Number of dentists registered in the UK in 2007: 49 in 2008: 52 in 2009: 50 in 2010: 51 in 2011:49
The Dutch Dental Association (NMT) has reported that the active dental workforce is decreasing but in 2008 there was a balance between supply and demand. About 45 per cent of the dentists in active practice are over 50 years of age and about 6 per cent of the dental workforce qualified outside the Netherlands. There is no major movement of Dutch dentists out of the Netherlands. (5)
Health care is provided by a government-regulated system of health insurance. Patients must belong to public schemes (sick funds), or private health insurance. The public scheme is compulsory and covers all citizens. (5)
On the basis of the Public Health Care Act, those under 22 years of age have access to preventive oral health care and basic treatment (excluding crowns and bridges and orthodontic treatment) completely free of charge.
Patient complaints may be handled in various ways through an internal procedure at professional organisations, or the Dutch legal system of client complaints and the medical code. Sanctions in the latter may be a warning, a reprimand, a fine or suspension/ removal from the register.
Whilst the use of specialists is limited to orthodontics and oral maxillo-facial surgery, it is possible for dentists to undertake three year training programmes in periodontology, endodontics and paediatric dentistry and then limit their practice to the specialty.
There is a broad use of dental auxiliaries such as dental technicians, dental nurses, dental hygienist and denturists. Continuing education became mandatory in January 2012.
Summary of relevant points
1. Regulatory Mechanisms
The Institute for a Quality Register for Dentists is the organisation in charge of the transparency of dentists’ quality of care, and thereby contributes to patient safety. In order to be registered, dentists must meet five registration standards: unconditional registration in the BIG (the Individual Health Care Professions Act) register, observing the code of conduct and guidelines, studying professional literature (240 hours every five years), following extra training and refresher courses and consulting with colleagues and having a complaints procedure in place.
If a patient visits a dentist with a problem such as pain, then under Dutch law the dentist is obliged to see them. However, the dentist is not required to accept the patient on a regular basis. It also states that when established patients (those who receive regular care from that dentist) face financial difficulties a dentist must continue to treat them.
Hepatitis B vaccination is mandatory for dental workers.
Indemnity insurance is not compulsory for dentists and is provided by general insurance companies. General insurance covers damage to persons, property, capital liability and employer liability. It also covers dentists working in other European countries but only if their main activity as a dentist takes place in the Netherlands (5).
A practice needs a permit to use radiation equipment. Intraoral radiographs can only be taken by dentists or by trained dental staff on the order of a dentist. Panoramic x-rays may be taken by hygienists who have been trained for the purpose.
Amalgam separators have been required in practices by law since 1997.
2. Education and Training
There are three dental schools in the Netherlands. The training lasts for six years.
Dental students receive the title “Bachelor of Science” after three years, and after six years they qualify with the title “Master of Science of Dentistry (MSc).
No post-qualification vocational training is necessary for entering into full, unsupervised practice.
Two dental specialties are recognised: oral and maxillo facial surgery and orthodontics. However, it is possible for Dutch dentists to undertake three year training programmes in professional “differentiations” such as periodontics and then limit their practice to the area concerned. Specialists must be registered by the Specialist Registration Board 'Specialisten-Registratiecommissie (SRC).
3. Support Systems
The main national associations are the Nederlandse Maatschappij tot bevordering der Tandheelkunde (NMT) or Dutch Dental Association and the Association Netherlandse Tandarlandse (ANT). A dentist is free to become a member or not. Three quarters of dentists and dental specialists are members of the NMT
4. The Dental Team
Dental hygienists are paramedics with independent status. They form an official profession with a legally protected title are required to be qualified and have a diploma. They train in special dental hygienist schools for four years full time. Two thirds are employees in dental practices, some work in hospitals and centres for paediatric dentistry or independently from a dentist. Patients have free access to hygienists without being referred by a registered dental practitioner.
Besides the preventive competencies dental hygienists are taught how to provide routine dental treatment e.g. take radiographics, administer local anaesthetic and place simple fillings to the prescription of a dentist.
Dental technicians train in special schools, for two years full time or for four years part time. On completion of training they receive a diploma, but are not required to register. Most dental technicians work in dental laboratories.
There is ‘certified training’ available for dental chair-side assistants (nurses); although there are approximately 30 training schools and a postal course, most assistants are trained by individual dentists in their dental practices.
Because of a shortage of dental hygienists, some assistants also carry out scaling but not root planning.
Clinical dental technicians are trained for three years part-time, after completion of training as a dental technician. They are only allowed to provide removable prosthetic appliances and may work in independent practice.
5. Dental care Delivery
Almost all dentistry is provided by dentists working in general dental practice. About 90 per cent of the dentists working privately have a contract with a public insurance schemes.
Dental treatment is provided under the public and private systems. From January 2012, fees are no longer legally regulated. For a trial period of the next three years, dental care providers are permitted to set their own fees. This trial is being monitored by a Government appointed body. Those under 18 years of age have access to preventive oral health care and treatment (excluding crowns, bridges and orthodontic treatment) completely free of charge. Coverage for oral health for adults over 18 years is restricted to patients with special medical conditions and patients who need full dentures. The rest of the population is encouraged to take out private health insurance to cover their oral health needs. In most cases these insurances refund up to a fixed (limited) maximum of total costs (19).
Patients normally attend for their re-examinations about every 9 months. There is no formal system for domiciliary care.
Apart from the extension of coverage of the public insurance scheme, to provide dental care for young people and those with special needs, there is no separate public dental service in the Netherlands.
6. Quality assurance mechanisms
Continuing postgraduate education became compulsory for dentists in January 2012 and is now required for re-licensing.
Quality improvement is achieved through continuing education, peer review and the development of standards and certification. The purpose of the BIG Act was to promote and monitor the quality of professional practice across the whole of health care and to protect the patient against inexpert and negligent treatment by professional practitioners.
A Dutch Health Inspectorate makes occasional visits to practices. Their checklist for screening dental practices covers: clinical practice, infection control, waste disposal and radiation practice.
Patients’ complaints may be handled in various ways. Under the law patients’ complaints, regarding care provision are considered by one of five regional medical disciplinary boards. Sanctions may be a warning, a reprimand, a fine or suspension/removal from the register (5). Any appeal will be heard by a board of three lawyers (including the chairman) and two dentists. Complaints regarding financial or other consumer matters are considered by other institutions.
The NMT also has a system, which conforms to legislation, where patients and colleagues can register a complaint against a member of the Association. Dentists who are not NMT members must set up their own complaints procedures.
As a last resort, the patient has the option of starting a civil lawsuit against the dentist.
Key Points to Consider When Inducting or Supporting a Dentist Qualified in the Netherlands
Dentists qualified in the Netherlands:
Mainly work in private practice and have a contract with the public insurance scheme;
Will not have undertaken foundation training in the Netherlands;
Are likely to have experience of working with a dental hygienist, who may be able to work independently and to provide routine dental treatment e.g. fillings, extractions for children or can take panoramic x-rays, this may result in confusion between the role of the dental hygienist and the dental therapist in the UK;
Will have experience of working with a dental technician or a clinical dental technician in the Netherlands;
May have little experience of working in a multi practitioner environment;
Country : Poland
Number of registered dentists: 29,947 (2008)
Number of active dentists: 21, 750 (2008)
Qualified overseas : 600 (2008)
Number of dentists registered in the UK in 2007: 848 in 2008: 872 in 2009: 849 in 2010: 847 in 2011: 849
In 2008, the total number of registered dentists was 29,947 and 78 per cent were female.
In general dental practice, only the dentist or a radiographer can act as the competent person for the use of ionising radiation. Others trained in radiography can only act under the prescription of a dentist. In 2008, there were ten dental schools, and the intake was 855 students. The number of graduates was 809, and 80 per cent were female (5). In 2002, the undergraduate training curriculum was changed to bring it in line with the requirements of the EU. More clinical training was added, prior to that the curriculum contained more general medical training. After graduation each dental graduate is required to apply for a limited licence (limited right to practice the profession). In order to be awarded the (full) “right to practice the profession” a graduate must complete a post-graduate internship of 12 months (vocational training) and pass a State Dental Examination. There are seven principal dental specialties in Poland (5):
oral and maxillo-facial surgery
periodontology (in Poland the speciality of periodontology includes oral pathology but the official title for this
specialty is periodontology)
conservative dentistry with endodontics
In addition dentists can also specialise in:
The principal regulatory body in Poland is the Polish Chamber of Physicians and Dentists, consisting of a Supreme Chamber and 24 Regional Chambers, and membership is mandatory.
The title awarded upon qualification from Dental School between 1996 and 2004, treated as equivalent with the current title.
Summary of relevant points
1. Regulatory Mechanisms
The principal regulatory body in Poland is The Polish Chamber of Physicians and Dentists, and membership is mandatory. All dental graduates who wish to practice the profession are required to register, according to their place of residence, with the Regional Chamber of Physicians and Dentists (5). The Chamber is the competent authority, as determined by the state, and maintains the registers of dentists and of dental specialists. It also awards the right to practice dentistry (5).
Dentists are bound by the ethical code, which was adopted in 1993 and later amended. The sanctions against a dentist found guilty of breaching the ethical code by a Medical Court are laid down in the law on chambers of physicians and include admonishment, reprimand, fine, suspension of the licence (for up to five years) or full removal of the licence. Any appeal is made to the Supreme Medical Court (5), thereafter one may appeal to the Polish Supreme Court.
Vaccination against hepatitis B is not mandatory, but “recommended”. Students are vaccinated against hepatitis B at Dental School (5).
Dental indemnity insurance is mandatory (5).
In general dental practice, only a dentist can act as the competent person to utilise ionising radiation. Others trained in radiography can only act under the prescription of a dentist (5).
Amalgam separators are not a legal requirement (5), but they are commonly used.
The regulations for entry onto the dental practice list are specified by an Act, as well as by the Minister of Health. There are specific regulations governing the practice site, local epidemiological surveys, ionising radiation, sterilisation, storage and disposal of waste materials. The practice must also be registered with the Regional Chamber of Physicians and Dentists (5).
2. Education and Training
Training in ionising radiation is now part of the new undergraduate course. Previously radiography was restricted to qualified radiographers only. Courses are currently organised in the medical faculties for those who did not receive training as part of the previous undergraduate course (5).
The titles awarded upon qualification have been or are (5):
Dental doctor- until 1996
Stomatologist- 1996 to 2004
Dental doctor – since 2004
In order to be awarded the “right to practice the profession” a graduate must complete a post-graduate internship of 12 months (vocational training). Each dental graduate is required to apply for a provisional licence - “limited right to practice the profession”. This licence is awarded in order to undergo vocational training. Since October 2004, there has been an additional requirement to pass the State Dental Examination which can be undertaken during, or after the internship (5).
3. Support Systems
The main professional organization of dentists is the Polish Chamber of Physicians and Dentists – which provides professional self-government associating the two professions – physicians and dentists. The self-government consists of the Supreme Chamber and 24 Regional Chambers. Membership is mandatory – every dental practitioner holding the right to practice the profession in Poland is by virtue of the law a member of one of the regional chambers. The main tasks of the chambers are: regulation of the profession (awarding the right to practice, supervision over professional conduct, setting the principles of professional ethics, carrying out disciplinary actions, accrediting and supervising continuing professional development and the representation and protection of the profession.
Besides the chambers there are other professional dental organisations - scientific societies that are established for specialized dentists (eg. the Polish Orthodontic Society). The Polish Dental Society is the main scientific dental association. Membership of scientific associations is not mandatory for all dentists.
Other registered scientific and dental specialist societies are: the Polish Society of Oral Cavity and Maxillo-Facial Surgery, and the Polish Society of Stomatological Implantology. All dental specialists, but not general dentists, must belong to an appropriate scientific specialist society (5).
4. The Dental Team
There are three groups of auxiliary dental care professionals in Poland: dental nurses, dental hygienists and dental technicians (5)
There are two dental hygienist training programmes, each of three years in duration (5)
Dental hygienists’ duties include delivering preventative dental care, and oral health promotion. They are not permitted to formulate a diagnosis, nor deliver local anaesthesic, and cannot work without the physical presence of a dentist on site. They cannot accept fees from patients, except on behalf of a dentist (5).
The training for dental technicians takes place in schools at medical schools and universities, and is two and a half or three years in duration (5).
There are three groups of dental care professional in Poland: dental nurses, dental hygienists and dental technicians.
Dental nurses used to be trained by the supervising dentist, nowadays there is a formalised training programme available – regulated by the Ministry of Science (a new law that has been drafted will fully regulate the auxiliary dental professions). Besides assisting the dentist at the chair side, they are not permitted to undertake other treatment (5).
5. Dental care delivery
Dental care in Poland is delivered as part of the public health insurance system, within the National Health Fund (NHF), and also within the private sector. The delivery of NHF dental services is limited due to the Fund’s limited financial resources (20). Thus only a third of practitioners work within the state system, and the remainder work outside the NHF, within the private sector (5).
A compulsory health insurance system exists, in which salaried employees are required to contribute 9 per cent of their salary to one of the sixteen regional funds. This contribution also ensures health care cover for family members of the insured individual. Health insurance contributions are paid by the Social Insurance Institution for retired individuals. The unemployed and the homeless are also covered within the public health insurance system (20,9).
Basic dental services are provided for employees and their children, as specified by the Ministry of Health. These include examinations; preventive care (oral hygiene instruction, topical fluoride application, fissure sealing); diagnostic procedures (radiographs-limited to two per patient per year, and biopsies); restorative treatment (restorations, endodontic treatment of single-rooted teeth in adults, endodontic treatment of all teeth in those aged 18 years and under); extractions; basic periodontal treatment; basic emergency treatment of dental trauma; orthodontic treatment with removable appliances; and treatment of oral mucosal lesions. Children and young people are entitled to an additional periodical examination and a broader range of services. Pregnant women, or nursing mothers (up to 42 days after childbirth) are also entitled to additional services (20, 9).
For adults, any interventions not delivered within the NHF can be undertaken on a private basis, via a co-payment, subject to availability at the practice concerned (20, 9). Private fees are negotiated between a dentist, and their patient according to market value. Patients pay the full cost of treatment for specialist dental interventions (5).
6. Quality assurance mechanisms
Continuing dental education is a mandatory requirement, and a credit-point system operates, where 200 credit points must be accrued in a four year period (5)
Radiation protection training is followed by a test, which is repeated every five years for certification (5)
Quality assurance of those practitioners working in single chair practices, and dentists working in multi-chair private practices is undertaken by dentists from the regional chamber, (offices of the dental association). The quality of service delivered within the NHF is monitored through NHF consultant dentists. Regular inspections are carried out in this sector, as well as those undertaken specifically following a complaint. All private practitioners are monitored by the Chamber of Physicians and Dentists (5).
A patient is entitled to lodge a complaint, and demand compensation before a medical court or a common court (5).
Fitness to practice and the management of disciplinary matters is governed by the Act for the Profession for Physicians and Dental Practitioners. The Medical, and Supreme Medical Courts comprise both dentists (dental doctors/stomatologists) and physicians. However, cases of poor dental practitioner performance are managed solely by dentists. Other more general problems involving a breach of the ethical code may be undertaken by physicians. Screeners for professional liability, and for the Regional Courts (at each of the 24 regional chambers), and one Supreme Court screener, monitor compliance with the ethical code (5).
Patient complaints are managed by a screener. Proceedings may be abandoned, or a case may be brought to a regional medical court. An appeal can also be made to the Supreme Screener. In addition, a complaint may be brought to the common courts by a complainant, and if an error is suspected, the case may be taken over by the prosecutor and, subsequently, decided by the common court under criminal proceedings (5).