with a dental therapist, an orthodontic therapist, or a clinical dental technician in Malta;
May not appreciate that continuing professional education is a requirement for continued dental registration in the UK.